Obefazimod

近日，2024年的诺贝尔医学或生理学奖颁给了发现microRNA的维克多·安布罗斯（Victor Ambros）和加里·鲁夫昆（Gary Ruvkun），本文就将汇总一些诺奖转化Biotech技术路线和研发现状。 microRNA技术转化的目前现状 microRNA（以下简称miRNA）的定义是在动物细胞内发现的内源性非编码RNA，长度相对较短，是参与RNAi机制中的一环：特定RNA分子（如siRNA和miRNA）通过与其目标mRNA部分互补结合，抑制mRNA的翻译或诱导其降解，从而调节基因的表达水平。 图：MiRNA 生物发生途径和治疗干扰方式 来源：doi.org/10.1038/s41573-021-00219-z miRNA在许多生物过程中起着不可或缺的作用，包括免疫反应、细胞周期控制、新陈代谢、病毒复制、干细胞分化和人类发育。 然而实际开发时，miRNA就会面临很多问题，人体内的miRNA各自功能复杂多样化，每个miRNA可以有多个靶基因，而几个miRNA也可以调节同一个基因。考虑到针对特定基因的特异性非常差，药物开发中远不如siRNA和ASO好用，安全性问题往往频繁出现。因此采用RNAi机制的药物开发上，更多的是采用ASO和siRNA等另一类小核酸药物。 目前作为冷门研发项目，miRNA药物管线开发主要集中在miRNA模拟物或靶向miRNA的抑制剂上。不过不管如何，下文的一些企业，曾经开发过或者仍然在坚持开发miRNA，在这一领域的探索值得敬佩。 Regulus Therapeutics Regulus的历程就能体现出miRNA药物开发的不易，当然这家公司也是这轮诺奖股价概念的受益者。 这家公司曾经开发出一款anti-miR-122药物RG-101，这是第一款进入临床的miRNA药物，结合了chemistry 2.5、Alnylam的GalNAc缀合物和Regulus的化学技术三大技术而成， 所靶向的miR-122是一种肝脏特异性miRNA，在肝脏代谢中具有相关功能，也是丙型肝炎病毒复制的重要宿主因子。临床用于治疗HCV（丙肝），I期临床效果优异，然而在II期临床中安全性问题意外出现，RG-101引起了胆红素症，因此被迫放弃开发。 该公司还开发了抗miR-21疗法RG-012，用于治疗Alport综合征(纤维化肾病)，2018年时被授权给了赛诺菲。miR-21已被证明在Alport综合征中上调。临床前研究表明，施用抗miR-21可通过降低肾纤维化的进展速度来显著缓解肾衰竭。然而，2022年7月，该药物针对alport综合征的II期临床试验被终止。该公司是在一项中期分析显示，与安慰剂相比，使用RG-012治疗并不能明显改善肾功能。 另外，这家公司一直在试图用miRNA疗法治疗常染色体显性多囊肾病（ADPKD）。ADPKD由PKD1或PKD2基因突变引起，PKD1和PKD2基因突变会破坏其编码蛋白polycytin-1 (PC1)和polycytin- 2 (PC2)在肾小管上皮中的正常功能，最终导致肾囊肿增生破坏原有肾脏细胞。研究发现miR-17 miRNA家族在人鼠ADPKD中上调，而在小鼠模型中缺失或抑制miR-1可以减弱小鼠的囊肿生长。 这家公司开发了miR-17寡核苷酸药物RGLS4326，然而I期临床和临床前开发都遇到问题，RGLS4326在临床前毒理研究中测得的最高剂量下出现的脱靶效应，会影响神经系统，而实际进入I期临床压低剂量后就发现治疗剂量和持续时间都非常短，显然没有太大的治疗窗口。因此公司放弃了RGLS4326转而开发下一代更优的RGLS8429，目前I期临床数据不错，在今年第一季度获得1亿美元融资。 Mirna Therapeutics Mirna Therapeutics可以说是比较倒霉的，Mirna Therapeutics开发了MRX34，是miR-34a mimic，设计用于模拟肿瘤抑制因子miR-34a的活性，该抑制因子被封装到脂质体配制的纳米颗粒(NOV40)中，用于治疗晚期实体瘤，包括黑色素瘤、非小细胞肺癌、肝细胞癌和肾癌。 早期数据临床前还不错，，然而，I期临床发生了5例严重的治疗相关免疫副作用，4例发生死亡，疗效也不尽如人意，试验结束时只有3名患者获得了持续的确认的部分缓解，因此临床研究被关闭。在此之后，MiRNA Therapeutics于2017年停止运营，并同意与Synlogic Inc合并。 Curamir Therapeutics Curamir Therapeutics是石溪大学文艺复兴医学院Jingfang Ju教授科研成果的转化。他和他的同事开发了一项miRNA技术开发平台。目前该公司仍然处于隐身状态，目前可知该公司可能拥有一款miR-129模拟物管线来针对结直肠癌的5-氟尿嘧啶耐药。 Abivax 纳斯达克上市企业Abivax并未从此轮诺奖概念中受益，股价从10月初的11.5美元左右一路下跌到近期的9.6美元左右。 该公司核心管线是obefazimod，有可能增强单一miRNA miR-124的表达，最开始试图开发HIV，但后来发现该药物似乎对HIV患者中出现的胃肠道粘膜损伤有保护作用，因此拿来开发胃肠道炎症疾病，目前单药疗法已经进入III期临床，因为机制和现有疗法并不重合，联用潜力是非常巨大的。 Viridian Therapeutics（miRagen） Viridian Therapeutics原名miRagen，在身为miRagen的时候该公司先后开发了多款基于miRNA的疗法，同时也兼有miRNA诊断。 例如：MRG-106：MRG-106是一种基于LNA的miR-155的拮抗剂。 MRG-110: MRG-110是miRNA-92a的合成拮抗剂，由MiRagen Therapeutics与Servier合作开发，用于治疗缺血性疾病，如心力衰竭。 MRG-201：一种合成的RNA寡核苷酸，靶向并激活miR-29，miR-29已被证明可以抑制纤维化。 MGN-1374：是一种8聚体LNA ASO，旨在特异性靶向miR-15家族，旨在治疗心肌梗死后的重塑。 然后后来出于商业战略，该公司选择战略重组，被Viridian Therapeutics借壳上市后转而去开发Viridian Therapeutics的眼部和自免管线。该公司原先的管线则基本因为商业战略问题停止临床。 EnGeneIC EnGeneIC的疗法TargomiRs倒是不单纯是miRNA，而是混合物。TargomiRs由微细胞包含的miR16模拟物和抗EGFR双特异性抗体组成，以靶向表达EGFR的癌细胞。由于miR-15/16与胸膜间皮瘤的肿瘤抑制因子哟管，因此此前曾试图用于复发性恶性胸膜间皮瘤二线或三线治疗，在低剂量全身给药TargomiRs后，5%的患者表现出部分反应，68%的患者表现出稳定的疾病，27%的患者表现出进行性疾病，但出现了剂量限制性毒性，如过敏反应、炎症和心脏事件，因为剂量限制性毒性，该疗法开发就此放弃。 该公司现有疗法还是主要集中在载体囊泡方面。 Cardior Pharmaceuticals Cardior Pharmaceuticals在今年5月被诺和诺德以11亿美元收购，该公司本身开发了一款miRNA132 (miR-132)的抑制剂CDR132L，旨在停止和逆转有害心脏重塑的发展。 CDR132L可以选择性阻断异常的miR-132水平，使得细胞病理学逆转和心肌细胞正常功能的恢复，有助于改善心力衰竭患者的心脏收缩和舒张功能。目前处于II期心衰研究。 有趣的是，CDR132L的设计还是水溶性，可以用于肠胃外和皮下注射。该公司除了CDR132L还另外有两款非编码RNA管线。 命码生物 命码生物有一款靶向miR214的小核酸管线，该公司由南京大学生命科学院院长张辰宇教授创立，依据张辰宇教授发现“细胞外微小核糖核酸稳定存在，具有独特的生物学功能”的科学规律而进行科研转化。 参考来源： Seyhan, A.A. Trials and Tribulations of MicroRNA Therapeutics. Int. J. Mol. Sci. 2024, 25, 1469. https://doi.org/10.3390/ijms25031469 Rupaimoole, R., Slack, F. MicroRNA therapeutics: towards a new era for the management of cancer and other diseases. Nat Rev Drug Discov 16, 203–222 (2017). https://doi.org/10.1038/nrd.2016.246

Abivax Reports Positive Interim Efficacy and Safety Analysis of Once-Daily 25mg Obefazimod in Moderate to Severe Ulcerative Colitis Patients After 2-Years of Open-Label Maintenance Patients treated with a de-escalated dose of 25 mg of obefazimod once daily demonstrated maintenance of clinical remission at weeks 48 and 96Efficacy and safety demonstrated out to six years of treatment The treatment was well-tolerated, with a safety profile consistent with previous studies and no new safety signals detected PARIS, France, October 3, 2024, 8:30 a.m. CEST – Abivax SA (Euronext Paris & Nasdaq: ABVX) (“Abivax” or the “Company”), a clinical-stage biotechnology company focused on developing therapeutics that harness the body’s natural regulatory mechanisms to stabilize the immune response in patients with chronic inflammatory diseases, announced the results of an interim efficacy and safety analysis of an open-label maintenance (OLM) study that enrolled patients with UC at the conclusion of the Phase 2a and Phase 2b OLM studies, where they had received obefazimod 50mg once daily. The data demonstrated maintenance of clinical remission and a safety profile consistent with prior studies of oral, once-daily obefazimod when administered at a reduced dose of 25mg for up to an additional two years. “These important data further support the potential of obefazimod as a promising therapeutic option for patients with UC,” said Marla Dubinsky, MD, Co-Director, Susan and Leonard Feinstein IBD Clinical Center at Icahn School of Medicine at Mount Sinai New York. “The results observed at a lower dose are particularly encouraging, as clinicians often like to have the option to de-escalate dosing once patients achieve remission”. In this open-label maintenance study, patients who had completed the 4-year Phase 2a or 2-year Phase 2b OLM studies, where they had received 50 mg of once-daily obefazimod, were given the opportunity to continue receiving obefazimod at a reduced dose of 25mg daily for up to five additional years (provided they met the eligibility criteria of Mayo Endoscopic Subscore = 0 or 1). A total of 130 patients entered the study, as of Sep 11, 2024, the data cut-off date, 113 have been evaluated out to 48 weeks and 74 have undergone the full 96-week evaluation. At study baseline, 89% (116/130) of patients were in clinical remission. At weeks 48 and 96 of treatment, 84% (95/113) and 87% (64/74) of patients evaluated were in clinical remission, respectively. Similarly, 92% (119/130) of patients were in symptomatic remission at study baseline. At weeks 48 and 96, 91% (103/113) and 92% (68/74) of patients evaluated were in symptomatic remission, respectively. Similar trends were observed with other efficacy analyses. Silvio Danese, MD, Professor of Gastroenterology at the San Raffaele University, Milan, Italy, stated “For patients with UC, a significant need exists for an oral treatment option that is not only well-tolerated and convenient, but that provides maintenance of remission over a long period of time. The obefazimod data released today, with patients maintained for up to 6 years of treatment, provides me with great hope that we are getting closer to meeting that significant need.” The safety results were consistent with previous studies, with no new safety signals detected. Patient retention rates were high, with only 12% (16/130) of patients discontinuing in the first year and 5% (6/114) discontinuing during the second year of treatment (33 patients have not reached week 96 as of Sept 11, 2024, the data cutoff date. “The maintenance of clinical remission and the promising tolerability data observed to date, underscores the potential of obefazimod as a treatment for ulcerative colitis. We look forward to presenting this data at an upcoming medical meeting,” said Fabio Cataldi, MD, Chief Medical Officer, Abivax. About Obefazimod Obefazimod, Abivax’s lead investigational drug candidate, is an orally administered small molecule that was demonstrated to potentially enhance the expression of a single microRNA, miR-124. Phase 2 clinical trials in patients with UC have generated positive data, resulting in the initiation of a pivotal global Phase 3 clinical trial program (ABTECT Program), with first patients enrolled in the United States in October 2022. Initiation of a Phase 2b clinical trial in Crohn’s disease is expected in Q4 2024, and exploration of potential combination therapy opportunities in UC is ongoing. About Abivax Abivax is a clinical-stage biotechnology company focused on developing therapeutics that harness the body’s natural regulatory mechanisms to stabilize the immune response in patients with chronic inflammatory diseases. Based in France and the United States, Abivax’s lead drug candidate, obefazimod (ABX464), is in Phase 3 clinical trials for the treatment of moderately to severely active ulcerative colitis. More information on the Company is available at www.abivax.com. Follow us on LinkedIn and on X, formerly Twitter, @Abivax. Contact: Patrick MalloySVP, Investor Relations, Abivax patrick.malloy@abivax.com +1 847 987 4878 FORWARD-LOOKING STATEMENTS This press release contains forward-looking statements, forecasts and estimates, including those relating to the Company’s business and financial objectives. Words such as “expect,” “plan,” “potential,” “will” and variations of such words and similar expressions are intended to identify forward-looking statements. These forward-looking statements include statements concerning or implying the therapeutic potential of Abivax's drug candidates, the timing of initiation of clinical trials, obefazimod’s potential, as monotherapy or in combination with other therapies, to provide meaningful benefit to patients suffering from UC, Crohn’s disease, IBD or other indications, and other statements that are not historical fact. Although Abivax’s management believes that the expectations reflected in such forward-looking statements are reasonable, investors are cautioned that forward-looking information and statements are subject to various risks, contingencies and uncertainties, many of which are difficult to predict and generally beyond the control of Abivax, that could cause actual results and developments to differ materially from those expressed in, or implied or projected by, the forward-looking information and statements. A description of these risks, contingencies and uncertainties can be found in the documents filed by the Company with the French Autorité des Marchés Financiers pursuant to its legal obligations including its universal registration document (Document d’Enregistrement Universel) and in our Annual Report on Form 20-F filed with the U.S. Securities and Exchange Commission on April 5, 2024, under the caption “Risk Factors.” These risks, contingencies and uncertainties include, among other things, the uncertainties inherent in research and development, future clinical data and analysis, decisions by regulatory authorities, such as the FDA or the EMA, regarding whether and when to approve any drug candidate, as well as their decisions regarding labelling and other matters that could affect the availability or commercial potential of such product candidates. Current results are not necessarily indicative of future results. Special consideration should be given to the potential hurdles of clinical and pharmaceutical development including further assessment by the company and regulatory agencies and IRBs/ethics committees following the assessment of preclinical, pharmacokinetic, carcinogenicity, toxicity, CMC and clinical data. Furthermore, these forward-looking statements, forecasts and estimates are only as of the date of this press release. Readers are cautioned not to place undue reliance on these forward-looking statements. Abivax disclaims any obligation to update these forward-looking statements, forecasts or estimates to reflect any subsequent changes that the Company becomes aware of, except as required by law. Information about pharmaceutical products (including products currently in development) that is included in this press release is not intended to constitute an advertisement. This press release is for information purposes only, and the information contained herein does not constitute either an offer to sell, or the solicitation of an offer to purchase or subscribe securities of the Company in any jurisdiction. Similarly, it does not give and should not be treated as giving investment advice. It has no connection with the investment objectives, financial situation or specific needs of any recipient. It should not be regarded by recipients as a substitute for exercise of their own judgment. All opinions expressed herein are subject to change without notice. The distribution of this document may be restricted by law in certain jurisdictions. Persons into whose possession this document comes are required to inform themselves about and to observe any such restrictions.