SBIR-STTR Award

Coronary heart disease, the most prevalent manifestation of atherosclerosis, remains the single largest killer of American men and women. The "hallmark" of vascular disease or atherosclerosis is the accumulation of cholesterol in arteries, which can lead to heart attack (coronary heart disease), stroke or peripheral artery disease. The excess cholesterol causes stenosis and disruptions of signaling cascades leading to instability within the plaque. Therefore, a method to rapidly remove cholesterol from the atheromas and reduce the peripheral cholesterol burden may stabilize the plaque. Normally, cholesterol is removed from arteries and delivered to the liver for excretion in bile by a multistage process known as "Reverse Cholesterol Transport" (RCT). In the first stage, high-density lipoprotein (HDL) acquires cholesterol from artery walls. In the second stage, the enzyme lecithin:cholesterol acyltransferase (LCAT) increases the amount of cholesterol carried in HDL by the conversion of cholesterol to cholesteryl ester. The observation that individuals with reduced LCAT function exhibit reduced HDL cholesterol (HDL-C) and increased vascular disease suggests that LCAT function is protective. Moreover, enhancement of LCAT in animal models by gene over-expression is known to increase HDL-C and reduces atherosclerosis. AlphaCore Pharma proposes that the injection of active LCAT will result in the rapid mobilization of vessel and peripheral cholesterol to HDL, and consequent stabilization of arterial atheromas, thereby reducing the risk of primary or secondary vascular events in the patient. The Phase I specific aims are 1) Develop a mammalian cell expression system to produce sufficient quantities of recombinant, active, human LCAT (rhLCAT) and 2) Characterize the pharmacodynamics of rhLCAT infusion in mice expressing human apolipoprotein AI (apoA-ITG). The principle measures will be plasma cholesterol, HDL-C, human apoA-I, plasma LCAT activity and plasma content of rhLCAT. The kinetics of these parameters will be determined following a single infusion. Additionally, a comparison between routes of administration (intravenous, intraperitoneal and intra-muscular) will be performed. The data obtained from these studies will demonstrate the kinetics and magnitudes of HDL-C changes in response to a bolus rhLCAT infusion, which is unprecedented. The results will help define the dose sizes and dose frequency needed to obtain significant elevations in HDL-C. This information will be the foundation for a subsequent study of the effects of rhLCAT infusion on atherosclerosis development in an animal model. The ultimate goal of AlphaCore Pharma is to develop LCAT infusion as an acute therapy for unstable plaque and atherosclerosis.

Public Health Relevance:
Coronary heart disease, the most prevalent manifestation of atherosclerosis, remains the single largest killer of American men and women. AlphaCore Pharma proposes that the injection of the enzyme lecithin:cholesterol acyltransferase will result in the rapid mobilization of vessel and peripheral cholesterol to HDL, and consequent stabilization of the arteries, reducing the risk of repeated events in patients who have suffered at least one heart attack.

Public Health Relevance:
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The ""hallmark"" of atherosclerosis is the accumulation of cholesterol in arteries, resulting in plaque which can lead to a heart attack (myocardial infarction (MI)). The excess cholesterol causes inflammation, promotes plaque instability, and in later stages, narrows the vessel lumen to obstruct blood flow. Normally, cholesterol is removed from arteries and delivered to the liver for excretion into bile by a multistep process known as ""Reverse Cholesterol Transport"" (RCT). In the first step of RCT, small high-density lipoprotein (HDL) particles called ""pre-beta"" HDL acquire cholesterol from artery walls. In the second step, the plasma enzyme lecithin:cholesterol acyltransferase (LCAT) increases the amount of cholesterol carried in HDL by the esterification of cholesterol to cholesteryl ester. The recent observation that individuals with heart disease have high pre-beta HDL levels and reduced LCAT activity suggests that LCAT is a critical and perhaps rate-limiting component of RCT. Moreover, enhancement of LCAT in animal models by gene transfer, or more recently by the injection of recombinant LCAT, is known to increase HDL-C, enhance RCT and reduce atherosclerosis. Therefore, it is reasonable that increasing the amount of LCAT in patients who have suffered an MI will rapidly stimulate RCT, stabilize the plaque, and consequently, reduce the likelihood of another adverse clinical event. The long-term commercial objective of AlphaCore Pharma is to gain FDA approval for recombinant human LCAT (rhLCAT) as a therapy for reducing the risk of a repeat (secondary) MI in post-MI patients. Phase I of this project was highly successful. SBIR funding was used for bench-scale production of active rhLCAT and to conduct initial proof-of-concept studies in mice. A single injection of rhLCAT in three relevant mouse models increased HDL cholesterol (principally LCAT-derived cholesteryl esters) and size. Moreover, HDL-C remained elevated for more than 48 hours, which increases the possibility that once-weekly dosing may be achievable in humans. The response to rhLCAT was similar whether the injection route was intravascular, intramuscular or subcutaneous, which suggests different dosing options may be possible in humans, including self- administration. Multiple injections of rhLCAT over several days produced even greater increases in HDL-C, and resulted in enhanced expression of liver genes involved in bile acid production, suggesting enhanced delivery of cholesterol to the liver. The Phase II specific aims are 1) to demonstrate enhancement of macrophage specific RCT after rhLCAT injection, 2) to determine if rhLCAT will induce rapid changes in atherosclerotic lesions in rabbits, 3) to conduct a toxicology study in non-human primates to obtain the data for an Investigational New Drug submission;4) to demonstrate that rhLCAT becomes associated with HDL after injection and is functional. Achievement of these specific aims will enable application to the FDA for approval to test rhLCAT safety and efficacy in humans. The ultimate goal is to make rhLCAT a unique and effective therapy for reducing the unacceptable number of recurrent cardiovascular events in post-infarct patients. , ,

Public Health Relevance:
Coronary heart disease, the most prevalent manifestation of atherosclerosis, remains the single largest killer of American men and women. AlphaCore Pharma proposes that the injection of the enzyme lecithin:cholesterol acyltransferase will result in the rapid mobilization of vessel and peripheral cholesterol to HDL, and consequent stabilization of the arteries, reducing the risk of repeated events in patients who have suffered at least one heart attack.

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