About DME
DME is an important cause of vision loss in diabetes and is due to leakage from the blood vessels in the retina. The leakage of fluid from damaged blood vessels results in swelling and a buildup of pressure in the eye, which leads to disorganization of the retinal layers and ultimately results in vision loss.1 While current treatments focus on vascular endothelial growth factor (VEGF) inhibition, DME can develop from other mechanisms, such as the kallikrein-bradykinin pathway, a system at the cellular level that plays a vital role in human physiology. This is supported by observations that many patients with DME have an incomplete response to intravitreal anti-VEGF therapies that are administered every 4 to 8 weeks.2,3
We are developing avoralstat, a plasma kallikrein inhibitor that is designed to target the kallikrein-bradykinin system on the retinal vascular endothelial cells and may result in less vascular leakage and less edema. Using a different mechanism of action from current anti-VEGF therapies and delivered to the suprachoroidal space as a depot formulation, avoralstat is designed to provide high dose levels to the retinal vessels with long-lasting exposure. This could result in less-frequent injections and a reduced burden on patients and the healthcare system. We plan to advance avoralstat into a clinical trial in patients with DME in 2025.

Educational resources and support
Publications on Diabetic Macular Edema
Publications
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Discovery of highly potent small molecule kallikrein inhibitors
Mol Immunol
|2007
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The suprachoroidal pathway: a new drug delivery route to the back of the eye
Drug Discov Today
|2015
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Microinjection via the suprachoroidal space: a review of a novel mode of administration
Am J Manag Care
|2022
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Plasma Kallikrein-Kinin System as a VEGF-Independent Mediator of Diabetic Macular EdemaÂ
Diabetes
|2015
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Characterization of the Vitreous Proteome in Diabetes without Diabetic Retinopathy and Diabetes with Proliferative Diabetic Retinopathy
J Proteome Res
|2008
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Extracellular carbonic anhydrase mediates hemorrhagic retinal and cerebral vascular permeability through prekallikrein activation
Nat Med
|2007
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The Role of Plasma Kallikrein–Kinin Pathway in the Development of Diabetic Retinopathy: Pathophysiology and Therapeutic Approaches
Semin Ophthalmol
|2016
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Kinins and Their Receptors as Potential Therapeutic Targets in Retinal Pathologies
Cells
|2021
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Plasma Kallikrein Mediates Vascular Endothelial Growth Factor-Induced Retinal Dysfunction and Thickening
Invest Ophthalmol Vis Sci
|2016
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Molecules related to diabetic retinopathy in the vitreous and involved pathways
Int J Ophthalmol
|2022
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Plasma kallikrein-kinin system and diabetic retinopathy
Biol Chem
|2013
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The evolving therapeutic landscape of diabetic retinopathy
Expert Opin Biol Ther
|2023
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Mechanisms of macular edema
Front Med (Lausanne)
|2023
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Diabetic Macular Edema: Current Understanding, Molecular Mechanisms and Therapeutic Implications
Cells
|2022
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Mechanisms of macular edema: Beyond the surface
Prog Retin Eye Res
|2018
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Diabetic Macular Edema Pathophysiology: Vasogenic versus Inflammatory
J Diabetes Res
|2016
A growing pipeline of small-molecule and protein therapeutics
BioCryst development programs represent the potential to improve the well-being of people whose lives are currently limited by HAE and other rare diseases. We discover novel, small-molecule and protein therapeutics that treat diseases in which significant unmet medical needs exist.
References
1. Macular Society. Diabetic macular oedema (DMO). Accessed August 14, 2024. https://www.macularsociety.org/macular-disease/macular-conditions/diabetic-macular-oedema/ 2. Bhatwadekar AD, Kansara VS, Ciulla TA. Investigational plasma kallikrein inhibitors for the treatment of diabetic macular edema: an expert assessment. Expert Opin Investig Drugs. 2020;29(3):237-244. 3. Elyasi N, Hemmati HD. Diabetic macular edema: diagnosis and management. American Academy of Opthalmology website. Accessed August 14, 2024. https://www.aao.org/eyenet/article/diabetic-macular-edema-diagnosis-and-management