• John J Savarese, Hiroshi Sunaga, Jeff D McGilvra, Matthew R Belmont, Matthew T Murrell, Erin Jeannotte, Farrell E Cooke, William B Wastila, and Paul M Heerdt.
• From the Department of Anesthesiology, Weill Medical College of Cornell University, New York, New York (J.J.S., H.S., M.R.B., M.T.M., F.E.C.) Cedarburg Pharmaceuticals, Albany Molecular Research, Inc., Grafton, Wisconsin (J.D.M.) Animal Resources Facility, Albany Medical Center, Albany, New York (E.J.) the Department of Cardiovascular Pharmacology, Burroughs Wellcome Co., Research Triangle Park, North Carolina (W.B.W.) the Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (P.M.H.) Current position: Jikei University School of Medicine, Tokyo, Japan (H.S.).
• Anesthesiology. 2018 Nov 1; 129 (5): 970-988.

What We Already Know About This TopicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Structure-activity studies were performed to identify a new neuromuscular blocking agent retaining the ultra-short acting characteristics of gantacurium, including degradation and reversal by L-cysteine, but lacking its histaminoid properties in man. CW 1759-50 has emerged from this program.MethodsAdduction of CW 1759-50 with L-cysteine was studied by high-performance liquid chromatography and mass spectrometry. Institutional Animal Care and Use Committee-approved comparisons of CW 1759-50 to gantacurium were performed in rhesus monkeys. ED95 for neuromuscular blockade was established. Spontaneous recovery was compared to reversal by L-cysteine in paired studies of boluses or infusions. In addition, changes in mean arterial pressure and heart rate after very large doses of 15 to 60 × ED95 were compared.ResultsThe half-time of adduction of L-cysteine to CW 1759-50 in vitro was 2.3 min. The ED95 of CW 1759-50 was 0.069 ± 0.02 mg/kg; ED95 of gantacurium was 0.081 ± 0.05 mg/kg (P = 0.006). Duration of action (recovery to 95% twitch height after 98 to 99% blockade) was as follows: CW 1759-50, 8.2 ± 1.5 min; and gantacurium, 7.4 ± 1.9 min; (n = 8 and 9, P = 0.355). Administration of L-cysteine (30 mg/kg) shortened recovery (i.e., induced reversal) from CW 1759-50 after boluses or infusions (P always less than 0.0001). Recovery intervals (5 to 95% twitch) ranged from 6.1 to 6.7 min (and did not differ significantly) after boluses of 0.10 to 0.50 mg/kg, as well as control infusions (P = 0.426 by analysis of variance). Dose ratios comparing changes of 30% in mean arterial pressure or heart rate to ED95 for neuromuscular blockade (ED 30% Δ [mean arterial pressure or heart rate]/ED95) were higher for CW 1759-50 than for gantacurium.ConclusionsCW 1759-50, similar to gantacurium, is an ultra-short acting neuromuscular blocking agent, antagonized by L-cysteine, in the monkey. The circulatory effects, however, are much reduced in comparison with gantacurium, suggesting a trial in humans.

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