Effects of RM-493 on Energy Expenditure in Obese Individuals

Obesity is a chronic relapsing health problem and a strong risk factor for type 2 diabetes,
hypertension, heart disease and stroke. Life expectancy is shorter in obese individuals who
often suffer from costly related co-morbidities such as certain cancers, liver disease,
osteoarthritis, sleep apnea and depression. Weight loss improves the co-morbidities. Diet
and exercise are effective in the short term, but are rarely effective over a span of years.
New therapies are needed especially for patients with obesity. The melanocortin system,
and specifically, melanocortin 4 receptor (MC4R) is involved in the regulation of energy
homeostasis and body weight. This role is validated in human genetic mutations, and in
animal models of obesity, stimulation of MC4R reduces food intake and increases metabolic
rate, causing a reduction in body weight.

RM-493 is a potent, selective peptide agonist for the MC4R that suppressed food intake and
reduced body weight in preclinical studies. RM-493 has been studied in single dose and
multiple ascending dose clinical studies in obese volunteers. This study is a randomized,
double-blind, placebo-controlled, multiple-dose, 2-period, crossover study to assess the
effects of RM-493 on resting energy expenditure measured in a room calorimeter. Twelve
obese but otherwise healthy adult subjects between the ages of 18 and 50 inclusive, will be
enrolled and randomized to one of 2 treatment sequences (RM-493 then placebo; or placebo
then RM-493) over an 8-day study interval. Components of 24-hour energy expenditure,
exercise induced energy expenditure, spontaneous physical activity, respiratory quotient,
safety and pharmacokinetic data will be collected.

- INCLUSION CRITERIA:

Male and female subjects aged 18 to 50 years at screening who meet the following inclusion
and exclusion criteria will be eligible for enrollment:

- Able to provide written informed consent prior to any study procedures, and be
willing and able to comply with study procedures

- Body mass index of 30-40 kg/m(2)

- Subjects who are medically healthy with normal or clinically insignificant screening
results (laboratory profiles, medical histories, electrocardiograms and physical
examination)

- Female subjects must have negative serum or urine pregnancy tests and must not be
lactating. For females able to bear children, a hormonal (i.e., oral, implantable,
or injectable) and single-barrier method, or a double-barrier method of birth control
or abstinence must be used/ practiced throughout the study. Female subjects unable
to bear children must have this documented in the case report form (CRF) (i.e., tubal
ligation, hysterectomy, or post-menopausal [defined as a minimum of one year since
the last menstrual period]). Post-menopausal status will be confirmed by follicle
stimulating hormone (FSH).

- Female subjects must have a negative serum pregnancy test prior to administering the
OmniPod in both Period 1 and Period 2 to continue in the study.

- Males with female partners of childbearing potential must agree to use two medically
acceptable forms of contraception as described above, with one of the two forms being
condom with spermicide, from the Screening Period through the follow up phone call
after completion of study treatment. Males with female partners of childbearing
potential who themselves are surgically sterile (status post vasectomy) must agree to
use condoms with spermicide over the same period of time.

EXCLUSION CRITERIA:

- Pregnant or lactating women

- Any clinically significant abnormalities on screening laboratories or physical
examination as determined by the Investigator

- Abnormal 12-lead electrocardiogram (ECG) except minor deviations deemed to be of no
clinical significance by the Investigator

- ALT or AST > 1.5 times the upper limit of normal (ULN) during screening

- Treated or untreated hypertension or blood pressure 140/90

- Treated or untreated diabetes diagnosed as fasting plasma glucose 126 or a HbA1c
6.5%

- TSH outside of the normal range

- Active or history of any significant medical condition such as and including renal,
hepatic, pulmonary, gastrointestinal, cardiovascular, genitourinary, endocrine,
immunologic, metabolic, neurologic or hematological disease.

- Clinical symptoms of or treatment for sleep apnea (severe snoring, excessive daytime
somnolence)

- Any history of cancer, including personal history or close family history (parents or
siblings) of melanoma; and/or personal history of multiple atypical nevi, nevoid
basal cell carcinoma syndrome, or a personal history of non-melanoma skin cancer.

- Bariatric surgery

- History of recent surgery (within 60 days of screening)

- Current or recent (within last month) infection or viral illness

- Prescription drug use including topical steroids and inhalers, and non-prescription
medicines with sympathomimetic actions (eg decongestants) if not stopped 1 week prior
to and throughout the admission.

- Weight loss or gain of greater than 3% of body weight in last 3 months

- Inflexible dietary restrictions

- Actively training athletes (collegiate or professional level)

- Cigarette smoking (must be completely nonsmoking for at least 2 months)

- Dependence on caffeine, alcohol or drugs; unable or unwilling to abstain completely
from caffeine and related substances for 72 hours prior to study and throughout the
study

- Claustrophobia or other psychiatric conditions that would preclude participation in
all aspects of the study

- Unable or unwilling to wear an insulin pump for the 6 days of treatment during the
study (to deliver test drug and placebo)

- Participation in an investigational clinical study within the 30 days prior to dosing
in the present study

- Any other reason, which in the opinion of the Investigator, would confound proper
interpretation of the study