4th International mRNA Health Conference – November 1, 2016 Boston, MA VEGF-A modified mRNA in diabetic wound healing and future treatment opportunities

1. VEGF-A modified mRNA in diabetic wound healing
and future treatment opportunities
Kenny Hansson, PhD, Cardiovascular and Metabolic Diseases, Innovative Medicines
and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
4th International mRNA Health Conference, Boston
Nov 1, 2016

2. Diabetic foot ulcer (DFU) –an indication with high unmet medical
need
• 10-15 percent of all diabetic patients will suffer from DFU during their lifetime
• The complications are severe with a risk of amputation in connection with a
DFU being as high as 4.9% (US 2008)
• The 10 year mortality for diabetes + DFU is 49% compared to 35% for
diabetes alone with similar severity - same rate as many cancers
• The estimated cost for treatment of DFU was between 9-13 BUSD in the US
2014

3. The role of VEGF-A in wound healing
VEGF-A
Angiogenesis
Granulation
tissue
ReepithelializationInflammation
Keratinocytes Mast cells
Monocytes/
macrophages Fibroblasts
Vascular
permeability

4. The modified mRNA concept
• VEGF-A mRNA is taken up and transfects the cell
• VEGF-A protein is produced
• VEGF-A is secreted into the neighboring microenvironment
mimicking the paracrine role of the protein
• VEGF-A is transiently locally expressed in tissue
Chien et al Cold Spring Harb Perspect Med. 2014

5. VEGF-A mRNA -induces efficient production of VEGF-A protein
following intradermal injection in rabbit hind leg
# of probes with VEGF-A
levels >LLOQ
1 cm
1 cm
Microdialysis experimental design
• 100 KDa probe (2/animal)
• Intradermal positioning (probe), hind leg
• 0.5 µL/min flow, push
• Saline perfusate
• Intradermal administration
• 4x50 µg (4x50 µL) modRNA in citrate/saline
• ~5 hr sampling
• N=4
0 1 2 3 4 5 6
1 0
1 0 0
1 0 0 0
L L O Q
M ean S E M
0 /8 0 /8
3 /8
5 /8 5 /8
T im e a fte r V E G F -A m R N A in je c tio n (h )
hVEGF-Aineluate(pg/mL)

6. VEGF-A mRNA -Experimental outline and wound healing model in
diabetic db/db mice
Day 0
-Full-thickness
wound punch
-Injection of
compound/vehicle
-Imaging
Day 3
-Injection
-Imaging
Day 6
-Imaging
Day 10
-Imaging
Day 13
-Imaging
Day 18
-Imaging
-Harvest of tissue
5 mm
-VEGF-A and VEGFR2
downstream signaling
analysis
-H&E and CD31 histology
-VEGF-A protein analysis
in tissue and plasma
5 mm

7. VEGF-A mRNA significantly increases wound healing rate and vascular
density after two intradermal injections at day 0 and 3 in diabetic (db/db)
mice
Improved closing of open wound area in mice treated
with two intradermal injections of VEGF-A mRNA
Increased vascular density in mice
treated with two intradermal injections
of VEGF-A mRNA
Data presented as mean + standard error. n=7-8
Data presented as mean + standard error. n=3

8. VEGF-A mRNA significantly increases wound oxygenation 6 days
after intradermal injection
Day 3 Day 6 Day 3 Day 6
[F/P] 1.50
Lower O2% Higher O2%
VEGF-A mRNA
Double injection
Vehicle
Double injection
Data: mean + SEM, n=3-4
* = p-value < 0.05 vs vehicle
Quantification of oxygen tension
Wound oxygenation visualized by
oxygen-sensitive nanoparticles
100
120
140
160
180
200
220
240
260
Day 3 Day 6
Meangreyvalue
Double inj vehicle Double inj VEGF-A mRNA
*

9. Is VEGF-A enough to heal diabetic foot ulcers?
• FDA requires significant improvement in complete wound closure vs. standard of
care/placebo for approval
• Telbermin (recombinant human VEGF-A) was evaluated in 2006-2008 by
GenenTech in a phase 2 trial over 12 weeks but could failed
• Other single factor treatments (KGF, FGF2) have failed or been questioned for
efficacy (Regranex (PDGF-BB))
We propose that a combination of factors influencing wound healing would
be the next step to achieve complete wound closure

10. Conclusions
• Evidence of local VEGF-A production following intradermal injection of
VEGF-A mRNA in rabbits
• Evidence to support effective wound healing following intradermal injection
of VEGF-A mRNA in diabetic mice
– Improved wound healing rate
– Improved oxygenation
– New vessel formation
• Combination of factors influencing wound healing could be the way forward
to address the DFU indication

11. Acknowledgement
• AstraZeneca R&D Gothenburg,
Sweden
– Regina Fritsche-Danielson
– Karin Jennbacken
– Leif Carlsson
– Susanne Pehrsson
– Madeleine Antonsson
– Monika Sundkvist
– Alan Sabirsh
• University of Virginia, USA
– Shayn Peirce-Cottler
– Anthony Bruce
– Scott Seaman
• Karolinska Institute, Sweden
– Kenneth Chien
– Jonathan Clarke
• Moderna, USA
– Barry Ticho