Acute kidney injury during therapy with an antisense oligonucleotide directed against PCSK9

Am J Kidney Dis. 2013 Oct;62(4):796-800. doi: 10.1053/j.ajkd.2013.02.359. Epub 2013 Apr 3.

Abstract

Antisense oligonucleotides have been explored widely in clinical trials and generally are considered to be nontoxic for the kidney, even at high concentrations. We report a case of toxic acute tubular injury in a healthy 56-year-old female volunteer after a pharmacologically active dose of a locked nucleic acid antisense oligonucleotide was administered. The patient received 3 weekly subcutaneous doses of experimental drug SPC5001, an antisense oligonucleotide directed against PCSK9 (proprotein convertase subtilisin/kexin type 9) that is under investigation as an agent to reduce low-density lipoprotein cholesterol levels. Five days after the last dose, the patient's serum creatinine level increased from 0.81 mg/dL at baseline (corresponding to an estimated glomerular filtration rate [eGFR] of 78 mL/min/1.73 m(2)) to 2.67 mg/dL (eGFR, 20 mL/min/1.73 m(2)), and this increase coincided with the presence of white blood cells, granular casts, and minimal hematuria on urine microscopy. The patient's serum creatinine level peaked at 3.81 mg/dL (eGFR, 13 mL/min/1.73 m(2)) 1 week after the last oligonucleotide dose. Kidney biopsy showed multifocal tubular necrosis and signs of oligonucleotide accumulation. Upon conservative treatment, the patient's serum creatinine level gradually decreased and reached her baseline level 44 days after the last oligonucleotide was administered. The patient recovered fully and kidney function was normal at every follow-up visit.

Keywords: Clinical kidney injury; PCSK9 (proprotein convertase subtilisin/kexin type 9); oligonucleotide.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Female
  • Humans
  • Middle Aged
  • Oligonucleotides, Antisense / adverse effects*
  • Oligonucleotides, Antisense / therapeutic use
  • Proprotein Convertase 9
  • Proprotein Convertases / adverse effects*
  • Proprotein Convertases / therapeutic use
  • Serine Endopeptidases / adverse effects*
  • Serine Endopeptidases / therapeutic use

Substances

  • Oligonucleotides, Antisense
  • PCSK9 protein, human
  • Proprotein Convertase 9
  • Proprotein Convertases
  • Serine Endopeptidases