Myostatin inhibitor ACE-031 treatment of ambulatory boys with Duchenne muscular dystrophy: Results of a randomized, placebo-controlled clinical trial
Corresponding Author
Craig Campbell MD
Pediatrics, Epidemiology and Clinical Neurological Sciences, Western University, London, Ontario, Canada
Correspondence to: C. Campbell, B1-177, Children's Hospital, 800 Commissioners Road E, London Health Sciences Centre, London, ON N6A5W9, Canada; e-mail: [email protected]Search for more papers by this authorHugh J. McMillan MD
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
All authors contributed equally to the study.
Search for more papers by this authorJean K. Mah MD
Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
All authors contributed equally to the study.
Search for more papers by this authorMark Tarnopolsky MD
McMaster University Medical Centre, Hamilton, Ontario, Canada
All authors contributed equally to the study.
Search for more papers by this authorKathryn Selby MD
British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
All authors contributed equally to the study.
Search for more papers by this authorTy McClure PhD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorDawn M. Wilson BS
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorMatthew L. Sherman MD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorDiana Escolar MD
Kennedy Krieger Institute, Johns Hopkins Medical School, Baltimore, Maryland, USA
All authors contributed equally to the study.
Search for more papers by this authorKenneth M. Attie MD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorCorresponding Author
Craig Campbell MD
Pediatrics, Epidemiology and Clinical Neurological Sciences, Western University, London, Ontario, Canada
Correspondence to: C. Campbell, B1-177, Children's Hospital, 800 Commissioners Road E, London Health Sciences Centre, London, ON N6A5W9, Canada; e-mail: [email protected]Search for more papers by this authorHugh J. McMillan MD
Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
All authors contributed equally to the study.
Search for more papers by this authorJean K. Mah MD
Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
All authors contributed equally to the study.
Search for more papers by this authorMark Tarnopolsky MD
McMaster University Medical Centre, Hamilton, Ontario, Canada
All authors contributed equally to the study.
Search for more papers by this authorKathryn Selby MD
British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
All authors contributed equally to the study.
Search for more papers by this authorTy McClure PhD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorDawn M. Wilson BS
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorMatthew L. Sherman MD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorDiana Escolar MD
Kennedy Krieger Institute, Johns Hopkins Medical School, Baltimore, Maryland, USA
All authors contributed equally to the study.
Search for more papers by this authorKenneth M. Attie MD
Acceleron Pharma, Cambridge, Massachusetts, USA
All authors contributed equally to the study.
Search for more papers by this authorABSTRACT
Introduction: ACE-031 is a fusion protein of activin receptor type IIB and IgG1-Fc, which binds myostatin and related ligands. It aims to disrupt the inhibitory effect on muscle development and provide potential therapy for myopathies like Duchenne muscular dystrophy (DMD). Methods: ACE-031 was administered subcutaneously every 2–4 weeks to DMD boys in a randomized, double-blind, placebo-controlled, ascending-dose trial. The primary objective was safety evaluation. Secondary objectives included characterization of pharmacokinetics and pharmacodynamics. Results: ACE-031 was not associated with serious or severe adverse events. The study was stopped after the second dosing regimen due to potential safety concerns of epistaxis and telangiectasias. A trend for maintenance of the 6-minute walk test (6MWT) distance in the ACE-031 groups compared with a decline in the placebo group (not statistically significant) was noted, as was a trend for increased lean body mass and bone mineral density (BMD) and reduced fat mass. Conclusion: ACE-031 use demonstrated trends for pharmacodynamic effects on lean mass, fat mass, BMD, and 6MWT. Non–muscle-related adverse events contributed to the decision to discontinue the study. Myostatin inhibition is a promising therapeutic approach for DMD. Muscle Nerve 55: 458–464, 2017
REFERENCES
- 1 Bushby K, Finkel R, Birnkrant DJ, Case LE, Clemens PR, Cripe L, et al. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol 2010; 9: 77–93.
- 2 Emery AE. Population frequencies of inherited neuromuscular diseases—a world survey. Neuromuscul Disord 1991; 1: 19–29.
- 3 Dooley J, Gordon KE, Dodds L, MacSween J. Duchenne muscular dystrophy: a 30-year population-based incidence study. Clin Pediatr (Phila) 2010; 49: 177–179.
- 4 Eagle M, Baudouin SV, Chandler C, Giddings DR, Bullock R, Bushby K. Survival in Duchenne muscular dystrophy: improvements in life expectancy since 1967 and the impact of home nocturnal ventilation. Neuromuscul Disord 2002; 12: 926–929.
- 5 McPherron AC, Lawler AM, Lee SJ. Regulation of skeletal muscle mass in mice by a new TGF-beta superfamily member. Nature 1997; 387: 83–90.
- 6 Schuelke M, Wagner KR, Stolz LE, Hubner C, Riebel T, Komen W, et al. Myostatin mutation associated with gross muscle hypertrophy in a child. N Engl J Med 2004; 350: 2682–2688.
- 7 Grobet L, Martin LJ, Poncelet D, Pirottin D, Brouwers B, Riquet J, et al. A deletion in the bovine myostatin gene causes the double-muscled phenotype in cattle. Nat Genet 1997; 17: 71–74.
- 8 Mosher DS, Quignon P, Bustamante CD, Sutter NB, Mellersh CS, Parker HG, et al. A mutation in the myostatin gene increases muscle mass and enhances racing performance in heterozygote dogs. PLoS Genet 2007; 3: e79.
- 9 McCroskery S, Thomas M, Maxwell L, Sharma M, Kambadur R. Myostatin negatively regulates satellite cell activation and self-renewal. J Cell Biol 2003; 162: 1135–1147.
- 10 Reisz-Porszasz S, Bhasin S, Artaza JN, Shen R, Sinha-Hikim I, Hogue A, et al. Lower skeletal muscle mass in male transgenic mice with muscle-specific overexpression of myostatin. Am J Physiol Endocrinol Metab 2003; 285: E876–E888.
- 11 Lee SJ, McPherron AC. Regulation of myostatin activity and muscle growth. Proc Natl Acad Sci USA 2001; 98: 9306–9311.
- 12 Lee SJ, Reed LA, Davies MV, Girgenrath S, Goad ME, Tomkinson KN, et al. Regulation of muscle growth by multiple ligands signaling through activin type II receptors. Proc Natl Acad Sci USA 2005; 102: 18117–18122.
- 13 Bo LZ, Zhang J, Wagner KR. Inhibition of myostatin reverses muscle fibrosis through apoptosis. J Cell Sci 2012; 125: 3957–3965.
- 14 Bogdanovich S, Krag TO, Barton ER, Morris LD, Whittemore LA, Ahima RS, et al. Functional improvement of dystrophic muscle by myostatin blockade. Nature 2002; 420: 418–421.
- 15 Wagner KR, McPherron AC, Winik N, Lee SJ. Loss of myostatin attenuates severity of muscular dystrophy in mdx mice. Ann Neurol 2002; 52: 832–836.
- 16 McCroskery S, Thomas M, Platt L, Hennebry A, Nishimura T, McLeay L, et al. Improved muscle healing through enhanced regeneration and reduced fibrosis in myostatin-null mice. J Cell Sci 2005; 118: 3531–3541.
- 17 Morine KJ, Bish LT, Selsby JT, Gazzara JA, Pendrak K, Sleeper MM, et al. Activin IIB receptor blockade attenuates dystrophic pathology in a mouse model of Duchenne muscular dystrophy. Muscle Nerve 2010; 42: 722–730.
- 18 Cadena SM, Tomkinson KN, Monnell TE, Spaits MS, Kumar R, Underwood KW, et al. Administration of a soluble activin type IIB receptor promotes skeletal muscle growth independent of fiber type. J Appl Physiol 2010; 109: 635–642.
- 19 George CC, Bruemmer K, Sesti J, Stefanski C, Curtis H, Ucran J, et al. Soluble activin receptor type IIB increases forward pulling tension in the mdx mouse. Muscle Nerve 2011; 43: 694–699.
- 20 Pistilli EE, Bogdanovich S, Goncalves MD, Ahima RS, Lachey J, Seehra J, et al. Targeting the activin type IIB receptor to improve muscle mass and function in the mdx mouse model of Duchenne muscular dystrophy. Am J Pathol 2011; 178: 1287–1297.
- 21 Attie KM, Borgstein NG, Yang Y, Condon CH, Wilson DM, Pearsall AE, et al. A single ascending-dose study of muscle regulator ACE-031 in healthy volunteers. Muscle Nerve 2013; 47: 416–423.
- 22 Attie KM, Yang Y, Wilson DM, Haltom E, Sherman ML. Increased lean mass and muscle volume in healthy post-menopausal women treated with ACE-031 (soluble activin type IIB receptor), an inhibitor of myostatin and other negative regulators of muscle. Poster presentation at the American Academy of Neurology Meeting; 2011.
- 23 U.S. Department of Health and Human Services. 2010. Common terminology criteria for adverse events (CTCAE) version 4.0. http://evs.nci.nih.gov/ftp1/CtCae/CtCae_4.03_2010-06-14_quickreference_8.5x11.pdf. Accessed March 10, 2015.
- 24 Davis SE, Hynan LS, Limbers CA, Andersen CM, Greene MC, Varni JW, et al. The PedsQL in pediatric patients with Duchenne muscular dystrophy: feasibility, reliability, and validity of the Pediatric Quality of Life Inventory Neuromuscular Module and Generic Core Scales. J Clin Neuromuscul Dis 2010; 11: 97–109.
- 25 Gauld LM, Kappers J, Carlin JB, Robertson CF. Height prediction from ulna length. Dev Med Child Neurol 2004; 46: 475–480.
- 26 de Caestecker M. The transforming growth factor-b superfamily of receptors. Cytokine Growth Factor Rev 2004; 15: 1–11.
- 27 David L, Mallet C, Mazerbourg S, Feige JJ, Bailly S. Identification of BMP9 and BMP10 as functional activators of the orphan activin receptor-like kinase 1 (ALK1) in endothelial cells. Blood 2007; 109: 1953–1961.
- 28 Wagner KR, Fleckenstein JL, Amato AA, Barohn RJ, Bushby K, Escolar DM, et al. A phase I/IItrial of MYO-029 in adult subjects with muscular dystrophy. Ann Neurol 2008; 63: 561–571.
- 29 Wagner KR. Clinical application of myostatin inhibitors for neuromuscular diseases. Immun Endocrinol Metab Agents Med Chem 2010; 10: 204–210.
- 30 Relizani K, Mouisel E, Giannesini B, Hourde C, Patel K, Morales GS, et al. Blockade of ActRIIB signaling triggers muscle fatigability and metabolic myopathy. Mol Ther 2014; 22: 1423–1433.
- 31 Artaza JN, Reisz-Porszasz S, Dow JS, Kloner RA, Tsao J, Bhasin S, et al. Alterations in myostatin expression are associated with changes in cardiac left ventricular mass but not ejection fraction in the mouse. J Endocrinol 2007; 194: 63–76.
- 32 Cohn RD, Liang HY, Shetty R, Abraham T, Wagner KR. Myostatin does not regulate cardiac hypertrophy or fibrosis. Neuromuscul Disord 2007; 17: 290–296.