# A Novel Small Molecule Inhibitor of Sclerostin to Improve Surgical Spine Fusions In Vivo

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Spinal arthrodesis procedures are commonly performed in our veterans for a wide range of pathology.
Despite state-of-the-art surgical procedures, fusion failure rates still range from 10-40%. This is important, as
failure to fuse is often associated with continued pain, worse outcomes, increased medication requirements, and
possibly the cost of additional surgeries. Given the individual shortcomings of the currently available bone graft
options, there is a clear clinical need for additional strategies that the surgeon can utilize in order to achieve
consistently successful spinal fusions. We have specifically identified an opportunity to address this clinical
problem by taking advantage of the complex crosstalk between the Wnt and BMP signaling pathways. Promotion
of canonical Wnt signaling through blocking the Wnt inhibitor sclerostin represents a unique opportunity to
enhance bone formation locally. The cumulative literature on sclerostin inhibition suggests that an anabolic bone
forming effect can be achieved while simultaneously decreasing bone resorption. As such, sclerostin inhibition
is the only known anabolic strategy that leads to an uncoupling of bone formation and resorption in humans.
The majority of sclerostin blocking strategies involve monoclonal antibodies (mAbs) delivered systemically, which
is not ideal in local bone healing applications like posterolateral spine fusions. Systemic dosing, as compared to
local delivery, typically requires higher dosing regimens and raises concern over the potential for off-target side
effects. mAbs also have limited stability and a short shelf-life, are prone to batch-to-batch variation, and are
difficult to engineer into a carrier. In addition, their high manufacturing cost will continue to be a limitation as we
move towards a more value-based healthcare economy.
 Using the pioneering work of anti-sclerostin mAbs as a demonstration of the viability of sclerostin
blockade, we propose to investigate a novel and highly innovative strategy based on the local delivery of small
molecule inhibitors (SMIs) of sclerostin. We believe that SMIs are more advantageous than mAb-based
strategies for local bone formation because of multiple key factors: ease and consistency of manufacturing,
improved stability, immunoprivilege, controllable spatial and temporal release, and significantly reduced cost.
The goal of this application is to demonstrate that a single administration of a locally delivered anti-sclerostin
SMI at the time of spinal arthrodesis surgery will result in a lower pseudarthrosis rate compared to autologous
ICBG (the gold standard). Certainly, a reduced spinal pseudarthrosis rate in our veterans will directly lead to
better outcomes as well as a decrease in the overall cost associated with these commonly performed surgeries.
 We have utilized a validated in silico strategy to computationally identify two FDA approved compounds
with the potential to be repurposed as anti-sclerostin SMIs. Here, w...

## Key facts

- **NIH application ID:** 9932895
- **Project number:** 5IK2BX003845-04
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Steven M Presciutti
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-07-01 → 2021-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9932895

## Citation

> US National Institutes of Health, RePORTER application 9932895, A Novel Small Molecule Inhibitor of Sclerostin to Improve Surgical Spine Fusions In Vivo (5IK2BX003845-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9932895. Licensed CC0.

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