Enabling Studies for the Treatment of Frozen Shoulder Using Relaxin

PROJECT SUMMARY/ABSTRACTFrozen shoulder or “shoulder arthrofibrosis” is a painful and gradual loss of shoulder motion caused by trauma, surgical procedures, inflammation, or prolonged joint immobilization. Shoulder arthrofibrosis occurs in 9 million individuals in the United States with more than 1.6 million seeking surgical remedies each year. Current treatment options, including intra-articular corticosteroid injections, NSAIDs, and nerve blockers, provide only marginal and temporary relief of patient symptoms and do not address the underlying cause of the disease—the accumulation of fibrotic collagenous tissue. Surgical interventions are used in more severe cases, but these procedures are fraught with complications and can further aggravate symptoms. Ortholevo is developing a local injectable polymeric microparticle sustained release formulation of relaxin-2 for the treatment of shoulder arthro- fibrosis. Human relaxin-2 (RLX) is a 6-kDa naturally-occurring reproductive hormone peptide that temporally downregulates collagen production and upregulates matrix metalloproteases prior to childbirth. Using this pep- tide therapeutic for the treatment of arthrofibrosis provides an unprecedented opportunity to treat this disease with a first of its kind therapy and a resulting paradigm shift in the treatment of shoulder arthrofibrosis.Ortholevo proposes to advance its technology down the path of commercialization by the completion of the following Direct Phase II proposed aims: 1) Transfer our microparticle encapsulation process to Lubrizol Life Science Health in order to establish product specifications and assess sterilization and shelf-stability; 2) Deter- mine in vivo Minimum Effective Dose (MED), Maximum Tolerated Dose (MTD), and Repeated Dose Toxicity (RDT) of relaxin-2 loaded microparticles in an in vivo rat model; and 3) Determine pharmacokinetics (PK) and efficacy of relaxin-2 loaded microparticles in an in vivo canine joint contracture model. To accomplish these aims, we have collected key preliminary data demonstrating efficacy using a relaxin-2 loaded microparticle formulation as well as assembled a team with expertise in science/engineering (e.g., protein therapeutics, microparticles, biomechanics, and frozen shoulder) and translation and commercialization (e.g., management, regulatory, man- ufacturing and marketing). With the successful completion of the specific aims in this Direct Phase II SBIR pro- posal, the next steps include pre-IND meeting, attaining IND/IRB clinical site approval, followed by Phase I first- in-human clinical safety trial. Achievement of these goals will lead to the first standard of care treatment for shoulder arthrofibrosis based on reversing the underlying and abnormal accumulation of fibrotic collagenous tissue that delivers the therapeutic in a sustained and controlled manner to the site of disease.