1
|
Wipperman MF, Lin AZ, Gayvert KM, Lahner B, Somersan-Karakaya S, Wu X, Im J, Lee M, Koyani B, Setliff I, Thakur M, Duan D, Breazna A, Wang F, Lim WK, Halasz G, Urbanek J, Patel Y, Atwal GS, Hamilton JD, Stuart S, Levy O, Avbersek A, Alaj R, Hamon SC, Harari O. Digital wearable insole-based identification of knee arthropathies and gait signatures using machine learning. eLife 2024; 13:e86132. [PMID: 38686919 DOI: 10.7554/elife.86132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024] Open
Abstract
Gait is impaired in musculoskeletal conditions, such as knee arthropathy. Gait analysis is used in clinical practice to inform diagnosis and monitor disease progression or intervention response. However, clinical gait analysis relies on subjective visual observation of walking as objective gait analysis has not been possible within clinical settings due to the expensive equipment, large-scale facilities, and highly trained staff required. Relatively low-cost wearable digital insoles may offer a solution to these challenges. In this work, we demonstrate how a digital insole measuring osteoarthritis-specific gait signatures yields similar results to the clinical gait-lab standard. To achieve this, we constructed a machine learning model, trained on force plate data collected in participants with knee arthropathy and controls. This model was highly predictive of force plate data from a validation set (area under the receiver operating characteristics curve [auROC] = 0.86; area under the precision-recall curve [auPR] = 0.90) and of a separate, independent digital insole dataset containing control and knee osteoarthritis subjects (auROC = 0.83; auPR = 0.86). After showing that digital insole-derived gait characteristics are comparable to traditional gait measurements, we next showed that a single stride of raw sensor time-series data could be accurately assigned to each subject, highlighting that individuals using digital insoles can be identified by their gait characteristics. This work provides a framework for a promising alternative to traditional clinical gait analysis methods, adds to the growing body of knowledge regarding wearable technology analytical pipelines, and supports clinical development of at-home gait assessments, with the potential to improve the ease, frequency, and depth of patient monitoring.
Collapse
Affiliation(s)
- Matthew F Wipperman
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Allen Z Lin
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Kaitlyn M Gayvert
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Benjamin Lahner
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Selin Somersan-Karakaya
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Xuefang Wu
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Joseph Im
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Minji Lee
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Bharatkumar Koyani
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Ian Setliff
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Malika Thakur
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Daoyu Duan
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Aurora Breazna
- Biostatistics and Data Management, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Fang Wang
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Wei Keat Lim
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Gabor Halasz
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Jacek Urbanek
- Biostatistics and Data Management, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Yamini Patel
- General Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Gurinder S Atwal
- Molecular Profiling & Data Science, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Jennifer D Hamilton
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Samuel Stuart
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Oren Levy
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Andreja Avbersek
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Rinol Alaj
- Clinical Outcomes Assessment and Patient Innovation, Global Clinical Trial Services, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Sara C Hamon
- Precision Medicine, Regeneron Pharmaceuticals Inc, Tarrytown, United States
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| | - Olivier Harari
- Early Clinical Development & Experimental Sciences, Regeneron Pharmaceuticals Inc, Tarrytown, United States
| |
Collapse
|
2
|
Davis JD, Bravo Padros M, Conrado DJ, Ganguly S, Guan X, Hassan HE, Hazra A, Irvin SC, Jayachandran P, Kosloski MP, Lin KJ, Mukherjee K, Paccaly A, Papachristos A, Partridge MA, Prabhu S, Visich J, Welf ES, Xu X, Zhao A, Zhu M. Subcutaneous Administration of Monoclonal Antibodies: Pharmacology, Delivery, Immunogenicity, and Learnings From Applications to Clinical Development. Clin Pharmacol Ther 2024; 115:422-439. [PMID: 38093583 DOI: 10.1002/cpt.3150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
Subcutaneous (s.c.) administration of monoclonal antibodies (mAbs) can reduce treatment burden for patients and healthcare systems compared with intravenous (i.v.) infusion through shorter administration times, made possible by convenient, patient-centric devices. A deeper understanding of clinical pharmacology principles related to efficacy and safety of s.c.-administered mAbs over the past decade has streamlined s.c. product development. This review presents learnings from key constituents of the s.c. mAb development pathway, including pharmacology, administration variables, immunogenicity, and delivery devices. Restricted mAb transportation through the hypodermis explains their incomplete absorption at a relatively slow rate (pharmacokinetic (PK)) and may impact mAb-cellular interactions and/or onset and magnitude of physiological responses (pharmacodynamic). Injection volumes, formulation, rate and site of injection, and needle attributes may affect PKs and the occurrence/severity of adverse events like injection-site reactions or pain, with important consequences for treatment adherence. A review of immunogenicity data for numerous compounds reveals that incidence of anti-drug antibodies (ADAs) is generally comparable across i.v. and s.c. routes, and complementary factors including response magnitude (ADA titer), persistence over time, and neutralizing antibody presence are needed to assess clinical impact. Finally, four case studies showcase how s.c. biologics have been clinically developed: (i) by implementation of i.v./s.c. bridging strategies to streamline PD-1/PD-L1 inhibitor development, (ii) through co-development with i.v. presentations for anti-severe acute respiratory syndrome-coronavirus 2 antibodies to support rapid deployment of both formulations, (iii) as the lead route for bispecific T cell engagers (BTCEs) to mitigate BTCE-mediated cytokine release syndrome, and (iv) for pediatric patients in the case of dupilumab.
Collapse
Affiliation(s)
- John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | - Samit Ganguly
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Xiaowen Guan
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Hazem E Hassan
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Anasuya Hazra
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Susan C Irvin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | - Kuan-Ju Lin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Anne Paccaly
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | - Saileta Prabhu
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Erik S Welf
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Xiaoying Xu
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - An Zhao
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | - Min Zhu
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| |
Collapse
|