Therapeutics

ACI-35

Overview

Name: ACI-35
Therapy Type: Immunotherapy (active) (timeline)
Target Type: Tau (timeline)
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Phase 1)
Company: AC Immune SA, Janssen

Background

ACI-35 is a liposome-based vaccine. The rationale behind it is that the vaccine will treat tauopathy in Alzheimer’s disease by eliciting an immune response targeted to certain pathological conformers of phosphorylated tau without also mounting autoimmune B cell or T cell responses against physiological forms of this ubiquitous intracellular protein. The vaccine contains 16 copies of a synthetic tau fragment that is phosphorylated at the protein’s pathological phosphorylation residues S396 and S404 and is anchored into a lipid bilayer. It uses the adjuvant MPLA (Hickman et al., 2011; Jun 2012 conference news).

In both wild-type C57BL/6 and P301L mutant tau transgenic mice, a three-month regimen of subcutaneous ACI-35 injection rapidly generated high titers of polyclonal IgG antibodies specifically directed against phosphorylated tau, rather than non-phosphorylated tau. The resulting antibodies were reported to bind neurofibrillary tangles in mouse brain tissue sections and to reduce soluble tau as well as insoluble, aggregated tau in brain extracts. ACI-35 also reportedly improved three of four tested clinical parameters: It increased retention of body weight, delayed onset of a clasping motor phenotype, and extended lifespan, but it did not improve endurance on a rotarod test. This preclinical study also reported that tests of gliosis, T cell activation, and other inflammatory markers were negative (Theunis et al., 2013). Similar data in nonhuman primates were presented at the 2013 Society for Neuroscience conference. In 2015, ACI-35 was licensed to Janssen.

Findings

In December 2013, AC Immune began the first human trial of a phospho-tau-specific vaccine. This Phase 1b study compared a six-month course of undisclosed low, medium, and high doses of ACI-35 to placebo in 24 people with mild to moderate AD. The initial dosing regimen was followed by a subsequent booster shot, and a further six-month safety observation period. This was a safety, tolerability, immunogenicity study with secondary outcomes to take an initial look at biomarkers and clinical/functional outcomes, according to the company (Aug 2014 news). Besides routine safety measures, primary outcomes included MRI scans taken five times, biochemistry measures from CSF collected twice, as well as antibody titer measurements from blood collected throughout the study. Secondary outcomes included ADAS-cog, MMSE, trail-making and fluency tests, Clinical Global Impression of Change Disability Assessment in Dementia, and Neuropsychiatric Inventory Scale. This trial was registered in May 2015, ran at sites in Finland and the U.K., and was completed in June 2017 (see ISRCTN registry).

Results were presented at the virtual AAT-AD/PD Focus Meeting (Apr 2020 conference news). ACI-35 raised no safety concerns, but elicited a weak immune response. Booster shots had little effect. A redesigned version, ACI-35.030, includes a second adjuvant and an epitope to activate helper T cells. According to the presentation, the second-generation vaccine produced a stronger immune response in rhesus monkeys than the original, and booster shots increased antibody titers. The antibodies were specific for phosphorylated tau, and recognized paired helical filaments extracted from AD brain.

In July 2019 AC Immune and Janssen initiated a Phase 1b/2a trial to test safety and immunogenicity of ACI-35.030 in people with early AD. The trial enrolls 24 people for sequential testing of up to three dose levels of the vaccine versus placebo, administered multiple times over 48 weeks. Primary outcomes are adverse events and other safety measures, plus anti-phosphoTau IgG titers in blood up to 74 weeks after baseline. This trial will also evaluate the presence of anti-tau antibodies, and monitor cognition and behavior changes using the CDR-SB, RBANS, and NPI. 

In July 2020, AC Immune announced that the lowest-dose cohort was complete and had generated positive safety, tolerability, and immunogenicity data. The company is recruiting for the next-highest dose (press release). Running at six centers in Finland, the Netherlands, and the U.K., the study is slated for primary completion in 2022. 

For details on ACI-35 trials in Alzheimer's, see clinicaltrials.gov.

Last Updated: 17 Jul 2020

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References

News Citations

  1. Therapies Take Aim at Tau
  2. Active Tau Vaccine: Hints of Slowing Neurodegeneration
  3. Stockholm: New Strategies for Immunotherapy

Paper Citations

  1. . Sequence-independent control of peptide conformation in liposomal vaccines for targeting protein misfolding diseases. J Biol Chem. 2011 Apr 22;286(16):13966-76. PubMed.
  2. . Efficacy and Safety of A Liposome-Based Vaccine against Protein Tau, Assessed in Tau.P301L Mice That Model Tauopathy. PLoS One. 2013;8(8):e72301. PubMed.

External Citations

  1. ISRCTN registry
  2. press release
  3. clinicaltrials.gov

Further Reading

Papers

  1. . TLR4- and TRIF-dependent stimulation of B lymphocytes by peptide liposomes enables T cell-independent isotype switch in mice. Blood. 2013 Jan 3;121(1):85-94. Epub 2012 Nov 8 PubMed.
  2. . Liposomal vaccines with conformation-specific amyloid peptide antigens define immune response and efficacy in APP transgenic mice. Proc Natl Acad Sci U S A. 2007 Jun 5;104(23):9810-5. PubMed.
  3. . Dynamic nuclear polarization NMR spectroscopy: revealing multiple conformations in lipid-anchored peptide vaccines. Angew Chem Int Ed Engl. 2013 Oct 4;52(41):10905-8. Epub 2013 Aug 23 PubMed.
  4. . Tau-based therapeutics for Alzheimer's disease: active and passive immunotherapy. Immunotherapy. 2016 Sep;8(9):1119-34. PubMed.