From structure to clinic: Design of a muscarinic M1 receptor agonist with potential to treatment of Alzheimer's disease

Alastair J.H. Brown, Sophie J. Bradley, Fiona H. Marshall, Giles A. Brown, Kirstie A. Bennett, Jason Brown, Julie E. Cansfield, David M. Cross, Chris de Graaf, Brian D. Hudson, Louis Dwomoh, João M. Dias, James C. Errey, Edward Hurrell, Jan Liptrot, Giulio Mattedi, Colin Molloy, Pradeep J. Nathan, Krzysztof Okrasa, Greg OsborneJayesh C. Patel, Mark Pickworth, Nathan Robertson, Shahram Shahabi, Christoffer Bundgaard, Keith Phillips, Lisa M. Broad, Anushka V. Goonawardena, Stephen R. Morairty, Michael Browning, Francesca Perini, Gerard R. Dawson, John F.W. Deakin, Robert T. Smith, Patrick M. Sexton, Julie Warneck, Mary Vinson, Tim Tasker, Benjamin G. Tehan, Barry Teobald, Arthur Christopoulos, Christopher J. Langmead, Ali Jazayeri, Robert M. Cooke, Prakash Rucktooa, Miles S. Congreve, Malcolm Weir, Andrew B. Tobin

Research output: Contribution to journalArticleResearchpeer-review

36 Citations (Scopus)


Current therapies for Alzheimer's disease seek to correct for defective cholinergic transmission by preventing the breakdown of acetylcholine through inhibition of acetylcholinesterase, these however have limited clinical efficacy. An alternative approach is to directly activate cholinergic receptors responsible for learning and memory. The M1-muscarinic acetylcholine (M1) receptor is the target of choice but has been hampered by adverse effects. Here we aimed to design the drug properties needed for a well-tolerated M1-agonist with the potential to alleviate cognitive loss by taking a stepwise translational approach from atomic structure, cell/tissue-based assays, evaluation in preclinical species, clinical safety testing, and finally establishing activity in memory centers in humans. Through this approach, we rationally designed the optimal properties, including selectivity and partial agonism, into HTL9936—a potential candidate for the treatment of memory loss in Alzheimer's disease. More broadly, this demonstrates a strategy for targeting difficult GPCR targets from structure to clinic.

Original languageEnglish
Pages (from-to)5886-5901.e22
Number of pages38
Issue number24
Publication statusPublished - 24 Nov 2021


  • Alzheimer's disease
  • G protein coupled receptors
  • M1 muscarinic acetylcholine receptor
  • muscarinic receptor
  • neurodegeneration
  • prion disease
  • structural based drug design

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