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Novel 5-HT6 receptor antagonists/ D2 receptor partial 
agonists targeting behavioral and 
psychological symptoms of dementia (BPSD) 
Monika Marcinkowska,1 Adam Bucki,1 Maciej Pawłowski,1 
Anna Wesołowska,1Paweł Mierzejewski,2 Przemysław Bieńkowski2 
and Marcin Kołaczkowski1,3 
1Jagiellonian University, Medical College, Cracow, Poland; 
2Institute of Psychiatry and Neurology, Warsaw, Poland 
3Adamed Ltd., Pieńków, Poland 
monika.marcinkowska@uj.edu.pl ,marcin.kolaczkowski@uj.edu.pl
Dementia is much more than forgetting… 
The risk of BPSD in dementia patients approaches 90%1 
Behavioral and psychological 
symptoms (BPSD) 
Cognitive 
decline 
Social 
withdrawal 
Agitation 
Aggression 
Psychosis 
Anxiety 
Depression 
[1] Iwasaki, K.; Satoh-Nakagawa, T. et al. J. Clin Psychiatry 2005, 66, 248-252
Current therapeutic strategies are far from ideal… 
• Behavioral symptoms are treated off label with atypical antypsychotics 
However: 
• This therapy displays only modest efficacy, 
• Cause further cognitive decline and serious side effects 
Cognitive 
decline 
Behavioral and psychological 
symptoms (BPSD) Cognitive decline 
There is a need for a more effective and safe therapy, 
dedicated for BPSD
Molecular targets 
5-HT6 antagonists2 
+ Procognitive effects in humans 
+ Moderate antidepressant and 
anxiolytic effects in animals 
D2 partial agonists3 
+ Promising anxiolyticantidepressant activity 
antipsychoticantiparkinsonian effects 
- No procognitive effects in dementia patients 
Multimodal approach may combine the strengths of both groups 
+ Enhancement of antidepressant and anxiolytic activity – proven synergy 
in animal models 
+ Introduction of pro-cognitive effect 
[2] Wesołowska, A., Pharmacol Rep, 2010, 62, 564-577 
[3] Burda, K. et al Pharmacol Rep. 2011, 63, 898-907
Design of innovative hybrid molecules 
5-HT6 receptor antagonist D2 receptor partial agonist 
SB-271046 
Aripiprazole 
‘Merged’ pharmacophores resulting in 
dually acting 5-HT6/ D2 hybrid molecule 
5-HT6 fragment 
D2 fragment
Library of hybrid molecules 
5-HT6 fragment 
D2 fragment 
n = 1, 2
In vitro assays 
5-HT6 fragment 
D2 fragment
Compound 14 is the most promising 4 
Target pKi pEC50 
(ago) 
pKB 
(anta) 
5-HT6 9.52 - 8.77 
D2 8.49 7.51 8.59 
5-HT1A 8.41 - 7.55 
M3 ~5 - - 
H1 ~7 - - 
hERG ~5 - - 
[4] The series was protected by a world patent application WO13_001499 
In vitro profile of 14 
 Affinity for targets that improve 
cognition and mood 
 5-HT6, D2, 5-HT1A 
 Negligible affinity for targets 
associated with side-effects 
 H1, M1, hERG
In vivo activity 
Test procedures 
Compound 14 SB-271046 Aripiprazole 
MED mg/kg 
ANTIDEPRESANT ACTIVITY: 
Porsolt's forced swim test in rats 1 10 3 
Saccharin Self-Administration in rats 1 - - 
ANXIOLYTIC ACTIVITY: 
Vogel's conflict drinking test in rats 1 3 10 
Elevated plus maze test in rats 0.03 10 3 
Compound 14 shows significant improvement of antidepressant and anxiolytic 
activity in rats, comparing to selective 5-HT6 antagonist or D2 partial agonist.
Summary 
• We designed a library of hybrid molecules acting as 
5-HT6 antagonists/D2 partial agonists 
• Compound 14 shows significant antidepressant and anxiolytic 
activity in rats, which makes it suitable for further evaluation 
regarding BPSD
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5-HT6 antagonist/D2 partial agonist targeting behavioural and psychological symptoms of dementia

  • 1. Novel 5-HT6 receptor antagonists/ D2 receptor partial agonists targeting behavioral and psychological symptoms of dementia (BPSD) Monika Marcinkowska,1 Adam Bucki,1 Maciej Pawłowski,1 Anna Wesołowska,1Paweł Mierzejewski,2 Przemysław Bieńkowski2 and Marcin Kołaczkowski1,3 1Jagiellonian University, Medical College, Cracow, Poland; 2Institute of Psychiatry and Neurology, Warsaw, Poland 3Adamed Ltd., Pieńków, Poland monika.marcinkowska@uj.edu.pl ,marcin.kolaczkowski@uj.edu.pl
  • 2. Dementia is much more than forgetting… The risk of BPSD in dementia patients approaches 90%1 Behavioral and psychological symptoms (BPSD) Cognitive decline Social withdrawal Agitation Aggression Psychosis Anxiety Depression [1] Iwasaki, K.; Satoh-Nakagawa, T. et al. J. Clin Psychiatry 2005, 66, 248-252
  • 3. Current therapeutic strategies are far from ideal… • Behavioral symptoms are treated off label with atypical antypsychotics However: • This therapy displays only modest efficacy, • Cause further cognitive decline and serious side effects Cognitive decline Behavioral and psychological symptoms (BPSD) Cognitive decline There is a need for a more effective and safe therapy, dedicated for BPSD
  • 4. Molecular targets 5-HT6 antagonists2 + Procognitive effects in humans + Moderate antidepressant and anxiolytic effects in animals D2 partial agonists3 + Promising anxiolyticantidepressant activity antipsychoticantiparkinsonian effects - No procognitive effects in dementia patients Multimodal approach may combine the strengths of both groups + Enhancement of antidepressant and anxiolytic activity – proven synergy in animal models + Introduction of pro-cognitive effect [2] Wesołowska, A., Pharmacol Rep, 2010, 62, 564-577 [3] Burda, K. et al Pharmacol Rep. 2011, 63, 898-907
  • 5. Design of innovative hybrid molecules 5-HT6 receptor antagonist D2 receptor partial agonist SB-271046 Aripiprazole ‘Merged’ pharmacophores resulting in dually acting 5-HT6/ D2 hybrid molecule 5-HT6 fragment D2 fragment
  • 6. Library of hybrid molecules 5-HT6 fragment D2 fragment n = 1, 2
  • 7. In vitro assays 5-HT6 fragment D2 fragment
  • 8. Compound 14 is the most promising 4 Target pKi pEC50 (ago) pKB (anta) 5-HT6 9.52 - 8.77 D2 8.49 7.51 8.59 5-HT1A 8.41 - 7.55 M3 ~5 - - H1 ~7 - - hERG ~5 - - [4] The series was protected by a world patent application WO13_001499 In vitro profile of 14  Affinity for targets that improve cognition and mood  5-HT6, D2, 5-HT1A  Negligible affinity for targets associated with side-effects  H1, M1, hERG
  • 9. In vivo activity Test procedures Compound 14 SB-271046 Aripiprazole MED mg/kg ANTIDEPRESANT ACTIVITY: Porsolt's forced swim test in rats 1 10 3 Saccharin Self-Administration in rats 1 - - ANXIOLYTIC ACTIVITY: Vogel's conflict drinking test in rats 1 3 10 Elevated plus maze test in rats 0.03 10 3 Compound 14 shows significant improvement of antidepressant and anxiolytic activity in rats, comparing to selective 5-HT6 antagonist or D2 partial agonist.
  • 10. Summary • We designed a library of hybrid molecules acting as 5-HT6 antagonists/D2 partial agonists • Compound 14 shows significant antidepressant and anxiolytic activity in rats, which makes it suitable for further evaluation regarding BPSD
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