A short report on NGM282/aldafermin for the treatment of nonalcoholic steatohepatitis (NASH)

ABSTRACT

Introduction

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the major cause of liver disease worldwide. Bile acids play a central part in the pathogenesis of NAFLD with agents that target bile acid synthesis and metabolism in development as potential therapies

Areas covered

The paper presents an overview of NAFLD and its pathogenesis, with focus on bile acid metabolism and regulation through fibroblast growth factor 19 (FGF-19), and the development of aldafermin as a non-tumorigenic FGF-19 analogue. We explore results from preclinical studies on the efficacy and safety of aldafermin.

Expert opinion

Bile acid regulation is a promising therapeutic target in the management of NAFLD. FGF-19 plays key role in this mechanistic pathway, but also exhibits hepatocarcinogenic effect. Aldafermin is an FGF-19 analogue that has shown promising results in nonalcoholic steatohepatitis animal models, with preclinical data supporting its safety profile, specifically, the lack of a tumorigenic effect. The preclinical data presented in this paper support the clinical development of aldafermin, and indeed early data from several phase II clinical trials report promising results in relation to the ability of aldafermin to improve the histological features of NASH particularly in relation to a reduction in liver fat content.

KEYWORDS:

• Aldafermin
• NGM282
• NASH
• preclinical

Article highlights

• Aldafermin (aka NGM282), a non-tumorigenic analogue of fibroblast growth factor 19 (FGF19), shows promise as an effective therapy for nonalcoholic steatohepatitis (NASH).

• Aldafermin has been evaluated in several established animal models of NASH to assess its efficacy at improving liver histology, as well as biochemical markers and gene expression associated with hepatic inflammation and fibrogenesis.

• Administration of aldafermin in preclinical mouse models of NASH has resulted in a significant improvement in key histological components of NASH including decreased hepatic steatosis, inflammation, and hepatocyte balloon degeneration, as well as hepatic fibrosis levels in longer-term studies.

• Aldafermin has been shown to be safe and effective and well tolerated in healthy volunteers and in patients with several liver diseases.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One reviewer has received research funding support (paid to institution) for the conduct of early phase human studies of Aldafermin in patients with NASH. The reviewer is a scientific advisor to NGM Biopharmaceuticals on the clinical drug-development pathway evaluating Aldafermin for treatment of NASH and NASH-related cirrhosis. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.