Preclinical Development of a Novel Therapeutic to Rejuvenate Aging Muscle Stem Cells and Enhance Muscle Strength and Function Post Hip Fracture

肌肉老化的定义是质量和力量的逐渐下降，这在美国老年人（60岁以上）中造成跌倒、致命伤害和创伤性骨折的高风险。每年，约有30%的老年人跌倒，导致约280万例外伤性骨折，大大降低了老年人的行动能力、独立性、整体健康状况和生活质量。在与跌倒有关的伤害中，髋部骨折是最普遍和最严重的；每年住院治疗髋部骨折的30万美国老年人面临着长期的术后康复，恢复独立生活的可能性很低，1年的死亡率在10-30%左右。在髋部骨折的老年人中，肌肉力量受潮容易导致并预示着较差的恢复。包括抗阻运动和富含蛋白质的饮食在内的标准治疗只能略微改善髋部骨折后的肌肉力量和功能结果。迄今为止，使用药物疗法改善老年人肌肉力量的尝试尚未成功。为了应对这一挑战，Ridgeline Therapeutics开发了一流的小分子烟酰胺n-甲基转移酶抑制剂（NNMTis），可以重新激活老化的肌肉干细胞（musc）。随着骨骼肌和muSC的衰老，它们越来越多地表达干扰NAD生物合成和控制muSC再生功能和细胞能量代谢的下游事件的NNMT。因此，NNMT是衰老性肌肉c功能障碍和相关肌肉力量下降的重要因素。由于muSCs是再生和修复的基础，衰老muSCs的再生（包括使用NNMTi）已被证明有助于增强老年小鼠的肌肉再生能力，改善肌肉力量和功能。Ridgeline的治疗开发工作从发现到领先的优化、机制和临床前概念验证，在临床相关的老年肌肉损伤模型中迅速发展。用NNMTi RT-001导联剂治疗老年、损伤小鼠，其muSC活性和肌纤维融合指数增加2倍，肌肉生长增加35-80%，肌肉力量增加70%。RT-001的强大功效和早期安全性指数证明降低了风险，并将其定位于后期临床前和ind研究。Ridgeline正在推进RT-001作为一种安全有效的小分子治疗药物，用于临床改善老年人髋部骨折手术修复后的肌肉力量和功能。该项目的目标与这一目标直接一致，重点是完成必要的体内PK/PD研究，以优化口服给药方案，扩大2公斤批次RT-001的合成，以及非GLP和GLP毒性研究；辅助代谢和临床相关生物标志物评估将完成，以补充和支持IND申请和首次人体临床试验。

Muscle-aging is defined by progressive declines in mass and strength that poses a high risk for falls, fatal injury, and trauma-related fractures among older Americans (age 60+). Each year, >30% of older adults suffer a fall, resulting in ~2.8 million traumatic fractures that significantly reduce mobility, independence, overall health, and quality of life for the elderly. Among fall-related injuries, hip fractures are the most prevalent and serious; the 300,000 elderly Americans hospitalized each year with hip fracture repairs face long-term post-surgery rehabilitation with a low probability of returning to independent living and a 1-year mortality rate that staggers around 10-30%. Dampened muscle strength predisposes to and predicts poor recovery among the elderly following hip fracture. Standard-of-care including resistance exercise and protein-rich diets only marginally improve muscle strength and functional outcomes post hip fracture. Attempts to improve muscle strength in elderly individuals using pharmacotherapies have not succeeded to date. To address this challenge, Ridgeline Therapeutics has developed first-in-class small molecule nicotinamide N-methyltransferase inhibitors (NNMTis) that reactivate aged muscle stem cells (muSCs). As skeletal muscle and muSCs age, they increasingly express NNMT that interferes with NAD biosynthesis and the downstream events that control muSC regenerative function and cellular energy metabolism. Thus, NNMT is a vital contributing factor to aging muSC dysfunction and associated declines in muscle strength. Since muSCs are fundamental to regeneration and repair, rejuvenation of aged muSCs (including using NNMTi) has proven useful to boost muscle regenerative capacity and improve muscle strength and function in aged mice. Ridgeline’s therapeutic development efforts have swiftly progressed from discovery, to lead optimization, mechanistic and preclinical proof-of-concept validations in clinically relevant aged muscle injury models. Treatment of aged, injured mice with the lead NNMTi RT-001 showed 2-fold increase in muSC activity and myofiber fusion index, 35-80% increase in muscle growth, and 70% increase in muscle strength. Robust efficacy and early safety index demonstration for RT-001 have de-risked and positioned it for late-stage preclinical and IND-enabling studies. Ridgeline is advancing RT-001 as a safe and effective small molecule therapeutic for clinical use in improving muscle strength and function among older adults following hip fracture surgical repairs. The objectives of this project directly aligns with this goal and focuses on completing necessary in vivo PK/PD studies to optimize oral dosing regimens, scale up synthesis of a 2 kilogram batch of RT-001, and non-GLP and GLP toxicity studies; accessory metabolism and clinically relevant biomarker assessments will be completed to complement and support IND filing and first-in-human clinical trials.