1 2 Cardiovascular risks in dyslipidemia patients are commonly controlled by lowering the LDL-C level using statins. 3 However, a significant residual cardiovascular risk persists in patients with additional concurrent risk factors such 4 as obesity, diabetes, insulin resistance, and elevated triglyceride-rich lipoproteins. Given the multifaceted 5 underlying pathology of cardiovascular disease, polypharmacy approaches are applied to target individual risk 6 factors but with limited success due to various drug side effects, lack of synergy, and low patient adherence. 7 Fish oils effectively lower hypertriglyceridemia, and omega-3 fatty acids-based treatments are approved by FDA 8 to treat this condition. We discovered a minor component of fish oil, also present in FDA-approved omega-3- 9 based drugs, that is more potent in eliciting these effects. Using a medicinal chemistry approach, we designed,10 synthesized, tested, and optimized a series of compounds with improved metabolic stability and therapeutic11 potency. The lead compound, FA-1011, demonstrated significant protection in a high-fat diet NAFLD mouse12 model, reducing circulating cholesterol, triglycerides, hepatic steatosis, inflammatory markers caused by a13 significant hepatic metabolic rewiring. The protective, anti-inflammatory effect and the improvement in circulating14 lipid profile led us to hypothesize that FA-1011 could tackle the multifactorial cardiovascular disease by reducing15 plaque formation, normalizing dyslipidemia, alleviating insulin resistance, and soliciting anti-inflammatory16 responses. In particular, the hypothesis will be tested by pursuing the following Specific Aims:17 Aim 1: Evaluate the absorption, distribution, and metabolism of FA-1011.18 Aim 2: Define the protection of FA-1011 against atherosclerosis in ApoE-/- mice.19 The multidisciplinary approach involved in the project including synthetic chemistry, mass spectrometer-based20 analytics, and animal pharmacokinetics and pharmacology will definitively reveal the ADME, validate the anti-21 atherosclerotic impact and characterize the modes of action of the lead compound FA-1011. The successful22 outcomes of this project will result in a solid preclinical candidate ready for IND-enabling studies, and greatly23 accelerate its translation to real clinical value for patients with excessive cardiovascular risk burden.24 The team leading this effort is experienced and has participated in several preclinical and clinical studies (525 Phase I and 2 Phase II) in related disease areas. In addition, the team is supported by significant collaborators26 and consultants to successfully execute the proposed research plan.27
Public Health Relevance Statement: Project Narrative
Cardiovascular disease accounts for 30% of all deaths worldwide. The applicant proposes to advance novel fatty
acid mimetics to manage 1) dyslipidemia, 2) glucose homeostasis, and 3) cardiovascular disease. The
successful development of this class of novel fatty acids would greatly benefit those patients who are exposed
to excessive residual cardiovascular risks.
Project Terms: <Ï-3 fatty acids> 
