health markers. We conducted additional preclinical profiling in CD34+ derived cells and observed that treatment with FTX-6058 increased HbF levels to approximately 30% of total hemoglobin, as measured by mass spectrometry, high performance liquid chromatography, and fast protein liquid chromatography techniques. The elevation of HbF was significantly greater than we observed with hydroxyurea in the cell models.
In the fourth quarter of 2020, we initiated our Phase 1 clinical trial of FTX-6058 in healthy adult volunteers. In this trial, we are evaluating the safety, tolerability and pharmacokinetics of FTX-6058. The trial is comprised of four parts. Part A is a randomized, double-blind, placebo-controlled, single ascending dose, or SAD, study in up to six cohorts. Part B is a randomized, double-blind, placebo-controlled, multiple ascending dose, or MAD, study in up to four cohorts dosed once daily for 14 days. Part C is an open label pilot food effect study in subjects randomized to take FTX-6058 with and without a high-fat meal, and Part D is an open label study to evaluate the potential of FTX-6058 to induce a liver enzyme known as CYP3A, which is involved in drug metabolism.
Interim Data from Phase 1 Clinical Trial of FTX-6058 in Healthy Adult Volunteers
In August 2021, we reported interim data from the cohorts completed to date in the SAD portion of the trial and the MAD portion of the trial.
In the SAD portion of the trial, healthy volunteers received a single oral dose of either placebo or 2, 4, 10, 20, 30 or 40 mg of FTX-6058. In the MAD portion of the trial, healthy volunteers received an oral dose of placebo or 2, 6, or 10 mg of FTX-6058 daily for 14 consecutive days. Subjects were seen 7 to 10 days after the conclusion of study drug or placebo for a safety follow-up. Safety assessments are performed regularly throughout the trial. The primary endpoint of this trial is safety and tolerability.
The trial is also collecting secondary pharmacokinetic measurements, including bioavailability and half-life assessments. Exploratory measures were included to assess target engagement, HBG mRNA changes and F-reticulocyte changes. We assessed target engagement of FTX-6058 as a change from baseline in the ratio of lysine 27 on histone H3, or H3K27me3, to total histone H3 in circulating monocytes. H3K27me3 is a downstream target of PRC2. FTX-6058 is designed to bind embryonic ectoderm development and inhibit the transcriptional silencing activity of PRC2.
Pharmacodynamic parameters assessed include changes in HBG mRNA, or HBG1/2 mRNA which encodes for y-globin, a component of fetal hemoglobin, and changes in F-reticulocytes, which are immature red blood cells that contain fetal hemoglobin, or HbF.
FTX-6058 has been generally well tolerated in all cohorts completed to date. There were no serious adverse events reported and no discontinuations. All treatment-emergent adverse events, or TEAEs, deemed at least possibly related were mild (Grade 1 or 2) in both the SAD and MAD cohorts. There was one Grade 4 TEAE in the 10 mg MAD cohort, which was determined to be unrelated to FTX-6058. No clinically significant changes in safety-related laboratory tests were reported during treatment periods for any of the FTX-6058 dose cohorts included in the analysis.
Results from the MAD cohorts showed maximal target engagement as evidenced by 70% – 80% reduction in baseline H3K27me3 levels, which we believe represents proof of mechanism. The 10 mg dose showed a mean 4.5-fold induction in HBG mRNA at day 14 and mean 4.2-fold increases in F-reticulocytes at the safety follow-up, indicating increased HbF protein expression, which we believe represents proof of biology. The kinetics observed across the target engagement and pharmacodynamic endpoints are consistent with the process of erythropoiesis in healthy individuals. These results demonstrated a time- and dose-dependent relationship between target engagement, mRNA induction and F-reticulocyte increases. The increases in F-reticulocytes indicate that the HBG mRNA increases observed with FTX-6058 treatment are translating to HbF protein production.