Study for Safety and Tolerability of TOP1288 Administered Rectally in Healthy and Ulcerative Colitis Subjects

TOP1288, a narrow spectrum protein kinase inhibitor, is being developed as a novel, non-absorbed treatment for ulcerative colitis (UC). UC is a disease of unknown cause characterised by inflammation of the lining of the large intestine and manifesting with abdominal pain and bloody diarrhoea. TOP1288 given rectally has a local anti-inflammatory action in experimental models of UC. The present study will be the first time TOP1288 has been given to humans and explores the safety, tolerability and how the body handles (absorbs, distributes and eliminates) TOP1288 and seeks evidence of the biochemical effect of the drug in the body. The study is in three parts: Part 1 investigates single doses in groups of healthy volunteers, each group dosed with an increased dose provided the drug was safe and well tolerated at the previous level. Part 2 investigates multiple ascending doses in healthy volunteers each group dosed with an increased dose provided the drug was safe and well tolerated at the previous level. Part 3 investigates one dose level by administering that dose in patient volunteers with UC. The study design is adaptive - that is after the first dose level in Part 1, which is predefined, the exact dose and dose-intervals can be modified from a pre-set plan by a Safety Review Committee in the light of the emerging results.

Inclusion criteria

Healthy Subjects and Ulcerative Colitis Subjects

• Male or Female aged between 18 and 55 years (inclusive)
• Female subjects negative serum pregnancy test at Screening, non child-bearing potential.
• Body Mass Index between 18.0 and 29.9 kg/m2
• Good physical and mental health (other than ulcerative colitis for subjects in Part 3)
• Clinical laboratory test results within the reference ranges of the testing laboratory (with the exception of ulcerative colitis subjects with laboratory abnormalities consistent with their disease activity which will be allowed at Investigator's and the Sponsor's study physician/medical monitor's discretion)
• Blood pressure and pulse within normal range

Specific to Ulcerative Colitis Subjects

• Documented diagnosis of ulcerative colitis of at least 6 months duration confirmed by sigmoidoscopy
• Documented disease extending at least 15cm proximal from the anal verge
• Subject has experienced symptoms of ulcerative colitis on oral 5-ASA therapy in the 14 days before Screening and has been on stable dose regimen (no more than 2.4g/day) for at least 4 weeks duration prior to Day 1 and is willing to continue on this regimen for the duration of the study

Exclusion criteria

Healthy Subjects and Ulcerative Colitis Subjects

• Participation in another study of investigational medication within the last 3 months or 5 half-lives of the investigational medication, whichever is longer
• Positive for HIV 1/2 antibodies, hepatitis B surface antigen or hepatitis C antibodies
• Any prescription or non-prescription medications within prior 14 days (other than ulcerative colitis for subjects in Part 3 for whom a stable dose regimen of oral 5-ASA (no more than 2.4g/day) for at least 4 weeks before Day 1 is allowed and required)
• Consumption of any products containing caffeine or xanthine-related substances, foods or beverages containing Seville-type oranges or poppy seeds within 72 hours prior to admission
• Any acute or chronic illness (other than ulcerative colitis in Part 3) affecting the colon and/or rectum and/or anus, including haemorrhoids and irritable bowel syndrome, sufficient to cause symptoms and/or that in the judgement of the Investigator and the Sponsor's study physician/medical monitor would interfere with the subject's participation in the study
• Cardiovascular or cerebrovascular disease, including hypertension, angina, ischemic heart disease, transient ischaemic attacks, stroke and peripheral arterial disease sufficient to cause symptoms and/or require therapy to maintain stable status
• Abnormalities in haematology or ECG.
• Renal or liver impairment
• Active neoplastic disease or history of neoplastic disease within 5 years before Screening

Specific to Ulcerative Colitis Subjects

• Documented history of ulcerative colitis in immediate need of dose escalation of maintenance 5-aminosalicylate therapy.
• Proctitis at baseline endoscopy (on Day 1).
• Started oral 5-aminosalicylate within 4 weeks prior to baseline endoscopy or is not yet on a stable dose.
• Any medication administered per rectum within 1 week prior to baseline endoscopy.
• Oral or parenteral steroid within 2 weeks before the baseline endoscopy.
• Systemic immunomodulatory therapy (with the exception of azathioprine or 6-mercaptopurine in a dose regimen that is deemed acceptable for participation in the judgement of the Principal Investigator) within 12 weeks prior to baseline endoscopy.
• Previous treatment with biologic agents (including anti-TNF agents and vedolizumab) prior to baseline endoscopy.
• Mayo Score Physician's global assessment of 3, i.e., severe disease.