A Phase 1 Randomized, Double-Blind, Placebo-Controlled Single and Multiple Ascending Dose Study of DISC-3405, a Novel...

Hepcidin is the central regulator of iron homeostasis, controlling iron sequestration and dietary iron absorption. Transmembrane serine protease 6 (TMPRSS6) suppresses hepcidin via the bone morphogenetic protein/small mothers against decapentaplegic (BMP/SMAD) pathway by cleaving the co-receptor hemojuvelin. DISC-3405 is a novel humanized monoclonal antibody that enhances hepcidin expression by inhibiting TMPRSS6, thereby promoting iron restriction. This Phase 1 study evaluated the safety/tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and immunogenicity of DISC-3405 or placebo in 56 healthy participants. DISC-3405 (37.5 to 300 mg) or placebo was administered subcutaneously (SC) or intravenously (IV). DISC-3405 was well tolerated. No deaths, serious adverse events, or participant discontinuations occurred. Most treatment-emergent adverse events were Grade 1 (mild) in severity, with 2 participants reporting Grade 2 (moderate) events following single dosing and no Grade 3/4 (severe/life-threatening) events reported. Median time to maximum plasma concentration was ≈96 to 168 h. Elimination half-life rose from 130 h at 37.5 mg to 265 h at 300 mg, with a clinically relevant half-life of ≈11 days. Absolute bioavailability was 39.7% (75 mg SC vs. IV). Minor accumulation occurred with repeat 4-week dosing of two doses, and PK was greater than dose proportional. DISC-3405 increased hepcidin-25 and reduced serum iron and transferrin saturation across dose levels. Single and repeated dosing of DISC-3405 produced reductions in reticulocyte hemoglobin, hemoglobin, and hematocrit. Overall, DISC-3405 was well tolerated with PK/PD data supporting further development for patients who could benefit from iron restriction, such as those with polycythemia vera.