A novel approach for prevention of Bronchopulmonary dysplasia in at-risk pre-term infants

ABSTRACT Bronchopulmonary Dysplasia (BPD) is the most common chronic respiratory disease in infants and is a devastating condition that disrupts the developmental program of the lung secondary to preterm birth. BPD affects neonates exposed to mechanical ventilation and, to date, there are no specific drugs available to prevent or treat this life-threatening condition. The pathologic hallmarks of BPD are hyperoxia-induced pulmonary inflammation, increased cell death, dysregulated angiogenic factors culminating in impaired alveolarization, dysregulated vascularization of the lung and pulmonary hypertension. AyuVis Research, Inc, is developing a novel class of low molecular weight natural oligosaccharide-derived small molecules which activate macrophage to a non-inflammatory phenotype via TLR4 signalling. Our lead candidate AVR-48 binds to TLR4 resulting in selective activation of the target cell to block inflammatory mediators in lung and upregulation of endogenous vascularization pathways improving lung vascularization leading to improved lung function. AVR-48 has a glucosamine core, making it responsive to O-GlcNAcylation of serine/threonine of lung proteins, a conserved defense against injury that enables cellular remodeling. Additionaly, it enhances production of certain host anti- inflammatory molecule such as IL-10 and growth factor VEGF with vascularization effects remaining local to lungs. We have demonstrated that intraperitoneal injection of AVR-48 prevents hyperoxia-induced BPD in a neonatal mice pup model at 10mg/kg dose and intravenous injection in invasive mechanical ventilator induced BPD in pre-term lambs at 0.3mg/kg-3.0 mg/kg doses. In order to advance the lead candidate AVR-48, AyuVis is proposing three complimentary aims: (1) Determine safety and long-term efficacy in the preterm lamb model by testing whether prophylactic treatment with AVR-48 improves the long-term respiratory, cardiac and neurodevelopmental outcomes measured after 2 months of life to mimic 1-2 years of infant life; (2) Demonstrate anti-inflammatory effect of AVR-48 in human cord blood after hyperoxia challenge by measuring cytotoxicity, inflammatory and anti-inflammatory mediators and macrophages; and (3) Determine toxicokinetic parameters in juvenile rats that will be used to model human equivalent dose in clinic. These studies are expected to provide mechanistic and confirmatory efficacy data which would enable AVR-48 to progress to GMP manufacturing and file an Investigational New Drug application.