L i v e r P - A M P K / A M P K PXL770, a new direct … · m g / k g) 0 1 0 0 2 0 0 3 0 0 P l a s...
1
Background • Nonalcoholic fatty liver disease (NAFLD) is the most prevalent hepatic pathology in the Western world and nonalcoholic steatohepatitis (NASH) is estimated to occur in 10-30% of patients with NAFLD • The AMP-activated protein kinase (AMPK) is a central regulator of multiple metabolic pathways and may have therapeutic importances for treating NAFLD • PXL770 is a new direct AMPK activator. PXL770 is currently assessed in multiple ascending dose phase 1 study in healthy subjects. PXL770 has been shown to decrease de novo lipogenesis and to broadly improve metabolic profile in various rodent models suggesting that it could play an important role in the management of patients with NAFLD/NASH Objective The aim of this study was to assess the effects of PXL770 in a diet induced obesity NASH mouse model Methods and Design Male C57BL/6J were fed a diet high in trans fat (40%), fructose (20%) and cholesterol (2%) for a total of 41 weeks. After the diet induction period, a liver biopsy was collected to confirm steatosis and fibrosis status and to stratify the mice into diet induced obesity (DIO)-NASH groups treated per os for 8 weeks (n=12/group) with vehicle, PXL770 35 or 75 mg/kg twice daily or elafibranor (30 mg/kg daily). NAFLD activity score (NAS) and fibrosis score were determined at baseline and at the end of the treatment period based on Hematoxylin Eosin (H&E) stain and Sirius Red respectively. Plasma liver enzymes and lipids as well as liver triglycerides and liver collagen genes expression were assessed PXL770, a new direct AMP Kinase activator, demonstrates promising effects for treatment of non-alcoholic steatohepatitis Pascale Gluais-Dagorn 1 , Pascale Fouqueray 1 , Sebastien Bolze 1 , Sophie Hallakou-Bozec 1 1 Poxel, 259-261 avenue Jean Jaurès, 69007 Lyon, France PXL770 75 mg/kg Elafibranor 30 mg/kg LEAN-CHOW Vehicle DIO-NASH Vehicle PXL770 35 mg/kg LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 20 40 60 80 100 **** *** **** Liver triglyceride (mg/g liver) **** Figure 3 – DIO-NASH mice demonstrated significant elevated NAS (H&E staining) accompanied by an increase in liver triglycerides. Both PXL770 doses reduced significantly NAS (-36% and -46% p<0.001 at 35 and 75 mg/kg respectively) decreasing Steatosis, Inflammation and hepatic Ballooning. The benefit on liver steatosis was confirmed by the reduction of liver triglycerides (-36% and -42% p<0.001 at 35 and 75 mg/kg respectively) Steatosis LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 2 4 6 8 10 12 *** ** *** Number of animals Inflammation LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 2 4 6 8 10 12 Number of animals *** ** Ballooning LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 2 4 6 8 10 12 Lower Same Higher N u m b e r o f a n im a ls ** ** ** Figure 4 – DIO-NASH mice demonstrated significant elevated fibrosis score. PXL770 strongly down-regulated a panel of genes expression involved in fibrosis e.g. type I (-68%) and type III (-63%) collagen genes expression, suggesting that a longer term treatment could lead to a benefit of PXL770 on fibrosis GLOBAL NASH CONGRESS 2018 – LONDON 26-27 FEBRUARY 2018 The number of animals with a higher (worsening), same or lower (improvement) in score at post- compared to pre-study is indicated by the height of the bar. **p<0.01, ***p<0.001 vs. DIO-NASH vehicle ***p<0.001, ****p<0.0001 vs. DIO-NASH vehicle **p<0.01, ***p<0.001, ****p<0.0001 vs. DIO-NASH vehicle 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 85 90 95 100 105 Time (days) Body weight (%) * **** * * * * * *** LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 2 4 6 8 10 *** **** **** **** Plasma total cholesterol (mmol/L) LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 50 100 150 200 250 **** **** **** Plasma free fatty acids (umol/L) LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 100 200 300 **** **** **** Plasma alanine aminotransferase (U/L) **** LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 100 200 300 ** **** **** **** Plasma aspartate aminotransferase (U/L) LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0 1 2 3 4 5 *** ** **** **** Liver weight (g) Figure 1 - PXL770 increases AMPK phosphorylation in liver tissue Results LEAN-CHOW Vehicle DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0.0 0.5 1.0 1.5 2.0 2.5 **** *** **** **** Epididymal fat (g) *p<0.05, **P<0.01, ***P<0.001, ****P<0.0001 vs. DIO-NASH Vehicle Figure 2 - DIO-NASH mice demonstrated significant increase in body weight (38g vs. 29g in Lean mice, p<0.001), liver weight and epididymal fat depot weight, increase in levels of plasma cholesterol and free fatty acids (FFA) and levels of liver enzymes. PXL770 slightly reduced body weight at the highest dose (-5%) and reduced liver and epididymal fat depot weights at both doses. PXL770 decreased significantly plasma cholesterol and FFA as well as liver enzymes, ALT and AST Plasma Total Cholesterol Plasma Free Fatty Acids *p<0.05, **P<0.01 vs. DIO-NASH Vehicle Plasma ALT Plasma AST Epididymal fat weight Liver weight DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL 770 (35 mg/kg) PXL 770 (75 mg/kg) 0 2 4 6 8 NAS **** **** **** ****p<0.0001 vs. DIO-NASH vehicle Liver TG -33% -34% -37% -38% -68% -79% -52% -61% -23% -33% -25% -37% Representative liver H&E stained section from lean-chow and DIO-NASH mouse treated with vehicle and DIO-NASH mouse treated with elafibranor (30 mg/kg/d) or PXL770 (35 or 75 mg/kg twice daily) DIO-NASH Vehicle Elafibranor (30 mg/kg) PXL770 (35 mg/kg) PXL770 (75 mg/kg) 0.0 0.1 0.2 0.3 0.4 0.5 Liver P-AMPK/AMPK P-AMPK/AMPK (A.U./100μg proteins) 128% 100% 108% *** 143% * Conclusion In this DIO-NASH mouse model, PXL770 by directly activating AMPK: • Improved metabolic parameters (plasma cholesterol, FFA, liver enzymes) • Reduced liver weight and epididymal fat depot weight • Reduced NAFLD activity score and liver triglycerides content • Reduced fibrotic genes expression According to these results, PXL770 appears promising for the treatment of NAFLD/NASH
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Transcript of L i v e r P - A M P K / A M P K PXL770, a new direct … · m g / k g) 0 1 0 0 2 0 0 3 0 0 P l a s...
Background• Nonalcoholic fatty liver disease (NAFLD) is the most prevalent hepatic
pathology in the Western world and nonalcoholic steatohepatitis(NASH) is estimated to occur in 10-30% of patients with NAFLD
• The AMP-activated protein kinase (AMPK) is a central regulator ofmultiple metabolic pathways and may have therapeutic importancesfor treating NAFLD
• PXL770 is a new direct AMPK activator. PXL770 is currently assessed inmultiple ascending dose phase 1 study in healthy subjects. PXL770has been shown to decrease de novo lipogenesis and to broadlyimprove metabolic profile in various rodent models suggesting that itcould play an important role in the management of patients withNAFLD/NASH
ObjectiveThe aim of this study was to assess the effects of PXL770 in a diet inducedobesity NASH mouse model
Methods and DesignMale C57BL/6J were fed a diet high in trans fat (40%), fructose (20%) and cholesterol (2%) fora total of 41 weeks. After the diet induction period, a liver biopsy was collected to confirmsteatosis and fibrosis status and to stratify the mice into diet induced obesity (DIO)-NASHgroups treated per os for 8 weeks (n=12/group) with vehicle, PXL770 35 or 75 mg/kg twicedaily or elafibranor (30 mg/kg daily). NAFLD activity score (NAS) and fibrosis score weredetermined at baseline and at the end of the treatment period based on Hematoxylin Eosin(H&E) stain and Sirius Red respectively. Plasma liver enzymes and lipids as well as livertriglycerides and liver collagen genes expression were assessed
PXL770, a new direct AMP Kinase activator, demonstrates
promising effects for treatment of non-alcoholic steatohepatitisPascale Gluais-Dagorn1, Pascale Fouqueray1, Sebastien Bolze1, Sophie Hallakou-Bozec1
1Poxel, 259-261 avenue Jean Jaurès, 69007 Lyon, France
PXL770 75 mg/kgElafibranor 30 mg/kg
LEAN-CHOW Vehicle DIO-NASH Vehicle PXL770 35 mg/kg
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2 0
4 0
6 0
8 0
1 0 0
R e l a t i v e l i v e r T G
* * * *
* * *
* * * *
Liv
er t
rig
lyc
erid
e (
mg
/g l
ive
r)
* * * *
Figure 3 – DIO-NASH mice demonstrated significant elevated NAS (H&E staining)accompanied by an increase in liver triglycerides.Both PXL770 doses reduced significantly NAS (-36% and -46% p<0.001 at 35 and 75mg/kg respectively) decreasing Steatosis, Inflammation and hepatic Ballooning.The benefit on liver steatosis was confirmed by the reduction of liver triglycerides (-36%and -42% p<0.001 at 35 and 75 mg/kg respectively)
S t e a t o s i s
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2
4
6
8
1 0
1 2
* * *
* *
* * *
Nu
mb
er o
f a
nim
als
I n f l a m m a t i o n
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2
4
6
8
1 0
1 2
Nu
mb
er o
f a
nim
als
* * *
* *
B a l l o o n i n g
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2
4
6
8
1 0
1 2
L o w e r
S a m e
H i g h e r
Nu
mb
er o
f a
nim
als * * * * * *
Body weight
Figure 4 – DIO-NASH mice demonstrated significant elevated fibrosis score.PXL770 strongly down-regulated a panel of genes expression involved in fibrosise.g. type I (-68%) and type III (-63%) collagen genes expression, suggesting that alonger term treatment could lead to a benefit of PXL770 on fibrosis
Plasma ALT Plasma AST
GLOBAL NASH CONGRESS 2018 – LONDON 26-27 FEBRUARY 2018
The number of animals with a higher (worsening), same or lower (improvement) in score at post-compared to pre-study is indicated by the height of the bar. **p<0.01, ***p<0.001 vs. DIO-NASH vehicle
***p<0.001, ****p<0.0001 vs. DIO-NASH vehicle
**p<0.01, ***p<0.001, ****p<0.0001vs. DIO-NASH vehicle
0 4 8 1 2 1 6 2 0 2 4 2 8 3 2 3 6 4 0 4 4 4 8 5 2 5 6
8 5
9 0
9 5
1 0 0
1 0 5
T im e ( d a y s )
B
od
y w
eig
ht (%
)
* * * * *
* **
*
* * * *
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2
4
6
8
1 0
P l a s m a T C
* * *
* * * * * * * *
* * * *
Pla
sm
a to
ta
l c
ho
les
te
ro
l (m
mo
l/L
)
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
5 0
1 0 0
1 5 0
2 0 0
2 5 0
P l a s m a F F A
* * * * * * * * * * * *
Pla
sm
a fre
e fa
tty
a
cid
s (u
mo
l/L
)
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
1 0 0
2 0 0
3 0 0
P l a s m a A L T
* * * *
* * * *
* * * *
Pla
sm
a a
lan
ine
am
ino
tra
ns
fera
se
(U
/L)
* * * *
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
1 0 0
2 0 0
3 0 0
P l a s m a A S T
* *
* * * *
* * * *
* * * *
Pla
sm
a a
sp
arta
te a
min
otr
an
sfe
ra
se
(U
/L)
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
1
2
3
4
5
L i v e r w e i g h t
* * *
* *
* * * *
* * * *
Liv
er w
eig
ht
(g
)
Figure 1 - PXL770 increases AMPK phosphorylation in liver tissue
Results
LE
AN
- CH
OW
Ve
hi c
l e
DI O
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0 . 0
0 . 5
1 . 0
1 . 5
2 . 0
2 . 5
E p i d i d y m a l f a t w e i g h t
* * * *
* * *
* * * *
* * * *
Ep
idid
ym
al
fa
t (g
)
*p<0.05, **P<0.01, ***P<0.001, ****P<0.0001 vs. DIO-NASH Vehicle
Figure 2 - DIO-NASH mice demonstrated significant increase in body weight(38g vs. 29g in Lean mice, p<0.001), liver weight and epididymal fat depotweight, increase in levels of plasma cholesterol and free fatty acids (FFA) andlevels of liver enzymes. PXL770 slightly reduced body weight at the highestdose (-5%) and reduced liver and epididymal fat depot weights at both doses.PXL770 decreased significantly plasma cholesterol and FFA as well as liverenzymes, ALT and AST
Plasma Total Cholesterol Plasma Free Fatty Acids
*p<0.05, **P<0.01 vs. DIO-NASH Vehicle
Plasma ALT Plasma AST
Epididymal fat weightLiver weight
DIO
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0
2
4
6
8
NA
S
* * * *
* * * *
* * * *
****p<0.0001 vs. DIO-NASH vehicle
Liver TG
-33% -34%-37% -38%
-68%
-79%
-52%-61%
-23%-33%
-25%
-37%
Representative liver H&E stained section from lean-chow and DIO-NASH mouse treated with vehicle and DIO-NASH mouse treated with elafibranor (30 mg/kg/d) or PXL770 (35 or 75 mg/kg twice daily)
DIO
- NA
SH
Ve
hi c
l e
El a
f ib
r an
or
( 30
mg
/ kg
)
PX
L7
70
(3
5 m
g/ k
g)
PX
L7
70
(7
5 m
g/ k
g)
0 . 0
0 . 1
0 . 2
0 . 3
0 . 4
0 . 5 L i v e r P - A M P K / A M P K
P-A
MP
K/A
MP
K (
A.U
./1
00
µg
pro
tein
s)
1 2 8 %
1 0 0 %
1 0 8 %
* * *
1 4 3 %
*
ConclusionIn this DIO-NASH mouse model, PXL770 by directly activating AMPK:
• Improved metabolic parameters (plasma cholesterol, FFA, liverenzymes)
• Reduced liver weight and epididymal fat depot weight
• Reduced NAFLD activity score and liver triglycerides content
• Reduced fibrotic genes expression
According to these results, PXL770 appears promising for thetreatment of NAFLD/NASH
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