Trophos SA, a clinical stage pharmaceutical company developing innovative therapeutics from discovery to clinical validation for indications with under-served needs in neurology and cardiology, announces today the final patient completion of a phase II study of TR040303 in patients treated for acute myocardial infarction (MI). Outcome data of this study is expected to be available towards the end of 2013.
The Phase II proof-of-concept study has been designed to evaluate the efficacy and safety of Trophos TRO40303, a novel mitochondria pore modulator with broad cytoprotective properties, to treat cardiac ischemia-reperfusion injury (IRI) in acute myocardial infarction (MI) patients.
The clinical study is part of the FP7 collaborative MitoCare project, granted EUR 6 million by the European Commission. The project is led by Trophos and operated by a consortium of 16 European institutions specializing in clinical and basic research, biomarkers, imaging and informatics.
165 patients were enrolled in ten centers in four European countries, (France, Norway, Denmark and Sweden) in a double-blind, randomized, placebo-controlled study. Patients received an intravenous bolus of TRO40303 or matching placebo immediately preceding percutaneous coronary intervention (primary PCI) to treat a first acute STEMI.
The primary endpoint of the study is the reduction of myocardial tissue damage. The level of damage is assessed by measuring cardiac proteins, Troponin I and CK that are released into the circulation. An additional major endpoint is the measurement of infarct size as a percentage of the at-risk myocardium, expressed by myocardial salvage index. This is assessed by cardiac magnetic resonance imaging (CMR) performed between three and five days after intervention.
"Preventing mitochondrial permeability transition and subsequent tissue damage resulting from reperfusion is a promising approach to the treatment of IRI that should significantly reduce infarct size in STEMI patients," said Dr. Dan Atar MD PhD, professor of cardiology, University of Oslo, Norway and principal investigator for the study. "We look forward to sharing the clinical experience of this innovative compound and comparing CMR with plasma biomarkers as predictors of outcome in STEMI patients as soon as the results become available."
"Trophos is very pleased to report completion of the clinical part of the MitoCare study," said Wilfried Hauke MD, chief medical officer at Trophos. "TRO40303 offers a therapeutic option for the treatment of acute myocardial infarction. Further reducing the tissue damage due to reperfusion injury is expected to improve the long-term outcome in these patients."
“There are around 1.6 million cardiac reperfusion procedures performed in hospitals and specialist clinics each year in the western world alone”, said Christine Placet, CEO, Trophos. “This MitoCare program fits perfectly with Trophos strategy and pipeline of creating value by targeting niche, high unmet medical need markets.”
Cardiovascular diseases, among them acute MI, are the leading causes of death in the world today. Despite the overall improvements in the care of MI patients with efforts made to initiate PCI as early as possible, treatments that further reduce tissue damage due to reperfusion injury are needed to maximize survival of heart tissue and improve patients prognosis in terms of long-term morbidity, progression to heart failure and death following an MI.
About TRO40303 and cardiac reperfusion injury
Use of fibrinolytics and balloon angioplasty to rapidly reperfuse heart tissue with oxygen following an MI has greatly reduced morbidity and mortality. Although restoring blood flow to the heart is critical to the survival of heart tissue, paradoxically, this process may cause additional damage known as reperfusion injury, due to a burst of reactive oxygen species from mitochondria as energy production is reactivated.
TRO40303 was shown to reduce stress induced mitochondrial permeability transition, a target implicated in cardiac reperfusion injury (Schaller et al, http://www.ncbi.nlm.nih.gov/pubmed/20215409). The compound is taken up rapidly by cardiac tissue and interacts with the cholesterol uptake site of TSPO, a mitochondrial outer membrane protein that is highly expressed in heart.
In vitro studies using isolated cardiomyocytes showed that TRO40303 improved oxidative stress-induced cardiomyocyte survival. This was correlated with a reduction in reactive oxygen species production, reduced mitochondrial calcium overload and slowed triggering of mitochondrial permeability transition, reducing the release of apoptotic factors, all key events in cardiac reperfusion injury. The discovery and development of TRO40303 through Phase I was supported in part by a grant of nearly EUR 1 million from the French Agence Nationale pour la Recherche (ANR) in a project named IRIstop, (see release of February 28 2008).
About MitoCare - http://www.mitocare.eu
This clinical study is part of a FP7 collaborative project named MitoCare (Grant Agreement Number: Health-2010-261034). The European Commission EUR 6 million grant funds an international, translational medicine project led by Trophos. The MitoCare project is a consortium of ten clinical centers, three basic research centers and four SMEs (including Trophos), for a total of 16 institutional partners around Europe specializing in clinical and basic research, biomarkers, imaging and informatics. In addition to the clinical study, the MitoCare projects translational research objectives include identifying biomarkers and confounding / predictive factors in cardiac IRI in order to improve understanding and design of preclinical models of cardiac IRI, (see release of December 14 2010).
About Trophos - http://www.trophos.com
Trophos is a clinical stage pharmaceutical company developing innovative therapeutics for indications with under-served needs in neurology and cardiology. The company has a novel and proprietary cholesterol oxime based chemistry platform generating a pipeline of drug candidates, in spinal muscular atrophy, a rare neurological disease, with the lead product, olesoxime (TRO19622) currently at the end of clinical testing, for which orphan drug status has been granted by EMA and FDA. TRO40303 is the next most advanced compound and is in clinical development to treat cardiac reperfusion injury. Both compounds are members of a cholesterol-oxime family of mitochondrial pore modulators discovered by Trophos that enhance the function and survival of stressed cells via modulation of dysfunctional mitochondria through interactions with proteins forming the permeability transition pore. This target is implicated in multiple chronic and acute degenerative conditions highlighting the potential importance of mitochondria-targeted drugs, which Trophos cholesterol oxime family is uniquely placed to exploit. Trophos was founded in 1999 and is based in Marseille, France.