Cited by 971Amyloidosis: Diagnosis, Treatment, OutcomesRNA Interference and Gene DeliveryAlzheimer's disease research and treatments

Safety and efficacy of RNAi therapy for transthyretin amyloidosis

Open access
Coelho, Teresa, Adams, David, Silva, Ana, Lozeron, Pierre, Hawkins, Philip N., Mant, Timothy, Perez, Javier, Chiesa, Joseph +23 more·2013·New England Journal of Medicine

Abstract

BACKGROUND: Transthyretin amyloidosis is caused by the deposition of hepatocyte-derived transthyretin amyloid in peripheral nerves and the heart. A therapeutic approach mediated by RNA interference (RNAi) could reduce the production of transthyretin. METHODS: We identified a potent antitransthyretin small interfering RNA, which was encapsulated in two distinct first- and second-generation formulations of lipid nanoparticles, generating ALN-TTR01 and ALN-TTR02, respectively. Each formulation was studied in a single-dose, placebo-controlled phase 1 trial to assess safety and effect on transthyretin levels. We first evaluated ALN-TTR01 (at doses of 0.01 to 1.0 mg per kilogram of body weight) in 32 patients with transthyretin amyloidosis and then evaluated ALN-TTR02 (at doses of 0.01 to 0.5 mg per kilogram) in 17 healthy volunteers. RESULTS: Rapid, dose-dependent, and durable lowering of transthyretin levels was observed in the two trials. At a dose of 1.0 mg per kilogram, ALN-TTR01 suppressed transthyretin, with a mean reduction at day 7 of 38%, as compared with placebo (P=0.01); levels of mutant and nonmutant forms of transthyretin were lowered to a similar extent. For ALN-TTR02, the mean reductions in transthyretin levels at doses of 0.15 to 0.3 mg per kilogram ranged from 82.3 to 86.8%, with reductions of 56.6 to 67.1% at 28 days (P<0.001 for all comparisons). These reductions were shown to be RNAi-mediated. Mild-to-moderate infusion-related reactions occurred in 20.8% and 7.7% of participants receiving ALN-TTR01 and ALN-TTR02, respectively. CONCLUSIONS: ALN-TTR01 and ALN-TTR02 suppressed the production of both mutant and nonmutant forms of transthyretin, establishing proof of concept for RNAi therapy targeting messenger RNA transcribed from a disease-causing gene. (Funded by Alnylam Pharmaceuticals; ClinicalTrials.gov numbers, NCT01148953 and NCT01559077.).

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1056/nejmoa1208760

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The Acuitas mRNA delivery platform has been developed from technology shown previously to enable siRNA-dependent hepatic gene silencing across species in rodents, nonhuman primates and humans.

    “The Acuitas mRNA delivery platform has been developed from technology shown previously to enable siRNA-dependent hepatic gene silencing across species in rodents, nonhuman primates and humans.28,43,44”

    From Sequence-engineered mRNA without chemical nucleoside modifications enables an effective protein therapy in large animals (2015) · cites this paper as [44]

    The Discussion (page not supplied) reports that lipid-nanoparticle siRNA delivery silenced liver-expressed genes in animals, including nonhuman primates, and that this study demonstrated RNAi-mediated gene modulation in human liver. The paper also discusses results across multiple species, but our copy does not establish that the Acuitas mRNA platform was developed from this technology. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • siRNAs are large, negatively-charged, double-stranded molecules that require formulation or chemical conjugation for delivery to tissues, especially the CNS.

    “siRNAs are large, negatively-charged, double-stranded molecules that require formulation6 or chemical conjugation7–10 for delivery to tissues (especially CNS).”

    From A divalent siRNA chemical scaffold for potent and sustained modulation of gene expression throughout the central nervous system (2019) · cites this paper as [6]

    Citation 6 is attached to formulation. The paper describes lipid-nanoparticle formulations that deliver siRNAs to hepatocytes, supporting that part of the sentence. But it says these systemically administered formulations do not penetrate the CNS, so it does not support the CNS qualifier. The provided copy gives no page number for the relevant passage. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • The success of the first approved siRNA-LNP therapeutic and mRNA COVID-19 vaccines originates only from their delivery using ionizable lipid-containing LNPs.

    “Based on the potential toxicity of liposomes in clinical application,25,26 the success of the first approved small interfering RNA-lipid nanoparticle (LNP) therapeutic27 and mRNA COVID-19 vaccines originates only from their delivery using ionizable lipid-containing LNPs,28, 29, 30”

    From COVID-19 mRNA vaccines: Platforms and current developments (2022) · cites this paper as [29]

  • The combined functionality of Patisiran's RNAi technique and LNPs enables robust reduction in expression of the hATTR disease-linked gene, providing a therapeutic treatment for the genetic disease.

    “The combined functionality of Patisiran’s RNAi technique coupled with the use of LNPs as a delivery vehicle enables a robust reduction in the expression of the hATTR disease-linked gene, ultimately providing a therapeutic treatment for the genetic disease.[56, 57]”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Ando Y, Ueda M. Diagnosis and thera- peutic approaches to transthyretin amy- loidosis. Curr Med Chem 2012;19:2312- 23.
  2. Dungu JN, Anderson LJ, Whelan CJ, Hawkins PN. Cardiac transthyretin amy- loidosis. Heart 2012;98:1546-54.
  3. Stangou AJ, Hawkins PN. Liver trans- plantation in transthyretin-related famil- ial amyloid polyneuropathy. Curr Opin Neurol 2004;17:615-20.
  4. Rowinsky EK, Donehower RC. Pacli- taxel (Taxol). N Engl J Med 1995;332: 1004-14. [Erratum, N Engl J Med 1995; 333:75.]

Cited by

Sorted by citations

Authors
Coelho, T., Adams, D., Silva, A., Lozeron, P., Hawkins, P. N., Mant, T., Perez, J., Chiesa, J., Warrington, S., Tranter, E., Munisamy, M., Falzone, R., Harrop, J., Cehelsky, J., Bettencourt, B. R., Geissler, M., Butler, J. S., Sehgal, A., Meyers, R. E., Chen, Q., Borland, T., Hutabarat, R. M., Clausen, V. A., Alvarez, R., Fitzgerald, K., Gamba-Vitalo, C., Nochur, S. V., Vaishnaw, A. K., Sah, D. W. Y., Gollob, J. A., & Suhr, O. B.
Affiliations
  • Hospital de Santo António (PT)
  • Université Paris-Sud (FR)
  • Alnylam Pharmaceuticals (United States) (US)
  • The Royal Free Hospital (GB)
  • IQVIA (United Kingdom) (GB)
  • Hammersmith Medicines Research (GB)
  • Umeå University (SE)
Venue
New England Journal of Medicine
Published
2013-08-29
Volume
369
Issue
9
Pages
819-829
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2080718344
Cited by
971
References
48
Citations by year
2026: 31 · 2025: 50 · 2024: 64 · 2023: 53 · 2022: 62 · 2021: 58 · 2020: 75 · 2019: 91 · 2018: 66 · 2017: 98 · 2016: 99 · 2015: 122 · 2014: 84 · 2013: 18
FWCI
48.19
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • Alnylam Pharmaceuticals
  • National Institute for Health and Care Research
  • King's College London
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Amyloidosis: Diagnosis, Treatment, Outcomes
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › RNA Interference and Gene Delivery
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
Keywords
transthyretin amyloidosis, RNA interference, siRNA, lipid nanoparticles, infusion reactions, treatment efficacy and safety, gene silencing, amyloidosis treatment, healthy volunteers
MeSH terms
Adolescent, Adult, Animals, Dose-Response Relationship, Drug, Female, Humans, Liposomes, Macaca fascicularis, Male, Prealbumin, Amyloid Neuropathies, Familial, RNA, Small Interfering, Nanocapsules, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review