Despite current standard of care treatment, the period shortly after acute
myocardial infarction (AMI) is associated with high residual cardiovascular (CV) risk, with high rates of recurrent AMI and CV death in the first 90 days following the index event. This represents an area of high unmet need that may be potentially addressed by novel therapeutic agents that optimize
high-density lipoprotein cholesterol (HDL-C) function rather than increase HDL-C concentrations.
Apolipoprotein A-I (
apoA-I) is the major constituent of HDL and a key mediator of
cholesterol efflux from macrophages within
atherosclerotic plaque, a property especially relevant during the high-risk period immediately following an AMI when
cholesterol efflux capacity is found to be reduced.
CSL112 is a novel formulation of human plasma-derived
apolipoprotein A-I (
apoA-I), currently being evaluated in a Phase 3 clinical trial (AEGIS-II) for the reduction of major adverse CV events in the 90-day high-risk period post-AMI. In this review, we provide an overview of the
biological properties of
CSL112 that contribute to its proposed mechanism of action for potential therapeutic benefit. These properties include rapid and robust promotion of
cholesterol efflux from cells abundant in
atherosclerotic plaque, in addition to anti-inflammatory effects, which together, may have a stabilizing effect on
atherosclerotic plaque. We provide a detailed overview of these mechanisms, in addition to information on the composition of
CSL112 and how it is manufactured.