Phase II Amount
$1,036,641
Inflammatory bowel disease (IBD) is comprised mainly of Crohn's Disease (CD) and Ulcerative Colitis (UC), and ischaracterized by a chronic non-resolving inflammatory response in the intestinal mucosa. Although the exact etiology isunknown, dysbiosis, genetic, environmental, and immunologic factors are all thought to play roles in this multifactorialdisease. There are no cures, and in most cases, lifelong treatment is required. Current first line standards of care maybenefit 50% of patients, with non-responders being prescribed more aggressive corticosteroid and immunomodulatorytherapies that include many different classes of biologics. Although biologics like mAbs targeting TNF, IL-12/23, andvedolizumab (which targets the gut homing receptor integrin α4β7) have been a welcome addition in the treatment ofIBDs, they present unique issues. With respect to vedolizumab, this includes subsets of patients that lack a response totreatment, cost, and high rates of secondary loss of response. There is a clear need for new approaches to treat IBDpatients that offer better long-term prognosis and improved risk-benefit profiles. Vedolizumab selectively targets integrinα4β7 and is currently indicated for use in patients with moderate to severe CD or UC who have not responded to currentfirst and second line treatments. However, not all patients respond and secondary loss of response to vedolizumab can beas high as 39% in UC patients. A mechanism that could explain this is the upregulation of compensatory cell traffickingmolecules, like the integrin α4β1, allowing recruitment of inflammatory cells into the gut. The dual α4β1 and α4β7antagonist natalizumab could address this from an efficacy standpoint, however, despite being approved for Crohn'sdisease, the significant safety concerns around progressive multifocal leukoencephalopathy (PML) preclude its use in thispatient population. Development of an effective dual α4β1 and α4β7 antagonist, that is not biologic in nature but rather asmall molecule drug administered orally once-a-day and devoid of the safety concerns surrounding PML, would betransformative in the treatment of IBD. This is the goal of the Phase I STTR program proposed here. Phase I studies have identified a potential lead candidate antagonist of integrins α4β7 and α4β1 that is effective ina T cell transfer model of colitis but does not induce hematopoietic stem cell mobilization or B cell lymphocytosis, whichare linked to the development of PML with natalizumab treatment. The lead class of compounds are orally available, withpharmacokinetic parameters indicative of once-a-day dosing. In this phase II proposal, we will perform IND-enablingstudies, including safety pharmacology, ADME, toxicology/toxicokinetics, and biomarker development that will lead toeventual clinical candidate selection and submission of an IND for testing in IBD patients.
Public Health Relevance Statement: We are proposing the development of an orally available small molecule drug that targets inflammatory cell trafficking to
the gut as a safe alternative to current treatments strategies in inflammatory bowel disease that either are associated with
significant safety concerns, like the development of progressive multifocal leukoencephalopathy, or are associated with
high numbers of primary and secondary non-responders to therapy.
Project Terms: <3H-Purine-6-thiol><6 MP><6-Purinethiol><6-Thiohypoxanthine><6-Thiopurine><6-Thioxopurine><6-mercapto-purine>
<6-Mercaptopurine><(TNF)-α> | | | |