Tekmira Partner to Initiate Phase I Study for the Treatment of Severe Hypercholesterolemia

Tekmira’s partner and licensee Alnylam Pharmaceuticals announced today the submission of files to a European regulatory agency in anticipation of a phase I study with a candidate targeting PCSK9 for the treatment of Severe Hypercholesterolemia. The primary aim of this early-stage study is naturally the safety and tolerability of ALN-PCS. An important secondary aim, not just for Alnylam but also for the entire field of RNAi Therapeutics, will be assessing drug activity as measured by target protein levels in serum. Initial data are expected by year end.

ALN-PCS represents Alnylam’s 4^th clinical candidate, three of which are based on Tekmira’s SNALP technology (VSP, TTR, PCS). It also represents the 2^nd candidate under its 5x15(TM)program which aims to advance five RNAi Therapeutics candidates into late-stage clinical development by 2015. All disclosed candidates under that program (TTR, PCS, HPN) are based on SNALP technology.

Despite the success of statin in lowering cholesterol, many patients are still considered to be in need of additional treatment options. PCSK9 has emerged as a very attractive target for such uses based on human genetics which suggest PCSK9 knockdown to reduce ‘bad’ LDL cholesterol in addition to being well tolerated. While ALN-PCS is the first RNAi Therapeutics candidate to target PCSK9, other companies have already started clinical development of PCSK9-targeting hypercholesterolemia candidates.

These competitive efforts are based on monoclonal antibodies and antisense approaches and include a recently initiated program by Santaris (LNA antisense) and monoclonal antibody programs by Amgen, Pfizer, and Regeneron amongst others (mostly phase I and II). ISIS with partner BMS together are also developing a PCSK9 antisense candidate. This candidate, however, still appears to be in late preclinical studies following some delays.

The pre-clinical data show that RNAi, antisense, and monoclonal antibodies can all potently down-regulate or bind and inhibit PCSK9. It seems, however, that one advantage of ALN-PCS could turn out to be that it does not simultaneously down-regulate ‘good’ HDL cholesterol as was observed e.g. in a rodent study by ISIS (antisense; significant 50% reductions; Graham et al 2007) or in a non-human primate monoclonal antibody study by Amgen (moderate 20% reductions; Chan et al 2009).

Obviously, it is still early days to speculate on the eventual competitive profile of the various candidates. With regard to safety and tolerability it is notable, however, that the anticipated highest dose with ALN-PCS in the study is 0.25mg/kg. This means that an average Caucasian may receive only about 10-20mg siRNA per week (assuming bi-weekly or monthly administration). While there is still some more uncertainty about the safety profile of non-DLinDMA SNALPs such as ALN-PCS (this candidate uses MC3 while all other SNALP candidates so far made use of DLinDMA), such low doses make me optimistic that the safety profile should be quite competitive.

Adding Tekmira’s efforts, this program is the 5^th SNALP candidate in 3 years to enter clinical development. At least two more are anticipated this year. ALN-PCS therefore further illustrates one of the advantages of RNAi Therapeutics development, namely that once there is a suitable delivery technology for a given target organ, in this case SNALP for liver delivery, the indications can be rapidly expanded to multiple drug targets. This also means that the inventor behind and manufacturer of ALN-PCS, Tekmira, should receive a milestone from its partner and licensee upon initiation of dosing, adding to an increasing royalty stream.

Tekmira Reports Important Advances in Widening Applications of SNALP RNAi Therapeutics Delivery

‘We Make RNAi Work.’

Tekmira’s slogan may sound a bit cheesy as they all do, but when you consider that it is the only company that has managed to translate the theoretically very powerful unilamellar liposome technology into the clinic and ready for commercialization while essentially everybody else is being frustrated from following up on promising early-stage results with liposomal delivery, it is a very appropriate one.

This leadership position was underlined in a recent presentation by Tekmira Pharmaceuticals at the CC-CRS meeting on May 25 (see related press release here). There, the company presented the advances it has made in widening the applications of SNALP delivery for use in major additional medical and commercial opportunities. Some of these advances were made in collaboration with large pharmaceutical/biotech companies, illustrating that Tekmira views these collaborations not only as a way to simply monetize their assets, but also as a way to grow the potential of SNALP delivery to areas such as respiratory disease (after cancer arguably the highest priority area in drug development) and targeted RNAi delivery by leveraging the partners' capabilities.

However, before reporting on the company’s advances in nebulizing and tagging SNALPs with monoclonal antibodies, the presenter made the point that more potent lipids is not what is holding it, or the field back from applying SNALP technology. Using ApoB as a target in rodents (mouse and rats), the data show that many of Tekmira’s lipids developed without Alnylam, including Alnylam’s Canadian subsidiary Al-Cana, have equal or superior potency to the MC lipids that have become one point of contention in the Tekmira-Alnylam litigation as such lipids, in addition to manufacturing, have been one of the pillars of Tekmira's gate-keeping position in SNALP delivery. For example, in the case of ApoB and the 2111 lipid 10 microgram/kg SNALP-formulated siRNA triggered more than 50% target gene suppression.

The presentation then moved on to demonstrating the progress Tekmira has made in formulating SNALP for respiratory and actively targeted delivery applications. Actually, it is formulating SNALP at commercially relevant scales that is Tekmira’s most valuable competitive asset, and this is why the unbelievable disclosures in the Amended Complaint that Alnylam abused its insights into Tekmira’s technology to misappropriate and represent formulation technology as its own are so grave (I will give it a couple of more days rest before I comment on Tekmira's Amended Complaint).

Data on the Ebola biodefense program show that the US government contract has been successfully commenced and is working just as the program was intended to work: not only is the company on track to developing a treatment for Ebola infection with the goal of filing an IND in the second half of this year, but the process has proven very valuable in maturing and bringing SNALP delivery to the next level, especially in terms of one of the most critical steps in SNALP delivery: high-quality manufacturing at commercial scale. Being able to formulate 1 kilo-gram siRNA instead of just 10 grams at a time without changing critical SNALP parameters such as size, encapsulation efficiency and poly-dispersity is enormous and means that SNALP can not only be used for running clinical trials, but can also be readily commercialized.

Data on targeted SNALP delivery showed that it is possible to decorate SNALPs with antibodies using Genentech’s defined THIOMAB antibody conjugation technology, again without compromising on critical SNALP parameters. Tissue culture data show that highly specific, targeted uptake and gene silencing can be achieved using these antibody-decorated particles. Such liposomes will have particular utility for applications outside the liver where delivery does not rely on ApoE (apparently initially an insight of Tekmira, not Alnylam as that company claims- more on this in that other blog post). I look forward to learning more about the performance of these particles in animal models, especially for cancer applications.

Another area where antibody-targeting could have utility is in the delivery of siRNA to the respiratory epithelium following nebulization. As we know, Alnylam’s ALN-RSV01 has been overshadowed by concerns that some, or even most of the antiviral activity of the nebulized naked and unmodified siRNAs may be due to innate immune stimulation. More generally, while I am convinced by now that high concentrations of naked siRNAs on the epithelial lining of the respiratory tract can achieve some target gene knockdown, to my knowledge, there has been no convincing report of RNAi knockdown through inhaled siRNA delivery robust enough to warrant clinical development.

Tekmira’s success in nebulizing SNALP particles therefore is the first critical step in opening up the respiratory space for inhaled RNAi Therapeutics (there are some strategies such as cationic lipoplexes or PEIs that can deliver to parts of the lung following systemic administration). Again, the key to success will likely come from proper formulation/manufacturing.

Using traditional LNPs, nebulization leads to gross changes in morphology, uniformity, size, and dramatic loss of encapsulation efficiency (from mid 90%s to 10%s). However, with undisclosed changes to Tekmira’s SNALP formulation, it is now possible to nebulize SNALP without changing these parameters. Tissue culture data confirm that these particles retain unchanged knockdown activity.

Altogether the presentation emphasizes that not only has Tekmira/Protiva been leading SNALP technology in the past but is continuing to do so…by a distance. It seems that in order for it and shareholders to capitalize on this leadership, more than getting the technology right, it is preventing Alnylam from using partnership status, money and PR from misappropriating the technology and representing it as its own.

Comment on referring to Tekmira’s delivery technology as SNALP versus LNP

Stable nucleic acid lipid particles (SNALPs) are a form of liposomal nanoparticle (LNP). The reason why I prefer to keep using the narrower term ‘SNALP’ when referring to Tekmira’s liposomal delivery technology instead of adopting the broader term ‘LNP’ as both Tekmira and Alnylam have done, is that the liposomes in clinical development by Tekmira and Alnylam currently and in the foreseeable future are still based on the original formulation (cationic/ionizable lipid+neutral helper lipid+PEG-lipid+siRNA), whether the cationic/ionizable lipid is a different one or whether a ligand is added or not. The term ‘SNALP’ is therefore a reminder of the innovator behind the technology, Protiva (now part of Tekmira), as they coined the term.

In a way, you would think that such terms that lack precise scientific definition anyway should not matter that much. However, in Alnylam’s efforts to marginalize Tekmira’s role in liposomal delivery, first changing from ‘SNALP’ to ‘LNP’, and then calling the newer formulations ‘second-gen LNPs’ has been an effective way of hiding ownership of the technology with the goal of eventually not only denying Tekmira contractually owed milestones and royalties, but by-passing Tekmira altogether (incl. manufacturing) also to appease partners such as Novartis and Takeda. ALN-PCS01 looks set to be the first battleground.