INVA8001, a Novel and Highly Selective Chymase Inhibitor, Ameliorates Liver Inflammation, Fibrosis, and Hyperplasia in Mdr2 Knockout Mice

Background and aimsMast cells (MCs) play a significant role in autoimmune diseases by mediating inflammatory responses, innate and adaptive responses, angiogenesis, and various pathological processes. MC numbers are significantly increased in chronic liver disease and liver cancer, and degranulation leads to a release of MC mediators, including chymase, which increases inflammation, activates hepatic stellate cells (HSCs), ultimately leading to fibrosis. Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic liver disease characterized by inflammation, fibrosis, ductular reaction, and eventual liver failure. MCs and their mediators, particularly chymase, have been implicated in PSC pathogenesis; however, targeting chymase therapeutically has remains largely unexplored. In this study, we aimed to evaluate the efficacy of INVA8001, a highly selective chymase inhibitor, on PSC pathogenesis in the Mdr2 knockout mouse (Mdr2-/- mice) model of PSC. Approach and ResultsWe evaluated the levels of chymase and other MC markers in liver biopsy samples collected from late-stage PSC patients. The effect of chymase inhibition was evaluated using a highly selective and potent small molecule chymase inhibitor, INVA8001, in Mdr2-/- mice. Ten-week-old male Mdr2-/- mice were injected intraperitoneally (IP) with 20 mg/kg of INVA8001 daily for two weeks and varying parameters of disease pathogenesis, including MC activation, inflammation, fibrosis, biliary pathology, and cholestasis were evaluated. In addition, histological, immunohistochemical, biochemical, and molecular analyses were conducted to evaluate the effects of INVA8001 treatment in Mdr2-/- mice. The liver biopsies of PSC patients showed an increased number of chymase-positive cells compared with control samples (collected from non-diseased patients). INVA8001 treatment resulted in a reduction of MC accumulation, inflammation, histological damage, fibrosis, ductular reaction, and biliary senescence in Mdr2-/- mice. The current data show the pathophysiological role of chymase in PSC and the impact of a selective chymase inhibitor on PSC disease pathogenesis. This can further be extrapolated to various MC-driven diseases such as chronic urticaria, atopic dermatitis, asthma, metabolic dysfunction-associated steatohepatitis (MASH), and eosinophilic gastrointestinal diseases, among others, where chymase is central to the disease pathogenesis. ConclusionsOur findings identify chymase as a key driver of PSC pathogenesis establishing INVA8001 as a promising new therapeutic candidate for hepatobiliary disorders, including PSC. Chymase inhibition simultaneously targets MC activation, inflammation, fibrosis, and biliary senescence, and offers a multifaceted approach to treating PSC and other MC-related disorders.