PCSK9 RNAi Therapeutics Kevin FitzGerald
Presenter Disclosure Information PSCK9 RNAi Therapeutics The following relationships exist related to this presentation:» Kevin Fitzgerald and Alnylam team members: Holds stock options in Alnylam Pharmaceuticals» University of Texas Southwestern Medical Center: Engaged in research for Alnylam» Tekmira Pharmaceuticals/UBC Engaged in research for Alnylam Pharmaceuticals 2
RNAi Therapy for Hypercholesterolemia Rationale for PCSK9 Hypercholesterolemia/PCSK9 Well validated target» Gain and loss of function mutations Rodent and Human (gf) and (lf) mutations PCSK9 expressed in liver (delivery) Early clinical markers of activity possible (PCSK9, LDLc, ApoB) Alnylam PCSK9 program Discovery of pm active PCSK9 sirnas Formulations or conjugates for delivery Proof of concept» Multiple rodent models, NHP s Collaboration with UT Southwestern» Horton, Hobbs, Brown and Goldstein Liver VLDL Rem PCSK9 Pathway PCSK9 LDL receptor LDL VLDL Rem Peripheral cells LDL 3
RNAi Product Platform Turning sirnas into Drugs Bioinformatics, in vitro assays Phosphorothioate 2 OMe, 2 F Cholesterol, others Select» In silico design» In vitro assays Stabilize» Chemistry Deliver» Formulations» Conjugates Incorporate minimal number of modifications required for appropriate pharmaceutical properties 4
Target/GAPDH relative to control treated No Evidence of Off-Target Silencing by PCS-B2 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Endogenous Genes at High Concentration of PCS-B2 in vitro (Hep3B, RNAiMax, 1uM) Control ORMDL2 BMP6 TAPT1 MYEF2 LOC442252 RFT1 PCSK9 PCS-B2 PCS-B2 pm IC 50 5
Lack of PCS-B2 Cytokine Induction Panel of 7 Cytokines, IFN-, IP-10, IFN-, TNF, IL-6, IL-1ra, G-CSF (hpbmc) 13 Donors 9000 8000 7000 6000 Medium Medium plus transfection reagent Neg Control sirna Control sirna1 Control sirna2 Control sirna3 PCS-B2 5000 4000 3000 2000 1000 0 IFN- IP-10 IFN- TNF- IL-6 IL-1ra G-CSF 6
Viability relative to control PCS-B2 Has No Effect On Cell Proliferation In 4 Different Cell Lines (Hep3B, Cos7 Cells Example) 1.20 1.00 0.80 0.60 0.40 0.20 Hep3B Day 3 0.00 0.01 0.1 1.0 10 0.01 0.1 1.0 10 0.01 0.1 1.0 10 0.01 0.1 1.0 10 0.01 0.1 1.0 10 Neg-Ctrl (nm) Pos-Ctrl (nm) PCS-A1 (nm) PCS-A4 (nm) PCS-B2 (nm) 7
Lipid Nanoparticles for Systemic RNAi Multi-component lipid formulation» Cationic lipid» Structural lipid» PEG lipid» Cholesterol Highly efficient for liver delivery» Hepatocyte-specific gene silencing achieved Low surface charge Small uniform size particle <100 nm 8
Liver PCSK9 mrna and serum Tc levels* RNAi Silencing of PCSK9 in Rats 1.6 PCSK9 mrna Tc LNP-siRNA (mg/kg) Day 0 3 N=6/group PCSK9 mrna Total chol. LDLR 1.2 0.8 * * * ** ** 0.4 5 RACE (Liver) LNP-PCS-A2 LNP-Ctrl PBS 0 PBS 5 1 2.5 5 LNP-Ctrl LNP-PCS-A2 (mg/kg) (mg/kg) P 31 32 33 34 41 42 43 44 46 47 48 49 PBS LNP-Ctrl LNP-PCS-A2 PBS LDLR TFR Predicted PCR band Seq. Confirmed Lane 1 2 3 4 5 6 7 8 9 10 11 12131415 16 17 18 Frank-Kamenetsky et. al., Proc. Natl Acad. Sci., Aug 2008 9
Serum Tc level* Liver cholesterol and TG levels* RNAi Silencing of PCSK9 Decreases Total Cholesterol in Rats Duration and Lack of Fatty Liver LNP-siRNA 5mg/kg Day 0 N=6/group X Hepatic cholesterol and triglycerides Total serum cholesterol 1.2 1.0 2.0 d3 Hepatic cholesterol Hepatic TG 0.8 1.6 0.6 1.2 0.4 0.8 0.2 2 4 6 8 10 12 14 16 18 20 22 24 26 28 Days post-injection * P<.05 (ANOVA) at up to day 16 LNP-PCS-A2 LNP-Ctrl 0.4 0 PBS 5 1 2.5 5 LNP-Ctrl LNP-PCS-A2 (mg/kg) (mg/kg) Proc. Natl Acad. Sci., Aug 2008 10
Relative to PBS=1 PCSK9 mrna is down modulated in hcetp/hapob100 Transgenic Mice LDL particle number lowering Particle, nmol/l LNPX-PCS sirna (5mg/kg) Day 0 N=4/group 3 liver PCSK9 mrna NMR LipoProfile: LDL and HDL particle number 1.2 PCSK9/GAPDH 500 1.0 400 0.8 0.6 0.4 300 200 0.2 100 0.0 Control PCS-A2 0 LDL HDL Control Total Particle Number LDL HDL PCS-A2 Total Particle Number 11
Plasma PCSK9 levels relative to pre-dose Serum LDLc relative to pre-dose RNAi Silencing of LDLc and PCSK9 Protein Non-Human Primates Acute and durable effects after a single 30 minute infusion PCSK9 plasma levels reduced by up to 70% of pre-dose levels Rapid reductions in LDL cholesterol levels by 40-60% 2.5 2.0 ** = P<.01 *** = P<.001 1.4 1.2 1.0 ** = P<.01 *** = P<.001 ** 1.5 1.0 *** *** ** *** *** *** *** 0.8 0.6 *** *** *** *** *** *** *** *** *** 0.5 *** *** *** 0.4 0.2 0 PBS 3 4 5 7 14 21 3 4 5 7 14 21 LNP-PCS-A2 LNP-PCS-B2 0 PBS 3 4 5 7 14 21 3 4 5 7 14 21 LNP-PCS-A2 LNP-PCS-B2 Day Post-injection Day Post-injection Proc. Natl Acad. Sci., Aug 2008 12
% Residual Factor VII LNP- formulated FVII sirna LNP Progress Efficacy Improvement Over Time serum FVII protein Day0 3 120 100 C12-200 80 DLinDMA DLinDAP 60 DLin-KC2-DMA-a 40 20 DLin-KC2-DMA-b DLin-K-DMA 98N12-5(I) ED 50 0 0.01 0.1 1 10 FVII sirna Dose (mg/kg) 13
Total Cholesterol Relative to PBS=1 relative to PBS=1 1.2 1.0 PCSK9/GAPDH Cholesterol Dose Sparing Paradigm and Multiple Injections 0.8 0.6 0.4 0.2 0.0 0.1 1 10 LNP formulated PCS-A2 (mg/kg) 1.2 1.0 0.8 0.6 0.4 0.2 PBS 3mg/kg bolus+ PBS once a week 3mg/kg bolus+ 0. 3 mg/kg per week. 0 5 10 15 20 25 30 35 40 45 50 55 60 days post initial bolus Initial 3mg/kg bolus Maintenance: 1 x wk Rats were bled one day prior to repeated dosing 14
relative to PBS=1 Dose Response in Rats PCS-A2 ED50 <0.1 mg/kg in Newer Formulations LNP E- formulated PCS-A2 sirna Day 0 3 liver PCSK9 mrna, total serum cholesterol 1.2 1.0 0.8 PCSK9/GAPDH Cholesterol 0.6 0.4 0.2 0.0 0.01 0.1 1 10 LNP E-formulated PCS-A2 sirna (mg/kg) 15
PCSK9 protein, ng/ml LDLc, mg/dl PCSK9 Gene Silencing with 2 nd Generation LNPs Primate Model ALN-PCS demonstrates potent efficacy in primates Employs 2 nd generation LNPs Rapid and durable dose-dependent reduction in PCSK9 protein PCSK9 silencing results in >50% reductions in LDLc 800 700 600 500 400 LNP-control (1.00 mpk) 0.03 mpk 0.10 mpk 0.30 mpk 1.00 mpk 100 90 80 70 60 50 300 200 100 0-3 -1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 sirna Dosing Day 40 30 20 10 0-3 -1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 3133 35 37 sirna Dosing Day 16
LNP-PCS-B2 Treatment with LNP-PCS-B2 Does Not Affect HDLc Levels NHP 100 90 LNP-control (1.00 mpk) 0.03 mpk 80 70 60 0.10 mpk 0.30 mpk 1.00 mpk 50 40 30 20 10 0-3 -1 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 17
5 Different sirnas Formulated Nanoparticles Inhibit 5 Different Hepatic mrnas in Dose Dependent Manner Mice 72h Target mrna, relative to LNP12-Luc Control 1.2 1.0 0.8 PCSK9 ED50, mg/kg 0.07 0.6 0.4 ApoB FVII Xbp1 LNP-X-siRNAs Pool of 5 0.05 0.025 0.03 0.2 SORT1 0.08 0.0 0.001 0.01 0.1 1 sirna mg/kg PNAS publication in press 18
Target mrna 10 Different Formulated sirnas in One Nanoparticle Inhibit 10 Different Hepatic mrnas Mice, 0.1mg/kg of each sirna, 48h 1.5 Luc Pool of 10 1.0 0.5 0.0 PCSK9 FVII ApoB TTR Xbp1 SORT1 TTC39B Rab5c ITG 1 ApoC3 LNP-siRNA-Pool of 10 19
Summary PCSK9 Program RNAi therapeutic targeting PCSK9: Results in rapid, significant, and sustained lowering of LDLc levels, but not HDLc Lead molecules are active in all pre-clinical models tested:» pm and specific Rats» Total cholesterol lowering; RNAi based and LDLR mechanisms» <3 weeks duration on single dose» Steatosis free NHP study:» LDLc decreased ~40-60% with no effects on HDL cholesterol at doses >0.1mg/kg Dose sparing paradigms may be possible Combinations possible to treat metabolic syndrome» Up to ten targets in same formulation 20
ALN-PCS Team Alnylam Pharmaceuticals M. Frank-Kamenetsky T. Racie L. Qin A. Akinc V. Sharma L. Nechev S. Shulga-Morskaya K. Mills S. Millstein J. Wong T. Lei R. Duncan G. Wang R. Kallanthottathil M. Maier C. Gamba-Vitalo M. Kretschmer M. Jayaraman R. Myers K. Charisse M. Manoharan V. Kotelianski A. de Fougerolles University of Texas SW J. Horton A. Grefhorst N. Anderson Tekmira S. Semple A. Lee L. Jeffs E. Yaworski P. Lutwyche I. MacLachlan MIT Dan Anderson 21