19. Using a Novel Combinatorial Non-Viral Vector and Small Molecules to Treat Familial Hypercholesterolaemia (FH)

Familial hypercholesterolaemia (FH) is a life-threatening genetic disorder characterised by elevated levels of plasma low density lipoprotein cholesterol (LDL-C). Loss-of-function mutations in the gene encoding the low density lipoprotein receptor (LDLR) are responsible for ~85% of all FH cases. We have previously generated mini-gene vectors carrying the human LDLR cDNA, driven by 10 kb of genomic DNA from the native human LDLR locus, encompassing a promoter region with all essential elements required for physiologically regulated expression (pLDLR-LDLR). We demonstrated that incorporation of the genomic DNA promoter elements resulted in long-term physiologically-regulated LDLR transgene expression that complemented Ldlr deficiency. Here we further enhance LDLR transgene expression by characterising and cloning in a miRNA, targeting Hmgcr (miR82) generating a combinatorial RNAi-LDLR vector (pLDLR-LDLR-miR82). We show in vivo that the combinatorial vector efficiently suppresses endogenous Hmgcr transcripts, which leads to an increase in LDLR transgene expression through induction of the LDLR promoter. In a preliminary study the pLDLR-LDLR-miR82 vector was able to significantly reduce total and LDL-C, in Ldlr−/− mice fed a 1% cholesterol diet at two and four weeks post vector delivery. We then carried out a longer term study in Ldlr−/− mice fed a 0.25% cholesterol diet, LDLR expression could be detected 12-weeks post-delivery with the plasmid able to be rescued as a functioning episome. LDL-C was significantly lowered throughout the study and this resulted in reduced atherosclerosis in the pLDLR-LDLR-miR82 vector treated mice. Here we demonstrate for the first time, that an episomal non-viral vector is able to significantly reduce LDL-C and the progression of atherosclerosis in a mouse model of FH. Based on the success of the miRNA to further enhance the lipid lowering of our non-viral vector, we went on to screen small molecules which can drive the expression of the human LDLR promoter. 216 molecules were screened, where we identified a novel series of small molecules that increased the LDLR in human and mouse cell lines at nano molar potencies. We then went on to elucidate the mechanism of action as squalene synthase inhibitors and demonstrated, that when used in combination with statins, these compounds give a much greater increase in LDLR expression than statins alone. These small molecules could be used in conjunction with low dose statins, alongside our non-viral vector to further enhance expression of the LDLR and provide greater therapeutic outcome for patients of FH.