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Atreya R, Kühbacher T, Waldner MJ, Hirschmann S, Drvarov O, Abu Hashem R, Maaser C, Kucharzik T, Dinter J, Mertens J, Schramm C, Holler B, Mössner J, Suzuki K, Yokoyama J, Terai S, Uter W, Yoneyama H, Asakura H, Hibi T, Neurath MF. Submucosal Injection of the RNA Oligonucleotide GUT-1 in Active Ulcerative Colitis Patients: A Randomized, Double-Blind, Placebo-Controlled Phase 2a Induction Trial. J Crohns Colitis 2024; 18:406-415. [PMID: 37777210 DOI: 10.1093/ecco-jcc/jjad162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/11/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND AND AIMS Carbohydrate sulfotransferase 15 [CHST15] biosynthesizes sulphated matrix glycosaminoglycans and is implicated in intestinal inflammation and fibrosis. Here, we evaluate the efficacy and safety of the double-stranded RNA oligonucleotide GUT-1, a specific blocker of CHST15, as induction therapy in patients with ulcerative colitis [UC]. METHODS In this randomized, double-blind, placebo-controlled, phase 2a study, we enrolled endoscopically active UC patients, refractory to conventional therapy, in five hospital centres across Germany. Patients were randomized 1:1:1 using a block randomized technique to receive a single dosing of 25 nM GUT-1, 250 nM GUT-1, or placebo by endoscopic submucosal injections. The primary outcome measure was improvement of endoscopic lesions at weeks 2 or 4. The secondary outcome measures included clinical and histological responses. Safety was assessed in all patients who received treatment. RESULTS Twenty-eight patients were screened, 24 were randomized, and 21 were evaluated. Endoscopic improvement at weeks 2 or 4 was achieved by 71.4% in the GUT-1 250 nM, 0% in the GUT-1 25 nM, and 28.6% in the placebo group. Clinical remission was shown by 57.1% in the GUT-1 250 nM, 0% in the GUT-1 25 nM, and 14.3% in the placebo groups. Histological improvement was shown by 42.9% in the GUT-1 250 nM, 0% in the GUT-1 25 nM, and 0% in the placebo groups. GUT-1 250 nM reduced CHST15 expression significantly and suppressed mucosal inflammation and fibrosis. GUT-1 application was well tolerated. CONCLUSION Single dosing by submucosal injection of GUT-1 repressed CHST15 mucosal expression and may represent a novel induction therapy by modulating tissue remodelling in UC.
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Affiliation(s)
- Raja Atreya
- Department of Medicine 1, University of Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tanja Kühbacher
- Department of Internal Medicine/Gastroenterology, Asklepios Westklinikum, Hamburg, Germany
| | - Maximilian J Waldner
- Department of Medicine 1, University of Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Simon Hirschmann
- Department of Medicine 1, University of Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Drvarov
- Department of Internal Medicine/Gastroenterology, Asklepios Westklinikum, Hamburg, Germany
| | - Raed Abu Hashem
- Department of Internal Medicine/Gastroenterology, Asklepios Westklinikum, Hamburg, Germany
| | - Christian Maaser
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Johanna Dinter
- Klinik für Gastroenterologie und Hepatologie, Uniklinik Köln, Köln, Germany
| | - Jessica Mertens
- Klinik für Gastroenterologie und Hepatologie, Uniklinik Köln, Köln, Germany
| | - Christoph Schramm
- Klinik für Gastroenterologie und Hepatologie, Uniklinik Köln, Köln, Germany
| | - Babett Holler
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Joachim Mössner
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Kenji Suzuki
- Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata city, Niigata, Japan
| | - Junji Yokoyama
- Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata city, Niigata, Japan
| | - Shuji Terai
- Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata city, Niigata, Japan
| | - Wolfgang Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Hitoshi Asakura
- Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata city, Niigata, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Minato-city, Tokyo, Japan
| | - Markus F Neurath
- Department of Medicine 1, University of Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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