Up to eleven

Factor XI inhibitors may not only have safety advantages over more established anticoagulants, but could come with blood pressure-lowering benefits as well. A Science Translational Medicine study from Ionis Pharmaceuticals Inc. (NASDAQ:IONS) and Johannes Gutenberg University Mainz has shown Factor XI-targeting antisense oligos (ASOs) decrease arterial hypertension by shutting down a feedback loop that fuels inflammation at blood vessel walls, creating new value for the target.

Factor XI is the proenzyme precursor to Factor XIa, a protease that activates platelets to wall-off bacteria or other foreign substances in vessels. The downstream protease Factor Xa, which has the additional function of responding to blood vessel damage, is widely targeted for thrombosis indications, with at least 11 inhibitors on the market and more in development. But Factor Xa inhibition comes with higher bleeding risk than blockade of Factor XI or Factor XIa, prompting several companies to explore the latter strategy in thrombosis patients with certain co-morbidities...