Life Biosciences Reports Initial Results from the First Reprogramming Trial
Partial epigenetic reprogramming involves exposing cells to some or all of the Yamanaka factors for a long enough period of time to reset epigenetic decorations on nuclear DNA and its supporting structures to a youthful state, but not so long as to risk dedifferentiation, and thus loss of cell state and formation of induced pluripotent stem cells that can give rise to teratomas. It is a fine balance, and different cell types need different exposure times. Thus the first practical applications of reprogramming therapy under development are limited to one cell type, or small regions of tissue where greater control over delivery can be exerted. The limited options for delivery of gene therapies further restrict the options on which tissues can be targeted.
Life Biosciences sponsors the first clinical trial of a partial epigenetic reprogramming therapy, targeting degeneration of the retina and optic nerve in glaucoma patients. In animal models, reprogramming has shown itself capable of restoring function to a damaged optic nerve. Life Biosciences is using adeno-associated virus (AAV) as a vector, well proven in delivery to the retina and optic nerve via direct injection into the eye, to introduce an inducible package of Yamanaka factors into cells. Expression only occurs in the presence of doxycycline, which allows dosing of the Yamanaka factors to be tightly controlled and repeated over time as needed. AAV is effectively a permanent therapy in these tissues.
This first-in-human, Phase 1, open-label clinical trial (NCT07290244) is evaluating the safety and tolerability of ER-100 in adults with optic neuropathies. ER-100 uses controlled expression of three transcription factors, OSK (OCT4, SOX2, KLF4), delivered via a single intravitreal injection, with OSK expression induced by systemic doxycycline administered for 8 weeks (56 days). An oral prednisolone taper is administered to minimize risk of inflammation due to AAV-2 immune response. Multiple study visits assessing tolerability and visual endpoints were included in this first 56 day evaluation.
Optic neuropathies are a group of disorders characterized by damage to retinal ganglion cells (RGCs), the primary neurons connecting the eye to the brain. Because RGCs do not naturally regenerate, damage results in permanent vision impairment. One such optic neuropathy, open-angle glaucoma (OAG) is a chronic neurodegenerative disease and a leading cause of blindness in older adults. While often associated with elevated intraocular pressure, disease progression frequently continues despite treatment, and some patients suffer from OAG despite normal intraocular pressure. Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in adults over fifty. It involves sudden, painless vision loss due to insufficient blood flow, for which there are currently no approved treatments.
Interim data demonstrated that a single intravitreal administration along with daily oral doxycycline was well-tolerated through Day 56 in all three participants and showed preliminary signals of improvement in visual field testing in two participants. There were no reported dose-limiting toxicities, adverse events of special interest or serious adverse events. Improvements in Humphrey Visual Fields measurements, a standard eye exam that measures a participant's ability to detect light across many points in their field of vision, scored in decibels (dB), were observed in 2 of 3 OAG participants at Day 56. In each of these 2 participants, ≥ 28% of points in the visual fields showed a > 4 dB improvement.