Results from the phase 2 BESTOW clinical trial show Eledon Pharmaceuticals' tegoprubart outperforms standard-of-care tacrolimus in preserving kidney function and improving quality of life in adult kidney transplant recipients. By targeting the CD40L pathway, tegoprubart avoids tacrolimus-related toxicities, enabling breakthrough islet cell transplant trials funded by Breakthrough T1D for type 1 diabetes patients with chronic kidney disease.
BESTOW trial results and presentation
- ▪The Phase 2 BESTOW trial results comparing tegoprubart to tacrolimus in kidney transplant recipients were scheduled for presentation at ASN Kidney Week 2026, held October 22–25, 2026.
- ▪The phase 2 BESTOW clinical trial showed that tegoprubart was better at preserving kidney function than standard-of-care tacrolimus in adults receiving their first kidney transplant.
- ▪In the BESTOW trial, kidney graft function stabilized after the first month and demonstrated a statistically significant benefit for tegoprubart over tacrolimus at 18 months.
- ▪In a BESTOW trial analysis of 107 patients completing 52 weeks, tegoprubart led to greater health-related quality of life improvements and mental component scores than tacrolimus.
Tegoprubart mechanism and potential
- ▪Tegoprubart is an investigational anti-CD40L antibody therapy developed by Eledon Pharmaceuticals that targets the CD40L pathway central to immune cell communication.
- ▪According to Andrew Adams of the University of Minnesota, targeting the CD40L pathway with tegoprubart has potential to become standard immunosuppression across all transplant types.
Tacrolimus side effects and limitations
- ▪Potential kidney toxicity from standard immunosuppressants like tacrolimus historically excluded individuals with type 1 diabetes and reduced kidney function from islet cell transplant studies.
- ▪Tacrolimus is current standard-of-care transplant immunosuppressive therapy that prevents organ rejection but carries toxicity and side effects including hypertension, diabetes, tremors, and brain fog.
Type 1 diabetes overview and impact
- ▪Type 1 diabetes affects 9.5 million people globally, and nearly one in three people living with type 1 diabetes develop chronic kidney disease.
- ▪Type 1 diabetes is an autoimmune condition causing the pancreas to make little or no insulin, leading to risks of blood sugar fluctuations, organ damage, and death.
Breakthrough T1D islet transplant trials
- ▪A Breakthrough T1D-funded $8.5 million multi-center trial awarded to the University of Chicago and University of Miami is testing islet cell transplants paired with Eledon's tegoprubart in 10 participants aged 18-70 with type 1 diabetes and chronic kidney disease.
- ▪In a separate Breakthrough T1D-funded study testing tegoprubart with deceased-donor islet transplants, all 12 enrolled participants were able to stop external insulin therapy.
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