Orally Bioavailable Macrocyclic Peptide That Inhibits Binding of PCSK9 to the Low Density Lipoprotein Receptor.
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Johns Douglas G, Campeau Louis-Charles, Banka Puja, Bautmans An, Bueters Tjerk, Bianchi Elisabetta, Branca Danila, Bulger Paul G, Crevecoeur Inne, Ding Fa-Xiang, Garbaccio Robert M, Guetschow Erik D, Guo Yan, Ha Sookhee N, Johnston Jennifer M, Josien Hubert, Kauh Eunkyung A, Koeplinger Kenneth A, Kuethe Jeffrey T, Lai Eseng, Lanning Christine L, Lee Anita Y H, Li Li, Nair Anilkumar G, O'Neill Edward A, Stoch S Aubrey, Thaisrivongs David A, Tucker Thomas J, Vachal Petr, van Dyck Kristien, Vanhoutte Frederic P, Volckaert Bram, Wolford Dennis G, Xu Andy, Zhao Tian, Zhou Dan, Zhou Susan, Zhu Xiaohong, Zokian Hratch J, Walji Abbas M, Wood Harold B
Аннотация
METHODS: Novel mRNA display screening technology was used to identify lead chemical matter, which was then optimized by applying structure-based drug design enabled by novel synthetic chemistry to identify macrocyclic peptide (MK-0616) with exquisite potency and selectivity for PCSK9. Following completion of nonclinical safety studies, MK-0616 was administered to healthy adult participants in a single rising-dose Phase 1 clinical trial designed to evaluate its safety, pharmacokinetics, and pharmacodynamics. In a multiple-dose trial in participants taking statins, MK-0616 was administered once daily for 14 days to characterize the safety, pharmacokinetics, and pharmacodynamics (change in low density lipoprotein cholesterol).
RESULTS: MK-0616 displayed high affinity (Ki = 5pM) for PCSK9 in vitro and sufficient safety and oral bioavailability preclinically to enable advancement into the clinic. In Phase 1 clinical studies in healthy adults, single oral doses of MK-0616 were associated with >93% geometric mean reduction (95% CI, 84-103) of free, unbound plasma PCSK9; in participants on statin therapy, multiple-oral-dose regimens provided a maximum 61% geometric mean reduction (95% CI, 43-85) in low density lipoprotein cholesterol from baseline after 14 days of once-daily dosing of 20 mg MK-0616.
CONCLUSIONS: This work validates the use of mRNA display technology for identification of novel oral therapeutic agents, exemplified by the identification of an oral PCSK9 inhibitor, which has the potential to be a highly effective cholesterol lowering therapy for patients in need.