Sustained efficacy of a single intra-articular dose of FX006 in a rat model of repeated localized knee arthritis A. Kumar, A.M. Bendele, R.C. Blanks,

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Sustained efficacy of a single intra-articular dose of FX006 in a rat model of repeated localized knee arthritis A. Kumar, A.M. Bendele, R.C. Blanks, N. Bodick Osteoarthritis and Cartilage Volume 23, Issue 1, Pages 151-160 (January 2015) DOI: 10.1016/j.joca.2014.09.019 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 The timeline of study procedures and assessments is shown in the schematic above and described in the text. Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Gait analysis scores (mean ± s.e.m.) are shown for control rats (black diamonds) and for rats treated with FX006 or TCA IR through three reactivations of localized synovitis/arthritis (A) All treatment groups (B) Control animals and groups treated with the highest doses of FX006 (red squares) and TCA IR (purple open circles) that provide comparable systemic exposure to TCA. A single IA injection of FX006 on Day 0, most notably at 0.28 mg, resulted in sustained analgesic efficacy throughout the study period achieving statistical significance compared to vehicle control on Days 1, 2, 4, 15 and 16 (P ≤ 0.05 Kruskal–Wallis test with Dunn's multiple comparison post-test). Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Mean plasma concentrations of TCA over time measured in animals treated with FX006 or TCA IR are shown for all FX006 and TCA IR groups. Inset shows the low TCA concentrations (mean ± s.e.m.) in the FX006 groups on a smaller scale. Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 (A) Serum corticosterone levels (mean ± s.e.m.) are shown over time for vehicle-treated rats and those animals treated with only the highest dose levels of FX006 or TCA IR for clarity since the data were variable in these animals, likely on account of the pain and stress experienced during the conduct of this study. The initial TCA-related inhibition immediately following dose administration, recovered in all animals by 2 weeks. (B) Serum corticosterone levels measured in FX006-or TCA IR-treated rats are shown as a function of plasma TCA concentration. This PK/PD analysis showed (red line) that HPA axis effects as measured by serum corticosterone were a function of systemic TCA concentration and serum corticosterone was inhibited when plasma concentration was above 1 ng/mL. Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Histopathological analysis (mean ± s.e.m.) of rat knee joints at the end of the study following the last of three reactivations of synovitis/arthritis demonstrated joint degeneration in vehicle-treated control animals. Treatment with a single IA injection of FX006 improved joint scores significantly (P ≤ 0.05 Kruskal–Wallis test with Dunn's multiple comparison post-test at high- and mid-doses compared to vehicle control) as shown above in (A) Composite scores and (B) Individual scores for inflammation, cartilage damage, bone resorption and pannus formation. Treatment with TCA IR resulted in a smaller, non-significant improvement. Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 These representative micrographs showing toluidine blue stained sections of knee joints taken from a (A) vehicle (B) TCA IR and (C) FX006 (0.28 mg)-treated rats. FX006-treatment resulted in joint preservation as can be noted in the near-normal joint architecture that was maintained following a single IA injection of 0.28 mg of FX006. Images taken at 25×; note cartilage (large arrow; damaged in the vehicle and TCA IR-treated rats and intact in the FX006-treated rat), pannus formation (small arrow; in vehicle animal only), bone resorption (arrowhead; in vehicle and TCA IR animals only). S = synovium (note severe inflammation in the vehicle and TCA IR-treated animals and normal synovium in the FX006-treated animal); C = cruciates/intracondylar connective tissue. Osteoarthritis and Cartilage 2015 23, 151-160DOI: (10.1016/j.joca.2014.09.019) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions