GS-0976 (Firsocostat): an investigational liver-directed acetyl-CoA carboxylase (ACC) inhibitor for the treatment of non-alcoholic steatohepatitis (NASH)

ABSTRACT

Introduction: De novo lipogenesis (DNL) plays a major role in fatty acid metabolism and contributes significantly to triglyceride accumulation within the hepatocytes in patients with nonalcoholic steatohepatitis (NASH). Acetyl-CoA carboxylase (ACC) converts acetyl-CoA to malonyl CoA and is a rate-controlling step in DNL. Furthermore, malonyl-CoA is an important regulator of hepatic mitochondrial fat oxidation through its ability to inhibit carnitine palmitoyltransferase I. Therefore, inhibiting ACC pharmacologically represents an attractive approach to treating NASH.

Areas covered: This article summarizes preclinical and clinical data on the efficacy and safety of the liver-targeted ACC inhibitor GS-0976 (Firsocostat) for the treatment of NASH. In a phase 2 trial that included 126 patients with NASH and fibrosis, GS-0976 20 mg daily for 12 weeks showed significant relative reduction in liver fat by 29%; however, treatment was associated with an increase in plasma triglycerides with 16 patients having levels >500 mg/dL.

Expert opinion: Preclinical and preliminary clinical data support the development of GS-0976 as treatment for NASH. ACC-induced hypertriglyceridemia can be mitigated by fish oil or fibrates, but the long-term cardiovascular effects require further investigations.

KEYWORDS:

• Acetyl-CoA carboxylase
• nonalcoholic fatty liver disease
• de novo lipogenesis
• nonalcoholic steatohepatitis

Declaration of interest

GI Shulman receives investigator-initiated support from Merck, AstraZeneca and Gilead Sciences (the maker of GS-0976) and he serves on Scientific Advisory Boards for Merck, AstraZeneca, Gilead Sciences, Aegerion Pharmaceuticals, Novo Nordisk, iMetabolic Biopharma and Janseen Research and Development. N Alkhouri, E Lawitz, M Noureddin, and R DeFronz receive research funding from, and serve on Scientific Advisory Board for Gilead Sciences (the maker of GS-0976). The authors have no other 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 received study support and provided consultation services for Gilead Sciences. One reviewer has served as a consultant for Astra Zeneca, Pfizer, AMGEN, Sanofi, Camp4, Medacorp, foresite labs, Akcea, Ionis, and Celgene.

Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by grants from the United States Public Health Service: [R01 DK113984]; [R01 DK114793]; [DK116774]; [DK119968]; [P30 DK45735]; Gilead Sciences and The Novo Nordisk Foundation Center for Basic Metabolic Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.