New Study from Neuvivo
On March 30, 2023, Neuvivo – a private Company, announced the publication of a peer-reviewed paper in ‘Cells‘ titled: “Regulation of the Innate Immune System as a Therapeutic Approach to Supporting Respiratory Function in ALS”.
The biomarker study used vital capacity (VC), a quantitative test for respiratory function, to highlight the relationship between a compromised innate immune system and ALS disease activity.
Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous, currently terminal neurodegenerative disease, involving progressive loss of voluntary muscle function. The disease typically leads to death in 2-5 years, generally due to respiratory failure.
In the Study
NP001 demonstrated a significant positive impact on respiratory activity by augmenting the natural function of the innate immune system.
- The study evaluated data and newly obtained biomarker results from patients who were enrolled in the NP001 Phase 2 placebo-controlled 6-month clinical trial (Jan 2011-Nov 2012 at 17 sites in the US).
Patients under 65 years old receiving 2mg/kg NP001 treatment, plus placebo arms, who completed the 6-month trial and had accessible plasma from baseline and at end of trial (stored at -80) were included.
- The study, in accordance with FDA guidance published in 2019, defined a subgroup of patients that responded clinically to NP001.
The objective was to test whether regulation of the innate immune system with NP001 would be associated with effects on respiratory vital capacity.
Role of CRP and the Immune System
Patients in this vital capacity study were stratified based on plasma levels of a well-known marker of inflammation, C-reactive protein (CRP). Levels defined patients as “high CRP” and “low CRP” (CRP levels of under 3mg/L are typically considered within normal range, thus a 1.13mg/L level would not generally cause concern).
CRP plays an important role in the body clearing misfolded proteins, dying cells and infectious agents as part of a normal innate immune system response. Once stimuli that caused the inflammatory response have been cleared, CRP levels in a healthy person return to normal.
An ongoing elevated plasma CRP level indicates that there is disturbance of the cycle, such that the inflammatory response does not resolve.
In the study reported by McGrath and colleagues at UCSF and Neuvivo in “Cells”, data showed that patients treated with NP001 and with high CRP were able to better maintain lung function – treated patients had a 64% slower rate of vital capacity loss than patients on placebo.
These observations showed that patients with high CRP had stable vital capacity, leading to the possibility that high CRP values may be a biomarker for an immune system that is engaged but has been compromised.
Key points presented in the study.
- NP001-treated patients with high CRP lost 0.75% of vital capacity per month
- Placebo group patients with high CRP lost 2.1% of vital capacity per month
- These data represent a 64% slower rate of decline in high CRP patients receiving NP001.
- Importantly, plasma TGFB1, a dominant regulator of inflammation, was 95% higher after 6 months in high CRP treated patients compared with controls.
The 95% increase in plasma TGFB1 that occurred after treatment with NP001 vs placebo and the elevated level of this factor one month after the last dose of treatment, suggests that NP001 may have acted in part to reset the innate immune system.
Vital Capacity and Inflammation
Recent studies of ALS pathogenesis confirmed that inflammation caused by misfolded proteins such as SOD1 and TDP-43, begins at the neuromuscular junction (NMJ) and involves innate immune system activated macrophages. When the immune system is dysfunctional, inflammation in this area compromises the phrenic nerve – the nerve responsible for supplying motor signals to the diaphragm, essential for breathing. Vital capacity tests objectively assess the operation of the NMJ between the phrenic nerve and the diaphragm – potentially linking innate immune function with a measurable, survival-associated clinical outcome.
Michael McGrath, MD, PhD, CSO Neuvivo and Professor Emeritus of Medicine, UCSF informs, “In terms of immune system regulation, the presence of high CRP (plasma level > 1.13 mg/kg) is a strong signal that the innate immune system, including other acute phase reactants, is engaged, and trying to regulate an inflammatory process, contributing to ALS pathogenesisNP001 treatment acts to augment the naturally occurring immune response and supports resolution of the CRP-mediated process related to ongoing loss of respiratory function. Data regarding treatment initiation and effect on vital capacity confirm that respiratory function is measurably failing early in the disease course as NP001 slows VC loss early on. These observations are important even if vital capacity is near normal at date of diagnosis. Given its objectivity, the VC test used as a biomarker may allow for the direct evaluation of innate immune activity in relation to ALS disease progression.”
Ari Azhir, PhD, CEO, Neuvivo said, “Results of this study demonstrate the role of the innate immune system in ALS pathogenesis and importantly, in the maintenance of respiratory capacity. Given elevated levels of necessary anti-inflammatory proteins induced well after dosing, we postulate it may be possible to regulate immune function to the point where no further damage would be forthcoming in patients adequately controlled with NP001 treatment. A notable area of interest would be in additional neurodegenerative diseases with evidence of CRP elevation.”
Link to Study in Cells: Cells | Free Full-Text | Regulation of the Innate Immune System as a Therapeutic Approach to Supporting Respiratory Function in ALS (mdpi.com) – McGrath, et al.
Editor’s Note: The macrophage is the most primordial cell in the innate immune system. It is a type of white blood cell involved in the functioning of the inflammation-resolution cycle. Normally, in response to infection/activation, a subset of macrophages become inflammatory, and another subset become wound healing to maintain immune activation equilibrium. In ALS, the process is compromised, resulting in unchecked inflammation. Macrophage-targeted treatment with NP001 restores the innate immune activation balance.
Neuvivo is a private, late-clinical stage biopharmaceutical company developing advanced treatments for ALS and other neurodegenerative diseases. The company was formed by industry leaders and scientists, focused on improving the prognosis for patients diagnosed with ALS and a range of diseases for which few current treatment options exist. Lead candidate NP001 has been shown to be effective in a large subset of people living with ALS and has an exceptional safety profile. Neuvivo is working to make this treatment broadly available to patients as soon as possible.
For people interested in learning more about Neuvivo please visit www.Neuvivo.com.