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Starrett JH, Lemoine C, Guillo M, Fayad C, Kaci N, Neal M, Pettitt EA, Pache M, Ye Q, Chouinard M, Allen EL, Baujat G, Hudkins RL, Bober MB, Harris T, Swanson RV, Legeai-Mallet L. TYRA-300, an FGFR3-selective inhibitor, promotes bone growth in two FGFR3-driven models of chondrodysplasia. JCI Insight 2025; 10:e189307. [PMID: 40178985 DOI: 10.1172/jci.insight.189307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Accepted: 03/11/2025] [Indexed: 04/05/2025] Open
Abstract
Achondroplasia (ACH) and hypochondroplasia (HCH), the two most common types of dwarfism, are each caused by FGFR3 gain-of-function mutations that result in increased FGFR3 signaling, which disrupts chondrogenesis and osteogenesis, resulting in disproportionately shortened long bones. In this study, TYRA-300, a potent and selective FGFR3 inhibitor, was evaluated in 3 genetic contexts: wild-type mice, the Fgfr3Y367C/+ mouse model of ACH, and the Fgfr3N534K/+ mouse model of HCH. In each model, TYRA-300 treatment increased nasoanal length and tibia and femur length. In the two FGFR3-altered models, TYRA-300-induced growth partially restored the disproportionality of long bones. Histologic analysis of the growth plate in Fgfr3Y367C/+ mice revealed that TYRA-300 mechanistically increased both proliferation and differentiation of chondrocytes. Importantly, children with ACH can experience medical complications due to foramen magnum stenosis, and TYRA-300 significantly improved the size and shape of the skull and foramen magnum in Fgfr3Y367C/+ mice. Spinal stenosis is also a frequent complication, and TYRA-300 increased the lumbar vertebrae length and improved the shape of the intervertebral discs in both models. Taken together, these studies demonstrate that the selective FGFR3 inhibitor TYRA-300 led to a significant increase in bone growth in two independent FGFR3-driven preclinical models as well as in wild-type mice.
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MESH Headings
- Animals
- Receptor, Fibroblast Growth Factor, Type 3/antagonists & inhibitors
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Mice
- Achondroplasia/drug therapy
- Achondroplasia/genetics
- Achondroplasia/pathology
- Disease Models, Animal
- Bone Development/drug effects
- Chondrocytes/drug effects
- Chondrocytes/metabolism
- Lordosis/drug therapy
- Lordosis/genetics
- Lordosis/pathology
- Limb Deformities, Congenital/drug therapy
- Limb Deformities, Congenital/genetics
- Limb Deformities, Congenital/pathology
- Dwarfism/drug therapy
- Dwarfism/genetics
- Dwarfism/pathology
- Bone and Bones/drug effects
- Bone and Bones/abnormalities
- Humans
- Growth Plate/drug effects
- Male
- Osteogenesis/drug effects
- Chondrogenesis/drug effects
- Cell Proliferation/drug effects
- Female
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Affiliation(s)
| | - Clara Lemoine
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
| | - Matthias Guillo
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
| | - Chantal Fayad
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
| | - Nabil Kaci
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
| | | | | | | | - Qing Ye
- Tyra Biosciences, Carlsbad, California, USA
| | | | | | - Geneviève Baujat
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
- Department of Genomic Medicine for Rare Diseases, French Reference Center for Constitutional Bone Diseases, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | - Laurence Legeai-Mallet
- Université de Paris Cité, Imagine Institute, Laboratory of Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, Paris, France
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Savarirayan R, De Bergua JM, Arundel P, Salles JP, Saraff V, Delgado B, Leiva-Gea A, McDevitt H, Nicolino M, Rossi M, Salcedo M, Cormier-Daire V, Skae M, Kannu P, Phillips J, Saal H, Harmatz P, Candler T, Hill D, Muslimova E, Weng R, Bai Y, Raj S, Hoover-Fong J, Irving M, Rogoff D. Oral Infigratinib Therapy in Children with Achondroplasia. N Engl J Med 2025; 392:865-874. [PMID: 39555818 DOI: 10.1056/nejmoa2411790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
BACKGROUND Achondroplasia is a genetic skeletal condition that results in disproportionately short stature and medical complications throughout life. Infigratinib is an orally bioavailable FGFR1-3 selective tyrosine kinase inhibitor in development for achondroplasia. METHODS In this phase 2 dose-finding study, we evaluated the safety and efficacy of oral infigratinib in children with achondroplasia between the ages of 3 and 11 years. A total of 72 children were enrolled in five sequential cohorts to receive daily infigratinib at doses of 0.016 mg per kilogram of body weight (cohort 1), 0.032 mg per kilogram (cohort 2), 0.064 mg per kilogram (cohort 3), 0.128 mg per kilogram (cohort 4), and 0.25 mg per kilogram (cohort 5) for 6 months, followed by 12 months of extended treatment in which the dose in cohorts 1 and 2 could be escalated to the next ascending level at months 6 and 12. The primary safety outcome was the incidence of adverse events that led to a decrease in the dose or discontinuation of infigratinib. The primary efficacy outcome was the change from baseline in the annualized height velocity. RESULTS During treatment, all the children had at least one adverse event, most of which were mild or moderate in severity; none resulted in treatment discontinuation. In cohort 5, an increased annualized height velocity was observed, which persisted throughout the duration of the study, with a mean change from baseline at 18 months of 2.50 cm per year (95% confidence interval [CI], 1.22 to 3.79; P = 0.001). The mean change from baseline in height z score was 0.54 (95% CI, 0.35 to 0.72) relative to an untreated achondroplasia reference population at 18 months; the mean change from baseline in the upper-to-lower body segment ratio was -0.12 (95% CI, -0.18 to -0.06). CONCLUSIONS The administration of oral infigratinib did not result in any apparent major safety signal and increased the annualized height velocity and z score and decreased the upper-to-lower body segment ratio at 18 months of treatment in cohort 5. (Funded by BridgeBio Pharma; PROPEL2 ClinicalTrials.gov number, NCT04265651.).
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Affiliation(s)
- Ravi Savarirayan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Paul Arundel
- Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Vrinda Saraff
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Borja Delgado
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | | | - Marc Nicolino
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | | | | | | | - Mars Skae
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Peter Kannu
- University of Alberta-Stollery Children's Hospital, Edmonton, Canada
| | | | - Howard Saal
- Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Paul Harmatz
- Benioff Children's Hospital Oakland, Oakland, CA
| | - Toby Candler
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | | | | | | | - Yun Bai
- BridgeBio Pharma, San Francisco
| | - Supriya Raj
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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3
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Santos F, Argente J. Is collagen X marker (CXM) a useful index of growth velocity in children with chronic kidney disease? Pediatr Nephrol 2023; 38:3871-3873. [PMID: 37495740 DOI: 10.1007/s00467-023-06105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Fernando Santos
- Hospital Universitario Central de Asturias & Universidad de Oviedo, Oviedo, Asturias, Spain.
| | - Jesús Argente
- Hospital Universitario Niño Jesús & Universidad Autonoma de Madrid, Madrid, Spain
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4
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O'Connell DA, Carroll RS, Duker AL, Schelhaas AJ, Postell MM, Fawcett PT, Bober MB. Trends in Serum Cytokine Expression in Pediatric Skeletal Dysplasia. JBMR Plus 2023; 7:e10816. [PMID: 38130766 PMCID: PMC10731102 DOI: 10.1002/jbm4.10816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/29/2023] [Accepted: 08/18/2023] [Indexed: 12/23/2023] Open
Abstract
The skeletal dysplasias are a heterogeneous group of genetic conditions caused by abnormalities of growth, development, and maintenance of bone and cartilage. Little is known about the roles that cytokines play in the inflammatory and non-inflammatory pathophysiology of skeletal dysplasia. We sought to test our hypothesis that cytokines would be differentially expressed in children with skeletal dysplasia as compared to typically growing controls. Cytokine levels were analyzed using the Cytokine Human Magnetic 25-Plex Panel (Invitrogen, Waltham, MA, USA); 136 growing individuals with skeletal dysplasia and compared to a cohort of 275 healthy pediatric control subjects. We focused on the expression of 12 cytokines across nine dysplasia cohorts. The most common skeletal dysplasia diagnoses were: achondroplasia (58), osteogenesis imperfecta (19), type II collagenopathies (11), multiple epiphyseal dysplasia (MED: 9), diastrophic dysplasia (8), metatropic dysplasia (8), and microcephalic osteodysplastic primordial dwarfism type II (MOPDII: 8). Of the 108 specific observations made, 45 (41.7%) demonstrated statistically significant differences of expression between controls and individuals with skeletal dysplasia. Four of the 12 analyzed cytokines demonstrated elevated expression above control levels in all of the dysplasia cohorts (interleukin 12 [IL-12], IL-13, interferon γ-induced protein 10 kDa [IP-10], regulated on activation, normal T cell expressed and secreted [RANTES]) and two demonstrated expression below control levels across all dysplasia cohorts (monocyte chemoattractant protein 1 [MCP-1], macrophage inflammatory protein-1β [MIP-1β]). The highest levels of overexpression were seen in MOPDII, with expression levels of IP-10 being increased 3.8-fold (p < 0.0001). The lowest statistically significant levels of expressions were in type II collagenopathies, with expression levels of MCP-1 being expressed 0.43-fold lower (p < 0.005). With this data, we hope to lay the groundwork for future directions in dysplasia research that will enhance our understanding of these complex signaling pathways. Looking forward, validating these early trends in cytokine expression, and associating the observed variations with trends in the progression of dysplasia may offer new candidates for clinical biomarkers or even new therapeutics. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Ricki S. Carroll
- Thomas Jefferson UniversityPhiladelphiaPAUSA
- Nemours Children's Hospital, DelawareWilmingtonDEUSA
| | | | | | | | | | - Michael B. Bober
- Thomas Jefferson UniversityPhiladelphiaPAUSA
- Nemours Children's Hospital, DelawareWilmingtonDEUSA
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5
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Paganini C, Carroll RS, Gramegna Tota C, Schelhaas AJ, Leone A, Duker AL, O'Connell DA, Coghlan RF, Johnstone B, Ferreira CR, Peressini S, Albertini R, Forlino A, Bonafé L, Campos-Xavier AB, Superti-Furga A, Zankl A, Rossi A, Bober MB. Identification of potential non-invasive biomarkers in diastrophic dysplasia. Bone 2023; 175:116838. [PMID: 37454964 PMCID: PMC11638977 DOI: 10.1016/j.bone.2023.116838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
Diastrophic dysplasia (DTD) is a recessive chondrodysplasia caused by pathogenic variants in the SLC26A2 gene encoding for a cell membrane sulfate/chloride antiporter crucial for sulfate uptake and glycosaminoglycan (GAG) sulfation. Research on a DTD animal model has suggested possible pharmacological treatment approaches. In view of future clinical trials, the identification of non-invasive biomarkers is crucial to assess the efficacy of treatments. Urinary GAG composition has been analyzed in several metabolic disorders including mucopolysaccharidoses. Moreover, the N-terminal fragment of collagen X, known as collagen X marker (CXM), is considered a real-time marker of endochondral ossification and growth velocity and was studied in individuals with achondroplasia and osteogenesis imperfecta. In this work, urinary GAG sulfation and blood CXM levels were investigated as potential biomarkers for individuals affected by DTD. Chondroitin sulfate disaccharide analysis was performed on GAGs isolated from urine by HPLC after GAG digestion with chondroitinase ABC and ACII, while CXM was assessed in dried blood spots. Results from DTD patients were compared with an age-matched control population. Undersulfation of urinary GAGs was observed in DTD patients with some relationship to the clinical severity and underlying SLC26A2 variants. Lower than normal CXM levels were observed in most patients, even if the marker did not show a clear pattern in our small patient cohort because CXM values are highly dependent on age, gender and growth velocity. In summary, both non-invasive biomarkers are promising assays targeting various aspects of the disorder including overall metabolism of sulfated GAGs and endochondral ossification.
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Affiliation(s)
- Chiara Paganini
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | - Ricki S Carroll
- Nemours Children's Hospital, Wilmington, DE, USA; Thomas Jefferson University, Philadelphia, PA, USA
| | - Chiara Gramegna Tota
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | | | - Alessandra Leone
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy; University School for Advanced Studies Pavia, IUSS Pavia, Pavia, Italy
| | | | | | | | - Brian Johnstone
- Shriners Hospitals for Children, Portland, OR, USA; Oregon Health and Science University, Portland, OR, USA
| | | | - Sabrina Peressini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella Forlino
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | - Luisa Bonafé
- Division of Genetic Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Ana Belinda Campos-Xavier
- Division of Genetic Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Andreas Zankl
- University of Sydney, The Children's Hospital at Westmead and Garvan Institute for Medical Research, Sydney, Australia
| | - Antonio Rossi
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy.
| | - Michael B Bober
- Nemours Children's Hospital, Wilmington, DE, USA; Thomas Jefferson University, Philadelphia, PA, USA
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