Alnylam Pharmaceuticals, Cambridge, Massachusetts 02142, USA.
RNA. 2019 Feb;25(2):255-263. doi: 10.1261/rna.068916.118. Epub 2018 Nov 21.
Hereditary angioedema (HAE) is a genetic disorder mostly caused by mutations in the C1 esterase inhibitor gene (C1INH) that results in poor control of contact pathway activation and excess bradykinin generation. Bradykinin increases vascular permeability and is ultimately responsible for the episodes of swelling characteristic of HAE. We hypothesized that the use of RNA interference (RNAi) to reduce plasma Factor XII (FXII), which initiates the contact pathway signaling cascade, would reduce contact pathway activation and prevent excessive bradykinin generation. A subcutaneously administered GalNAc-conjugated small-interfering RNA (siRNA) targeting mRNA (ALN-F12) was developed, and potency was evaluated in mice, rats, and cynomolgus monkeys. The effect of FXII reduction by ALN-F12 administration was evaluated in two different vascular leakage mouse models. An ex vivo assay was developed to evaluate the correlation between human plasma FXII levels and high-molecular weight kininogen (HK) cleavage. A single subcutaneous dose of ALN-F12 led to potent, dose-dependent reduction of plasma FXII in mice, rats, and NHP. In cynomolgus monkeys, a single subcutaneous dose of ALN-F12 at 3 mg/kg resulted in >85% reduction of plasma FXII. Administration of ALN-F12 resulted in dose-dependent reduction of vascular permeability in two different mouse models of bradykinin-driven vascular leakage, demonstrating that RNAi-mediated reduction of FXII can potentially mitigate excess bradykinin stimulation. Lastly, ex vivo human plasma HK cleavage assay indicated FXII-dependent bradykinin generation. Together, these data suggest that RNAi-mediated knockdown of FXII by ALN-F12 is a potentially promising approach for the prophylactic treatment of HAE.
遗传性血管水肿(HAE)是一种遗传性疾病,主要由 C1 酯酶抑制剂基因(C1INH)的突变引起,导致接触途径激活失控和缓激肽生成过多。缓激肽增加血管通透性,最终导致 HAE 特征性的肿胀发作。我们假设使用 RNA 干扰(RNAi)来降低启动接触途径信号级联的血浆因子 XII(FXII),将减少接触途径激活并防止过度的缓激肽生成。开发了一种皮下给予的 GalNAc 缀合的针对 mRNA 的小干扰 RNA(siRNA)(ALN-F12),并在小鼠、大鼠和食蟹猴中评估了其效力。通过 ALN-F12 给药评估了 FXII 减少对两种不同血管渗漏小鼠模型的影响。开发了一种体外测定法来评估人血浆 FXII 水平与高分子量激肽原(HK)裂解之间的相关性。单次皮下给予 ALN-F12 可导致小鼠、大鼠和 NHP 血浆 FXII 产生强大的、剂量依赖性的降低。在食蟹猴中,单次皮下给予 3mg/kg 的 ALN-F12 可使血浆 FXII 降低>85%。ALN-F12 的给药导致两种不同的缓激肽驱动的血管渗漏小鼠模型中血管通透性呈剂量依赖性降低,表明 RNAi 介导的 FXII 降低可能潜在减轻过度的缓激肽刺激。最后,体外人血浆 HK 裂解测定表明 FXII 依赖性缓激肽生成。总之,这些数据表明,ALN-F12 通过 RNAi 介导的 FXII 敲低是预防治疗 HAE 的一种有前途的方法。