Discovery, characterization, and effects on renal fluid and electrolyte excretion of the Kir4.1 potassium channel pore blocker, VU0134992

Article abstract of DOI:10.1124/mol.118.112359

The inward rectifier potassium (Kir) channel Kir4.1 (KCNJ10) carries out important physiologic roles in epithelial cells of the kidney, astrocytes in the central nervous system, and stria vascularis of the inner ear. Loss-of-function mutations in KCNJ10 lead to EAST/SeSAME syndrome, which is characterized by epilepsy, ataxia, renal salt wasting, and sensorineural deafness. Although genetic approaches have been indispensable for establishing the importance of Kir4.1 in the normal function of these tissues, the availability of pharmacological tools for acutely manipulating the activity of Kir4.1 in genetically normal animals has been lacking. We therefore carried out a high-throughput screen of 76, 575 compounds from the Vanderbilt Institute of Chemical Biology library for small-molecule modulators of Kir4.1. The most potent inhibitor identified was 2-(2-bromo-4-isopropylphenoxy)- N-(2, 2, 6, 6-tetramethylpiperidin-4-yl)acetamide (VU0134992). In whole-cell patch-clamp electrophysiology experiments, VU0134992 inhibits Kir4.1 with an IC₅₀ value of 0.97 μM and is 9-fold selective for homomeric Kir4.1 over Kir4.1/5.1 concatemeric channels (IC₅₀ 5 9 μM) at 2120 mV. In thallium (Tl⁺) flux assays, VU0134992 is greater than 30-fold selective for Kir4.1 over Kir1.1, Kir2.1, and Kir2.2; is weakly active toward Kir2.3, Kir6.2/SUR1, and Kir7.1; and is equally active toward Kir3.1/3.2, Kir3.1/3.4, and Kir4.2. This potency and selectivity profile is superior to Kir4.1 inhibitors amitriptyline, nortriptyline, and fluoxetine. Medicinal chemistry identified components of VU0134992 that are critical for inhibiting Kir4.1. Patch-clamp electrophysiology, molecular modeling, and site-directed mutagenesis identified pore-lining glutamate 158 and isoleucine 159 as critical residues for block of the channel. VU0134992 displayed a large free unbound fraction (f_u) in rat plasma (f_u 5 0.213). Consistent with the known role of Kir4.1 in renal function, oral dosing of VU0134992 led to a dose-dependent diuresis, natriuresis, and kaliuresis in rats. Thus, VU0134992 represents the first in vivo active tool compound for probing the therapeutic potential of Kir4.1 as a novel diuretic target for the treatment of hypertension.

Full text of DOI:10.1124/mol.118.112359

Molecular Pharmacology Fast Forward. Published on June 12, 2018 as DOI: 10.1124/mol.118.112359
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Discovery, characterization, and effects on renal fluid and electrolyte excretion of the Kir4.1
potassium channel pore blocker, VU0134992
Sujay V. Kharade, Haruto Kurata, Aaron M. Bender, Anna L. Blobaum, Eric Figueroa, Amanda Duran,
Meghan Kramer, Emily Days, Paige Vinson, Daniel Flores, Lisa M. Satlin, Jens Meiler, C. David
Weaver, Craig W. Lindsley, Corey R. Hopkins, and Jerod S. Denton
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232: SVK, MK,
JSD
Center for Neuroscience Drug Discovery and the Vanderbilt Specialized Chemistry Center for
Accelerated Probe Development, Vanderbilt University, Nashville, TN 37232: KH, AMB, ALB, CWL,
CRH
Department of Pharmacology, Vanderbilt University, Nashville, TN 37232: HK, AMB, EF, JM, CDW,
CWL, JSD
Department of Chemistry, Vanderbilt University, Nashville, TN 37232: AD, JM, CDW, CWL
High-Throughput Screening Center, Vanderbilt University, Nashville, TN 37232: ED, PV
Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, 10029: DF,
LMS
Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198-
6125: CRH
Institute of Chemical Biology, Vanderbilt University, Nashville, TN 37232: CDW, CWL, JSD
1

Molecular Pharmacology Fast Forward. Published on June 12, 2018 as DOI: 10.1124/mol.118.112359
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Running Title: Kir4.1 inhibitor: VU0134992
Number of text pages: 19
Number of tables: 2
Number of figures: 6
Number of references: 61
Number of words in Abstract: 298
Number of words in Introduction: 757
Number of words in Discussion: 1,779
Corresponding authors:
Jerod S. Denton, Ph.D.
T4208 Medical Center North
1161 21st Avenue South
Nashville, TN 37232
jerod.s.denton@vanderbilt.edu
Corey Hopkins, Ph.D.
Department of Pharmaceutical Sciences
College of Pharmacy
University of Nebraska Medical Center
986125 Nebraska Medical Center
Omaha, NE 68198-6125
corey.hopkins@unmc.edu
Abbreviations: CCD, cortical collecting duct; DCT, distal convoluted tubule; EAST, Epilepsy Ataxia
Sensorineural deafness Tubulopathy; MECP2, methyl CpG binding protein 2; SIDS, sudden infant death
syndrome; TAL, thick ascending loop; SeSAME, Seizures Sensorineural deafness Mental retardation
Electrolyte imbalances; SSRI, Selective Serotonin Reuptake Inhibitor; TCA, tricyclic antidepressant;
VU0134992, 2-(2-Bromo-4-iso-propylphenoxy)-N-(2,2,6,6-tetramethylpiperidin-4-yl)acetamide
2

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ABSTRACT
The inward rectifier potassium (Kir) channel Kir4.1 (KCNJ10) carries out important physiological roles
in epithelial cells of the kidney, astrocytes in the central nervous system, and stria vascularis of the inner
ear. Loss-of-function mutations in KCNJ10 lead to EAST/SeSAME syndrome, which is characterized by
epilepsy, ataxia, renal salt wasting, and sensorineural deafness. While genetic approaches have been
indispensable for establishing the importance of Kir4.1 in the normal function of these tissues, the
availability of pharmacological tools for acutely manipulating the activity of Kir4.1 in genetically
normal animals has been lacking. We therefore carried out a high-throughput screen of 76,575
compounds from the Vanderbilt Institute of Chemical Biology library for small-molecule modulators of
Kir4.1. The most potent inhibitor identified was 2-(2-Bromo-4-iso-propylphenoxy)-N-(2,2,6,6-
tetramethylpiperidin-4-yl)acetamide (VU0134992). In whole-cell patch clamp electrophysiology
experiments, VU0134992 inhibits Kir4.1 with an IC50 of 0.97 µM and is 9-fold selective for homomeric
Kir4.1 over Kir4.1/5.1 concatemeric channels (IC50=9 µM) at -120 mV. In thallium (Tl+) flux assays,
VU0134992 is greater than 30-fold selective for Kir4.1 over Kir1.1, Kir2.1, and Kir2.2, is weakly active
toward Kir2.3, Kir6.2/SUR1, and Kir7.1, and is equally active toward Kir3.1/3.2, Kir3.1/3.4, and Kir4.2.
This potency and selectivity profile is superior to Kir4.1 inhibitors amitriptyline, nortriptyline, and
fluoxetine. Medicinal chemistry identified components of VU0134992 that are critical for inhibiting
Kir4.1. Patch clamp electrophysiology, molecular modeling, and site-directed mutagenesis identified
pore-lining glutamate 158 and isoleucine 159 as critical residues for block of the channel. VU0134992
displayed a large free fraction in rat plasma (fu = 0.213). Consistent with the known role of Kir4.1 in
renal function, oral dosing of VU0134992 led to a dose-dependent diuresis, natriuresis, and kaliuresis in
rats. Thus, VU0134992 represents the first in vivo-active tool compound for probing the therapeutic
potential of Kir4.1 as a novel diuretic target for the treatment of hypertension.
3

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INTRODUCTION
Kir4.1 inward rectifier potassium (Kir) channels (encoded by KCNJ10) are critical for regulating
potassium (K+) transport and electrolyte homeostasis in the central nervous system (CNS), retina, inner
ear, and nephrons of the kidney (Hibino et al., 2010; Welling, 2016). In the brain and spinal cord,
homotetrameric Kir4.1 channels are expressed almost exclusively in glia, oligodendrocytes, and
astrocytes, although some evidence for neuronal expression has been reported (Zhang et al., 2011) (see
below). Kir4.1 expression levels are variable between different brain and spinal cord regions, indicating
the channel’s contributions to CNS physiology are complex and anatomically heterogeneous(Nwaobi et
al., 2016). Astroglial Kir4.1 channels are best known for their role in clearance, or “spatial buffering,” of
extracellular K+ and glutamate in the CNS. By virtue of their prominent membrane expression and high
open probability, Kir4.1 channels drive the membrane potential (Vm) of glial cells to negative voltages.
When K+ is released from active neurons, thereby locally depolarizing the Nernst equilibrium potential
for K+ with respect to the astrocyte Vm, an inwardly directed electrochemical driving force that promotes
K+ and glutamate uptake into astrocytes is generated (Djukic et al., 2007; Kofuji et al., 2002;
Kucheryavykh et al., 2007; Olsen and Sontheimer, 2008).
Alterations in Kir4.1 expression and function are associated with a number of human diseases (Nwaobi
et al., 2016). Autosomal recessive mutations in KCNJ10 cause EAST (Epilepsy Ataxia Sensorineural
deafness Tubulopathy) or SeSAME (Seizures Sensorineural deafness Ataxia Mental retardation
Electrolyte imbalances) syndrome(Bockenhauer et al., 2009; Reichold et al., 2010; Scholl et al., 2009).
The clinical presentation of EAST/SeSAME syndrome is readily explained by the loss of Kir4.1
function in the CNS, inner ear, and kidney. In two separate mouse models of Huntington’s disease (i.e.
R6/2 and Q175 mice), the functional expression of Kir4.1 in astrocytes is reduced, leading to elevated
extracellular K+ concentration and increase in neuronal excitability. Viral delivery of Kir4.1 channels to
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Molecular Pharmacology Fast Forward. Published on June 12, 2018 as DOI: 10.1124/mol.118.112359
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striatal astrocytes prolongs the lifespan and attenuates some of the motor deficits in R6/2 mice (Tong et
al., 2014). Epigenetic changes in Kir4.1 expression have been linked to Rett syndrome, a neurological
disorder that affects cognitive, sensory, motor, and autonomic functions (e.g. cardiac function, digestion,
and breathing). In most cases, Rett syndrome is caused by mutations in the methyl CpG binding protein
2 (MECP2) gene located on the X chromosome, which is responsible for the transcriptional regulation of
dozens of genes, including KCNJ10 (Nwaobi et al., 2016). Zhang and colleagues proposed that the
overexpression of Kir4.1 homotetrameric channels in respiratory-related neurons from MecP2 mice
leads to a reduction in CO2/pH chemosensitivity and disruption of normal breathing (Zhang et al., 2011).
This overexpression could be restricted to respiratory neurons since recent data from Olsen and
colleagues suggest that there is a reduction in glial cell Kir4.1 from MeCP2 mice (Kahanovitch et al.,
2018). An emerging body of literature has implicated Kir4.1 in autism spectrum disorder, SIDS,
epilepsy, pain, and multiple sclerosis (Sicca et al., 2016; Sicca et al., 2011), although in most cases a
clear mechanistic link between the channel and these diseases has not yet been established.
In polarized epithelial cells of the distal convoluted tubule (DCT) and cortical collecting duct (CCD),
Kir4.1 is expressed on the basolateral (i.e. blood-facing) membrane, predominantly in a heteromeric
complex with Kir5.1 (encoded by KCNJ16)(Lourdel et al., 2002; Welling, 2016; Zhang et al., 2014).
Kir5.1 does not produce functional K+ channels on its own, but serves to modify the functional (e.g.
unitary conductance, activation kinetics, rectification) and regulatory (e.g. pH sensitivity) properties of
Kir4.1-containing channels(Paulais et al., 2011; Pessia et al., 2001; Tucker et al., 2000). In the DCT,
Kir4.1/5.1 channels 1) recycle K+ ions across the basolateral membrane to sustain the activity of the
basolateral Na+/K+/ATPase, which maintains a favorable chemical driving force for Na+ reabsorption
across the luminal (urine-facing) membrane by the Na+/Cl- co-transporter NCC, and 2) create a negative
membrane potential that promotes Cl- exit across the basolateral membrane. In the CCD, basolateral
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Kir4.1/5.1 and Kir4.1 channels hyperpolarize the basolateral membrane potential and electrically
coupled luminal membrane to promote Na+ reabsorption via the Epithelial Na+ Channel (ENaC). Thus,
Kir4.1-containing channels play key roles in promoting NaCl reabsorption in the DCT and CCD of the
nephron (Welling, 2016).
The lack of specific pharmacological tool compounds has slowed progress in exploring the function,
integrative physiology, and in some cases therapeutic potential of Kir4.1, leading us to carry out a high-
throughput screen (HTS) of 76,575 compounds for pharmacological modulators of Kir4.1. Here we
report the discovery and characterization of VU0134992, the first in vivo-active inhibitor of renal Kir4.1
channels.
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MATERIALS AND METHODS
Stable Cell Lines and Transient Transfection
Stably transfected monoclonal T-Rex-HEK-293 cell lines expressing Kir1.1, Kir2.2, Kir2.3, Kir4.1,
Kir4.2, Kir6.2/SUR1, or Kir7.1-M125R from a tetracycline-inducible promoter were generated as
described previously (Lewis et al., 2009; Raphemot et al., 2013; Raphemot et al., 2011; Swale et al.,
2016). To promote cell surface expression and function of Kir4.2, lysine 110 was mutated to asparagine
and the most distal 22 amino acids were deleted from the carboxyl-terminus (Kir4.2-K110N-Δ22), as
described by Nichols and colleagues (Pearson et al., 2006). The day before Tl+ flux assays, cells were
plated at a density of 20,000 cells per well in black-walled, clear-bottomed, amine-coated 384-well
plates (PurecoatTM, Corning) in the presence of 1 µg/ml tetracycline to induce Kir channel expression.
Constitutively expressing Kir3.1/3.2, Kir3.1/3.4 cells were used without any induction. Kir6.2/SUR1
was activated with 30 µM VU063 (Raphemot et al., 2014) for testing inhibitors. Transient transfections
were performed using Lipofectamine-LTX according the manufacturer’s instructions. The pcDNA3.1-
Kir4.1-5.1 concatemer plasmid was obtained from Chung Jiang (Georgia State University) with
permission from John Adelman (Oregon Health and Science University).
Kir4.1 Primary Screen
Tl+ flux assays were performed as described previously (Lewis et al., 2009; Raphemot et al., 2013;
Raphemot et al., 2011; Swale et al., 2016) with modifications to reagents optimized per cell line as noted
below. Briefly, cells cultured overnight 37 °C and 5% CO2 in 384-well plates were loaded with the
thallium-sensitive dye Thallos-AM (TEFLabs, Austin, TX) in ambient conditions, washing before and
after dye using Hank’s Balanced Salt Solution/20mM HEPES (assay buffer). Media and buffer exchange
was performed on the ELx405 plate washer (BioTek). Dye loaded cells were then transferred to the
Hamamatsu Functional Drug Screening System 6000 (FDSS6000; Hamamatsu, Tokyo, Japan) or
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Panoptic kinetic imaging plate reader (Wavefront Bioscience, Franklin, TN, USA). Both instruments
collect live measurements at 1 Hz (480/40 nm excitation and 540/40 nm emission) during simultaneous
384-well pipetting of 10 µM small-molecules (0.1% DMSO assay buffer) or control (100 µM
fluoxetine). Cells are treated 20 minutes, continuing ambient conditions, before adding 5X Tl+ stimulus
buffer (125 mM NaHCO3 , 1 mM MgSO4 , 1.8 mM CaSO4, 5 mM glucose, 20 mM HEPES, and 1.8 – 6
mM Tl2SO4) to each well to initiate Tl+ flux. Screening data were collected into a custom database and
data reduction software application to merge individual compounds with the associated values on a well-
to-well, then plate-by-plate basis. Fluorescence values for individual wells were normalized by dividing
each data point for that well by the initial data point (F/F0). After normalization of all wells, the
fluorescence data (i.e. fluorescence vs. time) from each of the designated vehicle-control wells was
averaged and this averaged control wave was subtracted from all wells on the plate to yield normalized,
vehicle control-subtracted data. Fluorescence amplitudes (max-min) were extracted from the control-
subtracted wells over a range from 0-200 seconds. Alternatively, the slope 5-20 sec after Tl+ addition
was calculated. Hit selections were made by analysis on a per plate basis evaluating 3 standard
deviations from the mean of the compound population. Compounds that were tested in dose-response
were calculated as above, and reduced values were then plotted with GraphPad Prism version 5.01
(GraphPad Software, San Diego, CA) to generate estimated potencies of concentration response curves
(CRC) fit using a four-parameter logistic model of non-linear regression analysis.
Site-Directed Mutagenesis
Mutations in Kir4.1 were introduced using a QuickChange II Site-Directed Mutagenesis kit (Agilent
Technologies) according to the manufacturer’s instructions. The complete cDNA was sequenced to
verify introduction of the intended codon changes.
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Patch Clamp Electrophysiology
HEK-293T cells were transfected with wild type or mutant pcDNA5-Kir4.1 (1µg) and pcDNA3.1-EGFP
(0.5µg; transfection marker) using Lipofectamine LTX reagent according to the manufacturer’s
instructions. The cells were dissociated the following day and plated on poly-L-lysine-coated coverslips
and allowed to recover for at least 1h in a 37 °C 5% CO2/95% air incubator before starting experiments.
Patch clamp experiments were performed essentially as described previously (Raphemot et al., 2013).
Briefly, patch electrodes (2-3MΩ) were filled with an intracellular solution containing 135 mM KCl, 2
mM MgCl2, 1 mM EGTA, 10 mM HEPES-free acid, and 2 mM Na2ATP (Roche Diagnostics), pH 7.3,
275 mOsmol/kg water. The standard bath solution contained 135 mM NaCl, 5 mM KCl, 2 mM CaCl2, 1
mM MgCl2, 5 mM glucose, and 10 mM HEPES free acid, pH 7.4. Macroscopic currents were recorded
under whole-cell voltage-clamp conditions using an Axopatch 200B amplifier (Molecular Devices,
Sunnyvale, CA). Cells were voltage clamped at a holding potential of −75 mV and stepped every 5 s to
−120 mV for 200 msec before ramping to 120 mV at a rate of 1.2 mV/msec. Data were collected at 5
kHz and filtered at 1 kHz. Data acquisition and analysis were performed using the pClamp 9.2 software
suite (Molecular Devices, Sunnyvale, CA). Pharmacology experiments were terminated by applying
2 mM barium (Ba2+) chloride to measure leak current. Cells exhibiting <90% block by Ba2+ were
excluded from analysis. The mean current amplitude recorded over five successive steps to −120 mV in
WT control or mutants at single concentration were expressed as mean ± SD. Statistical analysis was
performed using one-way ANOVA with Bonferroni's multiple comparisons test with statistical
significance defined at P < 0.05. IC50 values were determined by fitting the Hill equation to
concentration-response curves (CRCs) using variable-slope nonlinear regression analyses. All the
analysis was performed with GraphPad Prism version 5.01 (GraphPad Software, San Diego, CA).
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Homology Modeling of Kir4.1
The Kir4.1 sequence (residues 28-360) was threaded onto the Kir2.2 crystal structure (PDB 3JYC) based
on a sequence alignment generated by ClustalW. The sequence identity between Kir4.1 and Kir2.2 is
43.3%. Transmembrane segments for Kir4.1 were predicted using the OCTOPUS topology prediction
web server (http://octopus.cbr.su.se/). Missing coordinates in the threaded Kir4.1 model were
reconstructed using Rosetta with fragment insertion from the fragment libraries generated by the Rosetta
server (Leaver-Fay et al., 2007). The modeling pipeline utilized RosettaMembrane (Barth et al., 2007)
and RosettaSymmetry (King et al., 2012) in the Rosetta revision 58019. Loops were closed using the
cyclic coordinate descent (CCD) algorithm and refined using Kinematic loop closure (KLC) from the
Rosetta Loop Modeling application (Mandell et al., 2009). 1000 models were generated and the top
eight models by score and RMSD to Kir2.2 (models 1-8) were further relaxed using FastRelax in the
Rosetta relax application producing 100 models each. The top 3 models from parent models 1, 2, 3, 5
and 7 were chosen for ligand docking studies.
Docking VU0134992 in the Kir4.1 Channel Pore
VU0134992 was manually placed in a coordinate frame that corresponds to the pore cavity below the
selectivity filter of Kir4.1. VU0134992 conformers were generated usingBCL::Conf (Kothiwale et al.,
2015). The top 15 homology models described above were used for ligand binding studies with
RosettaLigand (Meiler and Baker, 2006), producing 7500 VU0134992-Kir4.1 complexes. The top 10%
of 750 models by Rosetta interface score were analyzed for favorable residue interactions (better than -1
REU) and highest frequency interaction between residues of Kir4.1 and VU0134992.
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Chemical Synthesis
Synthesis and Characterization of VU0134992
Synthetic scheme of VU0134992 is shown in Supplemental Figure S1 as an example of general
synthetic scheme. Experimental procedure for VU0134992 is described below. Specific synthetic
schemes for selected compounds are also shown in supplemental information (Figures S2 and S3).
2-Bromo-4-iso-propylphenol (2): To a solution of 4-iso-propylphenol (2.00 g, 14.7 mmol) in CH3CN
(30 mL) was added N-bromosuccinimide (2.88 g, 16.2 mmol) at 0oC. After a resulting greenish solution
was stirred at 0oC for 1.5 hours, ice/NaHCO3-aq was added to the reaction mixture which was extracted
with ethyl acetate twice. Combined organic extracts were washed with brine and dried over MgSO4. The
filtrate was evaporated under reduced pressure to give crude residue which was purified on silica gel
chromatography (hexane/ethyl acetate) to yield 2-bromo-4-iso-propylphenol 2 (723 mg (content 618
mg), 20% yield) as a pale yellow oil. Crude fraction collected was purified by Gilson HPLC separation
system using (0.1% TFA in water)/CH3CN as an eluent. Extraction from the collected fraction with
DCM gave another batch of 2 (1.06 g (content 1.02 g), 32% yield) as a pale reddish oil. Total yield was
52%.
2-Chloro-N-(2,2,6,6-tetramethylpiperidin-4-yl)acetamide hydrochloride (4): To a solution of 4-amino-
2,2,6,6-tetramethylpiperidine 3 (2.345 g, 15.0 mmol) in DCM (30 mL) was added chloroacetyl chloride
(1.19 mL, 15.0 mmol) at 0oC. After a resulting white suspension was stirred at 0oC for 40 min,
precipitates were collected by filtration to yield 2-chloro-N-(2,2,6,6-tetramethylpiperidin-4-yl)acetamide
hydrochloride 4 (4.052 g (content 3.908 g), 97% yield).
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2-(2-Bromo-4-iso-propylphenoxy)-N-(2,2,6,6-tetramethylpiperidin-4-yl)acetamide (VU0134992): To a
solution of 2 (935 mg, 4.35 mmol) in DMF (30 mL) was added 4 (975 mg, 3.62 mmol), Cs2CO3 (2.95 g,
9.05 mmol) and NaI (179 mg, 1.19 mmol) at ambient temperature. After a resulting white suspension
was stirred at 50oC for 18h hour, the reaction mixture was poured into cold 1 mol/L NaOH-aq (120 mL)
and it was extracted with DCM three times (1st: 50 mL, 2nd: 50 mL, 3rd: 30 mL). Combined organic
extracts were washed with brine (40 mL) and dried over MgSO4. The filtrate was evaporated under
reduced pressure. The residue was purified by Gilson HPLC separation system using (0.1% TFA in
water)/CH3CN as an eluent. Desired fractions were collected and concentrated up to about half amount.
CH3CN was added to the aqueous solution until precipitates were formed (ratio of water:CH3CN was
about 1:2). After the precipitate was collected by filtration, it was extracted with DCM from 1 mol/L
NaOH-aq three times. Combined organic extracts were dried over MgSO4. The filtrate was evaporated
under reduced pressure to yield 2-(2-bromo-4-iso-propylphenoxy)-N-(2,2,6,6-tetramethylpiperidin-4-
yl)acetamide VU0134992 (1.16 g, 78% yield) as a white powder. 1H NMR (400.1 MHz, CDCl3): 7.42 (d,
J = 1.7 Hz, 1H), 7.13 (dd, J = 8.4, 1.7 Hz, 1H), 6.80 (d, J = 8.4 Hz, 1H), 6.74 (d, J = 8.0 Hz, 1H), 4.48 (s,
2H), 4.39-4.30 (m, 1H), 2.85 (sept, J = 6.9 Hz, 1H), 1.96-1.92 (m, 2H), 1.27 (s, 6H), 1.22 (d, J = 6.9 Hz,
13
6H), 1.14 (s, 6H), 1.03-0.97 (m, 2H). C NMR (100.6 MHz, CDCl3): 166.87, 151.81, 144.44, 131.41,
126.90, 113.87, 112.10, 68.51, 51.17, 45.27, 42.47, 35.10, 33.38, 28.73, 24.12. LCMS: RT = 0.912 min,
m/z = 411 [M + H]+. HRMS calculated for C20H31BrN2O2 [M+], 410.1569; found 410.1571.
Drug Metabolism and Pharmacokinetics (DMPK)
Detailed methods for in-vitro and in vivo DMPK analyses are described in Supplemental Methods.
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Metabolic Cage Studies
All studies involving animals were approved by Institutional Animal Care and Use Committee.
Metabolic cage studies were done as described previously (Kharade et al., 2015). Briefly, male Sprague-
Dawley rats (250-300 g) were allowed to acclimatize to single housing in metabolic cages for 2h before
an experiment. Access to food and water was restricted during the entire experiment. Rats were given
drug VU0134992 or vehicle (10% ethanol + 40% PEG400 + 50% saline) by oral gavage (PO). After 30
mins, voiding was induced by giving each animal a saline load (18 ml/kg by oral gavage), and urine was
collected at 2h, 4h and 6h time points. Urine volumes were measured, centrifuged, aliquoted, and frozen
at -80°C until analyzed. Urine Na+ and K+ concentrations were measured by flame photometry
(Instrumentation Laboratories model 943, Lexington, MA). The total number of moles of Na+ or K+
excreted over the 4 hours was normalized to animal body weight (i.e. µmol/100 g/4h). The data are
expressed as the mean ± SD and was analyzed using one-way ANOVA with Bonferroni's multiple
comparisons test with statistical significance defined at P < 0.05.
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RESULTS
Discovery of VU0134992
76,575 structurally diverse small-molecules from the Vanderbilt Institute of Chemical Biology library
were screened against Kir4.1 using a Tl+ flux assay that we have described previously (Raphemot et al.,
2013). Briefly, the assay reports the inwardly directed movement of Tl+ through the ion conduction pore
of Kir4.1 using the intracellular, Tl+-sensitive dye Thallos. The mean Z’ plate statistic for the primary
screen was 0.78, indicating the assay’s performance was robust and reproducible, and a hit rate of 0.8%.
We selected 640 hit compounds resupplied from the vendor for confirmation and counter screening
against induced and uninduced cells. 58 hits inhibited Tl+ flux in tetracycline-induced T-Rex-HEK-293-
Kir4.1 cells in duplicate testing at 10 µM. Screening against uninduced cells identified 42 compounds
that inhibited endogenous Tl+ flux pathways expressed in T-Rex-HEK293 cells. This left 16 authentic
inhibitors of Kir4.1 (0.02% success rate). We focused on VU0134992 because of its superior potency,
selectivity, and chemical tractability. In gold-standard patch clamp electrophysiology experiments,
VU0134992 markedly inhibited Kir4.1 at 3 µM with an IC50 of 0.97 µM (95% CI, 0.5 µM to 1.7 µM)
(Fig. 1). Because Kir4.1 forms heteromeric channels with Kir5.1 in the kidney (Lachheb et al., 2008;
Tucker et al., 2000; Zhang et al., 2015; Zhang et al., 2014), we evaluated the sensitivity of Kir4.1-5.1
concatemeric channels to VU0134992. As shown in Fig. 1, VU0134992 inhibits Kir4.1-5.1
concatemeric channels with an IC50 of 9.05 µM (95% CI 7.4 µM to 11.1 µM) at -120 mV, providing
approximately 9-fold selectivity toward Kir4.1 over Kir4.1-5.1 channels at this test potential. The IC50
values for inhibition of outward currents through Kir4.1 and Kir4.1-5.1 at +120 mV were 1.2 µM (95%
CI – 0.97 µM to 1.6 µM) and 26.8 µM (95% CI 18.2 µM to 39.8 µM)(22-fold selectivity).
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VU0134992 Selectivity
The selectivity of VU0134992 for Kir4.1 versus 9 other members of the Kir channel family was
evaluated at concentrations ranging from 0.3 nM to 30 µM in 11-point CRC experiments, using
established Tl+ flux assays (Swale et al., 2016). The results are summarized in Table 1. VU0134992
exhibited no apparent activity toward Kir1.1, Kir2.1, or Kir2.2, and caused only partial inhibition of
Kir2.3 (73% inhibition at 30 µM), Kir6.2/SUR1 (12% inhibition at 30 µM), and Kir7.1 (15% inhibition
at 30 µM,). However, upon further evaluation, we found that VU0134992 inhibits Kir3.1/3.2 (92%
inhibition at 30 µM, IC50=2.5 µM), Kir3.1/3.4 (92% inhibition at 30 µM, IC50=3.1 µM), and Kir4.2
(100% inhibition at 30 µM, IC50=8.1 µM with approximately the same efficacy and potency that
VU0134992 inhibits Kir4.1 (100% at 30 µM, IC50=5.2 µM). The rightward shift in Kir4.1 IC50 derived
from Tl+ flux experiments compared to electrophysiology experiments is commonly observed with other
Kir channels (Bhave et al., 2011; Raphemot et al., 2013; Raphemot et al., 2011; Swale et al., 2016).
The antidepressants amitriptyline, nortriptyline, and fluoxetine have been used to inhibit Kir4.1 activity
in heterologous expression and native cell systems (Furutani et al., 2009; Ohno et al., 2007; Su et al.,
2007). However, these drugs have never been systematically evaluated for selectivity toward Kir4.1 over
several closely related Kir channels in a single, systematic study. Toward this end, and to provide a
comparison for VU0134992, we evaluated the potency and efficacy of amitriptyline, nortriptyline, and
fluoxetine toward Kir1.1, Kir2.1, Kir2.3, Kir3.1/3.2, Kir3.1/3.4, Kir4.1, Kir4.2, Kir6.1/SUR1, and
Kir7.1-M125R, in 11-point CRCs at concentrations up to 90 µM. As summarized in Table 1, all 3 drugs
exhibited weak and non-specific activity toward most members of the Kir channel family at
concentrations that also inhibit Kir4.1. Thus, VU0134992 is more potent and selective than
amitriptyline, nortriptyline, and fluoxetine toward Kir4.1 channels.
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VU0134992 Interacts with E158 and I159 to Block the Kir4.1 Channel Pore
A common mechanism by which small-molecules inhibit Kir channels is through blockade of the ion-
conduction pore (Furutani et al., 2009; Kharade et al., 2017; Swale et al., 2014; Swale et al., 2016).
Some pore-blocker exhibit voltage-dependent “knock-off” behavior at test potentials more negative than
the Nernst K+ equilibrium potential difference. We therefore evaluated the voltage- and K+-dependence
of VU0134992 inhibition of Kir4.1 to begin identifying the VU0134992 binding site. As shown in Fig.
2A, 30 µM VU0134992 fully inhibited Kir4.1-mediated outward and inward currents across all test
potentials when cells were bathed in a solution containing 5 mM K+ and patch clamped using an internal
solution containing 135 mM K+ (Nernst equilibrium potential = -83 mV). However, when extracellular
K+ concentration was raised to 50 mM K+ (Nernst equilibrium potential = -25 mV), we observed a time-
dependent knock-off of VU0134992 at strong hyperpolarizing potentials (Fig. 2) and statistically
significant reduction of block between -120 mV and -100 mV (Fig. 2). These data suggested that the
VU0134992 binding site is indeed located within the Kir4.1 channel pore.
To identify pore-lining residues that participate in VU0134992 binding in the pore, we generated a
comparative homology model of Kir4.1 based on the human Kir2.2 crystal structure and employed in
silico docking to identify energetically favorable VU0134992 docking sites within the channel pore.
Analysis of the top scoring VU0134992-Kir4.1 complexes by Rosetta interface score identified 4 pore-
lining residues in Kir4.1 that 1) showed high frequency (>10% out of 750 models) interactions with
VU0134992 and 2) were different between Kir4.1 and Kir1.1. These residues are in the rank order of
glutamate (E)158 (39.5% of interactions) > threonine (T)162 (37.3% of interactions) > T155 (10.1 % of
interactions) > isoleucine (I)159 (10.0 % of interactions). The interactions are a combination of
hydrogen bonds and van der Waals interactions (Fig. 3A)The homology model in Fig. 3A shows the
predicted location of the VU0134992 in the membrane-spanning pore (right), whereas the close-up view
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(left) identifies close interactions of VU0134992 with E158, the top-scoring residue. Interactions with
E158 are dominated by hydrogen bonds. However, several van der Waals contacts exist in addition.
We mutated these four amino acids to the corresponding residues in Kir1.1, which is virtually
insensitive to VU0134992 (Fig. 3B-E), and measured the inhibition of the mutant channels to 3 µM
VU0134992 by whole-cell patch clamp electrophysiology. As shown in Figure 3B, 3 µM VU0134992
inhibited inward current at -120 mV carried by WT Kir4.1 by 85.9 ± 11 % (n = 12). In striking contrast,
mutation of E158 to asparagine (E158N) dramatically reduced the sensitivity of the channel to
VU0134992 (0.4 ± 12 % inhibition, n = 8; IC50 ~235 µM with only 38.2 ± 14.7 % inhibition at 30 µM)
at -120mV. To determine if this loss of sensitivity is caused by alteration of side chain charge or
structure, we evaluated channels in which E158 was mutated to either glutamine (E158Q) or aspartate
(E158D). Both mutant channels exhibited a complete loss of sensitivity to 3 µM VU0134992 and a large
rightward shift in IC50 (Kir4.1-E158Q ~28 mM; Kir4.1-E158D = no fit), suggesting that changes in side-
chain structure at position 158 are sufficient to affect VU0134992 block. Mutation of I159 to serine
(I159S) caused a complete loss of block by 3 µM VU0134992 and large rightward shift in the CRC (9.5
± 7.7 %, n=6; IC50 ~199 µM and 77±20 % inhibition at 30 µM; Fig. 3B, D). Kir4.1-T155V channels
were not functional (NF) and therefore could not be evaluated. We also mutated nearby residues T162 to
cysteine (T162C), T164 to alanine (T164A) and F165 to isoleucine (F165I), however neither mutation
affected VU0134992 sensitivity.
VU0134992 Structure-Activity Relationships
We employed medicinal chemistry in an effort to improve the potency of VU0134992 and establish its
structure-activity relationships (SAR) for inhibition of Kir4.1. No modifications made to the scaffold of
VU0134992 improved its activity toward Kir4.1. It was revealed that VU0134992 bears fundamental
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components for inhibition of Kir4.1 channels (Supplemental Tables. S1-3). An overview of the SAR is
shown in Fig. 4. While flat SAR was observed at the 4-position in the left-hand part for inhibitory
activity of Kir4.1 with IC50 of 3.0 – 9.6 µM in the thallium flux assay (methyl, ethyl, iso-propyl
(VU0134992), tert-butyl, chloro and phenyl substituents), the mono-bromine atom at the 2-position was
critical for the potency (Not only F, Cl, H substituents for Br were all inactive (No Fit) but also addition
of Br and Cl at the 6-position resulted in notable decrease in potency) (Table. S1). While the linker
modification was tolerated, such as incorporation of dimethyl substituents at α-position of the amide
(Table. S3), all of modifications in the right-hand part made the compound noticeably less active (Table.
S2).
VU0134992 Serum Binding, Clearance, and Blood-Brain-Barrier Permeability
VU0134992 displayed a large free fraction in rat plasma (fu = 0.213), modest fraction unbound in rat
brain (fu = 0.013), moderate predicted hepatic clearance in human (13.4 mL/min/kg), and high predicted
hepatic clearance in rat (60.5 mL/min/kg) liver microsomes. A good in vitro:in vivo correlation was
noted, with clearance above cardiac output (CLp > 1000 mL/min/kg), and with a short half-life (t1/2
=
10.6 min) driven by a large volume of distribution at steady state (Vss = 13.5 L/kg). In a standard rat
plasma:brain level (PBL) cassette, which is routinely used to rapidly screen the brain distribution
potential of compounds, VU0134992 levels were below the limit of quantification (BLQ) in brain. We
also measured plasma and brain levels following an oral dose of 50 mg/kg, a dosing regimen that was
used in subsequent metabolic cage studies (see below). Total VU0134992 brain and plasma
concentrations were 0.94 µM and 0.76 µM (Kp = 1.2), respectively, whereas unbound VU0134992
concentrations in brain and plasma were 0.012 µM and 0.16 µM (Kp,uu = 0.08).
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Effects of VU0134992 on Renal Fluid and Electrolyte Excretion
Given the important role of Kir4.1 in renal Na+ reabsorption and K+ secretion, we have postulated that
small-molecule inhibitors of Kir4.1 will induce diuresis, natriuresis, and kaliuresis (Denton et al., 2013).
To test this hypothesis, we evaluated the effects of VU0134992 on renal function in volume-loaded
Sprague-Dawley rats. The rats were administered with either vehicle or different doses of VU0134992
followed by volume-loading. The effects of VU0134992 on urine output are summarized in Fig. 5.
Consistent with the hypothesis, oral administration of VU0134992 led to a statistically significant
increase in urine output as compared to vehicle at doses of 50 mg/kg and 100 mg/kg. Urine Na+ and K+
concentrations were measured to determine how VU0134992 alters electrolyte transport along the
nephron. As shown in Figs. 5B and 5C, VU0134992 statistically significantly (P<0.05) increased urinary
Na+ as well as K+ excretion at doses of 50 mg/kg and 100 mg/kg compared to vehicle-treated control
animals.
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DISCUSSION
Here we report the discovery and characterization of VU0134992, the first Kir4.1 K+ channel inhibitor
to emerge from a high-throughput screening campaign. VU0134992 affords approximately 9-22 fold
selectivity between homotetrameric Kir4.1 and heterotetrameric Kir4.1/5.1 channels when evaluated at -
120 mV and +120 mV, respectively, a property that could be useful for sorting out the relative
contribution of these two channel populations in native cells. To our knowledge, VU0134992 is the first
subtype-preferring Kir4.1 inhibitor to be reported. Efforts to understand the molecular basis of this
selectivity and to identify VU0134992 analogs with improved potency and selectivity toward Kir4.1 and
Kir4.1/5.1 channels are underway.
The pharmacology of Kir4.1 has been primarily limited to inorganic cations (e.g. Ba2+, cesium) and anti-
depressants that have relatively weak off-target activity toward Kir4.1. A summary of published small-
molecule Kir4.1 inhibitors, their intended drug targets, and IC50 values for Kir4.1 are shown in Table 2.
The tricyclic antidepressant (TCA) drugs nortriptyline, amitriptyline, desipramine, and imipramine were
the first small-molecules shown to inhibit Kir4.1 (Su et al., 2007). The IC50 for inhibition by
nortriptyline is 16 µM and 38 µM at test potentials of +30 mV and -110 mV, respectively, and block is
relieved upon elevation of extracellular K+ concentration. Kir4.1 is also inhibited by the Selective
Serotonin Reuptake Inhibitor (SSRI) drugs fluoxetine, sertraline, and fluvoxamine (Ohno et al., 2007).
Similar to nortriptyline, block by fluvoxamine is voltage-dependent and reduced by membrane
hyperpolarization. Mutational analysis revealed that Kir4.1 inhibition by fluoxetine and nortriptyline
requires T128 and E158 (Furutani et al., 2009). More recently, the anti-malarial drugs quinacrine and
chloroquine were also shown to inhibit Kir4.1 in a voltage-dependent manner involving interactions
with T128 and E158 (Marmolejo-Murillo et al., 2017a; Marmolejo-Murillo et al., 2017b). The most
potent intracellular pore blocker of Kir4.1 is currently pentamidine (Arechiga-Figueroa et al., 2017).
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When applied to the intracellular face of excised membrane patches, pentamidine inhibits Kir4.1 at +80
mV with an IC50 of 97 nM. Similar to the other inhibitors, Kir4.1 block by pentamidine requires
interactions with T127, T128, and E158. Unfortunately, pentamidine is a poor inhibitor of Kir4.1 in the
whole-cell configuration (i.e. ~25% inhibition by 1 µM pentamidine after 20 mins) and presumably
intact cells. Thus, pentamidine is a useful tool for probing the structure of the intracellular pore, but will
be limited as an in vitro and in vivo tool compound for exploring the physiology and druggability of
Kir4.1. In the present study, we found that inhibition of Kir4.1 by VU0134992 exhibited voltage-
dependent knockoff behavior at hyperpolarized test potentials that is consistent with block of the inner
pore cavity. We employed in silico docking calculations to guide mutagenic analysis of potential pore-
lining binding sites in Kir4.1. Mutation of two of the top-scoring residues led to a severe (E158N/Q/D,
I159S) loss of VU0134992 sensitivity, lending experimental validation for this computational approach
to identifying small-molecule binding sites in the Kir4.1 channel pore. Interestingly, VU0134992
inhibited Kir3.1/3.2 and Kir3.1/3.4 channels with similar potencies. Because Kir3.2 and Kir3.4 have
asparagine (N) residues at positions equivalent to E158 in Kir4.1, we postulate that this cross-activity is
due to D173 in Kir3.1 (also equivalent to Kir4.1-E158) in heteromeric Kir3.1/3.2 and Kir3.1/3.4
channels.
Kir4.1 was the first K+ channel to be immunolocalized to the basolateral membrane of renal epithelial
cells (Ito et al., 1996). The “silent” subunit, Kir5.1, was subsequently co-localized with Kir4.1 in the
nephron, which, taken together with heterologous expression experiments showing that Kir4.1 and
Kir5.1 form heteromeric channel complexes, suggested that the native channel subtype in the nephron is
a Kir4.1-5.1 heteromer. Patch clamp experiments on isolated nephron segments have identified a
predominant ~40-picoSiemens (pS) basolateral K+ current that exhibits biophysical and regulatory
properties that resemble heterologously expressed Kir4.1-5.1 (Lachheb et al., 2008) and is absent in
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KCNJ10-knockout mice (Zhang et al., 2015; Zhang et al., 2014), and a less common ~20 pS current that
resembles homomeric Kir4.1 (Zaika et al., 2013a; Zhang et al., 2013). Both of these channels appear to
play important physiological roles in the nephron (see below).
The basolateral K+ conductance of the cortical TAL is carried by a 40-pS channel that is likely
comprised of Kir4.1-5.1 heteromeric channels, and an 80-pS channel possibly carried by Na+-activated
K+ (KNa) channels (Fan et al., 2015; Zhang et al., 2015)(Fig. 6). Genetic ablation of KCNJ10 has no
effect on the basolateral membrane potential in the TAL due to compensatory upregulation of the 80-pS
channel (Zhang et al., 2015), suggesting that depolarization of the basolateral membrane potential in the
TAL is unlikely to contribute to salt wasting in KCNJ10-knockout mice and EAST/SeSAME syndrome
patients (Bockenhauer et al., 2009; Scholl et al., 2009). Interestingly, however, inhibition of the 40-pS
channel with Ba2+ reduces the activity of basolateral ClC-Kb Cl- channels through mechanisms that are
currently unclear but do not appear to involve membrane depolarization (Fan et al., 2015). These data
suggest that the natriuretic and diuretic effects of VU0134992 could result at least in part through
inhibition of NaCl reabsorption in the TAL, as follows. NaCl reabsorption from the tubule fluid in the
TAL is mediated by the electroneutral, loop diuretic-inhibitable, Na+-K+-2Cl- co-transporter, NKCC2
(Fig. 6). Na+ is then pumped across the basolateral membrane through the Na+-K+-ATPase, and Cl- is
conducted out of the cell through ClC-Kb Cl- channels. The indirect inhibition of ClC-Kb channels with
VU0134992 should increase intracellular Cl- concentrations and thereby reduce the inwardly directed
driving force for Cl- and coupled Na+ and K+ transport by NKCC2. In addition, basolateral K+ secretion
provides substrate K+ ions that are needed to maintain the activity of the Na+-K+-ATPase. Provided that
the 80-pS channel cannot compensate for the pharmacological inhibition of 40-pS Kir4.1-5.1 channels,
VU0134992 should also slow the activity of the Na+-K+-ATPase, increase intracellular Na+, and further
reduce the chemical driving force for NaCl reabsorption via NKCC2 (Fig. 6).
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NaCl reabsorption in the DCT is mediated by the luminal membrane, electroneutral, thiazide-sensitive
Na+-Cl- co-transporter, NCC (Fig. 6). A rapidly developing body of evidence indicates that
heterotetrameric Kir4.1-5.1 channels, which dominate the basolateral K+ conductance in the DCT, are
critical regulators of NCC expression and activity (Penton et al., 2016; Zhang et al., 2014). Deletion of
KCNJ10 in mice depolarizes the basolateral membrane potential, inhibits the basolateral Cl- conductance,
and reduces the expression of NCC (Zhang et al., 2014). Furthermore, Penton and colleagues
demonstrated that application of Ba2+ to kidney slices induced dephosphorylation and hence inhibition
of NCC. Taken together, these data are consistent with a model in which inhibition of Kir4.1 activity
increases intracellular Cl- concentration, which, in turn, inhibits NCC function through the Cl--sensitive
WNK/SPAK kinase pathway (reviewed in (Su and Wang, 2016). Ongoing studies are testing if
VU0134992 administration induces the dephosphorylation of NCC in mice.
In the mouse CCD, Kir4.1 is expressed as a common 40-pS Kir4.1/5.1 current and a scarce 20-pS
current carried by homomeric Kir4.1 channels (Zaika et al., 2013b)(Fig. 6). Although the 40 pS channel
is more common, the 20 pS current has a higher open probability and thus likely plays an important role
in setting the resting membrane potential. In principle cells of the CCD, activation of insulin receptors
stimulates the activity of Kir4.1-containing channels, which, in turn, increases the electrochemical
driving force for Na+ reabsorption by the epithelial sodium channel (ENaC). In contrast, inhibition of
Kir4.1 and Kir4.1/5.1 channels by dopamine acting on D2-like receptors leads to reduced Na+
reabsorption via ENaC (Zaika et al., 2013a). These data suggest that VU0134992 induces natriuresis at
least in part through inhibition of Kir4.1-containing channels expressed in the CCD (Fig. 6).
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The diuretic and natriuretic responses induced by VU0134992 were accompanied by increases in urinary
K+ excretion. In this regard, the renal actions of VU0134992 are reminiscent of those caused by loop or
thiazide diuretics. The simplest interpretation is that the increased volume and Na+ load delivered to the
distal nephron, secondary to inhibition of Na+ reabsorption in the TAL and/or DCT, stimulates K+
secretion via flow-stimulated large-conductance “BK” K+ channels expressed in the CCD (Liu et al.,
2007; Liu et al., 2009). These responses are different from those induced by inhibitors of the Renal
Outer Medullary K+ channel, ROMK (Kir1.1), another emerging diuretic target in the Kir channel
family (Denton et al., 2013). We and others have shown that ROMK inhibition evokes diuresis and
natriuresis without causing K+ wasting (Garcia et al., 2014; Kharade et al., 2015; Zhou et al., 2017). The
K+-sparing effect appears to result predominantly from inhibition of K+ secretion in the TAL with a
relatively minor effect on distal K+ secretion (Kharade et al., 2015).
In conclusion, we have identified and characterized a moderately potent and selective inhibitor of Kir4.1
that exhibits preference for the homotetrameric channel over heteromeric Kir4.1-5.1 channels. Oral
administration of VU0134992 induces dose-dependent increases in urine volume, Na+ excretion, and K+
excretion in rats. We propose that the observed changes in renal excretion of water and electrolytes
results from inhibition of basolateral Kir4.1-containing channels somewhere along the nephron. The low
unbound VU0134992 brain-to-plasma ratio (Kp,uu = 0.08) also supports the idea that the effects of
VU0134992 on renal excretion is due to inhibition of Kir4.1 channels in the kidney and not in the brain.
Future studies will be aimed at characterizing the activity of VU0134992 on electrolyte transport in the
TAL, DCT, and CCD. The data presented herein raise the intriguing possibility that inhibition of
basolateral Kir4.1-containing channels could be an effective way to lower blood pressure in
hypertensive and heart failure patients. Targeting a basolateral membrane protein could provide
therapeutic advantages over conventional diuretics. For example, loop (furosemide and bumetanide) and
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thiazide diuretics must be secreted into the tubule fluid before reaching their respective luminal target
sites in the TAL and DCT (Hasannejad et al., 2004; Hasegawa et al., 2007; Uwai et al., 2000; Vallon et
al., 2008). In clinical settings where diuretic secretion is compromised, such as chronic kidney disease or
when other drugs compete for renal tubule secretion, the availability of a diuretic that acts basolaterally
and independently of renal secretion would be beneficial over conventional diuretics. Furthermore, a
recent study by Rao and colleagues demonstrated that a majority of loop diuretic resistance cases in their
heart failure patient cohort resulted from enhanced distal tubule Na+ reabsorption. The authors suggested
that administration of thiazide diuretics or a combination of thiazide and K+-sparing diuretics should
help overcome loop diuretic resistance in some patients (Rao et al., 2017). An inhibitor of Kir4.1-
containing channels would be potentially superior to thiazide or K+-sparing diuretics because it would
simultaneously inhibit Na+ reabsorption all along the nephron without sparing K+. The development of
VU0134992 provides the first in vivo-active tool compound to enable these and other hypotheses to be
tested.
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AUTHOR CONTRIBUTIONS
Research Design: SVK, HK, ALB, EF, AD, LMS, JM, CWL, CDW, CRH, JSD
Conducted experiments: SVK, HK, ALB, EF, AD, MK, ED, PV, DF
Performed data analysis: SVK, HK, ALB, EF, AD, MK, ED, DF
Contributed new reagents or analytical tools: HK, AMB, JM, CRH
Wrote manuscript: SVK, HK, ALB, EF, PV, AD, CDW, CWL, CRH, JSD
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