Abstract 15751: Pharmacodynamic Effect of ARO-ANG3, an Investigational RNA Interference Targeting Hepatic Angiopoietin-like Protein 3, in Patients With Hypercholesterolemia

Background: Angiopoietin-like protein 3 (ANGPTL3) regulates triglyceride (TG) and lipoprotein (LP) metabolism by inhibiting liver and endothelial LP lipases and reduces plasma LDL-C. In Phase 1 Study AROANG1001 (NCT03747224), single and multiple doses of RNA interference therapeutic ARO-ANG3 (100, 200, or 300 mg; n=36) in healthy volunteers substantially reduced ANGPTL3, LDL-C, and other LPs (AHA 2019) compared with placebo (n=16). Purpose: We report preliminary results following repeat doses (days 1 and 29) of ARO-ANG3 in patients with heterozygous familial hypercholesterolemia (FH) with elevated LDL-C despite statin therapy and average LDL-C of 130 mg/dL. An additional group (non-FH patients) had LDL-C > 70 mg/dL despite statin therapy. Methods: Seventeen FH patients received open-label, subcutaneous, ARO-ANG3 100 mg (n=6), 200 mg (n=6), or 300 mg (n=5). Nine non-FH, high risk patients with elevated LDL-C not at goal received either 200 mg ARO-ANG3 (n=6) or placebo (n=3) using a randomized double-blind design. Pharmacodynamic markers included serum ANGPTL3, LDL-C, TG, and others. Results: Results are reported as of 04 May 2020. In FH patients, ARO-ANG3 significantly reduced mean ANGPTL3 levels between 62-92% at week 16 in a dose-dependent manner (Table). LDL-C (23-37%) and TG (25-43%) were consistently reduced at all doses (Table). The mean percent reductions in non-FH patients for ANGPTL3 (85%), LDL-C (28%), and TG (29%) were comparable to those in FH patients, despite their initially lower LDL-C at baseline. As of 15 May 2020, there were no drug-related serious or severe adverse events (AEs) or discontinuations and most AEs were mild. The most common AEs reported in subjects receiving ARO-ANG3 were respiratory tract infection (30% of subjects) and injection site AEs (13% of subjects). Conclusions: In FH and non-FH patients, repeat doses of ARO-ANG3 significantly reduced ANGPTL3, LDL-C, and TG, with favorable safety.

Hepatic steatosis and plasma dyslipidemia induced by a high-sucrose diet are corrected by an acute leptin infusion

High sucrose (HS) feeding in rats induces hepatic steatosis and plasma dyslipidemia. In previous reports (Huang W, Dedousis N, Bhatt BA, O'Doherty RM. J Biol Chem 279: 21695–21700, 2004; and Huang W, Dedousis N, Bandi A, Lopaschuk GD, O'Doherty RM. Endocrinology 147: 1480–1487, 2006), our laboratory demonstrated a rapid (∼100 min) leptin-induced decrease in liver and plasma VLDL triglycerides (TG) in lean rats, effects that were abolished in obese rats fed a high-fat diet, a model that also presents with hepatic steatosis and plasma dyslipidemia. To further examine the capacity of acute leptin treatment to improve metabolic abnormalities induced by nutrient excess, hepatic leptin action was studied in rats after 5 wk of HS feeding. HS feeding induced hepatic steatosis (TG +80 ± 8%; P = 0.001), plasma hyperlipidemia (VLDL-TG +102 ± 14%; P = 0.001), hyperinsulinemia (plasma insulin +67 ± 12%; P = 0.04), and insulin resistance as measured by homeostasis model assessment (+125 ± 20%; P = 0.02), without increases in adiposity or plasma leptin concentration compared with standard chow-fed controls. A 120-min infusion of leptin (plasma leptin 13.6 ± 0.7 ng/ml) corrected hepatic steatosis (liver TG −29 ± 3%; P = 0.003) and plasma hyperlipidemia in HS (VLDL-TG −42 ± 4%; P = 0.001) and increased plasma ketones (+45 ± 3%; P = 0.006), without altering plasma glucose, insulin, or homeostasis model assessment compared with saline-infused HS controls. In addition, leptin activated liver phosphatidylinositol 3-kinase (+70 ± 18%; P = 0.01) and protein kinase B (Akt; +90 ± 29%; P = 0.02), and inhibited acetyl-CoA carboxylase (40 ± 7%; P = 0.04) in HS, further demonstrating that hepatic leptin action was intact in these animals. We conclude that 1) leptin action on hepatic lipid metabolism remains intact in HS-fed rats, 2) leptin rapidly reverses hepatic steatosis and plasma dyslipidemia induced by sucrose, and 3) the preservation of hepatic leptin action after a HS diet is associated with the maintenance of low adiposity and plasma leptin concentrations.