SBIR-STTR Award

Long Term Goal: To develop a drug for treating inflammatory bowel disease with reduced side effects Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract. There are two types of inflammatory bowel disease; Crohn's disease, primarily affecting the small intestine and ulcerative colitis, which affects only the colon. Approximately 1 million people in the U.S. suffer from IBD. Currently used therapeutics are anti-TNF antibodies, which are highly effective in treating both Crohn's disease and ulcerative colitis. However, because they are delivered by injection and neutralize TNF throughout the body, their use is associated with serious side effects, including the reactivation of tuberculosis and a long-term risk of malignancy. Avaxia is developing an oral polyclonal anti-TNF antibody therapeutic for IBD from the early milk (colostrum) of immunized cows. Bovine colostral antibodies are ideal for oral delivery, as the antibodies are stable to gastric digestion and there is a long history of safe human exposure. Published data have established that oral delivery of a polyclonal anti-TNF antibody dramatically reduced colitis in a well-established rodent model of IBD. We hypothesize that oral administration of anti-TNF antibody will enable targeted distribution to the site of inflammation in the gut, with minimal systemic exposure, thus eliminating side effects while maintaining therapeutic efficacy. The goal of the work described in this SBIR phase I application is to evaluate the technical feasibility of treating inflammatory bowel disease with oral anti-TNF bovine colostral antibody. The specific aims are as follows: To test the activity and gastric stability of the anti-TNF antibody in vitro (SA#1). To test the activity of orally administered anti-TNF antibody in mice with TNBS induced colitis (SA#2). To define the distribution of orally administered anti-TNF antibody in mice with TNBS induced colitis (SA#3). If these studies are successful, the SBIR Phase II application will compare oral bovine polyclonal antibody with systemically administered anti-TNF1 monoclonal antibody. Together, these studies will define the commercial opportunity offered by the bovine antibody and will form the basis of the pre-clinical pharmacology package to be used in support of an IND filing.

Public Health Relevance:
Project Narrative Avaxia is developing an oral polyclonal anti-TNF antibody therapeutic for inflammatory bowel disease (IBD), from the early milk (colostrum) of immunized cows. We hypothesize that oral administration of anti-TNF antibody will enable targeted distribution to the site of inflammation in the gut, with minimal systemic exposure. This is expected to maintain therapeutic efficacy while eliminating the side effects which restrict the use of anti-TNF antibody for IBD.

Thesaurus Terms:
Administration, Oral; Adverse Effects; Affect; Alimentary Canal; Animal Model; Animal Models And Related Studies; Antibodies; Bleeding; Blood Circulation; Bloodstream; Body Weight; Bovine Species; Cancers; Cattle; Cell/Tissue, Immunohistochemistry; Chronic; Circulation; Clinical Pharmacology; Cola; Colitis; Colon; Colostrum; Colostrums; Crohn's Disease; Crohn's Disorder; Dif; Data; Digestion; Digestive Tract; Disease; Disorder; Dose; Drug Administration, Oral; Drugs; Enteritis, Granulomatous; Evaluation; Feces; Gi Tract; Gastrointestinal Tract; Gastrointestinal Tract, Feces; Gastrointestinal Tract, Small Intestine; Gastrointestinal Tract Structure; Genus Cola; Goals; Hemorrhage; History; Human; Human, General; Ihc; Inflm; Immunohistochemistry; Immunohistochemistry Staining Method; Immunosuppression Effect; Immunosuppressions (Physiology); Immunosuppressive Effect; In Vitro; Inflammation; Inflammatory; Inflammatory Bowel Diseases; Inflammatory Bowel Disorder; Inflammatory Intestinal Disease; Inflammatory Intestinal Disorder; Injection Of Therapeutic Agent; Injections; Intestines, Small; Malignant Neoplasms; Malignant Tumor; Mammals, Mice; Man (Taxonomy); Man, Modern; Measures; Medication; Mice; Milk; Moab, Clinical Treatment; Modeling; Monoclonal Antibodies; Murine; Mus; Natural Immunosuppression; Oral; Oral Administration; Peripheral; Pharmaceutic Preparations; Pharmaceutical Preparations; Phase; Publishing; Recording Of Previous Events; Regimen; Risk; Rodent Model; Sbir; Sbirs (R43/44); Site; Small Business Innovation Research; Small Business Innovation Research Grant; Small Intestines; Source; Stomach; Tnf; Tnf A; Tnf Gene; Tnfsf2; Testing; Therapeutic Uses; Therapeutic Antibodies; Treatment Efficacy; Treatment Side Effects; Tuberculosis; Tumor Necrosis Factor Gene; Ulcerated Colitis; Ulcerative Colitis; Work; Alimentary Tract; Base; Blood Loss; Bovid; Bovine; Cow; Design; Designing; Digestive Canal; Disease/Disorder; Disseminated Tb; Disseminated Tuberculosis; Drug/Agent; Eleocolitis; Experiment; Experimental Research; Experimental Study; Exposed Human Population; Gastric; Granulomatous Enterocolitis; Human Exposure; Immunosuppression; Intraoral Drug Delivery; Malignancy; Model Organism; Mouse Model; Neoplasm/Cancer; Polyclonal Antibody; Pre-Clinical; Preclinical; Public Health Relevance; Rectal; Regional Enteritis; Research Study; Side Effect; Small Bowel; Stool; Therapeutic Efficacy; Therapeutically Effective; Therapy Adverse Effect; Treatment Adverse Effect; Tuberculous Spondyloarthropathy

To develop an oral anti-TNF antibody therapeutic that is safe and effective enough to be used as a first line therapy for inflammatory bowel disease. Problem: Inflammatory bowel disease (IBD) comprises two chronic inflammatory disorders of the gastrointestinal tract: Crohn's disease and ulcerative colitis. Approximately 1 million people in the U.S. suffer from IBD, with direct healthcare costs of $6.3B/year and costs for lost work of $3.6B/year. Injectable anti-TNF antibodies are highly effective in treating inflammatory bowel disease. However, because they neutralize TNF throughout the body, their use is associated with serious side effects such as reactivation of tuberculosis and long-term risk of malignancy. This limits their use to 2nd or 3rd line treatment of severe/refractory IBD. Avaxia's Solution: Avaxia is developing AVX-470h, an oral polyclonal anti-TNF antibody therapeutic for IBD from the early milk (colostrum) of immunized cows. Bovine colostral antibodies are ideal for oral delivery, as the antibodies are stable to gastric digestion and there is a long history of safe human exposure. With the support of the SBIR Phase I grant, we established that oral delivery of AVX-470m (bovine antibody specific for murine TNF) significantly reduced the severity of colitis in the well-established TNBS and DSS mouse models of IBD while blood levels remained low. We hypothesize that oral administration of AVX-470h (bovine antibody specific for human TNF) to human subjects will enable targeted distribution to the site of inflammation in the gut, with minimal systemic exposure, thus eliminating side effects while maintaining therapeutic efficacy. Specific Aims: 1) To define the pharmacokinetics and determinants of efficacy in animal models of IBD. AVX- 470m will be evaluated in murine TNBS- and DSS-induced colitis models, selecting a single model for further analysis and defining the effects of dose and dosing regimen on efficacy, local and systemic exposure, immune function and immunogenicity. These studies will define the variables important in the clinical use and testing of AVX-470h. 2) To produce AVX-470h (bovine anti-human TNF antibody) for use in preclinical development in Aim 3. Cows will be immunized with human TNF and immunoglobulin will be purified from the immune colostrum. 3) To define the pharmacology of TNF inhibition by AVX-470m and AVX-470h. The molecular and cellular pharmacology of AVX-470m and AVX-470h will be defined by measuring TNF binding, neutralization and specificity. The goal of Aim 3 is to bridge between the anti-murine TNF (AVX-470m) used in preclinical studies and the anti-human TNF (AVX-470h) to be used in clinical trials. Development of clinical drug supply, toxicology work and regulatory filings for AVX-470h will be carried out in parallel with SBIR Phase II studies but funded independently. If AVX-470m is efficacious in murine colitis models with minimal systemic exposure and the TNF pharmacology profile of AVX-470h mimics AVX-470m, we will file an IND and proceed to clinical testing of AVX-470h.

Public Health Relevance:
Crohn's Disease and Ulcerative Colitis, collectively known as inflammatory bowel disease (IBD), are serious chronic diseases that afflict over 1 million Americans, costing the U.S. economy an estimated $6.3 billion in direct healthcare costs and $3.6 billion in lost work time each year. Our SBIR Phase I studies showed that AVX-470, Avaxia's orally delivered anti-TNF antibody therapeutic, is effective at treating mouse models of IBD and does not produce blood levels of antibody that are associated with immunosuppression (a major side effect of currently marketed anti-TNF antibodies administered by injection that limits their use to patients with severe disease). This proposal is focused on advancing AVX-470 toward an IND filing with the goal of developing an oral anti-TNF antibody therapeutic that is safe and effective enough to be used as a first line therapy to prevent the progression of IBD to severe disease.

Public Health Relevance Statement:
Crohn's Disease and Ulcerative Colitis, collectively known as inflammatory bowel disease (IBD), are serious chronic diseases that afflict over 1 million Americans, costing the U.S. economy an estimated $6.3 billion in direct healthcare costs and $3.6 billion in lost work time each year. Our SBIR Phase I studies showed that AVX-470, Avaxia's orally delivered anti-TNF antibody therapeutic, is effective at treating mouse models of IBD and does not produce blood levels of antibody that are associated with immunosuppression (a major side effect of currently marketed anti-TNF antibodies administered by injection that limits their use to patients with severe disease). This proposal is focused on advancing AVX-470 toward an IND filing with the goal of developing an oral anti-TNF antibody therapeutic that is safe and effective enough to be used as a first line therapy to prevent the progression of IBD to severe disease.

Project Terms:
5 Aminosalicylate; Adrenal Cortex Hormones; Adverse effects; Affect; American; Animal Model; Antibodies; Binding (Molecular Function); Blood; Cattle; Chronic; Chronic Disease; Clinical; Clinical Drug Development; Clinical Trials; Colitis; Colon; Colostrum; commercialization; cost; Crohn's disease; Data; Development; Digestion; Disease; Dose; Drug Kinetics; exposed human population; Funding; Gastrointestinal tract structure; Goals; Grant; Health Care Costs; Health system; Human; human subject; Immune; immune function; immunogenicity; Immunoglobulin G; Immunoglobulins; Immunomodulators; Immunosuppressive Agents; In Vitro; Inflammation; Inflammatory; Inflammatory Bowel Diseases; Injectable; Injection of therapeutic agent; lost work time; Malignant Neoplasms; Marketing; Measures; Milk; Modeling; Molecular; Monoclonal Antibodies; mouse model; Mus; Natural immunosuppression; Opportunistic Infections; Oral; Oral Administration; Patients; Pharmaceutical Preparations; Pharmacology; Phase; phase 1 study; phase 2 study; pre-clinical; preclinical study; Preparation; prevent; Production; Recording of previous events; Refractory; Regimen; research clinical testing; Risk; Severities; Severity of illness; Site; Small Business Innovation Research Grant; Small Intestines; Solutions; Specificity; Stomach; Testing; Therapeutic antibodies; TNF gene; Toxicology; Treatment Efficacy; Tuberculosis; Tumor Necrosis Factor-alpha; Ulcerative Colitis; Work