A Three-Part, Randomised Study to Investigate the Safety, Tolerability, Pharmacokinetics and Mode of Action of BC 007, Neutraliser of Pathogenic Autoantibodies Against G-Protein Coupled Receptors in Healthy, Young and Elderly Subjects

Abstract

Background and objective: BC 007 is a substance with a novel and innovative mode of action for the first-time causal treatment of chronic heart failure, associated with the occurrence of autoantibodies against the β1-adrenoceptor, and other diseases of mostly the heart and vascular system, being accompanied by the occurrence of functionally active agonistic autoantibodies against G-protein-coupled receptors (_fGPCR-AAb). The proposed mechanism of action of BC 007 is the neutralisation of these pathogenic autoantibodies which stimulate the respective receptor. To evaluate the safety, tolerability, pharmacokinetics and mode of action of BC 007, single intravenous infusions of increasing concentration were given to healthy young males and healthy elderly autoantibody-negative and autoantibody-positive participants of both sexes.

Methods: This study was subdivided into three parts. Part A was a single-centre, randomised, double-blind, placebo-controlled safety and tolerability study including healthy young male autoantibody-negative Whites (N = 23) and Asians (N = 1), testing doses of 15, 50 and 150 mg BC 007 (Cohorts 1-3) and elderly male and female Whites (N = 8), testing a dose of 150 mg BC 007 (Cohort 4), randomly assigned in a 3:1 ratio to BC 007 or placebo. Open-label Part B included _fGPCR-AAb-positive subjects (50 and 150 mg BC 007, Cohorts 1 and 2, respectively). Open-label Part C included _fGPCR-AAb-positive subjects for testing doses of 300, 450, 750, 1350 mg and 1900 mg BC 007. Lower doses were either given as an infusion or divided into a bolus plus infusion up to a dose of 300 mg followed by a constant bolus of 150 mg up to a dose of 750 mg, while at doses of 1350 mg and 1900 mg it was a slow infusion with a constant infusion rate. Infusion times increased with increasing dose from 20 min (15, 50 or 150 mg) to 40 min (300, 450 or 750 mg), 75 min (1350 mg) and 105 min (1900 mg).

Results: The mean observed BC 007 area under the concentration-time curve (AUC_0-24) increased with increasing dose in a dose proportional manner (slope estimate of 1.039). No serious adverse events were observed. Drug-related adverse events were predominantly the expected mild-to-moderate increase in bleeding time (aPTT), beginning with a dose of 50 mg, which paralleled the infusion and returned to normal shortly after infusion. _fGPCR-AAb neutralisation efficiency increased with increasing dose and was achieved for all subjects in the last cohort.

Conclusion: BC 007 is demonstrated to be safe and well tolerated. BC 007 neutralised _fGPCR-AAb, showing a trend for a dose-response relationship in elderly healthy but _fGPCR-AAb-positive subjects. CLINICALTRIALS.

Gov registration number: NCT02955420.

Fig. 1

Study design. FUP follow up period, i.v. intravenous, N number of participants, PK pharmacokinetic, _fGPCR-AAb functionally active agonistic autoantibodies against G-protein-coupled receptors

Fig. 2

Mean plasma BC 007 concentration–time profiles of Part A, bolus with infusion (inf): solid curve; infusion only: dotted curve; subjects who received the infusion with a bolus component, 50% of the total dose was delivered as a bolus and the remainder infused over 20 min; infusion was delivered over 20 min. a Cohort 1 (15 mg BC 007, 6 young males _fGPCR-AAb-negative), b Cohort 2 (50 mg BC 007, 6 young males _fGPCR-AAb-negative), c Cohort 3 (150 mg BC 007, 6 young males _fGPCR-AAb-negative), d Cohort 4 (150 mg BC 007, 6 elderly males and females _fGPCR-AAb-negative). Error bars indicate the standard deviation. LOQ limit of quantification (5 ng/mL), _fGPCR-AAb functionally active agonistic autoantibodies against G-protein-coupled receptors

Fig. 3

Mean plasma BC 007 concentration–time profiles of Part B, bolus with infusion (inf): solid curve; infusion only: dotted curve; in subjects who received the infusion with a bolus component, 50% of the total dose was delivered as a bolus and the remainder infused over 20 min; infusion was delivered over 20 min. a Cohort 1 (50 mg BC 007, 6 elderly males and females _fGPCR-AAb-positive), b Cohort 2 (150 mg BC 007, 6 elderly males and females _fGPCR-AAb positive). Error bars indicate the standard deviation. LOQ limit of quantification (5 ng/mL), _fGPCR-AAb functionally active agonistic autoantibodies against G-protein-coupled receptors

Fig. 4

Mean plasma BC 007 concentration–time profiles of Part C, bolus with infusion (inf): solid curve; infusion only: dotted curve, in subjects who received the infusion with a bolus component, 150 mg BC 007 was delivered as a bolus and the remainder infused over 40 min. All cohorts comprised six elderly male and female _fGPCR-AAb-positive participants. a Cohort 1 (300 mg BC 007 in total, bolus 150 mg, infusion time 40 min), b Cohort 2 (450 mg BC 007 in total, bolus 150 mg, infusion time 40 min). c Cohort 3 (750 mg BC 007 in total, bolus 150 mg, infusion time 40 min). d Cohort 4 (1350 mg BC 007 infusion only, infusion time 75 min). e Cohort 5 (1900 mg BC 007 infusion only, infusion time 105 min). Error bars indicate the standard deviation. LOQ limit of quantification (5 ng/mL), _fGPCR AAb functionally active agonistic autoantibodies against G-protein-coupled receptors

Fig. 5

Relationship between BC 007 dose and mean area under the concentration–time curve (0–24 h; AUC_(0–24)) following single intravenous infusions

Fig. 6

Mean plasma concentration–time profiles of 3′-exonuclease degradation products of BC 007 at the applied dose of 1900 mg