Ovid research is pioneering a scientific approach to develop therapies based on new understanding of key biological pathways and their central role in rare neurological disorders.
We seek to develop medicines using novel and clinically relevant endpoints to capture tangible patient benefits that emanate from addressing underlying disorder pathology.
Our OV101 program focuses on a potential treatment for Angelman syndrome and Fragile X syndrome, two neurodevelopmental disorders caused by genetic mutations. In Angelman syndrome, the mutation is most commonly a microdeletion on chromosome 15 encompassing the ubiquitin protein ligase E3a (UBE3A) gene, which results in a loss of expression of the UBE3A protein. In Fragile X syndrome, mutations in the fragile X mental retardation 1 (FMR1) gene, located on the X chromosome, result in loss of expression of the Fmr1 protein (Fmrp). There are currently no approved drugs for either syndrome.
Our OV935 program focuses on developing potential therapies for people living with rare epilepsies, known as epileptic encephalopathies, that cause intractable seizures and are often associated with cognitive, neurologic and behavioral problems. In collaboration with Takeda, we are developing potential treatments for these rare disorders, including Dravet Syndrome, Tuberous Sclerosis Complex and Lennox-Gastaut Syndrome.
Developing BoldMedicine to Transform the Lives of People with Rare Neurological Disorders
“The cause is hidden.
The effect is visible to all.”
– Ovid, Metamorphoses
Rare Disorders of the Brain
About Angelman Syndrome
Angelman syndrome is a rare genetic disorder characterized by delayed development, intellectual disability, severe speech impairment, problems with movement and balance, seizures, sleep disorders and anxiety. The estimated prevalence of Angelman syndrome is between 1 in 12,000 to 20,000 people. The genetic cause of Angelman syndrome has been traced to mutations and other disruptions of the ubiquitin protein ligase E3A (UBE3A) gene. The first signs of Angelman syndrome are usually developmental delays, such as lack of crawling or walking, seen between the ages of 6 and 12 months. Due to its similarity to other disorders, it is frequently misdiagnosed.
About Fragile X Syndrome
Fragile X syndrome (FXS) is a genetic condition that results in intellectual disability, anxiety disorders, behavioral and learning challenges and various physical disabilities. FXS has an estimated prevalence of 1 in 3,600 to 4,000 males and 1 in 4,000 to 6,000 females. FXS is caused by mutations in the Fragile X mental retardation gene (FMR1), resulting in the lack of fragile X mental retardation protein expression that is required for normal brain development. The current standard of care relies on symptomatic treatments to address attention deficit, anxiety, irritability and sleep disorders, including antipsychotics and antidepressants. FXS patients also may experience seizures, which are treated with traditional anticonvulsants.
About Dravet Syndrome
Dravet syndrome is a severe form of childhood epilepsy that typically presents during the first year of life. It is largely caused by mutations in the SCN1A gene. Children experience frequent seizures, loss of muscle control, cognitive deficits and, in approximately 10 percent of cases, death before the age of 12 years. While some patients may survive into adulthood, their long-term intellectual development and seizure outcomes are typically extremely poor. The incidence of Dravet syndrome in the United States ranges from 1 in 15,700 to 1 in 20,900 births. Patients are frequently treated with combinations of classic anti-epileptic drugs, none of which are particularly effective. No drugs have been approved specifically for the treatment of Dravet syndrome in the United States and only one drug, the anticonvulsant stiripentol, has been approved in Europe.
About Lennox-Gastaut Syndrome
Lennox–Gastaut syndrome is a rare disorder that is often diagnosed between three and five years of age. Patients diagnosed with Lennox–Gastaut syndrome experience multiple seizure types that are difficult to manage and have many of the same symptoms as other rare pediatric epilepsies. Studies estimate that Lennox–Gastaut syndrome affects approximately 14,500 to 18,500 children under the age of 18 and over 30,000 children and adults in the United States. It is also estimated that between 1 percent and 4 percent of childhood epilepsies are a result of Lennox–Gastaut syndrome. Only 10 percent of these patients have seizures that are fully controlled by existing therapies.
About Tuberous Sclerosis Complex
Tuberous Sclerosis Complex is a genetic disorder, often diagnosed in childhood, that causes non-malignant tumors to form in many different organs, primarily in the brain, eyes, heart, kidney, skin and lungs. The brain and skin are the most affected organs. Tuberous Sclerosis Complex results from a mutation in tumor suppression genes TSC1 or TSC2. Tuberous Sclerosis Complex is estimated to affect approximately 50,000 patients in the United States and occurs in 1 of 6,000 live births. The most common symptom of Tuberous Sclerosis Complex is epilepsy, which occurs in 60 to 90 percent of patients, of which 70 percent experience seizure onset in their first year of life. Despite available therapies, a significant number of Tuberous Sclerosis Complex patients have treatment-resistant seizures. Tuberous Sclerosis Complex is commonly associated with cognitive impairment in 50 percent of patients, autism spectrum disorders in up to 40 percent and neurobehavioral disorders in over 60 percent of patients.
Targeting Tonic Inhibition through OV101
Angelman syndrome and Fragile X syndrome are both rare neurogenetic conditions associated with developmental delays, physical characteristics and behavioral challenges.
It is believed that the symptoms of Angelman syndrome and Fragile X syndrome are a result of disrupted tonic inhibition.
What is Tonic Inhibition?
Tonic inhibition is what allows a healthy human brain to decipher signals correctly without being overloaded. A human brain is being constantly inundated with sensory information – sights, smells, sounds and touch – and tonic inhibition is what allows the brain to filter out the “white noise” and focus on the important information. If tonic inhibition is reduced, the brain becomes inundated with signals and loses the ability to separate background noise from critical information.
Tonic inhibition is key to the brain's ability to discriminate signal from noise.
GABA is a Key Player in Tonic Inhibition
The brain is composed of a vast network of interconnected neurons that facilitate the communication between cells. These communications are governed by the release of chemical signals, or neurotransmitters, across the synaptic gap (the physical gap separating two neurons). Neurotransmitters can create an excitatory signal – which carry messages that tell us how to move and speak – and inhibitory signals – which regulate how well, or not, we’re able to receive those signals. GABA is the primary inhibitory neurotransmitter in the human brain.
GABA signaling is involved in critical functions, like motor control, sleep, behavior and cognition. Under normal conditions, there is sufficient GABA present to stimulate synaptic and extrasynpatic (outside the synaptic gap) GABAA receptors. But in Angelman syndrome and Fragile X syndrome, the overall levels of GABA are reduced. This can lead to a situation in which there is not enough or insufficient GABA outside the synapse to stimulate the extrasynaptic receptors and maintain longer-term, or tonic, signaling. The decline in tonic inhibition triggered by the shortage of GABA leads to the chronic activation of the neurons receiving the signal and disruption of normal brain network activity.
In Angelman syndrome, there is a ubiquitin-protein ligase E3A (UBE3A) genetic defect that disrupts the cell’s normal maintenance function of tagging proteins for degradation. As a result, the GABA transport 1 (GAT1) protein is not tagged for degradation. The GAT1 protein is responsible for the reabsorption of GABA from the synaptic terminal into the presynaptic neuron. When not tagged for degradation, reabsorption of GABA into the presynaptic neuron continues, and GABA levels decrease in the synaptic terminal. This then leads to a loss of tonic inhibition.
In Fragile X syndrome, the fragile x mental retardation 1 (FMR1) genetic defect leads to a reduction of expression of the glutamate decarboxylase 65/67 (GAD 65/67) enzyme. This enzyme is responsible for the synthesis of GABA. In this syndrome, there is a reduced level of production of GABA within the presynaptic neuron. Hence, it is thought that there is a lower level of GABA available for release into the synaptic terminal which leads to a loss of tonic inhibition.
We believe our lead program, OV101 (gaboxadol), is the only clinically tested δ-selective direct-acting GABAA receptor agonist. This means it is able to bind to and activate this specific δ-subset of GABA receptors, which are found in the extrasynaptic space outside of the synapse. There are many types of GABA receptors in the brain, which help regulate neuronal activity, but tonic inhibition is specifically a function of the δ-subunit containing GABAA receptors.
The relationship between neural signaling and Angelman syndrome and Fragile X syndrome.
Rare Epilepsy – Epileptic Encephalopathies
Inhibiting the enzyme CH24H with OV935 as a potential approach to epileptic encephalopathies
The term epileptic encephalopathy describes a group of epilepsy syndromes which typically present early in life and are associated with severe cognitive and behavioral disturbances. These disorders vary in their developmental outcome, cause of onset, neuropsychological findings, electroencephalographic (EEG) patterns, seizure types, and overall prognosis.
Ovid believes that decreasing 24-hydroxycholesterol (24HC) levels (through inhibiting cholesterol 24 hydroxylase (CH24H) with OV935) represents a plausible approach to addressing the underlying biology of epilepsy.
Understanding CH24H and 24HC
The enzyme CH24H is predominantly expressed in the brain where it has a central role in clearing cholesterol. CH24H converts cholesterol into a molecule called 24HC, which allows it to pass across the blood brain barrier, enter the circulatory system and be cleared from the body (Healthy Brain Function). As CH24H is predominantly expressed in the brain, there is a strong correlation between circulating blood levels of 24HC and brain levels of 24HC.
24HC has been demonstrated to impact key signaling pathways in the brain including glutamatergic signaling, or signaling by the neurotransmitter glutamate. Elevated levels of 24HC have been shown in various cellular and tissue models to lead to increased activation of the glutamate signaling pathway through one subtype of glutamate receptor called N-Methyl-D-Aspartate (NMDA). Activation of NMDA receptors has been implicated in a number of neurological disorders, including epilepsy, and is proposed to contribute to increased excitatory signaling in the brain.
Excessive extracellular glutamate and 24HC levels are thought to play roles in epilepsy. Glutamate can over activate the NMDA receptors and potentially cause symptoms associated with epilepsy. As the CH24H enzyme converts cholesterol to 24HC, the circulating levels of 24HC increase, and data suggests that it may further contribute to underlying disease processes.
OV101 (gaboxadol) is clinically tested δ-selective direct-acting GABAA receptor agonist. It is able to bind to and activate this specific δ-subset of GABA receptors, which are found in the extrasynaptic space outside of the synapse. There are many types of GABA receptors in the brain, which help regulate neuronal activity, but tonic inhibition is specifically a function of the δ-subunit containing GABAA receptors.
In Angelman syndrome and Fragile X syndrome, tonic inhibition is diminished; with OV101, we aim to restore that function. By signaling through the δ-selective GABAA receptor, OV101 can potentially make up for the loss of tonic inhibition, which we hope will relieve several of the symptoms of these disorders. In preclinical animal models, OV101 improved symptoms of Angelman syndrome and Fragile X syndrome, such as motor function, sleep and aspects of behavior and cognition. In a Phase 1 clinical trial, OV101 was shown to be well tolerated in both adults and adolescents with Angelman syndrome and Fragile X syndrome.
Gaboxadol was originally being developed for sleep disorders and was acquired by Ovid from H. Lundbeck A/S in 2015.
1 J Neurosci. 2008 Feb 6;28(6):1421-6. doi: 10.1523/JNEUROSCI.4751-07.2008.
Which GABA(A) receptor subunits are necessary for tonic inhibition in the hippocampus? Glykys J1, Mann EO, Mody I.
Ovid Therapeutics and Takeda have joined in a global collaboration to develop OV935 for clinical development as a potential therapeutic option for people with various rare epileptic encephalopathies. OV935, if approved, has the potential to become a first-in-class inhibitor of the enzyme CH24H. Preclinical studies with OV935 has shown anti-seizure efficacy in models relevant to the rare epileptic encephalopathies (EE) which are inadequately treated by current anti-epileptic medications (Treatment of Epilepsy with OV935).
We believe that OV935 will potentially address the underlying biology of epilepsy by decreasing 24HC levels by inhibiting CH24H.
OV101 Phase 2 STARS Trial
In working with foundations focused on Angelman syndrome, we have designed a double-blind, placebo-controlled, randomized Phase 2 clinical trial, named STARS, looking at safety parameters and exploratory efficacy endpoints in adults and adolescents aged 13 years and older with Angelman syndrome. At this time, enrollment for the study has been completed and we look forward to providing topline results from the trial in the third quarter of 2018.
We called on the Angelman syndrome community to help us design the clinical trial, including identifying the trial endpoints. They also selected the final STARS clinical trial name and logo. The STARS logo was designed by Kaline, a proud parent of a child diagnosed with Angelman syndrome. The image “reaching for the STARS” is a depiction of her son, and every other person diagnosed with Angelman syndrome, standing with one foot firmly planted while using the “T” to stretch as far as they can to reach the brightest star in the sky.
OV101 Phase 1 Adolescent Pharmacokinetic (PK) Trial
In addition to the Phase 2 STARS trial, we completed a Phase 1 trial in adolescents with Angelman syndrome and Fragile X syndrome. The primary goal of this trial is to identify doses for use in younger patients with these disorders as well as to assess safety and tolerability. Results announced in November 2017 showed that OV101 was well tolerated and had a similar pharmacokinetic profile in adolescents as young adults. We now plan to start a Phase 2 clinical trial, named ROCKET, in 2018. This trial will evaluate OV101 for the treatment of adolescents and young adults with Fragile X syndrome.
It is proposed that decreased tonic inhibition underlies many of the behavioral changes characteristic of Angelman syndrome and Fragile X syndrome. We believe that OV101 may provide an opportunity to provide a meaningful impact to patients with both these disorders.
OV935 Phase 1b/2a Trial
OV935 is currently in development for the potential treatment for certain types of rare epilepsies. We are currently enrolling patients in a Phase 1b/2a randomized, double-blind, clinical trial for adult patients with rare developmental and/or epileptic encephalopathy. This study is designed to look at the safety, tolerability, pharmacokinetics (pK), and pharmacodynamics (pD) of OV935 in these adult patients. Developmental and/or epileptic encephalopathies are a group of rare epilepsies that include syndromes such as Dravet syndrome, Lennox-Gastaut syndrome, and Tuberous Sclerosis Complex.
Compassionate Access Policy (CAP)
Ovid Therapeutics is a New York-based, biopharmaceutical company using its BoldMedicineTM approach to develop therapies that transform the lives of patients with rare neurological disorders. Ovid’s drug candidate, OV101, is currently in development for the treatment of Angelman syndrome and Fragile X syndrome. Ovid initiated the Phase 2 STARS trial of OV101 in people with Angelman syndrome in 2017 and completed a Phase 1 trial in adolescents with Angelman syndrome or Fragile X syndrome. Ovid is also developing OV935 in collaboration with Takeda Pharmaceutical Company Limited for the treatment of epileptic encephalopathies and in 2017 initiated a Phase 1b/2a trial of OV935.
The establishment of the safety and efficacy of these drug candidates helps us obtain approvals from regulatory agencies such as the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). Approvals are required before these drug candidates can be made generally available to people who may potentially benefit from them. Ovid encourages awareness of and participation in clinical trials and believes that participating in clinical trials is the best way for patients to access investigational drugs prior to regulatory approval.
At times a health care provider may seek access to an unapproved drug candidate for a patient with a life threatening or serious disease who has exhausted all medical options. This use of a drug candidate outside of the context of a clinical trial is called compassionate access, among other names. Currently, Ovid does not make its unapproved drugs available on a compassionate access basis.
Ovid cares deeply about patients and families, but we believe it is critical to establish scientific evidence that its drugs are effective. Clinical trials are the only way to demonstrate the safety and efficacy of a drug. Once we have established a drug’s safety and efficacy and obtained the necessary approvals from regulatory agencies, we believe that then is the appropriate time to offer access of our medicines to patients. As a result, Ovid does not make its unapproved drugs available on a compassionate access basis at this time. However, Ovid encourages interested individuals to contact the company regarding potential participation in its clinical trials. The following is additional information regarding Ovid’s compassionate access policy in accordance with the 21st Century Cures Act:
- Contact Information. If you have any questions regarding Ovid’s compassionate access policy in general, please contact firstname.lastname@example.org. If you have any questions regarding potential participation in Ovid’s clinical trials, please contact the us by email at email@example.com.
- General Criteria. In the event Ovid decides to consider compassionate access use in the future, we will update this policy and evaluate and respond to each request on a case-by-case basis.
- Anticipated Timing. If you contact Ovid as described above, we anticipate that we will acknowledge receipt within ten business days.
- If Ovid decides to make its products available on a compassionate access basis in the future, this policy will be updated with a hyperlink to the expanded access record on clinicaltrials.gov after such record becomes active.
Ovid may revise this compassionate access policy at any time. Additionally, the posting of this policy by Ovid shall not serve as a guarantee of access to a specific investigational drug by any individual patient.
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