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Nonclinical cardiovascular safety evaluation of romosozumab, an inhibitor of sclerostin for the treatment of osteoporosis in postmenopausal women at high risk of fracture

ABSTRACT: Romosozumab is a humanized monoclonal antibody that inhibits sclerostin, an extracellular inhibitor of the canonical Wnt signaling pathway, expressed in osteocytes. Romosozumab results in increased bone formation and decreased bone resorption and has been approved in several countries for the treatment of osteoporosis in postmenopausal women at high risk of fracture. Sclerostin is also expressed in aortic vascular smooth muscle cells, the function of which is unclear but has been proposed to be an inhibitor of vascular calcification, atheroprogression, and associated inflammation. A slight increase in serious cardiovascular adverse events (CV AEs) was observed in romosozumab-treated subjects in a clinical trial comparing alendronate with romosozumab (ARCH; NCT01631214) but was not observed in a placebo-controlled trial (FRAME; NCT01575834). To investigate biological plausibility of the role of romosozumab in cardiovascular disease, a comprehensive nonclinical package with additional cardiovascular studies was conducted including studies in two murine models of atherosclerosis. Results of these studies demonstrated that the effects of romosozumab or a surrogate sclerostin antibody were either a direct or indirect consequence of its pharmacodynamic effects on bone. There were with no functional or morphologic effects on the cardiovascular system in animal models in the presence or absence of atherosclerosis. The totality of these nonclinical data has not identified a biologically plausible mechanism to explain the increase in serious CV AEs in the ARCH trial.

ORGANISM(S): Mus musculus

PROVIDER: GSE142634 | GEO | 2020/12/31

REPOSITORIES: GEO

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Sclerostin Antibody Does Not Promote Atheroprogression, Plaque Mineralization, or Inflammation in Ovariectomized Apolipoprotein E–Deficient Mice

Project description:Objective—Overexpression or administration of sclerostin has been reported to have atheroprotective and anti-inflammatory effects in apolipoprotein E knockout (ApoE KO) mice infused with angiotensin II; however, effects of sclerostin inhibition on these processes are not known. This study examined the effects of sclerostin inhibition with a sclerostin antibody on transcriptional changes in the aortic arch, associated morphological changes in aortic atherosclerotic plaques, and circulating markers of inflammation in ApoE KO ovariectomized (OVX) mice fed a high-fat diet. Approach and Results—Sclerostin antibody or vehicle was administered by subcutaneous injection once weekly for 3, 8, or 16 weeks to ApoE KO-OVX and wild-type-OVX mice fed a high-fat diet. As a comparator, alendronate or saline was administered twice weekly for 16 weeks to ApoE KO-OVX mice fed a high-fat diet. Sclerostin antibody had no effect on aortic total or mineralized plaque volume, determined by microcomputed tomography. Sclerostin antibody had no meaningful effects on plaque histopathology or systemic markers of inflammation or endothelial/platelet activation. Transcriptional analysis of the aortic arch revealed significant gene expression and signaling pathway changes in ApoE KO mice compared with wild-type, consistent with the genotype and atheroprogression, that were not affected by sclerostin antibody treatment. Alendronate treatment did not alter plaque volume or histopathology. Conclusions—This study shows that inhibition of sclerostin by sclerostin antibody does not promote atheroprogression or affect systemic markers of inflammation in the high-fat diet ApoE KO-OVX mouse model and does not alter the expression of genes/pathways implicated in atherosclerosis.

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Nonclinical cardiovascular safety evaluation of romosozumab, an inhibitor of sclerostin for the treatment of osteoporosis in postmenopausal women at high risk of fracture

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