<h3>Objective:</h3> This study investigates the <i>in vitro</i> effects of PRAX-628 on sodium current (I<sub>Na</sub>) expressed by hNa<sub>V</sub>1.6. <h3>Background:</h3> Voltage-gated sodium channels (Na<sub>V</sub>) are important therapeutic targets for anti-epileptic drugs (AEDs) due to their role in action potential initiation and propagation. Selective Na<sub>V</sub> blockade during periods of hyperexcitability (activity dependence) has been proposed as a pharmacological target for reducing pathologic neuronal hyperactivity, while sparing peak I<sub>Na</sub> is critical for normal neuronal function. <h3>Design/Methods:</h3> Persistent and peak I<sub>Na</sub> inhibition was studied using automated patch clamp recordings of Na<sub>V</sub> expressed in HEK cells (hNa<sub>V</sub>1.6). Voltage protocols measured I<sub>Na</sub> inhibition in multiple modes: persistent I<sub>Na</sub>, tonic block (TB), voltage-dependent block (VDB), and activity/use-dependent block (UDB). PRAX-628 was compared to a panel of AEDs, non-AEDs, and investigational compounds. Binding kinetics were inferred from inhibition kinetics to calculate an apparent binding (K<sub>ON</sub>) and unbinding (K<sub>OFF</sub>) rate. <h3>Results:</h3> PRAX-628 exhibited potent activity dependence (UDB IC<sub>50</sub> 200nM, 44× preference to TB). PRAX-628 blocked hNa<sub>V</sub>1.6 persistent I<sub>Na</sub> with an IC<sub>50</sub> of 128nM (68× preference to TB); at least 550× more potent than other tested compounds. This profile differed from CBZ (persistent I<sub>Na</sub> IC<sub>50</sub> 77,500nM, 30× preference to TB, no UDB observed) and cenobamate (persistent I<sub>Na</sub> IC<sub>50</sub> of 71,690nM, 24× preference to TB, UDB 2.3× preference to TB). The preference for persistent I<sub>Na</sub> exhibited by PRAX-628 was not retained versus activity in the more depolarized VDB assay (0.56× preference to VDB); contrasting with the preferential persistent I<sub>Na</sub> inhibitor PRAX-562 (2.2× preference to VDB). The enhanced activity dependence of PRAX-628 derives from a rapid K<sub>ON</sub> and moderate K<sub>OFF</sub>. <h3>Conclusions:</h3> PRAX-628 is a next generation Na<sub>V</sub> blocker with increased potency and activity dependence for peak I<sub>Na</sub>, and greater potency for persistent I<sub>Na</sub>. This profile may translate to efficacy in epilepsy and other indications caused by hyperexcitability, without tolerability issues caused by excessive block of peak I<sub>Na</sub>. <b>Disclosure:</b> Dr. Kahlig has received personal compensation for serving as an employee of Praxis Precisoin Medicines. Dr. Kahlig has stock in Praxis Precision Medicines. Dr. Chapman has received personal compensation for serving as an employee of Ligand. Dr. Chapman has stock in Ligand. Steven Petrou has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Praxis Precision Medicines. Steven Petrou has stock in Praxis Precision Medicines. The institution of Steven Petrou has received research support from Praxis Precision Medicines. The institution of Steven Petrou has received research support from Medical Research Future Fund. Steven Petrou has received intellectual property interests from a discovery or technology relating to health care. Steven Petrou has received intellectual property interests from a discovery or technology relating to health care.
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