Antisense oligonucleotides (ASOs) are gaining traction as highly specific, targeted treatments for a wide range of diseases. These synthetic DNA or RNA fragments bind to target RNA sequences, modulating protein expression and offering new avenues for treating conditions from ophthalmic disorders to genetic kidney diseases. Several companies are at the forefront of this emerging field, driving innovation and clinical progress.
Ionis Pharmaceuticals: A Pioneer in Antisense Technology
Ionis Pharmaceuticals, the first company to receive FDA approval for an ASO drug, remains a key player. Fomivirsen, approved in 1998 for cytomegalovirus (CMV) retinitis in immunocompromised AIDS patients, marked a significant milestone. With a pipeline of over 40 antisense drugs, Ionis is now focusing on independent commercial launches. The company has ongoing Phase 3 programs in neurology, cardiology, and rare diseases, including treatments for hepatitis B virus infection and complement factor B IgA nephropathy. In September 2024, Ionis priced a $500 million IPO to support its clinical and commercial activities. Ionis has also established partnerships with AstraZeneca for drugs targeting nonalcoholic steatohepatitis (NASH), amyloid transthyretin cardiomyopathy (ATTR-CM), and amyloid transthyretin polyneuropathy (ATTR-PN).
Isarna Therapeutics: Targeting TGF-β for Ophthalmic Diseases
Isarna Therapeutics is focused on developing ASO therapies targeting transforming growth factor beta (TGF-β) signaling, which plays a crucial role in cell proliferation, immune response, and tissue modeling. Their lead candidate, ISTH0036, is in a Phase 2 study for wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). Phase 2 trial data for ISTH0036 has demonstrated a good safety profile and efficacy. Morphological data, analyzed using AI, showed prevention of fibrosis and epithelial-mesenchymal transition, along with a drying effect, differentiating it from anti-angiogenic therapies.
Regulus Therapeutics: Addressing Genetic Kidney Diseases
Regulus Therapeutics is developing ASOs targeting microRNAs, key regulators of gene expression involved in various diseases. Their lead candidate, RGLS8429, is in a Phase 1b trial for autosomal dominant polycystic kidney disease (ADPKD), a condition leading to kidney failure. RGLS8429 inhibits miR-17, which is associated with increased expression in ADPKD. Preclinical and Phase 1 trials have shown improvements in kidney function and size. Positive topline data from multiple cohorts in the Phase 1b trial were recently announced, and the company anticipates requesting an end-of-Phase 1 meeting with the FDA in Q4 2024. In March 2024, Regulus received a $100 million private placement.
Sarepta Therapeutics: Advancing PPMO Therapies for DMD
Sarepta Therapeutics has a diverse pipeline spanning RNA, gene therapy, and gene editing, with a focus on neuromuscular, CNS, and cardiology indications. Their RNA platform is based on phosphorodiamidate morpholino oligomers (PMOs), synthetic ASOs known for their stability and low toxicity. Sarepta's peptide phosphorodiamidate morpholino oligomers (PPMOs) are designed to enhance tissue penetration. Sarepta has three approved PPMO therapies for Duchenne muscular dystrophy (DMD): Exondys 51, Vyondys 53, and Amondys 45. These therapies target exon-skipping to produce a shortened, functional dystrophin protein. Sarepta recently announced a $1 billion-plus global license and collaboration deal with Arrowhead Pharmaceuticals for multiple preclinical and clinical programs.
Secarna Pharmaceuticals: Immuno-Oncology Focus
Secarna Pharmaceuticals is developing ASOs for immuno-oncology, inflammatory, fibrotic, cardiometabolic diseases, and CNS disorders. Their lead program, SECN-15, targets Neuropilin 1 (NRP1), a protein involved in tumor-promoting functions such as angiogenesis and immune suppression. SECN-15 is progressing toward IND-enabling studies and has the potential to overcome resistance to checkpoint therapy in cancer patients. Secarna has collaborations with Denali Therapeutics and Evotec for novel antisense therapies.
Wave Life Sciences: RNA Editing and Antisense for Neurological Disorders
Wave Life Sciences is developing ASO therapies using its PRISM platform. Their lead antisense program, WVE-003, is in a Phase 1b/2a trial for Huntington’s disease. This allele-selective drug aims to lower mutant huntingtin (mHTT) protein while preserving healthy, wild-type huntingtin (wtHTT) protein. Positive results from the trial demonstrated a 46% reduction in mHTT with wtHTT preservation. Wave has partnerships with GSK and Takeda, although Takeda recently exited their collaboration. The positive Phase 1b/2a results have attracted interest from other drug developers.
Market Growth and Future Outlook
The global antisense oligonucleotides market is projected to reach $5.519 billion by 2033, growing at a CAGR of 6.6% from $2.913 billion in 2023, according to Future Market Insights. This growth is driven by the ability of ASOs to modify the immune system and treat autoimmune disorders, along with their ease of GMP production and minimal side effects. As more companies enter the field, the number of ASO therapies reaching the market is expected to increase.
