| Mitochondrial
Antioxidant Mitoquinone (MitoQ) May Reduce Liver Necroinflammation in Patients
with Chronic Hepatitis C By
Liz Highleyman In
people with hepatitis C, oxidative stress associated
with chronic viral infection is thought to be one of the mechanisms underlying
liver damage, which ultimately can progress to advanced fibrosis
or cirrhosis.
Since
only about half of all hepatitis C patients treated with pegylated
interferon plus ribavirin achieve a "cure," or sustained virological
response, there remains an urgent need for therapies that can slow, halt, or reverse
liver damage. At
the 43rd annual meeting of the European Association for
the Study of the Liver (EASL 2008) last month in Milan, investigators reported
results from a study of mitoquinone in chronic hepatitis C patients with elevated
liver enzyme levels. Mitoquinone,
being developed by Antipodean Pharmaceuticals, is a novel oral antioxidant that
covalently bonds with coenzyme Q10, causing the antioxidant to accumulate several-hundred
fold within the mitochondria (energy-producing structures within the cells) thereby
protecting them from oxidative damage and apoptosis (cell death). Several in
vitro and animal models of cell injury have demonstrated that mitoquinone
is more potent than non-selective antioxidants in preventing apoptosis due to
oxidative stress. The
researchers conducted a Phase II study to assess the effect of mitoquinone on
serum aminotransferase (ALT and AST) and HCV RNA levels. In this small trial,
30 hepatitis C patients were randomly assigned to receive 40 mg or 80 mg once-daily
mitoquinone or else placebo for 28 days. Participants had elevated ALT (2 to 10
x ULN) and Metavir stage F0-F2 fibrosis at baseline, and were either prior non-responders
or unsuitable for interferon-based therapy. Participants
were assessed at days 3, 7, 10, 14, 18, 21, and 28 during treatment, and at days
35, 42, and 56 in the post-treatment follow-up period. The last subject completed
treatment in November 2007. The primary endpoint was percentage change in serum
ALT from baseline to day 28. Results
Mitoquinone
was well tolerated, with no serious adverse events reported.
ALT declined
significantly from baseline in the mitoquinone arm, both in terms of absolute
level and percentage change (P < 0.05).
The ALT decline
in the mitoquinone arm was greater than in the placebo group (45 vs 9 U/L; P =
0.054).
Conclusion "These
results suggest that mitoquinone may reduce necroinflammation in HCV infection,"
the investigators concluded. They
added that, "Larger, longer duration studies are planned to determine the
role of mitoquinone in prevention of fibrosis progression in patients with chronic
liver disease." Liver Transplant Unit, Auckland City Hospital,
Auckland, New Zealand; Department of Gastroenterology, Waikato Hospital, Hamilton,
New Zealand; Antipodean Pharmaceuticals, Auckland, New Zealand; Mitochondrial
Dysfunction Group, MRC Dunn Human Nutrition Unit, Cambridge, UK; Department Of
Chemistry, Otago University, Dunedin, New Zealand; Department of Medicine, Otago
University, Christchurch, New Zealand. Below
is an edited excerpt of a recent press release from Antipodean Pharmaceuticals
announcing the results presented at EASL: Antipodean
Pharmaceuticals Announces Results of Phase 2 Study of Lead Compound MitoQ April
24, 2008 -- San Francisco, CA -- Antipodean Pharmaceuticals, Inc. announced today,
at the European Meeting for the Study of the Liver (EASL), the positive results
of a Phase 2 trial of its lead compound MitoQ (mitoquinone) in liver disease.
The trial, conducted by Dr. Edward Gane, Associate Professor of Medicine, New
Zealand Liver Transplant Unit at Auckland City Hospital, successfully met the
primary clinical endpoint, the reduction of elevated liver enzymes.
In
the 28-day trial, 30 patients with the hepatitis C virus (HCV) were enrolled to
study the effects of MitoQ on elevated liver enzymes. Researchers measured patients'
baseline levels of aminotransferase (ALT), an enzyme released into the blood that
indicates damage to the liver. The double-blind trial randomized patients to one
of three treatment groups: MitoQ 40 mg/day, MitoQ 80 mg/day, or placebo. The primary
endpoint was the reduction of levels of ALT.
Patients who received MitoQ
showed a significant decrease in ALT levels at the end of the study compared with
baseline levels. The decrease from baseline was 26.4% (P<0.002) for patients
in the 40 mg dose group, and 28% (P<0.05) for patients in the 80 mg dose group.
These results suggest that MitoQ can reduce necroinflammation and may halt disease
progression to fibrosis or cirrhosis.
The drug was well tolerated with
no significant safety issues. Commonly reported adverse events (AEs) included
nausea, headache and vomiting, which were usually mild and well tolerated. Only
one patient withdrew from the study due to nausea. There were no significant laboratory
or ECG abnormalities observed and no serious adverse events (SAEs) were reported.
"In patients with chronic liver disease, including the two patient
populations with the largest unmet need -- patients with chronic hepatitis C,
who have failed current standard of care, and patients with non-alcoholic fatty
liver disease (NAFLD) -- there are currently no therapeutic options available
to prevent progression to cirrhosis, liver failure and liver cancer," stated
Dr. Gane. "In the future, these patients may benefit from maintenance therapy
with interventions such as MitoQ, which block either hepatic necroinflammation
or fibrogenesis."
"In the coming year, Antipodean plans to explore
and develop its lead compound for the treatment of hepatological diseases, particularly
non-alcoholic fatty liver disease," said Ken Taylor, PhD, Chief Executive
Officer of Antipodean Pharmaceuticals. "The company is actively seeking to
achieve this goal with the help of a pharmaceutical partner."
A 12-month
study in patients in Parkinson's disease showed MitoQ to be well tolerated; however,
there was no significant effect on disease progression. Dr. Barry Snow, Department
of Neurology, Auckland Hospital, New Zealand, and Principal Investigator of the
trial of MitoQ in Parkinson's disease, believes that the lack of efficacy in Parkinson's
Disease may have been due to the large number of impaired cells in that disease;
these cells may have had limited or no ability to regenerate, and thus could not
benefit from MitoQ's antioxidant properties. The company believes MitoQ has therapeutic
potential in diseases where cell regeneration occurs, such as hepatological and
dermatological disorders.
About MitoQ
MitoQ
is a mitochondria-targeted antioxidant that selectively blocks mitochondrial oxidative
damage and prevents liver cell apoptosis. MitoQ is based on a novel technology,
targeted lipophilic cations that transport and concentrate antioxidants into the
mitochondria -- organelles inside cells that provide energy for life processes
-- where they accumulate up to a thousand fold. Targeted antioxidants can reduce
the hepatic oxidative damage that is induced by viral infection and that is also
involved in the progression of NAFLD through to NASH, leading to fibrosis or cirrhosis.
About
Antipodean
Antipodean
is a clinical-stage pharmaceutical company developing targeted molecules that
prevent oxidative damage to endothelial, epithelial and liver cells leading to
apoptosis and fibrosis. The company is developing a mitochondria-targeted antioxidant,
MitoQ (mitoquinone mesylate), for the treatment of hepatic inflammatory disorders
caused by oxidative stress such as nonalcoholic fatty liver disease (NAFLD) and
nonalcoholic steatohepatitis (NASH). The company's business plan is to develop
drugs to the point of proof of principle and then partner further development.
Antipodean has research collaborations with pre-clinical and clinical investigators
in Cambridge, U.K., Auckland, New Zealand, and several centers in the U.S. to
identify and develop lead compounds through to clinical proof-of-principle. Currently
the Company's lead compounds target liver and skin diseases. Antipodean is located
in San Francisco, California. |
Further
information is available at www.antipodeanpharma.com.
5/13/08
Reference EJ
Gane, DW Orr, F Weilert, and others. Phase II study of the mitochondrial antioxidant
mitoquinone for hepatitis C. 43rd annual meeting of the European Association for
the Study of the Liver (EASL 2008). Milan, Italy. April 23-27, 2008.
Additional
Source Antipodean Pharmaceuticals. Antipodean Pharmaceuticals Announces
Results of Phase 2 Study of Lead Compound MitoQ. Press release. April 24,
2008. |