
C
Tier
ActRIIB decoy receptor that traps myostatin.
Fusion protein, not a peptide
WADA Status:
Prohibited at all times (S4.3)
Human Trial Scoreboard
Completed human RCTs
Terminated before completion
Largest Human Study
Size not verified
Longest exposure
Stopped after cohort two
Most Recent Trial
Development discontinued
Description
ACE-031, or ramatercept, is not a peptide but a fusion protein, built from part of the activin receptor joined to an antibody fragment. It works as a decoy: it circulates and mops up myostatin before it can reach the receptors that would otherwise limit muscle growth. Acceleron Pharma and Shire developed it and early trials showed genuine increases in lean mass. Then the mid-stage trial in boys with Duchenne muscular dystrophy was halted in 2011 after patients developed nosebleeds, bleeding gums and small dilated blood vessels in the skin, caused by the drug also blocking related proteins involved in blood vessel regulation. The collaboration formally ended in May 2013. This is a case where the compound worked and was stopped anyway.
What Are The Claims
Claims made for this compound: Broad muscle-mass increase (research)
Evidence
The reason for the halt is the fact that matters, and it is almost always omitted when this compound is sold. A randomized, double-blind, placebo-controlled trial in ambulatory boys with Duchenne muscular dystrophy, published by Campbell and colleagues in Muscle and Nerve in 2017, was stopped after the second dosing regimen because of safety concerns involving epistaxis, meaning nosebleeds, and telangiectasias, meaning dilated blood vessels visible at the skin surface. The effects are attributed to off-target inhibition of BMP9 and BMP10 signaling, producing something mechanistically resembling hereditary hemorrhagic telangiectasia. So the record is this: ACE-031 was given to human beings under trial conditions, it produced vascular adverse events serious enough to stop the study, and its developers abandoned it. It continues to be sold.
Evidence Strength
Preliminary (Phase 2 halted for safety)
Caveats
Safety
Alternative Measures
Legal Status
US
Not approved; development discontinued
UK
Not approved
EU
Not approved
AU
Not approved
WADA
Prohibited at all times (S4.3)
Not approved. Clinical development was halted in 2011 and permanently discontinued by Acceleron and Shire in 2013.
Citations
Campbell C et al. (2017). Muscle & Nerve. Randomized placebo-controlled trial in ambulatory Duchenne muscular dystrophy; halted for epistaxis and telangiectasias. DOI: 10.1002/mus.25268. | Development discontinued by Acceleron/Shire, 2013.