Diabetic Cardiomyopathy (DbCM) is a form of heart failure (Stage B) characterized by a decrease in heart function and diagnosed by echocardiogram.

In the United States (U.S.), approximately 34 million people are living with diabetes – about one in ten people. The hallmark of diabetes is hyperglycemia, or high levels of glucose (sugar) in the blood. In people with diabetes – even those with adequate glucose control (HbAIC <8.5) – Aldose Reductase converts glucose to sorbitol, which can cause damage to tissues, including the heart. There are no approved therapies for DbCM, which affects ~20% of people with diabetes. Approximately 25% of patients with DbCM progress to overt heart failure or death within 18 months of diagnosis.

There are no approved treatments specifically approved for DbCM, which affects ~20% of people with diabetes

DbCM leads to progressive cardiac dysfunction and serious cardiovascular outcomes

25% of patients with DbCM progress to overt heart failure or death within 1.5 years of diagnosis​

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DbCM can occur in both Type 1 and Type 2 diabetics, despite glucose control. When there is too much glucose in the body, it is broken down by the polyol pathway. The polyol pathway is a specific chemical reaction that converts glucose into other substances. The first enzyme in this pathway is Aldose Reductase, which converts glucose to a substance called sorbitol.

Sorbitol and fructose can damage the heart in many ways; one such potential instance is called oxidative stress. As the name suggests, oxidative stress causes a lot of stress to the heart because of an increase in molecules, called free radicals, that are harmful to important structures in cells. When these structures are harmed, the cells in the heart cannot do their job properly. Aldose Reductase activation also detracts glucose from the energy efficient hexokinase/glycolytic pathway, resulting in less energy production for cardiomyocytes.

Sorbitol will eventually cause cell death if not controlled. The damage that occurs includes heart fibrosis, or “hardening” of the heart. When this happens, the heart becomes less effective at pumping blood to the rest of the body.

If DbCM is not treated, it can become worse, progressing to overt heart failure and potentially death. A specific treatment for DbCM is needed.

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DbCM patients present clinically with shortness of breath on exertion due to decreased functional capacity of the heart muscle. Fortunately, DbCM can be diagnosed early in the disease via echocardiogram, a simple non-invasive procedure performed in many physicians’ offices.

OUR COMMITMENT TO DbCM RESEARCH

Applied Therapeutics is committed to advancing research in DbCM and potentially finding a new treatment option for this urgent unmet medical need.

AT-001 was evaluated in the ARISE-HF Phase 3 study in patients with Diabetic Cardiomyopathy (DBCM). The primary endpoint of the ARISE-HF study was stabilization or improvement in cardiac functional capacity as measured by Peak VO2 in patients treated with AT-001 1500mg twice daily (BID) as compared to placebo. The placebo-treated group declined by a mean of -0.31 ml/kg/min over 15 months of treatment, while the AT-001 1500mg BID group remained primarily stable, with a mean change of -0.01 ml/kg/min over 15 months. While a trend favored active treatment, the difference between active and placebo treated groups (0.30 ml/kg/min) was not statistically significant (p=0.210).

In a pre-specified subgroup analysis of the primary endpoint in patients not concomitantly treated with SGLT2 or GLP-1 therapies, the placebo group declined by a mean of -0.54 ml/kg/min, while the 1500mg BID AT-001 treated group improved by a mean of 0.08 ml/kg/min over 15 months of treatment, with a statistically significant difference between groups of 0.62 ml/kg/min (p=0.040). Additionally, in this subgroup analysis, the number of patients who experienced a clinically significant worsening in cardiac functional capacity of 6% or more was substantially higher in the placebo group (46%) as compared to the 1500mg BID AT-001 treated group (32.7%), odds ratio 0.56 (p=0.035). A 6% change in cardiac functional capacity has been shown to predict long-term survival and hospitalization for heart failure.

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