Contact Activation Inhibitor and Factor XI Antibody, AB023, Produces Safe, Dose-Dependent Anticoagulation in a Phase 1 First-In-Human Trial

Christina U. Lorentz, Norah G. Verbout, Michael Wallisch, Matthew W. Hagen, Joseph J. Shatzel, Sven R. Olson, Cristina Puy, Monica Hinds, Owen McCarty, David Gailani, Andras Gruber, Erik Tucker

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective- Factor XI (FXI) contributes to thrombotic disease while playing a limited role in normal hemostasis. We generated a unique, humanized anti-FXI antibody, AB023, which blocks factor XIIa-mediated FXI activation without inhibiting FXI activation by thrombin or the procoagulant function of FXIa. We sought to confirm the antithrombotic activity of AB023 in a baboon thrombosis model and to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics in healthy adult subjects. Approach and Results- In a primate model of acute vascular graft thrombosis, AB023 reduced platelet and fibrin accumulation within the grafts by >75%. To evaluate the safety of AB023, we performed a first-in-human study in healthy adult volunteers without any serious adverse events. Overall, 10 of 21 (48%) subjects experienced 20 treatment-emergent adverse events, with 7 of 16 (44%) subjects following active treatment and 3 of 5 (60%) subjects following placebo. AB023 did not increase bleeding or prothrombin times. Anticoagulation was verified by a saturable ≈2-fold prolongation of the partial thromboplastin time for over 1 month after the highest dose. Conclusions- AB023, which inhibits contact activation-initiated blood coagulation in vitro and experimental thrombus formation in primates, produced a dose-dependent duration of limited anticoagulation without drug-related adverse effects in a phase 1 trial. When put in context with earlier observations suggesting that FXI contributes to venous thromboembolism and cardiovascular disease, although contributing minimally to hemostasis, our data further justify clinical evaluation of AB023 in conditions where contact-initiated FXI activation is suspected to have a pathogenic role. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT03097341.

Original languageEnglish (US)
Pages (from-to)799-809
Number of pages11
JournalArteriosclerosis, thrombosis, and vascular biology
Volume39
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Factor XI
Antibodies
Thrombosis
Hemostasis
Primates
Healthy Volunteers
Factor XIIa
Transplants
Safety
Bleeding Time
Partial Thromboplastin Time
Papio
Prothrombin Time
Venous Thromboembolism
Blood Coagulation
Fibrin
Thrombin
Blood Vessels
Cardiovascular Diseases
Blood Platelets

Keywords

  • factor XI
  • factor XII
  • hemostasis
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Contact Activation Inhibitor and Factor XI Antibody, AB023, Produces Safe, Dose-Dependent Anticoagulation in a Phase 1 First-In-Human Trial. / Lorentz, Christina U.; Verbout, Norah G.; Wallisch, Michael; Hagen, Matthew W.; Shatzel, Joseph J.; Olson, Sven R.; Puy, Cristina; Hinds, Monica; McCarty, Owen; Gailani, David; Gruber, Andras; Tucker, Erik.

In: Arteriosclerosis, thrombosis, and vascular biology, Vol. 39, No. 4, 01.04.2019, p. 799-809.

Research output: Contribution to journalArticle

Lorentz, Christina U. ; Verbout, Norah G. ; Wallisch, Michael ; Hagen, Matthew W. ; Shatzel, Joseph J. ; Olson, Sven R. ; Puy, Cristina ; Hinds, Monica ; McCarty, Owen ; Gailani, David ; Gruber, Andras ; Tucker, Erik. / Contact Activation Inhibitor and Factor XI Antibody, AB023, Produces Safe, Dose-Dependent Anticoagulation in a Phase 1 First-In-Human Trial. In: Arteriosclerosis, thrombosis, and vascular biology. 2019 ; Vol. 39, No. 4. pp. 799-809.
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abstract = "Objective- Factor XI (FXI) contributes to thrombotic disease while playing a limited role in normal hemostasis. We generated a unique, humanized anti-FXI antibody, AB023, which blocks factor XIIa-mediated FXI activation without inhibiting FXI activation by thrombin or the procoagulant function of FXIa. We sought to confirm the antithrombotic activity of AB023 in a baboon thrombosis model and to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics in healthy adult subjects. Approach and Results- In a primate model of acute vascular graft thrombosis, AB023 reduced platelet and fibrin accumulation within the grafts by >75{\%}. To evaluate the safety of AB023, we performed a first-in-human study in healthy adult volunteers without any serious adverse events. Overall, 10 of 21 (48{\%}) subjects experienced 20 treatment-emergent adverse events, with 7 of 16 (44{\%}) subjects following active treatment and 3 of 5 (60{\%}) subjects following placebo. AB023 did not increase bleeding or prothrombin times. Anticoagulation was verified by a saturable ≈2-fold prolongation of the partial thromboplastin time for over 1 month after the highest dose. Conclusions- AB023, which inhibits contact activation-initiated blood coagulation in vitro and experimental thrombus formation in primates, produced a dose-dependent duration of limited anticoagulation without drug-related adverse effects in a phase 1 trial. When put in context with earlier observations suggesting that FXI contributes to venous thromboembolism and cardiovascular disease, although contributing minimally to hemostasis, our data further justify clinical evaluation of AB023 in conditions where contact-initiated FXI activation is suspected to have a pathogenic role. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT03097341.",
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AU - Wallisch, Michael

AU - Hagen, Matthew W.

AU - Shatzel, Joseph J.

AU - Olson, Sven R.

AU - Puy, Cristina

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AU - Gruber, Andras

AU - Tucker, Erik

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