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    BridgeBio’s acoramidis (Attruby), an oral, second-generation stabilizer of the TTR protein, has been approved by the FDA for the treatment of ATTR-CM (transthyretin amyloid cardiomyopathy). Amyloid deposits in the heart muscle characterize the rare but potentially fatal disease. This case study reviews the history of TTR modulation, early experiments validating the therapeutic potential of TTR stabilization, the binding mechanism of acoramidis to TTR, the importance of binding enthalpy for differentiation, and the molecule’s impressive 30-month clinical data following an early scare.

    Molecule

    As the “Guardian of the Genome,” the tumor suppressor transcription factor p53 has been a much sought-after target in oncology, with over 50% of malignancies showing mutations in p53. The p53(Y220C) mutant has been of particular interest as it creates a pocket which small molecule stabilizers are able to bind to and restore p53 function. PMV Pharma is the first to enter the clinic with their p53(Y220C) stabilizer rezatapopt, which was optimized from a hybrid of known binders and which is showing real promise against a swath of solid tumors.

    Molecule

    Tyra Biosciences’ lead asset, TYRA-300, is a potent, selective, and orally bioavailable FGFR3 inhibitor designed to mitigate the toxicities commonly seen with pan-FGFR inhibitors. A key objective of the program was to meet the safety standards required for advancing into pediatric populations for the treatment of ACH (achondroplasia) and other skeletal dysplasias. TYRA-300 is currently being evaluated in Ph. I clinical trials for advanced urothelial cancers and other solid tumors and, importantly, has received IND clearance to initiate a Ph. II clinical trial in pediatric ACH patients.

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