CYCLOALKYL CARBOXYLIC ACID DERIVATIVES AS INHIBITORS OF GLYCOGEN SYNTHASE 1 (GYS1) AND METHODS OF USE THEREOF

1 . A compound of formula (I):

or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein:

m is 0, or 1, and nis 0, 1, or 2, wherein m+n is an integer from 1 to 2;

Y 1 and Y 2 are each CH, or

one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH;

X 1 and X 2 are each independently H or halo;

X 3 is H, C 1-6 alkyl, or C 3-10 cycloalkyl, wherein the C 3-10 cycloalkyl of X 3 is optionally substituted with one or more C 1-6 alkyl;

Q 1 is:

(i) C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl,

(ii) C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl,

(iii) 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl, or

(iv) 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 , and wherein the 5-20 membered heteroaryl of Q 1 contains at least 1 annular N when m is 1,

provided that, when X 3 is H, then Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl; and

R a is H, halo, —OH, or —NH—C(O)—C 1-6 alkoxy.

2 . The compound of claim 1 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the compounds of formula (I) has a stereochemical configuration of

3 . The compound of claim 1 or claim 2 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein m is 0 and nis 1.

4 . The compound of claim 1 or claim 2 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein m is 1 and n is 0.

5 . The compound of any one of claims 1-4 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Y 1 and Y 2 are each CH.

6 . The compound of any one of claims 1-5 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein

of formula (I) is selected from the group consisting of

7 . The compound of any one of claims 1-4 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH.

8 . The compound of any one of claim 1-4 or 7 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein

of formula (I) is selected from the group consisting of

9 . The compound of any one of claim 1-5, or 7 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein X 1 and X 2 are each independently H or F.

10 . The compound of any one of claim 1-5, 7, or 9 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein X 3 is H, C 1-3 alkyl, or C 3-6 cycloalkyl, wherein the C 3-6 cycloalkyl of X 3 is optionally substituted with one or more C 1-3 alkyl.

11 . The compound of any one of claims 1-10 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl.

12 . The compound of any one of claims 1-11 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is

13 . The compound of any one of claims 1-10 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl.

14 . The compound of any one of claim 1-10, or 13 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is phenyl, wherein the phenyl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently —CH 3 , —OCH 3 , —NH—C(O)—NH 2 , —NH—C(O)-(3-6 membered heterocyclyl), or 5-10 membered heteroaryl, wherein the 5-10 membered heteroaryl of R b is optionally substituted with one or more —CH 3 .

15 . The compound of any one of claim 1-10, 13, or 14 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is selected from the group consisting of

16 . The compound of any one of claims 1-10 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl.

17 . The compound of any one of claim 1-10, or 16 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is selected from the group consisting of

18 . The compound of any one of claims 1-10 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is 5-10 membered heteroaryl, wherein the 5-10 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 .

19 . The compound of any one of claim 1-10, or 18 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein Q 1 is selected from the group consisting of

20 . The compound of any one of claims 1-19 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein R a is H, F, —OH, or —NH—C(O)—C 1-4 alkoxy.

21 . The compound of any one of claims 1-20 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein R a is H.

22 . The compound of any one of claims 1-20 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein R a is F.

23 . The compound of any one of claim 1-10, 13, 15, or 20-22 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the compound is of formula (I-A):

or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein

either:

i. X 4-8 are each independently H, C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl is independently optionally substituted with one or more C 1-6 alkyl; or

ii. X 6 is taken together with either of X 4 or X 8 , and the atoms to which they are attached, to form ring A, wherein ring A is

3-3-9 membered heterocyclyl, wherein the 3-9 membered heterocyclyl of ring A is optionally substituted with one or more oxo or C 1-6 alkyl, and wherein X 3 , X 7 , and the other of X 4 or X 8 are each independently H, oxo or C 1-6 alkyl, or

5-14 membered heteroaryl, wherein the 5-14 membered heteroaryl of ring A is optionally substituted with one or more —NH 2 , and wherein the 5-14 membered heteroaryl of ring A contains at least 1 annular N when m is 1, and wherein X 5 , X 7 , and the other of X 4 or X 8 are each independently H, or more —NH 2 ; or

iii. X 7 is taken together with either of X 5 or X 8 , and the atoms to which they are attached, to form ring A, wherein ring A is

3-9 membered heterocyclyl, wherein the 3-9 membered heterocyclyl of ring A is optionally substituted with one or more oxo or C 1-6 alkyl, and wherein X 4 , X 6 , and the other of X 5 or X 8 are each independently H, oxo or C 1-6 alkyl, or

5-14 membered heteroaryl, wherein the 5-14 membered heteroaryl of ring A is optionally substituted with one or more —NH 2 , and wherein the 5-14 membered heteroaryl of ring A contains at least 1 annular N when m is 1, and wherein X 4 , X 6 , and the other of X 5 or X 8 are each independently H, or —NH 2 .

24 . The compound of any one of claims 1-15 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein one of X 4-8 is C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl is independently optionally substituted with one or more C 1-6 alkyl and the others of X 4-8 are each independently H.

25 . The compound of any one of claim 1-10, 13, 15, or 20-23 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the compound is of formula (I-B):

or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing.

26 . The compound of any one of claim 1-10, 13, 15, or 20-23 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the compound is of formula (I-C):

or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein ring A is

3-9 membered heterocyclyl, wherein the 3-9 membered heterocyclyl of ring A is optionally substituted with one or more oxo or C 1-6 alkyl, or

5-14 membered heteroaryl, wherein the 5-14 membered heteroaryl of ring A is optionally substituted with one or more —NH 2 , and wherein the 5-14 membered heteroaryl of ring A contains at least 1 annular N when m is 1.

27 . The compound of claim 1 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the compound, or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, is selected from the compounds of Table 1.

28 . A process for preparing a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the process comprises:

(a) reacting a compound of formula (I-1):

or a salt thereof, wherein

Y 1 and Y 2 are each CH, or

one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH;

X 1 and X 2 are each independently H or halo;

X 3 is H, C 1-6 alkyl, or C 3-10 cycloalkyl, wherein the C 3-10 cycloalkyl of X 3 is optionally substituted with one or more C 1-6 alkyl; and

Q 1 is:

(i) C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl,

(ii) C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl,

(iii) 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl, or

(iv) 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 , and wherein the 5-20 membered heteroaryl of Q 1 contains at least 1 annular N when m is 1,

provided that, when X 3 is H, then Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl;

with a compound of formula (I-2):

m is 0, or 1, and nis 0, 1, or 2, wherein m+n is an integer from 1 to 2;

R a is H, halo, —OH, or —NH—C(O)—C 1-6 alkoxy;

and PG is a protecting group;

in the presence of a coupling reagent, to provide a compound of formula (I-3):

wherein

m is 0, or 1, and n is 0, 1, or 2, wherein m+n is an integer from 1 to 2;

Y 1 and Y 2 are each CH, or

one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH;

X 1 and X 2 are each independently H or halo;

X 3 is H, C 1-6 alkyl, or C 3-10 cycloalkyl, wherein the C 3-10 cycloalkyl of X 3 is optionally substituted with one or more C 1-6 alkyl;

Q 1 is:

(i) C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl,

(ii) C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-4 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl,

(iii) 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl, or

(iv) 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 , and wherein the 5-20 membered heteroaryl of Q 1 contains at least 1 annular N when m is 1,

provided that, when X 3 is H, then Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl;

R a is H, halo, —OH, or —NH—C(O)—C 1-6 alkoxy; and

PG is a protecting group;

followed by

(b) contacting the compound of formula (I-3) with deprotecting agent to provide a compound of any one of claims 1-27 .

29 . A process for preparing a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, wherein the process comprises:

reacting a compound of formula (I-1):

or a salt thereof, wherein

Y 1 and Y 2 are each CH, or

one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH;

X 1 and X 2 are each independently H or halo;

X 3 is H, C 1-6 alkyl, or C 3-10 cycloalkyl, wherein the C 3-10 cycloalkyl of X 3 is optionally substituted with one or more C 1-6 alkyl; and

Q 1 is:

(i) C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl,

(ii) C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl,

(iii) 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl, or

(iv) 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 , and wherein the 5-20 membered heteroaryl of Q 1 contains at least 1 annular N when m is 1,

provided that, when X 3 is H, then Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl;

with a compound of formula (I-4):

wherein,

m is 0, or 1, and nis 0, 1, or 2, wherein m+n is an integer from 1 to 2;

Y 1 and Y 2 are each CH, or

one of Y 1 and Y 2 is N and the other of Y 1 and Y 2 is CH;

X 1 and X 2 are each independently H or halo;

X 3 is H, C 1-6 alkyl, or C 3-10 cycloalkyl, wherein the C 3-10 cycloalkyl of X 3 is optionally substituted with one or more C 1-6 alkyl;

Q 1 is:

(i) C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl,

(ii) C 6-20 aryl, wherein the C 6-20 aryl of Q 1 is optionally substituted with one or more R b , wherein each R b is independently C 1-6 alkyl, —C 1-6 alkoxy, —NH—C(O)—NH 2 , —NH—C(O)-(3-15 membered heterocyclyl), or 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of R b is optionally substituted with one or more C 1-6 alkyl,

(iii) 3-15 membered heterocyclyl, wherein the 3-15 membered heterocyclyl of Q 1 is optionally substituted with one or more oxo or C 1-6 alkyl, or

(iv) 5-20 membered heteroaryl, wherein the 5-20 membered heteroaryl of Q 1 is optionally substituted with one or more —NH 2 , and wherein the 5-20 membered heteroaryl of Q 1 contains at least 1 annular N when m is 1,

provided that, when X 3 is H, then Q 1 is C 6-10 cycloalkyl, wherein the C 6-10 cycloalkyl of Q 1 is optionally substituted with one or more C 1-6 alkyl; and

R a is H, halo, —OH, or —NH—C(O)—C 1-6 alkoxy;

in the presence of a coupling reagent to provide a compound of any one of claims 1-27 .

30 . A pharmaceutical composition comprising (i) a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, and (ii) one or more pharmaceutically acceptable excipients.

31 . A method of treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof, comprising administering to the individual a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 .

32 . The method of claim 31 , wherein the disease, disorder, or condition is a glycogen storage disorder (GSD).

33 . The method of claim 31 or claim 32 , wherein the disease, disorder, or condition is selected from the group consisting of Pompe disease, Cori disease (GSD III), adult polyglucosan body disease (APBD), and Lafora disease.

34 . The method of any one of claims 31-33 , wherein the disease, disorder, or condition is Pompe disease.

35 . The method of claim 31 , wherein the disease, disorder, or condition is cancer.

36 . The method of claim 31 or claim 35 , wherein the disease, disorder, or condition is selected from the group consisting of Ewing sarcoma (ES), clear cell renal cell carcinoma (ccRCC), glycogen rich clear cell carcinoma (GRCC) breast cancer, non-small-cell lung carcinoma (NSCLC), and acute myeloid leukemia (AML).

37 . The method of claim 31 , wherein the individual has a GAA mutation.

38 . The method of claim 37 , wherein the GAA mutation is a loss-of-function mutation.

39 . A kit, comprising (i) a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 , and (ii) instructions for use in treating an GYS1-mediated disease, disorder, or condition in an individual in need thereof.

40 . The kit of claim 39 , wherein the disease, disorder, or condition is a glycogen storage disorder (GSD).

41 . The kit of claim 39 or claim 40 , wherein the disease, disorder, or condition is selected from the group consisting of Pompe disease, Cori disease (GSD III), adult polyglucosan body disease (APBD), and Lafora disease.

42 . The kit of any one of claims 39-41 , wherein the disease, disorder, or condition is Pompe disease.

43 . The kit of claim 42 , wherein the disease, disorder, or condition is cancer.

44 . The kit of claim 39 or claim 43 , wherein the disease, disorder, or condition is selected from the group consisting of Ewing sarcoma (ES), clear cell renal cell carcinoma (ccRCC), glycogen rich clear cell carcinoma (GRCC) breast cancer, non-small-cell lung carcinoma (NSCLC), and acute myeloid leukemia (AML).

45 . The kit of claim 39 , wherein the individual has a GAA mutation.

46 . The kit of claim 45 , wherein the GAA mutation is a loss-of-function mutation.

47 . A method of modulating GYS1 in a cell, comprising exposing the cell to a composition comprising an effective amount of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 .

48 . A method of inhibiting GYS1 in a cell, comprising exposing the cell to a composition comprising an effective amount of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 .

49 . A method of reducing tissue glycogen stores in an individual in need thereof, comprising administering to the individual an effective amount of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 .

50 . A method of treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof, comprising subjecting the individual to glycogen substrate reduction therapy, wherein the glycogen substrate reduction therapy comprises administering to the individual an effective amount of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 .

51 . The method of claim 50 , comprising subjecting the individual to glycogen substrate reduction therapy in combination with enzyme replacement therapy.

52 . The method of claim 51 , wherein the enzyme replacement therapy is selected from the group consisting of alglucosidase alfa (human recombinant alpha-glucosidase (human GAA)) Myozyme and Lumizyme.

53 . The method of any one of claims 50-52 , wherein the disease, disorder, or condition is a glycogen storage disorder (GSD).

54 . The method of any one of claims 50-53 , wherein the disease, disorder, or condition is selected from the group consisting of Pompe disease, Cori disease (GSD III), adult polyglucosan body disease (APBD), and Lafora disease.

55 . The method of any one of claims 50-54 , wherein the disease, disorder, or condition is Pompe disease.

56 . The method of any one of claims 50-52 , wherein the disease, disorder, or condition is cancer.

57 . The method of any one of claim 50-52, or 56 , wherein the disease, disorder, or condition is selected from the group consisting of Ewing sarcoma (ES), clear cell renal cell carcinoma (ccRCC), glycogen rich clear cell carcinoma (GRCC) breast cancer, non-small-cell lung carcinoma (NSCLC), and acute myeloid leukemia (AML).

58 . The method of any one of claims 50-52 , wherein the individual has a GAA mutation.

59 . The method of claim 58 , wherein the GAA mutation comprises a loss-of-function mutation.

60 . The method of any one of claims 47-49 wherein the compound is selective for GYS1 over GYS2.

61 . The method of claim 60 , wherein the compound is greater than 500 or 1,000 or 1,500 or 1,700-fold selective for GYS1 over GYS2.

62 . The method of any one of claim 31-38 or 47-61 , comprising reducing the level of glycogen in skeletal muscle.

63 . A compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 , for use in treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof.

64 . A compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , for use in modulating GYS1 in a cell.

65 . A compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , for use in inhibiting GYS1 in a cell.

66 . A compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 , for use in reducing tissue glycogen stores in an individual in need thereof.

67 . A compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , for use in a glycogen substrate reduction therapy for treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof.

68 . Use of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 , in the manufacture of a medicament for use in treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof.

69 . Use of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , in the manufacture of a medicament for use in modulating GYS1 in a cell.

70 . Use of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , in the manufacture of a medicament for use in inhibiting GYS1 in a cell.

71 . Use of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or a pharmaceutical composition of claim 30 , in the manufacture of a medicament for use in reducing tissue glycogen stores in an individual in need thereof.

72 . Use of a compound of any one of claims 1-27 , or a stereoisomer or tautomer thereof, or a pharmaceutically acceptable salt of any of the foregoing, or the pharmaceutical composition of claim 30 , in the manufacture of a medicament for use in a glycogen substrate reduction therapy for treating a GYS1-mediated disease, disorder, or condition in an individual in need thereof.