Over the last couple of weeks, we have seen business development activities in the RNAi space that made me realize that the modality has firmly established itself as the third drug development pillar next to antibodies and small molecules. At the same time, surviving RNAi variations DNA-directed RNAi and microRNAs are catching a bid.
Biogen and Abbvie invest
Most Big Pharma companies have a history of making
significant investments in the sector. The
early (2004-2009) significant moves by Roche, Novartis, Takeda, and Merck were not well
rewarded. This was partly because they lacked patience and the willingness
to protect early platform development from the incongruent demands from their in-house therapeutic
area groups.
Novo Nordisk got the timing right when acquiring Dicerna in late
2021. Similar to Eli Lilly (through license to Dicerna IP and subsequent in-house work), they are now well placed to capitalize on the promise of RNAi for large cardiovascular
and metabolic disease applications.
Amgen and Takeda stand to benefit from two opportunistic deals with Arrowhead Pharmaceuticals for candidates that are now in
advanced phase 3 clinical development. The RNAi agents for alpha1-antitrypsin-related liver disease (Takeda) and Lp(a) (Amgen) for
cardiovascular disease will read out as early as next year. Both companies speak highly of these
products. Amgen in particular highlights
the Lp(a) program as its most exciting development candidate in corporate presentations and I expect the
company to be back for more RNAi.
Two pharma/big biotech companies that stood out for
having watched the developments from the sidelines are Biogen and Abbvie.
Biogen has gone out of their way and tried it seems every oligonucleotide modality but RNAi. This includes RNaseH antisense and splice modulation with Ionis and Stoke Therapeutics and microRNAs with Regulus. It had done so after laughing off RNAi as a scientist’s sandbox idea when presented with it early on by Phil Sharp, scientific co-founder of both Biogen and Alnylam, and thus turned down the opportunity of a life-time to take a major stake in it.
Instead, a certain former Biogen employee, John Maraganore would go on to build Alnylam into a major biotech player with Alnylam's market cap now exceeding Biogen's. In a personal anecdote to illustrate the lack of appreciation of RNAi at Biogen at the time (2002), when I did an internship at Biogen and attended a job interview presentation there by a scientist on his RNAi work at Cold Spring Harbor, I was pretty much the only attendee not directly involved in the hiring process.
It took a leadership generation and a realization that
Biogen has become a dinosaur in the drug development industry that it recently finallyinvested $46M in a deal for a CNS target with you would not believe it: City
Therapeutics, co-founded by John Maraganore.
2 weeks before it, Abbvie did a broader collaboration
and license option agreement with ADARx for $335M upfront. Abbvie’s predecessor Abbott had dabbled a
little bit in RNAi delivery around the early RNAi bubble, but with no serious
intention behind it, really.
MicroRNA dinosaur Regulus taken out by Novartis
As with CRISPR now, the early RNAi bubble phase saw numerous start-ups not only around the core RNAi platforms, but also derivative technologies. One of them was microRNA
therapeutics, a technology targeting or mimicking the endogenous small RNAs of
the RNAi apparatus. When the RNAi industry went through the 2010-12 financial
bottleneck most of these companies either died or were well on their way.
Regulus Therapeutics co-founded in 2007 by Alnylam and
Ionis around microRNA-targeting oligonucleotides, had the good fortune of having
deep-pocketed, influential backers that eventually enabled them to doggedly progress
anti-miR17 antisense oligonucleotide farabursen for autosomal dominant
polycystic kidney disease (ADPKD) to a stage where the FDA aligned with them on
a speedy pivotal trial development plan earlier this year.
This triggered a bidding war between Novartis and an
undisclosed bidder that on April 30 resulted in a ~10x premium over its 52-week
low that will be paid by Novartis, including a $800M upfront and contingent
value rights.
DNA-directed RNAi Therapeutics create tremendous
value for uniQure
In the vibrant field of developing disease-modifying medicines for Huntington’s disease, uniQure stands out with its chance to gain FDA approval in less than a year should 3-year data replicate that seen after 2 years. This is the big regulatory news of the day for genetically-targeted therapeutic development as uniQure aligned on a path towards accelerated approval, including a comparison with an external natural history cohort. Turns out, new CBER chief Vinay Prasad is actually human and has compassion for those suffering from severe genetic diseases.
What few people are talking about is that AMT-130 is an RNAi Therapeutic. It is a DNA-directed
RNAi version where the RNAi trigger is expressed from a DNA template following
AAV delivery. The key to uniQure’s
success is that delivery is done locally by intracranial access to where the gene
suppression is thought to be required (Spronck et al 2021; cool video illustration here). In
the case of Huntington’s disease, it is the striatum; in the case of AMT-260
for mesial temporal lobe epilepsy where uniQure presented intriguing seizure
reductions in the past week, the hippocampus.
By precisely following how the target structure is
filled up with the AAV solution, potential toxicities in off-target tissues can
be avoided. Obviously a big advantage at a time when the AAV field is struggling with toxicities due to systemic administration
of large vector doses.
What is more, DNA-directed RNAi allows for durable, potentially permanent gene silencing without the need for an exogenous protein. This comes as genome editing, be it via CRISPR or Sangamo’s zinc fingers, are hammering away at solutions for gene knockdown that require exogenous protein expression. Sometimes the old ways are more elegant after all. Being out of fashion has the advantage of allowing you to build value with less friction. uniQure is about to capitalize on that in a big way.
Pure-play RNAi stocks budding during biotech
winter
All this is happening as RNAi bellwether Alnylam ($40B
market cap) is hitting new all-time highs and is about to catch up with and
likely overtake Regeneron ($53B market cap) to become the 3rd most
valuable biotech behind Amgen and Vertex Pharmaceuticals. Besides the ATTR amyloidosis opportunity,
this prices in the potential of Alnylam's pipeline to address huge markets such as Alzheimer’s and
obesity with well tolerated, infrequently administered RNAi.
Silence Therapeutics has also risen slowly, but surely
over 200% in the last 2 months. As Lp(a)
RNAi is increasingly seen as a must-have in the cardiovascular disease space,
its phase 3-ready candidate SLN360 alone could be well worth a multiple of its
current $275M market cap. Add to this its
25 year experience as a pure-play RNAi developer and inhibinE for obesity being
an easy target with their technology, Silence Therapeutics is ripe for an
acquisition.
Arrowhead Pharmaceuticals is also up over 80% in the
same period as revenues in the form of ApoCIII knockdown for high triglyceride-related
disease and co-commercialization and royalty/milestone revenues come into
closer focus. Amgen would be an obvious
candidate to make a play for Arrowhead, also because Arrowhead can now manufacture
large amounts of RNAi triggers within the US.
There are a lot of lessons to be learned from the history of RNAi Therapeutics. One is that financial bottlenecks can richly reward those that persevere, also because it creates scarcity value and reduces competition. In general, the current biotech winter which forces companies to focus on their most promising and competitive product candidates will translate into greater profitabilities down the line. In a twist of irony, as the CRISPR field is going through its own bottleneck, CRISPR Therapeutics now spending money on a non-core RNAi asset, thus keeping spend unnecessarily high and losing focus, is not what the doctor would order based on RNAi history.
I believe that as long as Trump’s trade war
does not result on a run on the US dollar pushing interest rates up, anticipation
of Fed Chief Powell’s replacement in May 2026 will allow these assets to come
to fruition in a much less capital-constrained environment for biotechs.
