C

Tier

ACE-031

ACE-031

ACE-031

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

0
0
0

Terminated before completion

Largest Human Study

0
0
0

Size not verified

Longest exposure

0
0
0

Stopped after cohort two

Most Recent Trial

2013
2013
2013

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.

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