Medtronic (Minneapolis) and Alnylam Pharmaceuticals (Cambridge, Massachusetts) have reported new pre-clinical research findings from their Huntington's disease program at the 2009 World Congress on Huntington's Disease this week in Vancouver, British Columbia. The two companies are developing a drug-device combination for the treatment of Huntington's disease.

The drug, ALN-HTT, consists of an RNAi therapeutic targeting huntingtin, the gene responsible for Huntington's disease, and is delivered to the central nervous system (CNS) using an implantable pump infusion system developed by Medtronic.

The newly presented pre-clinical research, performed in collaboration with the laboratory of Don Gash, PhD, at the University of Kentucky College of Medicine (Lexington), demonstrate that a small interfering RNA (siRNA) targeting the huntingtin gene achieves broad distribution in the CNS following continuous direct CNS administration. Further, direct delivery to the CNS resulted in robust silencing of the huntingtin gene mRNA, extending previously presented pre-clinical data, the companies said. This silencing effect was achieved at substantial distances from the infusion site, an important step towards translating this delivery approach from animal models to the larger human brain. Additional pre-clinical studies showed ALN-HTT to be well-tolerated following continuous direct CNS administration over a period of about one month, according to Medtronic and Alnylam.

Doug Gwost, PhD, senior principal scientist at Medtronic, told Medical Device Daily in an email response to questions that the implantable pump system being used to deliver the drug in the Huntington's disease program with Alnylam was designed specifically for chronic intraparenchymal infusion of drugs and biopharma molecules using convection-enhanced delivery (CED) to improve distribution vs. relying simply on diffusion.

Gwost said the next step in the development of this drug-device combination for the treatment of Huntington's disease is to complete pre-clinical safety studies, and then the companies would be in a position to initiate clinical studies.

"We are very pleased with these promising results in our Huntington's disease program, as it continues to represent an exciting opportunity to combine innovative medicines with our state-of-the-art drug device delivery technology in an area of extreme unmet medical need," said Gregory Stewart PhD, director of CNS Drug Therapy R&D at Medtronic. "With no currently effective disease-modifying therapies for patients afflicted with Huntington's, the convergence of Alnylam and Medtronic technologies could provide a novel treatment strategy for this devastating neurodegenerative disease."

The new pre-clinical studies presented at this meeting employed direct delivery of ALN-HTT to the striatum using implantable infusion pumps and CED, or continuous infusion under positive pressure, the companies said.

"We are very excited by our new findings as they represent a major leap forward in our Huntington's disease program across multiple dimensions," said Dinah Sah, PhD, VP of Research, CNS, and Oncology at Alnylam. "Indeed, in our new ALN-HTT research findings, we have extended our earlier data in more advanced pre-clinical studies including key findings on siRNA biodistribution in the CNS, therapeutic silencing of the disease-causing huntingtin gene in a manner supportive of scaled effects for the human brain, and safety assessment following continuous infusion in the CNS over approximately one month. In aggregate, these new studies which were performed in collaboration with the University of Kentucky, one of the leading academic institutions for research on direct CNS delivery for neurodegenerative diseases support our continued and combined efforts with Medtronic to advance this important innovation to patients."

Specifically, the new data showed that direct CNS administration of ALN-HTT resulted in: broad distribution of the siRNA across the CNS, including the striatum and surrounding brain regions; silencing of the huntingtin gene mRNA by an average of about 45% in the putamen following continuous infusion over seven days, as well as reductions in the levels of huntingtin protein as demonstrated by immunohistochemistry; silencing of the huntingtin gene messenger RNA (mRNA) in the CNS at significant distances from the infusion site; and a safe and well tolerated profile following continuous infusion over 28 consecutive days, with no clinical abnormalities, neurological behavioral signs, and no clinically significant findings in histopathological examination of the brain.

"While still in development or at an investigational stage, Medtronic has therapy programs targeting intrathecal, intraventricular and intraparenchymal delivery of biopharmaceuticals to treat neurodegenerative disease and neurological disorders," Gwost said.

In February 2005, Alnylam formed a collaboration with Medtronic to pursue the development of novel drug-device combinations incorporating RNAi therapeutics to treat neurodegenerative disorders (Medical Device Daily, Feb. 10, 2005). In July 2007, the companies advanced their collaboration on their Huntington's disease program into development stages, following positive pre-clinical data generated under the initial joint technology development phase of the program (MDD, July 31, 2007). In addition, the agreement was revised as a 50-50 partnership in the U.S.

According to Medtronic and Alnylam, Huntington's disease is an autosomal dominant neurodegenerative genetic disease that afflicts about 30,000 patients in the U.S., with an estimated 200,000 additional patients having a 50% risk of developing the disease. The average lifespan for patients after onset is roughly 10 to 20 years. There are currently no effective therapies available for the treatment of Huntington's disease, the companies noted.

Amanda Pedersen, 229-471-4212

amanda.pedersen@ahcmedia.com