Auxora, a Selective CRAC Channel Inhibitor

CalciMedica’s lead product candidate, AuxoraTM (formerly CM4620), a proprietary intravenous-formulated CRAC channel inhibitor, is being developed for several indications including the treatment of respiratory distress syndrome associated with COVID-19, acute respiratory distress syndrome (ARDS) due to other types of pneumonia, predicted severe acute pancreatitis and other acute inflammatory diseases associated with dysregulation of intracellular calcium in organ tissues like the lung, pancreas or kidneys.

Acute pancreatitis (AP) is an acute inflammatory disease of the pancreas that presents as severe upper abdominal pain, often accompanied by nausea and vomiting. In acute pancreatitis, which has numerous causes, inflammation of the pancreas occurs, which can lead to pancreatic cell death or necrosis and systemic inflammation, a precursor to organ failure. Normal pancreatic functions, such as the secretion of digestive enzymes required to break down food in the gut, are disabled. There are no approved therapies for AP, but most cases resolve after several days of supportive care in the hospital where patients are given intravenous fluids and monitored for the development of more severe symptoms. Severe acute pancreatitis can result in significant morbidity, long hospital and/or ICU stays and death.

An estimated 275,000 hospitalizations for acute pancreatitis occur annually in the United States1 with a mortality rate ranging from 5% overall to 13.5% in severe forms of the disease2.

Severe complications arise due to the acute inflammatory response that takes place in the pancreas. These complications can lead to systemic inflammatory response syndrome, or SIRS, in which the function of other tissues including the lung are compromised. Approximately one third of patients with severe acute pancreatitis develop acute lung injury or ARDS. Lung failure accounts for 60% of deaths associated with acute pancreatitis in developed countries3

Excessive signaling through calcium-dependent pathways has been linked to multiple pathologies associated with acute pancreatitis:

  • Necrosis of pancreatic acinar cells. A primary function of the pancreas is to produce digestive enzymes that are required to digest food. The secretion of these enzymes from the pancreas is dependent on periodic release of calcium from internal stores in the cells called the pancreatic acinar cells. In acute pancreatitis, excess stimulation of these cells results in elevated, toxic levels of calcium in these cells and, as a consequence of inappropriate activation of digestive enzymes inside the cells, the acinar cells self-digest.
  • Systemic inflammatory response syndrome or SIRS. Acute pancreatitis is also associated with a high level of inflammation, which is exacerbated by cell death caused by autodigestion. In some patients, this inflammation causes release of inflammatory cytokines and triggers a life-threatening systemic inflammatory response syndrome, or SIRS, which can lead to organ failure. Previous studies have established a strong link between calcium signaling and release of inflammatory cytokines.
  • Pulmonary complications. The most frequent systemic complications in severe cases of acute pancreatitis are respiratory dysfunctions ranging from hypoxemia to ARDS. Acute pancreatitis-associated ARDS is the result of both increased vascular permeability and an increase in inflammation, which are believed to be calcium-dependent processes.

Auxora Acute Pancreatitis

Findings from a Phase 2 trial of Auxora in predicted severe acute pancreatitis patients showed patients treated with Auxora were associated with reduced lung and kidney organ failure, less frequent requirement for ventilator use, reduced pancreatic necrosis, improved ability to tolerate solid foods and shorter hospital stays. We initiated a Phase 2b clinical trial in March 2021. For more details, please visit our Clinical Trials page.

COVID-19 is a disease caused by infection with SARS-CoV-2, a pandemic strain of coronavirus. Respiratory illness is the most common symptom associated with COVID-19 with a severity ranging from mild disease to life-threatening acute respiratory distress syndrome, or ARDS.

Most cases of COVID-19 occur approximately four to five days after infection by the virus and present with symptoms such as fever, dry cough, body ache, sore throat and diarrhea. As the disease progresses, many patients develop shortness of breath due to reduced lung capacity and are hospitalized. In the majority of patients, this condition resolves over time, often with the help of supplemental oxygen, but in up to 20% of patients, it progresses to moderate to severe ARDS requiring mechanical ventilation1.

Disease progression in COVID-19 has similarities to that of severe community-acquired pneumonia caused by other viruses besides SARS-CoV-2 or by bacteria. The immune response to COVID-19 infection results in overproduction of early response proinflammatory cytokines, such as tumor necrosis factor alpha, or TNFα, interleukin 6, or IL-6, and interleukin 1 beta, or IL-1β, resulting in what has been described as a cytokine storm. It is often accompanied by complement and coagulation dysfunction, leading to an increased risk of vascular hyperpermeability where fluid and proteins leak from blood vessels to the interstitial space, causing respiratory failure, multi-organ failure and sometimes to death.

For more details, please see our Clinical Trials page.

ARDS is a rapidly progressive and very serious pulmonary disorder that leads to edema, or fluid, in the lungs which compromises oxygenation of the blood, resulting in hypoxia or respiratory failure. A study found that ARDS accounted for 10% of ICU admissions and 23% of mechanical ventilations. ARDS is typically classified as mild, moderate or severe, with mortality of 40-60% in severe cases. It is estimated that Auxora has the potential to bring therapeutic benefit to a broader population of patients suffering from ARDS, beyond those with ARDS due to SARS-CoV-2. A Phase 2 dose-escalation trial of Auxora in other viral (e.g., influenza) and bacterial-induced ARDS is expected to start in the second half of 2021. This trial will be conducted using an adaptive design, which will allow expansion into a pivotal trial once an optimal dose is determined.

Current therapies for acute lymphocytic leukemia (ALL) result in long term survival for over 90% of pediatric ALL patients. One of the mainstays of therapy in these patients is asparaginase, an enzyme that degrades the amino acid asparagine, which is essential for the leukemic cells to survive. However, the administration of asparaginase triggers the development of acute pancreatitis in up to 7% of patients.

For more details, please visit our Clinical Trials page.

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