Development of a Novel Chemokine Receptor Antagonist Peptide as a Non-Opioid Treatment for Relief of Chronic Pain

7. Project Summary In response to RFS-NS-20-11, Creative Bio-Peptides, Inc. will develop the multi-chemokine receptor antagonist peptide R103 to provide a non-opioid, potentially disease modifying treatment for neuropathic pain conditions. We have completed proof-of-concept (POC) animal studies in neuropathic pain by partial nerve ligation and diabetes. We will conduct a further POC study of R103 benefit in chemotherapy-induced peripheral neuropathy (CIPN), a dose-limiting side effect of many anticancer drugs that can affect 68% or more of cancer patients. We will also establish a neuroprotective mechanism for R103 pain effects. Additional chronic pain patients that may benefit from R103 include those with spinal cord injury, chronic low-back pain, and post-herpetic neuralgia. Our initial target patient population are the 2.5 million Americans with diabetic peripheral neuropathy (DPN), the most common chronic neuropathic pain condition. Chemokines, molecules of the innate immune system that mediate inflammation, acting through receptors such as CCR2, CCR5, and CCR8 promote pain by multiple mechanisms that cause sustained excitability of primary nociceptive neurons, desensitize endogenous opioid anti-pain effects, activate microglia and astrocytes, and cause peripheral monocyte infiltration into CNS. Blocking multiple chemokine receptors that establish and sustain chronic pain with the multi-chemokine receptor antagonist (CRA) R103 is a new and largely untested non-opioid approach to pain treatment. Substantial independent research by others shows the value of CRA’s in diverse chronic pain conditions. R103 is a preferred CRA because of its ease of dosing, rapid entry into the CNS, lack of toxicity and side effects, and potential to treat the defining pathology of neuropathic pain, axonal degeneration. Unlike current FDA approved chemokine antagonists (Plerixafor®, Selzentry®) which have significant safety concerns (allergic risks, need to be injected, “black-box” warning for hepatotoxicity), R103 is safe and targets multiple chemokine receptors (CCR2/CCR5/CCR8) implicated in persistent pain states. The program we propose will result in an IND for DPN and CINP use and fast-track human phase 1 studies with exploratory patient efficacy cohorts. We will assess any respiratory depression with R103, an FDA mandate for pain drugs. We will conduct scale-up peptide manufacture and complete IND-enabling pre-clinical safety and PK/PD studies. We will schedule a pre-IND meeting with the FDA to establish a regulatory approval plan and secure an IND for first-in human studies. The studies in the proposal support expanding the IND to treat other neuropathies, like CIPN, and eventually neuralgias, and back pain.8. Project Narrative Creative Bio-Peptides develops novel non-opioid treatments for the 50 million Americans who experience daily pain, including the 2.5 million who live with diabetic peripheral neuropathy (DPN), the most common chronic neuropathic pain condition. Our peptides block the innate immune chemokine receptors that when activated promote pain, block the action of opioids to stop pain, and damage nerves, causing even more pain. Poorly treated chronic pain contributes to opioid use and misuse and we seek to provide a safe and effective, non- opioid treatment for diabetic and other neuropathic pain conditions.