BCN057 as a mitigator of Radiation Induced Gastrointestinal Syndrome

Project Abstract
Currently, there is a need for drugs that mitigate acute radiation induced gastrointestinal syndrome (RIGS). Risk
of large populations encountering radiation exposure is real and growing due to the proliferation of rogue
nonstate actors, political instability resulting in potential access of nuclear weapons by terrorist, and by natural
disaster as evidenced by the release of radioactive material from the Fukushima nuclear power plant in early
2011. Currently, Neupogen®, Nulasta® (filgrastim) and Leukine™ (sargramostim) are the only FDA approved
agents available and only for the management of Hematopoietic Acute Radiation Syndrome. Due to radio-
sensitivity of intestinal epithelium, RIGS is the major cause of death from acute radiation syndrome at high
radiation doses and no drugs are approved at this time. The current options for mitigating tissue damage
and mortality of a large population after exposure to radiation are currently an un met need with approved
drugs unable to fill the gap. Moreover, high radio-sensitivity of intestinal epithelium increases susceptibility
to radiation induced gastrointestinal syndrome ( RIGS) and induces mortality rapidly
within 3-10 days post radiation, leaving very limited time for therapeutic intervention. We have demonstrated
that treatment with BCN057 at 24hrs post radiation exposure can mitigate RIGS by accelerating intestinal
epithelial repair with the activation of Wnt-β catenin signaling and improves survival following lethal dose of
irradiation. Intestinal epithelial repair process is dependent on induction of proliferation of residual
intestinal stem cells. we hypothesized that BCN057 will have a general applicability to
mitigate RIGS when delivered hours after radiation exposure. In this proposal we will
characterize the most effective dose and schedule for administration of BCN057 to
mitigate RIGS in mice. This will include Identifying the optimal dose and schedule of
BCN057 when given at 24 hr post exposure to mitigate RIGS in adult mice; Identify the
time to dosing beyond 24 hr at which BCN057 can still improve survival; Define the
radiation dose modifying factor for BCN057 treatment and verify biological variability in
radiosensitive and gender context. For Specific Aim 1 we will characterize dose proportionality, dose
regimen and dose response of BCN057 for mitigation of Radiation Induced Gastro Intestinal Syndrome by the
FDA animal rule. In Specific Aim2, we will assess time to dosing at 48 and 72 hours, age differences using
young and old mice, genetic radio sensitive and resistance, a phenomenon highly exhibited in adult humans
using (Balc and C57).
Together these studies will demonstrate the utility of BCN057 as a mitigator of RIGS as well as model
response behavior to advance its use for countermeasures and clinical use.PUBLIC HEALTH RELEVANCE:
Currently, there is a need for drugs that mitigate acute radiation syndrome (ARS). Radiation exposure in
large casualty settings is still an ongoing threat because of accidental nuclear disaster like Fukushima 2011
or possible nuclear terrorism. Currently, Neupogen®, Nulasta® (filgrastim) and Leukine™ (sargramostim) are the
only FDA approved agents available and only for the management of Hematopoietic Acute Radiation Syndrome.
Due to the acute radio-sensitivity of intestinal epithelium, RIGS is the major cause of death from acute radiation
syndrome at high radiation doses long before hematologic failure and no drugs are approved at this time. Thus,
the current options for mitigating tissue damage and mortality of a large population after exposure to radiation
are significantly limited. BCN057 works as a potent radiation mitigator; mitigating against whole body lethal
levels of ionizing radiation. Animal models reveal that the drug is effective at mitigating severe radiation induced
damage of intestinal epithelium and improves long term survival when given 24 hours after exposure. This is
not only relevant for public health and safety but also clinically. The estimate of the patient population that may
benefit from the availability of such a mitigating agent may be greater than several thousand during an incident
within US alone and many more thousand considering clinical applications of this drug (currently being
investigated for pancreatic cancer where small bowel tox is a dose limiting event negatively affecting the ability
to complete therapy).