AS SEEN IN USA TODAY LIFE SECTION, WEDNESDAY, NOVEMBER 5, 2003, PAGE 11D

Plaque-reducing protein shows promise
By Steve Sternberg, USA TODAY

Taking their cue from nature, researchers have developed the first treatment shown to dramatically shrink the fatty plaques that clog arteries, a study reports today.

The experimental drug is a synthetic version of a protein discovered in a handful of Italian villagers who had healthy arteries and lived long lives despite having low levels of good cholesterol, called HDL.

In its place, the 40 villagers have a different form of HDL, a protein dubbed ApoA-1 Milano. The new research shows that a genetically engineered version of the protein reversed the progression of coronary artery disease, says lead researcher Steven Nissen of the Cleveland Clinic.

Five infusions of ApoA-1 over six weeks reduced plaque deposits by an average of 4%, 10 times the reduction seen after years of taking cholesterol-lowering statin drugs. The benefit was even more pronounced in the large, inflamed plaque-filled bulges that are prone to burst and cause heart attacks, reducing them by as much as 34%.

"I almost fell out of my chair when I saw what happened," Nissen says.

Although the study was small, involving just 47 patients with severe heart disease, the results were so dramatic that researchers say it heralds the start of a new offensive against heart disease. Currently, researchers concentrate on drugs that lower levels of bad cholesterol (LDL), which carries fats into arteries. In the future, researchers will try bolstering HDL, which hauls fats away.

The treatment must be given intravenously, so it's likely to be used in people who have had heart attacks, says the study in The Journal of the American Medical Association.

"The ApoA-1 story is remarkable, beginning with discovery of rare individuals in a small Italian town and leading to the development of a potential new therapy," Daniel Rader of the University of Pennsylvania says in an accompanying editorial.

Esperion, the biotech firm that makes the protein, is planning a much larger trial involving 1,500 to 2,000 patients, prior to seeking government approval to market ApoA-1. Government approval is probably a decade away.