Pipeline

AN2 has a pipeline of novel boron-based compounds that have the potential to be best in class therapeutics. The company intends to advance its global health initiatives using non-dilutive funding, which the company obtains from sources such as public and private agencies and foundations.

development pipeline graphic

development pipeline graphic

About AN2-502998

AN2-502998 (formerly known as AN15368) is a boron-based small molecule therapeutic candidate under development for the treatment of chronic Trypanosoma cruzi (T. cruzi) infection, which causes Chagas disease. AN2-502998 was originally discovered by researchers at Anacor, in close collaboration with the University of Georgia, and with grant funding from Wellcome. IND-enabling studies are underway. AN2-502998, previously published under AN15368, is the only compound of which we are aware to have demonstrated curative activity in preclinical studies across multiple species, including in non-human primates with long-term, naturally acquired chronic infections of diverse T. cruzi genetic types1.

About Chagas Disease

Chagas disease is caused by the parasite Trypanosoma cruzi, which spreads via triatomine bugs (vector), a subspecies of blood-feeding insects more commonly known as “kissing bugs” because they tend to bite people on the face and lips. T. cruzi is also transmitted congenitally from infected mothers to their babies, through consumption of contaminated food or beverages, and via blood transfusions and organ transplants. While the disease can progress slowly, chronic infection almost inevitably results in irreparable damage to heart and digestive system tissues. If untreated, infection is lifelong and can be life threatening. Chagas disease kills more people in Latin America than any other infectious disease–including malaria, tuberculosis, and HIV—and is one of the major causes of infection-induced myocarditis or cardiomyopathy worldwide. An estimated 30% of Chagas patients develop chronic and often severe heart disease that leads to premature death.

According to the World Health Organization, approximately 6-7 million people worldwide are estimated to be infected with the parasite T. cruzi, mostly in Latin America. An increasing number of cases of Chagas are also being documented in the United States of America and Europe. In the United States, the CDC estimates that there more than 300,000 people infected with T. cruzi, most of whom were infected in Chagas-endemic regions in Latin America.

Chagas disease presents in an acute phase (~2 months after infection) and a chronic phase, where the T. cruzi parasites are hidden in muscle tissue, including the heart and digestive system. For over 50 years, two nitroheterocyclic compounds, benznidazole and nifurtimox, have been available for treatment of the infection and more recently were FDA approved for use in children, but are rarely used due to their inconsistent efficacy and high frequency of side effects. There are currently no approved therapies to cure the disease once it reaches the chronic phase; however, benznidazole and nifurtimox may be offered to people younger than age 50 because they may help slow the progression of the disease and its most serious complications.

About Epetraborole

Epetraborole is a boron-containing, orally-available, small molecule inhibitor of bacterial leucyl-tRNA synthetase, or LeuRS, an enzyme that catalyzes the attachment of leucine to transfer RNA, or tRNA, molecules, an essential step in protein synthesis. Epetraborole forms a complex with a tRNALeu molecule, trapping the terminal ribonucleotide of tRNALeu in the editing site of the enzyme, which prevents the synthetic site from attaching leucine to tRNALeu thus shutting down tRNA leucylation and leading to a block in protein synthesis. This is an example of a completely novel target being enabled by boron chemistry.

In partnership with NIH, we are planning to initiate a Phase 2 study of epetraborole in acute melioidosis in mid-2025 with the goal of significantly reducing mortality which is ~50%.

We continue to explore epetraborole’s potential in the treatment of non-tuberculous mycobacterial lung disease, or NTM lung disease. While the EBO-301 trial in treatment-refractory MAC lung disease failed to demonstrate adequate efficacy in patients with severe, difficult-to-treat MAC lung disease, we continue to explore epetraborole’s potential for treatment-naive MAC lung disease, the most common type of NTM, and M. abscessus, since oral epetraborole 500mg daily was generally well-tolerated.

About Non-Tuberculous Mycobacterial (NTM) Lung Disease

NTM lung disease is a rare, chronic, and progressive infectious disease caused by bacteria known as mycobacteria that leads to irreversible lung damage and can be fatal.

Unlike most bacteria, which replicate quickly and spread outside of cells, mycobacteria replicate slowly and mostly infect alveolar (lung) macrophages and survive within them. Due to the slow growth and survival within macrophages of mycobacteria, the current standard of care for NTM lung infections requires prolonged treatments, often for 18 months or longer, with a combination of three or more antibiotics. The most prevalent type of NTM, Mycobacterium avium complex or MAC, accounts for approximately 80% of NTM lung disease in the United States.

There are an estimated 200,000 patients with NTM lung disease in the United States. We believe that many remain underdiagnosed due to lack of clinical suspicion, nonspecific respiratory symptoms, and underlying lung diseases that are frequent in patients with this infection. The prevalence of NTM lung disease is increasing in the United States by an estimated 8% per year. Among the approximately 55,000 patients diagnosed with NTM lung disease in the United States, approximately 44,000 patients have MAC lung disease.

In addition, Japan has some of the highest rates of NTM lung disease in the world. It is estimated that there are 220,000 patients with NTM lung disease.

M. abscessus (Mycobacterium abscessus)

M. abscessus is a highly drug-resistant, rapidly growing NTM that is a common soil and water contaminant. We are developing epetraborole as a potential first-line therapy in M. abscessus lung disease, which represents a smaller subset of NTM (~20% of NTM patients) but has a high unmet need. Current treatments for M. abscessus lung disease have poor efficacy (~50%), are often delivered by intravenous infusion, and have significant tolerability and safety issues. We believe that oral epetraborole, in combination with other drugs, has the potential to treat M. abscessus lung disease based on its in vitro and in vivo potency against multiple isolates.

About Melioidosis

Melioidosis is an urgent unmet global health infectious disease caused by the bacterium Burkholderia pseudomallei (B. pseudomallei). This bacterium is also documented as a high priority biothreat pathogen. B. pseudomallei is endemic to tropical regions of the world with the majority of melioidosis cases occurring in South Asia. Melioidosis is contracted from direct contact with B. pseudomallei contaminated soil and water and is not transmitted person-to-person. B. pseudomallei can be an intra-cellular pathogen in macrophages, an important element of melioidosis. The disease can manifest as localized infectious causing pain, swelling and ulceration; as pulmonary infectious causing cough, chest pain, high fever, and headache; and as blood stream infectious causing fever, headache, respiratory distress and abdominal discomfort. Current treatment generally starts with an intense phase of intravenous antibiotic treatment for a minimum of two weeks. Even with antibiotic treatment, the mortality rate is between 20% and 40%. Without treatment, six out of ten people die. There are an estimated 165,000 cases of melioidosis diagnosed globally each year, mostly outside the United States, although small outbreaks have occurred in the United States and the pathogen was recently discovered in soil and water sampling from the Gulf Coast region of Mississippi. Nonclinical studies by AN2, Anacor, the U.S. Army Research Institute of Infectious Diseases, and Colorado State University indicate that epetraborole has potent activity against B. pseudomallei.

Clinical Trials

AN2 Therapeutics is committed to addressing the challenges of infectious and other diseases and improving global human health. Successful clinical trials are required to gain regulatory approval for new medications to advance patient care and may be required to support any approved products.

For information on AN2 Therapeutics clinical trials that may be recruiting, search AN2 Therapeutics at www.clinicaltrials.gov

Presentations and Publications

Efficacy of epetraborole against Mycobacteroides abscessus in a mouse model of lung infection
Antimicrobial Agents and Chemotherapy 2024

In Vitro Evaluation of Drug–Drug Interaction Potential of Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor Pharmaceuticals 2024

Epetraborole, a leucyl-tRNA synthetase inhibitor, demonstrates murine efficacy, enhancing the in vivo activity of ceftazidime against Burkholderia pseudomallei, the causative agent of melioidosis
PLOS 2023

Epetraborole In Vitro Activity Against Mycobacterium Avium Complex Recent Clinical Isolates from Japan (#2135)
ID Week 2023

A Phase 1, Multicenter, Open-Label, Parallel-Group Study to Assess the Safety and Pharmacokinetics of Oral Epetraborole Tablets in Adult Subjects with Varying Degrees of Renal Function (#2144)
ID Week 2023

A Phase 1, Open-Label, Single Dose Study to Evaluate the Pharmacokinetics (PK), Safety, and Tolerability of Epetraborole Tablets and the Impact of Alcohol Dehydrogenase Genotype on the PK of Epetraborole and Metabolite M3 in Healthy Japanese Adult Subjects (#2556)
ID Week 2023

Epetraborole: A Novel Antibiotic for NTM Lung Disease & Melioidosis
ID Week 2023

Epetraborole: A Novel, Oral Antibiotic for NTM Lung Disease
ID Week 2022

Pharmacokinetic-Pharmacodynamic Target Attainment Analyses to Support Epetraborole Dose Selection for the Treatment of Patients with Mycobacterium avium Complex Lung Disease
ID Week 2022

Population Pharmacokinetic Model Development for Epetraborole and MAC Lung Disease Patients Using Data from Phase 1 and 2 Studies
ID Week 2022

Dose-response Studies of the Novel Bacterial Leucyl-tRNA Synthetase Inhibitor, Epetraborole, in the Intracellular Hollow Fiber System Model of Mycobacterium avium complex Lung Disease
ID Week 2022

Pharmacokinetics/pharmacodynamics of Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor, and High Intracellular Penetration in the Intracellular Hollow Fiber System Model of Mycobacterium avium Complex Lung Disease
ID Week 2022

Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor, Demonstrates Potent Efficacy and Improves Efficacy of Standard of Care Regimen Against Mycobacterium avium complex in a Chronic Mouse Lung Infection Model
ID Week 2022

In Vitro Activity of Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor, in Drug Combinations Against Nontuberculous Mycobacteria Including Resistance Frequency and MIC Characterization of Mycobacterium avium ATCC 700898 Epetraborole-resistant Mutants
ID Week 2022

In Vitro Activities of Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor, Against Mycobacterium avium Complex Isolates
ID Week 2022

In Vitro Drug-Drug Interaction Evaluation of Epetraborole, a Novel Bacterial Leucyl-tRNA Synthetase Inhibitor
ID Week 2022

Tolerability and Pharmacokinetics of Oral Epetraborole at the Predicted Therapeutic Dosage for Mycobacterium avium Complex (MAC) Lung Disease: A Phase 1b Dose-ranging and Food Effect Study
ID Week 2022