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Kassimatis T, Greenlaw R, Hunter JP, Douiri A, Flach C, Rebollo-Mesa I, Nichols LL, Qasem A, Danzi G, Olsburgh J, Drage M, Friend PJ, Neri F, Karegli J, Horsfield C, Smith RA, Sacks SH. Ex vivo delivery of Mirococept: A dose-finding study in pig kidney after showing a low dose is insufficient to reduce delayed graft function in human kidney. Am J Transplant 2021; 21:1012-1026. [PMID: 33225626 DOI: 10.1111/ajt.16265] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 01/25/2023]
Abstract
The complement system plays a pivotal role in the pathogenesis of ischemia-reperfusion injury in solid organ transplantation. Mirococept is a potent membrane-localizing complement inhibitor that can be administered ex vivo to the donor kidney prior to transplantation. To evaluate the efficacy of Mirococept in reducing delayed graft function (DGF) in deceased donor renal transplantation, we undertook the efficacy of mirococept (APT070) for preventing ischaemia-reperfusion injury in the kidney allograft (EMPIRIKAL) trial (ISRCTN49958194). A dose range of 5-25 mg would be tested, starting with 10 mg in cohort 1. No significant difference between Mirococept at 10 mg and control was detected; hence the study was stopped to enable a further dose saturation study in a porcine kidney model. The optimal dose of Mirococept in pig kidney was 80 mg. This dose did not induce any additional histological damage compared to controls or after a subsequent 3 hours of normothermic machine perfusion. The amount of unbound Mirococept postperfusion was found to be within the systemic dose range considered safe in the Phase I trial. The ex vivo administration of Mirococept is a safe and feasible approach to treat DGF in deceased donor kidney transplantation. The porcine kidney study identified an optimal dose of 80 mg (equivalent to 120 mg in human kidney) that provides a basis for further clinical development.
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Affiliation(s)
- Theodoros Kassimatis
- Renal Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Roseanna Greenlaw
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - James P Hunter
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Abdel Douiri
- School of Population Health and Environmental Studies, King's College London, London, UK
| | - Clare Flach
- School of Population Health and Environmental Studies, King's College London, London, UK
| | - Irene Rebollo-Mesa
- School of Immunology and Microbial Sciences, King's College London, London, UK.,UCB Biopharma, Brussels, Belgium
| | - Laura L Nichols
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Anass Qasem
- Renal Unit, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Guilherme Danzi
- School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Nephrology, Clinic Hospital, Federal University of Pernambuco, Recife, Brazil
| | - Jonathon Olsburgh
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Martin Drage
- Department of Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter J Friend
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Flavia Neri
- Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Julieta Karegli
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Catherine Horsfield
- Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard A Smith
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Steven H Sacks
- School of Immunology and Microbial Sciences, King's College London, London, UK
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Karegli J, Melchionna T, Farrar CA, Greenlaw R, Smolarek D, Horsfield C, Charif R, McVey JH, Dorling A, Sacks SH, Smith RAG. Thrombalexins: Cell-Localized Inhibition of Thrombin and Its Effects in a Model of High-Risk Renal Transplantation. Am J Transplant 2017; 17:272-280. [PMID: 27376583 DOI: 10.1111/ajt.13951] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/13/2016] [Accepted: 06/28/2016] [Indexed: 01/25/2023]
Abstract
Allograft transplantation into sensitized recipients with antidonor antibodies results in accelerated antibody-mediated rejection (AMR), complement activation, and graft thrombosis. We have developed a membrane-localizing technology of wide applicability that enables therapeutic agents, including anticoagulants, to bind to cell surfaces and protect the donor endothelium. We describe here how this technology has been applied to thrombin inhibitors to generate a novel class of drugs termed thrombalexins (TLNs). Using a rat model of hyperacute rejection, we investigated the potential of one such inhibitor (thrombalexin-1 [TLN-1]) to prevent acute antibody-mediated thrombosis in the donor organ. TLN-1 alone was able to reduce intragraft thrombosis and significantly delay rejection. The results confirm a pivotal role for thrombin in AMR in vivo. This approach targets donor organs rather than the recipient and is intended to be directly translatable to clinical use.
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Affiliation(s)
- J Karegli
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - T Melchionna
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - C A Farrar
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - R Greenlaw
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - D Smolarek
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - C Horsfield
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - R Charif
- West London Renal and Transplantation Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - J H McVey
- School of Bioscience & Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - A Dorling
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - S H Sacks
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
| | - R A G Smith
- MRC Centre for Transplantation, King's College London, Guy's Hospital, London, UK
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Damrauer SM, Studer P, da Silva CG, Longo CR, Ramsey HE, Csizmadia E, Shrikhande GV, Scali ST, Libermann TA, Bhasin MK, Ferran C. A20 modulates lipid metabolism and energy production to promote liver regeneration. PLoS One 2011; 6:e17715. [PMID: 21437236 PMCID: PMC3060102 DOI: 10.1371/journal.pone.0017715] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 02/10/2011] [Indexed: 01/18/2023] Open
Abstract
Background Liver Regeneration is clinically of major importance in the setting of liver injury, resection or transplantation. We have demonstrated that the NF-κB inhibitory protein A20 significantly improves recovery of liver function and mass following extended liver resection (LR) in mice. In this study, we explored the Systems Biology modulated by A20 following extended LR in mice. Methodology and Principal Findings We performed transcriptional profiling using Affymetrix-Mouse 430.2 arrays on liver mRNA retrieved from recombinant adenovirus A20 (rAd.A20) and rAd.βgalactosidase treated livers, before and 24 hours after 78% LR. A20 overexpression impacted 1595 genes that were enriched for biological processes related to inflammatory and immune responses, cellular proliferation, energy production, oxidoreductase activity, and lipid and fatty acid metabolism. These pathways were modulated by A20 in a manner that favored decreased inflammation, heightened proliferation, and optimized metabolic control and energy production. Promoter analysis identified several transcriptional factors that implemented the effects of A20, including NF-κB, CEBPA, OCT-1, OCT-4 and EGR1. Interactive scale-free network analysis captured the key genes that delivered the specific functions of A20. Most of these genes were affected at basal level and after resection. We validated a number of A20's target genes by real-time PCR, including p21, the mitochondrial solute carriers SLC25a10 and SLC25a13, and the fatty acid metabolism regulator, peroxisome proliferator activated receptor alpha. This resulted in greater energy production in A20-expressing livers following LR, as demonstrated by increased enzymatic activity of cytochrome c oxidase, or mitochondrial complex IV. Conclusion This Systems Biology-based analysis unravels novel mechanisms supporting the pro-regenerative function of A20 in the liver, by optimizing energy production through improved lipid/fatty acid metabolism, and down-regulated inflammation. These findings support pursuit of A20-based therapies to improve patients’ outcomes in the context of extreme liver injury and extensive LR for tumor treatment or donation.
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Affiliation(s)
- Scott M. Damrauer
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Peter Studer
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cleide G. da Silva
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christopher R. Longo
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Haley E. Ramsey
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Eva Csizmadia
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gautam V. Shrikhande
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Salvatore T. Scali
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Towia A. Libermann
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Manoj K. Bhasin
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (MKB) (MB); (CF) (CF)
| | - Christiane Ferran
- Division of Vascular Surgery, Center for Vascular Biology Research and the Transplant Institute, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (MKB) (MB); (CF) (CF)
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Abstract
Complement has been studied for over a century and its role in promoting the effector side of antibody-mediated immune reactions and of inducing inflammation is well understood. Nevertheless, it has proved surprisingly difficult to translate this information into pharmaceutical agents that can be used to treat immunopathological and inflammatory disease. There are, however, now clear signs that this situation will change. New types of therapeutic agents to interfere with complement function are being developed and it has become apparent quite recently that some common and otherwise untreatable diseases such as age-related macular degeneration are very largely due to mutations in the complement system that leads to a hyperinflammatory state. This has stimulated a renaissance of interest in the complement system as a therapeutic target and in this short review we discuss the possible ways of taking complement to the clinic, and the indications for which this may be carried out.
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Affiliation(s)
- P J Lachmann
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
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