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Hekking KFW, Maroto S, van Kekem K, Haasjes FS, Slootweg JC, Oude Alink PGB, Dirks R, Sardana M, Bolster MG, Kuijpers B, Smith D, Doodeman R, Scheepstra M, Zech B, Mulvihill M, Renzetti LM, Babiss L, Centrella PA, Clark MA, Cuozzo JW, Guié MA, Sigel E, Habeshian S, Hupp CD, Liu J, Thomson HA, Zhang Y, Keefe AD, Müller G, Gremmen S. Development of Potent Mcl-1 Inhibitors: Structural Investigations on Macrocycles Originating from a DNA-Encoded Chemical Library Screen. J Med Chem 2024; 67:3039-3065. [PMID: 38306405 DOI: 10.1021/acs.jmedchem.3c02206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
Evasion of apoptosis is critical for the development and growth of tumors. The pro-survival protein myeloid cell leukemia 1 (Mcl-1) is an antiapoptotic member of the Bcl-2 family, associated with tumor aggressiveness, poor survival, and drug resistance. Development of Mcl-1 inhibitors implies blocking of protein-protein interactions, generally requiring a lengthy optimization process of large, complex molecules. Herein, we describe the use of DNA-encoded chemical library synthesis and screening to directly generate complex, yet conformationally privileged macrocyclic hits that serve as Mcl-1 inhibitors. By applying a conceptual combination of conformational analysis and structure-based design in combination with a robust synthetic platform allowing rapid analoging, we optimized in vitro potency of a lead series into the low nanomolar regime. Additionally, we demonstrate fine-tuning of the physicochemical properties of the macrocyclic compounds, resulting in the identification of lead candidates 57/59 with a balanced profile, which are suitable for future development toward therapeutic use.
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Affiliation(s)
| | | | | | | | | | | | - Ron Dirks
- Symeres, 6546BB Nijmegen, The Netherlands
| | | | | | | | | | | | | | - Birgit Zech
- X-Rx, Inc., New York, New York 10016, United States
| | | | | | - Lee Babiss
- X-Rx, Inc., New York, New York 10016, United States
| | | | | | - John W Cuozzo
- X-Chem, Inc., Waltham, Massachusetts 02453, United States
| | | | - Eric Sigel
- X-Chem, Inc., Waltham, Massachusetts 02453, United States
| | | | | | - Julie Liu
- X-Chem, Inc., Waltham, Massachusetts 02453, United States
| | | | - Ying Zhang
- X-Chem, Inc., Waltham, Massachusetts 02453, United States
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2
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Thomson HA. Wendy Leigh Thomson. Assoc Med J 2021. [DOI: 10.1136/bmj.n2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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3
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Guilinger JP, Archna A, Augustin M, Bergmann A, Centrella PA, Clark MA, Cuozzo JW, Däther M, Guié MA, Habeshian S, Kiefersauer R, Krapp S, Lammens A, Lercher L, Liu J, Liu Y, Maskos K, Mrosek M, Pflügler K, Siegert M, Thomson HA, Tian X, Zhang Y, Konz Makino DL, Keefe AD. Novel irreversible covalent BTK inhibitors discovered using DNA-encoded chemistry. Bioorg Med Chem 2021; 42:116223. [PMID: 34091303 DOI: 10.1016/j.bmc.2021.116223] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
Libraries of DNA-Encoded small molecules created using combinatorial chemistry and synthetic oligonucleotides are being applied to drug discovery projects across the pharmaceutical industry. The majority of reported projects describe the discovery of reversible, i.e. non-covalent, target modulators. We synthesized multiple DNA-encoded chemical libraries terminated in electrophiles and then used them to discover covalent irreversible inhibitors and report the successful discovery of acrylamide- and epoxide-terminated Bruton's Tyrosine Kinase (BTK) inhibitors. We also demonstrate their selectivity, potency and covalent cysteine engagement using a range of techniques including X-ray crystallography, thermal transition shift assay, reporter displacement assay and intact protein complex mass spectrometry. The epoxide BTK inhibitors described here are the first ever reported to utilize this electrophile for this target.
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Affiliation(s)
| | - Archna Archna
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Martin Augustin
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Andreas Bergmann
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | | | | | - John W Cuozzo
- ZebiAI Inc., 100 Beaver Street, Waltham, MA 02453, USA
| | - Maike Däther
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | | | - Sevan Habeshian
- Laboratory of Therapeutic Proteins and Peptides École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Reiner Kiefersauer
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Stephan Krapp
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Alfred Lammens
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Lukas Lercher
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Julie Liu
- Accent Therapeutics Inc., 65 Hayden Avenue, Lexington, MA 02421, USA
| | - Yanbin Liu
- Cyteir Therapeutics, 128 Spring St, Lexington, MA 02421, USA
| | - Klaus Maskos
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | | | - Klaus Pflügler
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | - Markus Siegert
- Proteros biostructures GmbH, Bunsenstr. 7a, 82152 Planegg-Martinsried, Germany
| | | | - Xia Tian
- Nurix Therapeutics Inc., 1700 Owens Street, Suite 205 San Francisco, CA 94158, USA
| | - Ying Zhang
- X-Chem Inc., 100 Beaver Street, Waltham, MA 02453, USA
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4
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Veerman JJN, Bruseker YB, Damen E, Heijne EH, van Bruggen W, Hekking KFW, Winkel R, Hupp CD, Keefe AD, Liu J, Thomson HA, Zhang Y, Cuozzo JW, McRiner AJ, Mulvihill MJ, van Rijnsbergen P, Zech B, Renzetti LM, Babiss L, Müller G. Discovery of 2,4-1 H-Imidazole Carboxamides as Potent and Selective TAK1 Inhibitors. ACS Med Chem Lett 2021; 12:555-562. [PMID: 33859795 DOI: 10.1021/acsmedchemlett.0c00547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
Herein we report the discovery of 2,4-1H-imidazole carboxamides as novel, biochemically potent, and kinome selective inhibitors of transforming growth factor β-activated kinase 1 (TAK1). The target was subjected to a DNA-encoded chemical library (DECL) screen. After hit analysis a cluster of compounds was identified, which was based on a central pyrrole-2,4-1H-dicarboxamide scaffold, showing remarkable kinome selectivity. A scaffold-hop to the corresponding imidazole resulted in increased biochemical potency. Next, X-ray crystallography revealed a distinct binding mode compared to other TAK1 inhibitors. A benzylamide was found in a perpendicular orientation with respect to the core hinge-binding imidazole. Additionally, an unusual amide flip was observed in the kinase hinge region. Using structure-based drug design (SBDD), key substitutions at the pyrrolidine amide and the glycine resulted in a significant increase in biochemical potency.
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Affiliation(s)
| | - Yorik B. Bruseker
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Eddy Damen
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Erik H. Heijne
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Wendy van Bruggen
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Koen F. W. Hekking
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Rob Winkel
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Christopher D. Hupp
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | - Anthony D. Keefe
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | - Julie Liu
- Civetta Therapeutics, 10 Wilson Road, Cambridge, Massachusetts 02138, United States
| | - Heather A. Thomson
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | - Ying Zhang
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | - John W. Cuozzo
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | - Andrew J. McRiner
- X-Chem, Inc., 100 Beaver Street, Waltham, Massachusetts 02453, United States
| | | | - Peter van Rijnsbergen
- Mercachem BV, Department of Medicinal Chemistry, Kerkenbos 1013, 6546 BB Nijmegen, The Netherlands
| | - Birgit Zech
- AnavoTherapeutics BV, J.H. Oortweg 19, 2333 CH Leiden, The Netherlands
| | | | - Lee Babiss
- Wilmington, North Carolina 28405, United States
| | - Gerhard Müller
- AnavoTherapeutics BV, J.H. Oortweg 19, 2333 CH Leiden, The Netherlands
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5
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Cuozzo JW, Clark MA, Keefe AD, Kohlmann A, Mulvihill M, Ni H, Renzetti LM, Resnicow DI, Ruebsam F, Sigel EA, Thomson HA, Wang C, Xie Z, Zhang Y. Novel Autotaxin Inhibitor for the Treatment of Idiopathic Pulmonary Fibrosis: A Clinical Candidate Discovered Using DNA-Encoded Chemistry. J Med Chem 2020; 63:7840-7856. [PMID: 32584034 DOI: 10.1021/acs.jmedchem.0c00688] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The activity of the secreted phosphodiesterase autotaxin produces the inflammatory signaling molecule LPA and has been associated with a number of human diseases including idiopathic pulmonary fibrosis (IPF). We screened a single DNA-encoded chemical library (DECL) of 225 million compounds and identified a series of potent inhibitors. Optimization of this series led to the discovery of compound 1 (X-165), a highly potent, selective, and bioavailable small molecule. Cocrystallization of compound 1 with human autotaxin demonstrated that it has a novel binding mode occupying both the hydrophobic pocket and a channel near the autotaxin active site. Compound 1 inhibited the production of LPA in human and mouse plasma at nanomolar levels and showed efficacy in a mouse model of human lung fibrosis. After successfully completing IND-enabling studies, compound 1 was approved by the FDA for a Phase I clinical trial. These results demonstrate that DECL hits can be readily optimized into clinical candidates.
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Affiliation(s)
- John W Cuozzo
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Matthew A Clark
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Anthony D Keefe
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Anna Kohlmann
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Mark Mulvihill
- X-Rx, Inc., 430 East 29th Street, Suite 1060, New York, New York 10016, United States
| | - Haihong Ni
- BioDuro, LLC, Building E, No. 29 Life Science Park Road, Changping District, Beijing 102206, China
| | - Louis M Renzetti
- X-Rx, Inc., 430 East 29th Street, Suite 1060, New York, New York 10016, United States
| | - Daniel I Resnicow
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Frank Ruebsam
- BioDuro, LLC, Building E, No. 29 Life Science Park Road, Changping District, Beijing 102206, China
| | - Eric A Sigel
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Heather A Thomson
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
| | - Ce Wang
- BioDuro, LLC, Building E, No. 29 Life Science Park Road, Changping District, Beijing 102206, China
| | - Zhifeng Xie
- BioDuro, LLC, Building E, No. 29 Life Science Park Road, Changping District, Beijing 102206, China
| | - Ying Zhang
- X-Chem, Inc., 100 Beaver Street, Suite 101, Waltham, Massachusetts 02543, United States
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6
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Cuozzo JW, Centrella PA, Gikunju D, Habeshian S, Hupp CD, Keefe AD, Sigel EA, Soutter HH, Thomson HA, Zhang Y, Clark MA. Corrigendum: Discovery of a Potent BTK Inhibitor with a Novel Binding Mode by Using Parallel Selections with a DNAEncoded Chemical Library. Chembiochem 2017; 18:2441. [PMID: 29239533 DOI: 10.1002/cbic.201700610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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7
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Cuozzo JW, Centrella PA, Gikunju D, Habeshian S, Hupp CD, Keefe AD, Sigel EA, Soutter HH, Thomson HA, Zhang Y, Clark MA. Inside Cover: Discovery of a Potent BTK Inhibitor with a Novel Binding Mode by Using Parallel Selections with a DNA-Encoded Chemical Library (ChemBioChem 9/2017). Chembiochem 2017. [DOI: 10.1002/cbic.201700180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- John W. Cuozzo
- X-Chem Pharmaceuticals; 100 Beaver Street Waltham MA 02453 USA
| | | | - Diana Gikunju
- X-Chem Pharmaceuticals; 100 Beaver Street Waltham MA 02453 USA
| | - Sevan Habeshian
- X-Chem Pharmaceuticals; 100 Beaver Street Waltham MA 02453 USA
| | | | | | - Eric A. Sigel
- X-Chem Pharmaceuticals; 100 Beaver Street Waltham MA 02453 USA
| | | | | | - Ying Zhang
- X-Chem Pharmaceuticals; 100 Beaver Street Waltham MA 02453 USA
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8
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Cuozzo JW, Centrella PA, Gikunju D, Habeshian S, Hupp CD, Keefe AD, Sigel EA, Soutter HH, Thomson HA, Zhang Y, Clark MA. Discovery of a Potent BTK Inhibitor with a Novel Binding Mode by Using Parallel Selections with a DNA-Encoded Chemical Library. Chembiochem 2017; 18:864-871. [PMID: 28056160 DOI: 10.1002/cbic.201600573] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 12/21/2022]
Abstract
We have identified and characterized novel potent inhibitors of Bruton's tyrosine kinase (BTK) from a single DNA-encoded library of over 110 million compounds by using multiple parallel selection conditions, including variation in target concentration and addition of known binders to provide competition information. Distinct binding profiles were observed by comparing enrichments of library building block combinations under these conditions; one enriched only at high concentrations of BTK and was competitive with ATP, and another enriched at both high and low concentrations of BTK and was not competitive with ATP. A compound representing the latter profile showed low nanomolar potency in biochemical and cellular BTK assays. Results from kinetic mechanism of action studies were consistent with the selection profiles. Analysis of the co-crystal structure of the most potent compound demonstrated a novel binding mode that revealed a new pocket in BTK. Our results demonstrate that profile-based selection strategies using DNA-encoded libraries form the basis of a new methodology to rapidly identify small molecule inhibitors with novel binding modes to clinically relevant targets.
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Affiliation(s)
- John W Cuozzo
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | | | - Diana Gikunju
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | - Sevan Habeshian
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | | | - Anthony D Keefe
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | - Eric A Sigel
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | - Holly H Soutter
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | | | - Ying Zhang
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
| | - Matthew A Clark
- X-Chem Pharmaceuticals, 100 Beaver Street, Waltham, MA, 02453, USA
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Pitt DW, Treharne AJ, Thomson HA, Scott JA, Lotery AJ, Grossel MC. Improving cellular adhesion on scaffolds for transplantation: synthesising a poly(MMA-co-PEGM) network. J Mater Chem B 2013; 1:6627-6633. [PMID: 32261271 DOI: 10.1039/c3tb21248c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Electrospun fibrous matrices prepared from methacrylate-based copolymers are investigated as a tool for retinal pigment epithelium (RPE) transplantation in the treatment of degenerative retinal diseases. Human RPE cells were used to probe the cell-surface interactions on these copolymer matrices. For the first time, simple changes in chemical functionality have been found to induce gel formation of these methacrylate backbone copolymers in vitro. This effect is shown to significantly improve RPE cell adhesion and survival.
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Affiliation(s)
- Darren W Pitt
- Faculty of Natural and Environmental Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
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Waters EK, Genga RM, Thomson HA, Kurz JC, Schaub RG, Scheiflinger F, McGinness KE. Aptamer BAX 499 mediates inhibition of tissue factor pathway inhibitor via interaction with multiple domains of the protein. J Thromb Haemost 2013; 11:1137-45. [PMID: 23528042 DOI: 10.1111/jth.12201] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/13/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tissue factor pathway inhibitor (TFPI) is a multidomain protein that negatively regulates the coagulation cascade. TFPI inhibits the tissue factor (TF)-activated factor VII-activated FX (FXa) complex during TF-mediated coagulation initiation. The aptamer BAX 499 binds specifically to TFPI and inhibits its function, mediating a procoagulant effect in both in vitro and in vivo models of hemophilia. OBJECTIVES This study sought to identify the regions of TFPI that are critical for BAX 499 binding, and to determine how binding mediates aptamer inhibition of TFPI. METHODS AND RESULTS In vitro biochemical methods were used to evaluate the BAX 499 interaction with and inhibition of TFPI. Binding experiments indicated that the full-length TFPI protein is required for tight aptamer binding. Binding-competition experiments implicated the Kunitz 1, Kunitz 3 and C-terminal domains of TFPI in aptamer binding, a finding that is supported by hydrogen-deuterium exchange experiments, and indicated that aptamer and FXa can bind simultaneously to TFPI. In enzymatic assays, BAX 499 inhibited TFPI in a manner that is distinct from domain-specific antibodies, and aptamer inhibitory activity is reduced in the presence of the TFPI cofactor protein S. CONCLUSIONS These studies demonstrate that BAX 499 binds to TFPI via multiple domains of the protein in a manner that is distinct from other TFPI inhibitors, mediating a mechanism of inhibition that does not involve direct competition with FXa. With this unique inhibitory mechanism, BAX 499 provides a useful tool for studying TFPI biology in health and disease.
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Affiliation(s)
- E K Waters
- Baxter Healthcare Corporation, Cambridge, MA, USA
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Schaffer RH, Thomson HA. Successful change programs begin with results. Harv Bus Rev 1992; 70:80-89. [PMID: 10119715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Most corporate improvement programs have a negligible impact on operational and financial performance because management focuses on the activities, not the results. By initiating activities-centered programs, such as seven-step problem solving, statistical process control, and total quality management training, managers falsely assume that one day results will materialize. But because there is no explicit connection between action and outcome, improvements seldom do materialize. The authors argue for an alternative approach: results-driven improvement programs that focus on achieving specific, measurable operational improvements within a few months. While both activity-centered and results-driven programs aim to strengthen fundamental corporate competitiveness, the approaches differ dramatically. Activity-centered programs rely on broad-based policies and are more concerned with time-consuming preparations than with measurable gains. Results-driven programs, on the other hand, rely on an incremental approach to change, building on what works and discarding what doesn't. As a result, successes come quickly, and managers build their skills and gain the support of their employees for future changes. Because results-driven improvements require minimal investment, there is no excuse for postponing action. Indeed, there is always an abundance of underexploited capability and dissipated resources within the organization that management can tap into to get the program off the ground. The authors give a few pointers for how to get started: translate the long-term vision into doable but ambitious short-term goals; periodically review strategy, learning from both successes and failures; and institutionalize the changes that work and get rid of the rest.
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12
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Thomson HA. Acromegaly, with the Description of a Skeleton. J Anat Physiol 1890; 24:475-92. [PMID: 17231873 PMCID: PMC1328067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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