In clinical trials
Immune & defense
Nangibotide
Nangibotide is an investigational peptide that blocks TREM-1 to calm inflammation in septic shock. Learn how it works and where its trial evidence stands.
- Reviewed by
- William Maish, MD MBA MPH, Clinical Product Lead
- Published
- October 5, 2026
- Last updated
- October 5, 2026
Key takeaway
Nangibotide is an investigational peptide that inhibits the inflammatory receptor TREM-1, developed by Inotrem as an intravenous treatment for septic shock. Its Phase 2b trial did not meet its primary endpoint, though a signal appeared in a subgroup of patients with high levels of a related biomarker. As of 2026 it is not approved.
At a glance
| FDA status | Investigational peptide, not approved by the FDA |
| What it is | TREM-1 inhibitor given by intravenous infusion for septic shock |
| Research | Phase 2b trial (ASTONISH) did not meet its primary endpoint |
| Subgroup signal | Appeared only in a biomarker-defined subgroup |
| Evidence strength | Low research |
What is nangibotide?
Nangibotide (also known as LR12 or Motrem) is an experimental peptide of twelve amino acids that inhibits TREM-1, a receptor that amplifies inflammation. It is developed by Inotrem and given by intravenous infusion, studied for septic shock, a life-threatening condition in which infection triggers a dangerous drop in blood pressure and organ dysfunction. It is investigational and not approved.
How does it work?
Nangibotide acts as a decoy that interferes with TREM-11 (Triggering Receptor Expressed on Myeloid cells-1). TREM-1 normally amplifies the immune system's inflammatory response, and in septic shock this amplification can become harmful. By blocking TREM-1 engagement, nangibotide is intended to dampen the excessive release of inflammatory signals. A related marker, soluble TREM-1, is used to identify patients whose TREM-1 pathway is most activated. This describes the mechanism, separate from the trial outcome below.
Is it FDA-approved?
No. Nangibotide is investigational and not approved. Development has continued toward a possible Phase 3 using a biomarker-enrichment strategy to select patients.
What does the research show?
The controlled evidence did not meet its goal. According to PubMed, the Phase 2b ASTONISH1 trial in septic shock did not meet its primary endpoint, an improvement in organ-failure score:
| Patient group | Organ-failure score result |
| Predefined high-biomarker group | Improvement not statistically significant |
| Overall | Improvement not statistically significant |
| Higher biomarker cutoffs only | Clinically relevant improvement, a subgroup finding that remains unconfirmed |
The company had earlier framed the result as positive, but the peer-reviewed publication states the primary outcome was not achieved. Efficacy is therefore not established.
More for immune & defense
Sources: the ASTONISH Phase 2b trial (François et al., The Lancet Respiratory Medicine, 2023, DOI: 10.1016/S2213-2600(23)00158-31), indexed on PubMed; and Inotrem program updates. This document is educational, is not medical advice or a health claim, and is not an offer to sell any product.