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In Reply: We agree with Dr Kim and colleagues that it is unlikely that HDL particle size represents the protective mechanism underlying the observed effects of ETC-216. Kim et al also point out the absence of a well-defined mechanistic explanation for the observed benefits of ApoA-1 Milano in carriers or following therapeutic administration. Now that we have preliminary evidence of a rapid regression of atherosclerosis in human subjects, we hope that our study will encourage further exploration of the molecular and cellular mechanisms of action of ApoA-1 Milano. Such efforts could provide important insights into the process of reverse cholesterol transport and lead to development of other approaches to achieve regression of coronary disease. Currently, the same team that developed ETC-216 is beginning human studies of a small molecule that appears to provide similar benefits and would be much easier to manufacture than a recombinant protein such as ApoA-1 Milano. . . . [Full Text of this Article]

Steven E. Nissen, MD
nissens@ccf.org
Department of Cardiovascular Medicine
Cleveland Clinic Foundation
Cleveland, Ohio

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