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Khalil A, Hakhverdyan S, Cheung P, Bossart M, Wagner M, Eriksson O, Velikyan I. Introduction of a fatty acid chain modification to prolong circulatory half-life of a radioligand towards glucose-dependent insulinotropic polypeptide receptor. Nucl Med Biol 2024; 128-129:108876. [PMID: 38241936 DOI: 10.1016/j.nucmedbio.2024.108876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/04/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The beneficial role of glucose-dependent insulinotropic polypeptide receptor (GIPR) in weight control and maintaining glucose levels has led to the development of several multi-agonistic peptide drug candidates, targeting GIPR and glucagon like peptide 1 receptor (GLP1R) and/or the glucagon receptor (GCGR). The in vivo quantification of target occupancy by these drugs would accelerate the development of new drug candidates. The aim of this study was to evaluate a novel peptide (GIP1234), based on previously reported ligand DOTA-GIP-C803, modified with a fatty acid moiety to prolong its blood circulation. It would allow higher target tissue exposure and consequently improved peptide uptake as well as in vivo PET imaging and quantification of GIPR occupancy by novel drugs of interest. METHOD A 40 amino acid residue peptide (GIP1234) was synthesized based on DOTA-GIP-C803, in turn based on the sequences of endogenous GIP and Exendin-4 with specific amino acid modifications to obtain GIPR selectivity. A palmitoyl fatty acid chain was furthermore added at Lys14 via a glutamic acid linker to prolong its blood circulation time by the interaction with albumin. GIP1234 was conjugated with a DOTA chelator at the C-terminal cysteine residue to achieve 68Ga radiolabeling. The resulting PET probe, [68Ga]Ga-DOTA-GIP1234 was evaluated for receptor binding specificity and selectivity using HEK293 cells transfected with human GIPR, GLP1R, or GCGR. Blocking experiments with tirzepatide (2 μM) were conducted using huGIPR HEK293 cells to investigate binding specificity. Ex vivo and in vivo organ distribution of [68Ga]Ga-DOTA-GIP1234 was studied in rats and a pig in comparison to [68Ga]Ga-DOTA-C803-GIP. Binding of [68Ga]Ga-DOTA-GIP1234 to albumin was assessed in situ using polyacrylamide gel electrophoresis (PAGE). The stability was tested in formulation buffer and rat blood plasma. RESULTS [68Ga]Ga-DOTA-GIP1234 was synthesized with non-decay corrected radiochemical yield of 88 ± 3.7 % and radiochemical purity of 97.8 ± 0.8 %. The molar activity for the radiotracer was 8.1 ± 1.1 MBq/nmol. [68Ga]Ga-DOTA-GIP1234 was stable and maintained affinity to huGIPR HEK293 cells (dissociation constant (Kd) = 40 ± 12.5 nM). The binding of [68Ga]Ga-DOTA-GIP1234 to huGCGR and huGLP1R cells was insignificant. Pre-incubation of huGIPR HEK293 cell sections with tirzepatide resulted in the decrease of [68Ga]Ga-DOTA-GIP1234 binding by close to 90 %. [68Ga]Ga-DOTA-GIP1234 displayed slow blood clearance in pigs with SUV = 3.5 after 60 min. Blood retention of the tracer in rat was 2-fold higher than that of [68Ga]Ga-DOTA-C803-GIP. [68Ga]Ga-DOTA-GIP1234 also demonstrated strong liver uptake in both pig and rat combined with decreased renal excretion. The concentration dependent binding of [68Ga]Ga-DOTA-GIP1234 to albumin was confirmed in situ by PAGE. CONCLUSION [68Ga]Ga-DOTA-GIP1234 demonstrated nanomolar affinity and selectivity for huGIPR in vitro. Addition of a fatty acid moiety prolonged blood circulation time and tissue exposure in both rat and pig in vivo. However, the liver uptake was also increased which may make PET imaging of abdominal tissues such as pancreas challenging. The investigation of the influence of fatty acid moiety on the biological performance of the peptide ligand paved the way for further rational design of GIPR ligand analogues with improved characteristics.
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Affiliation(s)
- Amina Khalil
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 83 Uppsala, Sweden
| | - Sona Hakhverdyan
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 83 Uppsala, Sweden
| | - Pierre Cheung
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 83 Uppsala, Sweden
| | - Martin Bossart
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany
| | - Michael Wagner
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany; Current address: Dewpoint Therapeutics, Frankfurt, Germany
| | - Olof Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 83 Uppsala, Sweden; Antaros Medical AB, Mölndal, Sweden; Antaros Tracer AB, Mölndal, Sweden.
| | - Irina Velikyan
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 83 Uppsala, Sweden; Department of Surgical Sciences, Radiology, Uppsala University Uppsala, Sweden.
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Ali A, Bauser M, Bertrand S, Blackaby W, Boss C, Bossart M, Hall A, Binch H, Czechtizky W, Gijsen H, Haning H, Hartung IV, Kilburn P, Lassalle G, Lücking U, Mack J, Missbach M, Otsomaa L, Torrens A, Wagner M, Walter M, Weinstabl H, van Hijfte L, von Nussbaum F. European Medicinal Chemistry Leaders in Industry (EMCL) - On the Status and Future of Medicinal Chemistry Research in Europe. ChemMedChem 2023; 18:e202300127. [PMID: 37276375 DOI: 10.1002/cmdc.202300127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/02/2023] [Revised: 05/16/2023] [Indexed: 07/18/2023]
Abstract
The status of industrial Medicinal Chemistry was discussed with European Medicinal Chemistry Leaders from large to mid-sized pharma and CRO companies as well as biotechs. The chemical modality space has expanded recently from small molecules to address new challenging targets. Besides the classical SAR/SPR optimization of drug molecules also their 'greenness' has increasing importance. The entire pharma discovery ecosystem has developed significantly. Beyond pharma and academia new key players such as Biotech and integrated CROs as well as Digital companies have appeared and are now to a large extend fueled by VC money. Digitalization is happening everywhere but surprisingly did not change speed and success rates of projects so far. Future Medicinal Chemists will still have to be excellent synthetic chemists but in addition they must be knowledgeable in new computational areas such as data sciences. Their ability to collaborate and to work in teams is key.
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Affiliation(s)
- Amjad Ali
- External Discovery Chemistry, Merck and Co. Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Marcus Bauser
- Research & Early Development, Global R&D, Leo Pharma, Industriparken 55, 2750, Ballerup, Denmark
| | - Sophie Bertrand
- Medicinal Chemistry, Medicine Design, R&D, GSK Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, UK
| | - Wesley Blackaby
- Chemistry and Analytical Sciences, Drug Design and Small Molecule Unit, Servier Research Institute, 125 Chemin de Ronde, 78290, Croissy sur Seine, France
| | - Christoph Boss
- Drug Discovery Chemistry, Idorsia Pharmaceuticals Ltd., Hegenheimermattweg 91, 4123, Allschwil/BK, Switzerland
| | - Martin Bossart
- Synthetic Medicinal Modalities, Sanofi, Industriepark Höchst G838, 65926, Frankfurt, Germany
| | - Adrian Hall
- Medicinal Chemistry, UCB Pharma, Chemin Du Foriest 1, 1420, Braine-l'Alleud, Belgium
| | - Hayley Binch
- Medicinal Chemistry, Roche Pharma Research & Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Werngard Czechtizky
- Medicinal Chemistry, Respiratory and Immunology, AstraZeneca, Pepparedsleden 1, 43183, Göteborg, Sweden
| | - Harrie Gijsen
- Discovery Chemistry, Therapeutics Discovery, Janssen Research & Development, A division of Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Helmut Haning
- Research & Development, Drug Discovery Sciences, Medicinal Chemistry, Bayer AG, Pharmaceuticals, < postCode/>42096, Wuppertal, Germany
| | - Ingo V Hartung
- Medicinal Chemistry & Drug Design, Merck Healthcare KGaA, Frankfurter Str. 250, 64293, Darmstadt, Germany
| | - Paul Kilburn
- Medicinal Chemistry and Translational DMPK, Lundbeck, Ottiliavej 9, 2500, Valby, Denmark
| | - Gilbert Lassalle
- Medicinal Chemistry, Evotec (France), SAS, Campus Curie, 195 Route d'Espagne, 31036, Toulouse Cedex, France
| | - Ulrich Lücking
- Chemistry, FoRx Therapeutics, Lichtstrasse 35, 4056, Basel, Switzerland
| | - Jürgen Mack
- Medicinal Chemistry, Boehringer Ingelheim, Birkendorfer Str. 65, 88400, Biberach, Germany
| | - Martin Missbach
- Global Discovery Chemistry, Novartis Institutes for BioMedical Research (NIBR), 4002, Basel, Switzerland
| | - Leena Otsomaa
- Medicine Design, R&D, Orion Corporation, Orion Pharma, Orionintie 1, 02200, Espoo, Finland
| | - Antoni Torrens
- Chemical Collaborations & Strategic Alliances, ABAC Therapeutics S.L., Joan XXIII, 10, 08950, Esplugues de Llobregat. Barcelona, Spain
| | - Michael Wagner
- Chemistry and Drug Discovery, Dewpoint Therapeutics GmbH, Industriepark Hoechst, G830, 65926, Frankfurt, Germany
| | - Magnus Walter
- Chemical Sciences and Process Development, Monte Rosa Therapeutics AG, Klybeckstrasse 191, WKL-136.3, 4057, Basel, Switzerland
| | - Harald Weinstabl
- Medicinal Chemistry, Boehringer Ingelheim, Dr. Boehringer Gasse 5-11, 1121, Vienna, Austria
| | - Luc van Hijfte
- Drug Discovery, Symeres, Kerkenbos 1013, 6546, BB Nijmegen, The Netherlands
| | - Franz von Nussbaum
- Life Science Chemistry, Nuvisan ICB GmbH, Müllerstr. 178, 13353, Berlin, Germany
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Bossart M, Plett H, Krämer B, Braicu E, Czogalla B, Klar M, Singer S, Mayr D, Staebler A, du Bois A, Kommoss S, Link T, Burges A, Heitz F, Grube M, Trillsch F, Harter P, Wimberger P, Buderath P, Hasenburg A. Depression and anxiety in women with malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST): an analysis of the AGO-CORSETT database. Arch Gynecol Obstet 2023; 307:1155-1162. [PMID: 36127525 PMCID: PMC10023613 DOI: 10.1007/s00404-022-06781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/20/2022] [Accepted: 08/31/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The intention of this study was to evaluate the level of anxiety and depression of malignant ovarian germ cell (MOGCT) and sex cord stromal tumors (SCST) survivors and to identify possible alterable cofactors. METHODS CORSETT was an observational, multicenter, mixed retrospective/prospective cohort study of the AGO Studygroup. Women who had been diagnosed with MOGCTs and SCSTs between 2001 and 2011 were asked to complete the Hospital Anxiety and Depression Scale (HADS) to evaluate distress. Predictors of distress (type of surgery, chemotherapy, time since diagnosis, recurrence, second tumor, pain) were investigated using multivariate linear regression analysis. RESULTS 150 MOGCT and SCST patients with confirmed histological diagnosis completed the questionnaire median seven years after diagnosis. They had a HADS total score ≥ 13 indicating severe mental distress in 34% of cases. Patients after fertility-conserving surgery had lower probability of severe mental distress than those without fertility-conserving treatment (β = - 3.1, p = 0.04). Pain was associated with the level of distress in uni- and multivariate analysis (coef 0.1, p < 0.01, coef. Beta 0.5). DISCUSSION Severe mental distress was frequent in patients with MOGCT and SCST and the level of pain was associated with the level of distress. Fertility conserving therapy, however, was associated with less mental distress. Screening and treatment of pain and depression is required to improve mental well-being in survivors of MOGCT and SCST.
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Affiliation(s)
- M Bossart
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg im Breisgau, Germany.
- Department of Gynecology and Obstetrics, St. Josefskrankenhaus Freiburg, Freiburg im Breisgau, Germany.
| | - H Plett
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - B Krämer
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - E Braicu
- Department of Gynecology, Charité Berlin, Campus Virchow Clinic, Berlin, Germany
| | - B Czogalla
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - M Klar
- Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg im Breisgau, Germany
| | - S Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Care Research, University Medical Center Mainz, Mainz, Germany
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
| | - D Mayr
- Institut of Pathology, Ludwig-Maximilians- University Munich, Munich, Germany
| | - A Staebler
- Division of Gynecologic Pathology, Institute of Pathology and Neuropathology, University of Tuebingen, Tuebingen, Germany
| | - A du Bois
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - S Kommoss
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - F Heitz
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - M Grube
- Department of Women's Health, Tuebingen University Hospital, Tuebingen, Germany
| | - F Trillsch
- Department of Obstetrics and Gynecology, University Hospital, Ludwig- Maximilians- University Munich, Munich, Germany
| | - P Harter
- Department of Gynecology & Gynecologic Oncology, Ev. Kliniken Essen-Mitte (KEM), Essen, Germany
| | - P Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - P Buderath
- Department of Gynecology and Obstetrics, University Hospital Essen, Essen, Germany
| | - A Hasenburg
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Mainz, Germany
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Velikyan I, Bossart M, Haack T, Laitinen I, Estrada S, Johansson L, Pierrou S, Wagner M, Eriksson O. Imaging of the Glucose-Dependent Insulinotropic Polypeptide Receptor Using a Novel Radiolabeled Peptide Rationally Designed Based on Endogenous GIP and Synthetic Exendin-4 Sequences. Pharmaceuticals (Basel) 2022; 16:ph16010061. [PMID: 36678558 PMCID: PMC9864903 DOI: 10.3390/ph16010061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Imaging and radiotherapy targeting the glucose-dependent insulinotropic polypeptide receptor (GIPR) could potentially benefit the management of neuroendocrine neoplasms (NENs), complementing clinically established radiopharmaceuticals. The aim of this study was to evaluate a GIPR-targeting positron emission tomography (PET) radioligand with receptor-specific binding, fast blood clearance, and low liver background uptake. The peptide DOTA-bioconjugate, C803-GIP, was developed based on the sequence of the endogenous GIP(1-30) and synthetic exendin-4 peptides with selective amino acid mutations to combine their specificity for the GIPR and in vivo stability, respectively. The 68Ga-labeled bioconjugate was evaluated in vitro in terms of binding affinity, specificity, and internalization in HEK293 cells transfected with the human GIPR, GLP1, or GCG receptors and in sections of human insulinoma and NENs. In vivo binding specificity, biodistribution, and tissue background were investigated in mice bearing huGIPR-HEK293 xenografts and in a pig. Ex vivo organ distribution, pharmacokinetics, and dosimetry were studied in normal rats. [68Ga]Ga-C803-GIP was stable and demonstrated a high affinity to the huGIPR-HEK293 cells. Binding specificity was demonstrated in vitro in frozen sections of NENs and huGIPR-HEK293 cells. No specific uptake was observed in the negative controls of huGLP1R and huGCGR cells. A novel rationally designed PET radioligand, [68Ga]Ga-C803-GIP, demonstrated promising binding characteristics and specificity towards the GIPR.
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Affiliation(s)
- Irina Velikyan
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden
- PET Centre, Centre for Medical Imaging, Uppsala University Hospital, SE-751 85 Uppsala, Sweden
- Correspondence: (I.V.); (M.B.); Tel.: +46-(0)70-4834137 (I.V.)
| | - Martin Bossart
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany
- Correspondence: (I.V.); (M.B.); Tel.: +46-(0)70-4834137 (I.V.)
| | - Torsten Haack
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany
| | | | - Sergio Estrada
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden
| | | | | | - Michael Wagner
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany
| | - Olof Eriksson
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, SE-751 83 Uppsala, Sweden
- Antaros Medical AB, SE-431 53 Mölndal, Sweden
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Bossart M, Wagner M, Elvert R, Evers A, Hübschle T, Kloeckener T, Lorenz K, Moessinger C, Eriksson O, Velikyan I, Pierrou S, Johansson L, Dietert G, Dietz-Baum Y, Kissner T, Nowotny I, Einig C, Jan C, Rharbaoui F, Gassenhuber J, Prochnow HP, Agueusop I, Porksen N, Smith WB, Nitsche A, Konkar A. Effects on weight loss and glycemic control with SAR441255, a potent unimolecular peptide GLP-1/GIP/GCG receptor triagonist. Cell Metab 2022; 34:59-74.e10. [PMID: 34932984 DOI: 10.1016/j.cmet.2021.12.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/13/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
Unimolecular triple incretins, combining the activity of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon (GCG), have demonstrated reduction in body weight and improved glucose control in rodent models. We developed SAR441255, a synthetic peptide agonist of the GLP-1, GCG, and GIP receptors, structurally based on the exendin-4 sequence. SAR441255 displays high potency with balanced activation of all three target receptors. In animal models, metabolic outcomes were superior to results with a dual GLP-1/GCG receptor agonist. Preclinical in vivo positron emission tomography imaging demonstrated SAR441255 binding to GLP-1 and GCG receptors. In healthy subjects, SAR441255 improved glycemic control during a mixed-meal tolerance test and impacted biomarkers for GCG and GIP receptor activation. Single doses of SAR441255 were well tolerated. The results demonstrate that integrating GIP activity into dual GLP-1 and GCG receptor agonism provides improved effects on weight loss and glycemic control while buffering the diabetogenic risk of chronic GCG receptor agonism.
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Affiliation(s)
- Martin Bossart
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany.
| | - Michael Wagner
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | - Andreas Evers
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | | | - Katrin Lorenz
- Synthetic Medicinal Modalities, Integrated Drug Discovery Germany, Sanofi, Frankfurt, Germany
| | | | - Olof Eriksson
- Antaros Medical AB, Mölndal, Sweden; Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden; PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
| | | | | | | | | | | | - Irene Nowotny
- Translational Medicine & Early Development, Sanofi, Frankfurt, Germany
| | | | - Christelle Jan
- Clinical Sciences & Operations, Sanofi, Chilly-Mazarin, France
| | - Faiza Rharbaoui
- Translational Medicine & Early Development, Sanofi, Frankfurt, Germany
| | | | | | | | | | - William B Smith
- NOCCR Alliance for Multispecialty Research (AMR), Knoxville, TN, USA
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Hasenburg A, Eichkorn D, Vosshagen F, Obermayr E, Geroldinger A, Zeillinger R, Bossart M. Biomarker-based early detection of epithelial ovarian cancer based on a five-protein signature in patient's plasma - a prospective trial. BMC Cancer 2021; 21:1037. [PMID: 34530759 PMCID: PMC8447799 DOI: 10.1186/s12885-021-08682-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trial on five plasma biomarkers (CA125, HE4, OPN, leptin, prolactin) and their possible role in differentiating benign from malignant ovarian tumors. METHODS In this unicentric prospective trial preoperative blood samples of 43 women with ovarian masses determined for ovarian surgery were analyzed. 25 patients had pathologically confirmed benign, 18 malignant ovarian tumors. Blood plasma was analyzed for CA125, HE4, OPN, leptin, prolactin and MIF by multiplex immunoassay analysis. Each single protein and a logistical regression model including all the listed proteins were tested as preoperative predictive marker for suspect ovarian masses. RESULTS Plasma CA125 was confirmed as a highly accurate tumor marker in ovarian cancer. HE4, OPN, leptin and prolactin plasma levels differed significantly between benign and malignant ovarian masses. With a logistical regression model a formula including CA125, HE4, OPN, leptin and prolactin was developed to predict malignant ovarian tumors. With a discriminatory AUC of 0.96 it showed to be a highly sensitive and specific diagnostic test for a malignant ovarian tumor. CONCLUSIONS The calculated formula with the combination of CA125, HE4, OPN, leptin and prolactin plasma levels surpasses each single marker in its diagnostic value to discriminate between benign and malignant ovarian tumors. The formula, applied to our patient population was highly accurate but should be validated in a larger cohort. TRIAL REGISTRATION Clinical Trials.gov under NCT01763125 , registered Jan. 8, 2013.
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Affiliation(s)
- A Hasenburg
- Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany
| | - D Eichkorn
- Department of Obstetrics and Gynecology, Schwarzwald-Baar Clinics, Villingen-Schwenningen, Germany
| | - F Vosshagen
- Department of Anesthesiology, Ortenau Clinics, Lahr-Ettenheim, Germany
| | - E Obermayr
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - A Geroldinger
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - R Zeillinger
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - M Bossart
- Department of Obstetrics and Gynecology, University Medical Center, Freiburg, Germany.
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Eriksson O, Velikyan I, Haack T, Bossart M, Laitinen I, Larsen PJ, Berglund JE, Antoni G, Johansson L, Pierrou S, Tillner J, Wagner M. Glucagon Like Peptide-1 receptor imaging in individuals with Type 2 Diabetes. J Nucl Med 2021; 63:794-800. [PMID: 34503957 PMCID: PMC9051593 DOI: 10.2967/jnumed.121.262506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
The glucagonlike peptide-1 receptor (GLP1R) is a gut hormone receptor, intricately linked to regulation of blood glucose homeostasis via several mechanisms. It is an established and emergent drug target in metabolic disease. The PET radioligand 68Ga-DO3A-VS-exendin4 (68Ga-exendin4) has the potential to enable longitudinal studies of GLP1R in the human pancreas. Methods:68Ga-exendin4 PET/CT examinations were performed on overweight-to-obese individuals with type 2 diabetes (n = 13) as part of a larger target engagement study (NCT03350191). A scanning protocol was developed to optimize reproducibility (target amount of 0.5 MBq/kg [corresponding to peptide amount of <0.2 µg/kg], blood sampling, and tracer stability assessment). The pancreas and abdominal organs were segmented, and binding was correlated with clinical parameters. Results: Uptake of 68Ga-exendin4 in the pancreas, but not in other abdominal tissues, was high but variable between individuals. There was no evidence of self-blocking of GLP1R by the tracer in this protocol, despite the high potency of exendin4. The results showed that a full dynamic scan can be simplified to a short static scan, potentially increasing throughput and reducing patient discomfort. The 68Ga-exendin4 concentration in the pancreas (i.e., GLP1R density) correlated inversely with the age of the individual and tended to correlate positively with body mass index. However, the total GLP1R content in the pancreas did not. Conclusion: In summary, we present an optimized and simplified 68Ga-exendin4 scanning protocol to enable reproducible imaging of GLP1R in the pancreas. 68Ga-exendin4 PET may enable quantification of longitudinal changes in pancreatic GLP1R during the development of type 2 diabetes, as well as target engagement studies of novel glucagonlike peptide-1 agonists.
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Eriksson O, Velikyan I, Haack T, Bossart M, Evers A, Lorenz K, Laitinen I, Larsen PJ, Plettenburg O, Johansson L, Pierrou S, Wagner M. Drug Occupancy Assessment at the Glucose-Dependent Insulinotropic Polypeptide Receptor by Positron Emission Tomography. Diabetes 2021; 70:842-853. [PMID: 33547046 DOI: 10.2337/db20-1096] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022]
Abstract
Targeting of the glucose-dependent insulinotropic polypeptide receptor (GIPR) is an emerging strategy in antidiabetic drug development. The aim of this study was to develop a positron emission tomography (PET) radioligand for the GIPR to enable the assessment of target distribution and drug target engagement in vivo. The GIPR-selective peptide S02-GIP was radiolabeled with 68Ga. The resulting PET tracer [68Ga]S02-GIP-T4 was evaluated for affinity and specificity to human GIPR (huGIPR). The in vivo GIPR binding of [68Ga]S02-GIP-T4 as well as the occupancy of a drug candidate with GIPR activity were assessed in nonhuman primates (NHPs) by PET. [68Ga]S02-GIP-T4 bound with nanomolar affinity and high selectivity to huGIPR in overexpressing cells. In vivo, pancreatic binding in NHPs could be dose-dependently inhibited by coinjection of unlabeled S02-GIP-T4. Finally, subcutaneous pretreatment with a high dose of a drug candidate with GIPR activity led to a decreased pancreatic binding of [68Ga]S02-GIP-T4, corresponding to a GIPR drug occupancy of almost 90%. [68Ga]S02-GIP-T4 demonstrated a safe dosimetric profile, allowing for repeated studies in humans. In conclusion, [68Ga]S02-GIP-T4 is a novel PET biomarker for safe, noninvasive, and quantitative assessment of GIPR target distribution and drug occupancy.
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Affiliation(s)
- Olof Eriksson
- Antaros Medical AB, Mölndal, Sweden
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
- PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden
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9
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Eriksson O, Velikyan I, Haack T, Bossart M, Laitinen I, Larsen PJ, Berglund JE, Antoni G, Johansson L, Pierrou S, Tillner J, Wagner M. Imaging of the Glucagon Receptor in Subjects with Type 2 Diabetes. J Nucl Med 2020; 62:833-838. [PMID: 33097629 DOI: 10.2967/jnumed.118.213306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/01/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the importance of the glucagon receptor (GCGR) in disease and in pharmaceutical drug development, there is a lack of specific and sensitive biomarkers of its activation in humans. The PET radioligand 68Ga-DO3A-VS-Tuna-2 (68Ga-Tuna-2) was developed to yield a noninvasive imaging marker for GCGR target distribution and drug target engagement in humans. Methods: The biodistribution and dosimetry of 68Ga-Tuna-2 was assessed by PET/CT in 13 individuals with type 2 diabetes as part of a clinical study assessing the occupancy of the dual GCGR/glucagon like peptide-1 receptor agonist SAR425899. Binding of 68Ga-Tuna-2 in liver and reference tissues was evaluated and correlated to biometrics (e.g., weight or body mass index) or other biomarkers (e.g., plasma glucagon levels). Results: 68Ga-Tuna-2 binding was seen primarily in the liver, which is in line with the strong expression of GCGR on hepatocytes. The kidneys demonstrated high excretion-related retention, whereas all other tissue demonstrated rapid washout. The SUV55 min (SUV during the last 10-min time frame, 50-60 min after administration) uptake endpoint was sensitive to endogenous levels of glucagon. 68Ga-Tuna-2 exhibited a safe dosimetry profile and no adverse events after intravenous administration. Conclusion: 68Ga-Tuna-2 can be used for safe and accurate assessment of the GCGR in human. It may serve as an important tool in understanding the in vivo pharmacology of novel drugs engaging the GCGR.
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Affiliation(s)
- Olof Eriksson
- Antaros Medical AB, Uppsala, Sweden.,Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | - Irina Velikyan
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.,Akademiska Sjukhuset, Uppsala, Sweden
| | - Torsten Haack
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany
| | - Martin Bossart
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany
| | | | - Philip J Larsen
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany
| | | | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.,Akademiska Sjukhuset, Uppsala, Sweden
| | | | | | | | - Michael Wagner
- R&D Research Platform, Integrated Drug Discovery, Sanofi, Frankfurt, Germany
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10
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Eichkorn D, Voßhagen F, Zeilinger R, Hasenburg A, Bossart M. Biomarker-based early detection of epithelial ovarian cancer based on a 5-protein signature in patients serum. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718132] [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: 10/23/2022] Open
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11
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Huß A, Hoang B, Klar M, Juhasz-Böss I, Bossart M. Retrospective unicenter analysis of uterine sarcoma treatment and survival. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718146] [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: 10/23/2022] Open
Affiliation(s)
- A Huß
- Albert-Ludwigs-Universität Freiburg, Frauenklinik
| | - B Hoang
- Albert-Ludwigs-Universität Freiburg, Frauenklinik
| | - M Klar
- Albert-Ludwigs-Universität Freiburg, Frauenklinik
| | | | - M Bossart
- Albert-Ludwigs-Universität Freiburg, Frauenklinik
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12
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Geißler C, Ge I, Hess M, Metzger P, Bronsert P, Lassmann S, Börries M, Juhasz-Böss I, Illert AL, Bossart M. Personalisierte Therapie des therapieresistenten Ovarialkarzinoms einer jungen Patientin. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718269] [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: 10/23/2022] Open
Affiliation(s)
- C Geißler
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
| | - I Ge
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
| | | | | | | | | | | | | | | | - M Bossart
- Uniklinik Freiburg, Gynäkologie und Geburtshilfe
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13
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Hasenburg A, Plett H, Krämer B, Braicu E, Czogalla B, Bossart M, Singer S, Mayr D, Staebler A, du Bois A, Kommoss S, Link T, Burges A, Heitz F, Keul J, Trillsch F, Harter P, Wimberger P, Buderath P, Klar M. 876P The effect of surgical techniques on sexuality and global quality of life (Qol) in women with ovarian germ cell (OGCT) and sex cord stromal tumours (SCST): An analysis of the AGO-CORSETT database. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1015] [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: 10/23/2022] Open
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14
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Kannt A, Madsen AN, Kammermeier C, Elvert R, Klöckener T, Bossart M, Haack T, Evers A, Lorenz K, Hennerici W, Rocher C, Böcskei Z, Guillemot JC, Mikol V, Pattou F, Staels B, Wagner M. Incretin combination therapy for the treatment of non-alcoholic steatohepatitis. Diabetes Obes Metab 2020; 22:1328-1338. [PMID: 32196896 DOI: 10.1111/dom.14035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/17/2022]
Abstract
AIMS To test specific mono-agonists to the glucagon-like peptide-1 receptor (GLP-1R), glucagon receptor (GCGR) and glucose-dependent insulinotropic peptide receptor (GIPR), individually and in combination, in a mouse model of diet-induced non-alcoholic steatohepatitis (NASH) and fibrosis in order to decipher the contribution of their activities and potential additive effects to improving systemic and hepatic metabolism. MATERIALS AND METHODS We induced NASH by pre-feeding C57BL/6J mice a diet rich in fat, fructose and cholesterol for 36 weeks. This was followed by 8 weeks of treatment with the receptor-specific agonists 1-GCG (20 μg/kg twice daily), 2-GLP1 (3 μg/kg twice daily) or 3-GIP (30 μg/kg twice daily), or the dual (1 + 2) or triple (1 + 2 + 3) combinations thereof. A dual GLP-1R/GCGR agonistic peptide, 4-dual-GLP1/GCGR (30 μg/kg twice daily), and liraglutide (100 μg/kg twice daily) were included as references. RESULTS Whereas low-dose 1-GCG or 3-GIP alone did not influence body weight, liver lipids and histology, their combination with 2-GLP1 provided additional weight loss, reduction in liver triglycerides and improvement in histological disease activity score. Notably, 4-dual-GLP-1R/GCGR and the triple combination of selective mono-agonists led to a significantly stronger reduction in the histological non-alcoholic fatty liver disease activity score compared to high-dose liraglutide, at the same extent of body weight loss. CONCLUSIONS GCGR and GIPR agonism provide additional, body weight-independent improvements on top of GLP-1R agonism in a murine model of manifest NASH with fibrosis.
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Affiliation(s)
- Aimo Kannt
- Sanofi Research and Development, Frankfurt, Germany
- Experimental Pharmacology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Branch for Translational Medicine and Pharmacology TMP, Frankfurt, Germany
| | | | | | - Ralf Elvert
- Sanofi Research and Development, Frankfurt, Germany
| | | | | | | | | | | | | | - Corinne Rocher
- Sanofi Research and Development, Chilly-Mazarin Cedex, France
| | - Zsolt Böcskei
- Sanofi Research and Development, Chilly-Mazarin Cedex, France
| | | | - Vincent Mikol
- Sanofi Research and Development, Chilly-Mazarin Cedex, France
| | - Francois Pattou
- Univ Lille, Inserm, CHU Lille, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
| | - Bart Staels
- Univ Lille, Inserm, CHU Lille, Institut Pasteur de Lille, UMR1011-EGID, Lille, France
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15
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Wagner M, Doverfjord JG, Tillner J, Antoni G, Haack T, Bossart M, Laitinen I, Johansson L, Pierrou S, Eriksson O, Velikyan I. Automated GMP-Compliant Production of [ 68Ga]Ga-DO3A-Tuna-2 for PET Microdosing Studies of the Glucagon Receptor in Humans. Pharmaceuticals (Basel) 2020; 13:ph13080176. [PMID: 32752075 PMCID: PMC7463542 DOI: 10.3390/ph13080176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 01/29/2023] Open
Abstract
Introduction: [68Ga]Ga-DO3A-VS-Cys40-Tuna-2 (previously published as [68Ga]Ga-DO3A-VS-Cys40-S01-GCG) has shown high-affinity specific binding to the glucagon receptor (GCGR) in vitro and in vivo in rats and non-human primates in our previous studies, confirming the suitability of the tracer for drug development applications in humans. The manufacturing process of [68Ga]Ga-DO3A-VS-Cys40-Tuna-2 was automated for clinical use to meet the radiation safety and good manufacturing practice (GMP) requirements. Methods: The automated synthesis platform (Modular-Lab PharmTrace, Eckert & Ziegler, Eurotope, Germany), disposable cassettes for 68Ga-labeling, and pharmaceutical-grade 68Ge/68Ga generator (GalliaPharm®) used in the study were purchased from Eckert & Ziegler. The parameters such as time, temperature, precursor concentration, radical scavenger, buffer concentration, and pH, as well as product purification step, were investigated and optimized. Process optimization was conducted with regard to product quality and quantity, as well as process reproducibility. The active pharmaceutical ingredient starting material DO3A-VS-Cys40-Tuna-2 (GMP-grade) was provided by Sanofi Aventis. Results: The reproducible and GMP-compliant automated production of [68Ga]Ga-DO3A-VS-Cys40-Tuna-2 with on-line documentation was developed. The non-decay-corrected radiochemical yield was 45.2 ± 2.5% (n = 3, process validation) at the end of the synthesis with a labeling synthesis duration of 38 min and a quality controlincluding release procedure of 20 min. The radiochemical purity of the product was 98.9 ± 0.6% (n = 17) with the total amount of the peptide in the preparation of 48 ± 2 µg (n = 3, process validation). Radionuclidic purity, sterility, endotoxin content, residual solvent content, and sterile filter integrity tests met the acceptance criteria. The product was stable at ambient temperature for at least 2 h. Conclusion: The fully automated GMP-compliant manufacturing process was developed and thoroughly validated. The resulting [68Ga]Ga-DO3A-VS-Cys40-Tuna-2 was used in a clinical study for accurate quantification of GCGR occupancy by a dual anti-diabetic drug in vivo in humans.
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Affiliation(s)
- Michael Wagner
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany; (T.H.); (M.B.)
- Correspondence: (M.W.); (I.V.); Tel.: +49-69-305-4875 (M.W.); Tel.: +46-70-483-4137 (I.V.)
| | - Johan G. Doverfjord
- PET Center, Center for Medical Imaging, Uppsala University Hospital, 751 85 Uppsala, Sweden;
| | | | - Gunnar Antoni
- Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden;
| | - Torsten Haack
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany; (T.H.); (M.B.)
| | - Martin Bossart
- R&D Research Platform, Integrated Drug Discovery, Sanofi, 65929 Frankfurt, Germany; (T.H.); (M.B.)
| | | | - Lars Johansson
- Antaros Medical AB, 431 83 Mölndal, Sweden; (L.J.); (S.P.); (O.E.)
| | - Stefan Pierrou
- Antaros Medical AB, 431 83 Mölndal, Sweden; (L.J.); (S.P.); (O.E.)
| | - Olof Eriksson
- Antaros Medical AB, 431 83 Mölndal, Sweden; (L.J.); (S.P.); (O.E.)
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
| | - Irina Velikyan
- Science for Life Laboratory, Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
- Correspondence: (M.W.); (I.V.); Tel.: +49-69-305-4875 (M.W.); Tel.: +46-70-483-4137 (I.V.)
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16
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Evers A, Pfeiffer‐Marek S, Bossart M, Elvert R, Lorenz K, Heubel C, Garea AV, Schroeter K, Riedel J, Stock U, Konkar A, Wagner M. Multiparameter Peptide Optimization toward Stable Triple Agonists for the Treatment of Diabetes and Obesity. Adv Therap 2020. [DOI: 10.1002/adtp.202000052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Evers
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Stefania Pfeiffer‐Marek
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Martin Bossart
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Ralf Elvert
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Katrin Lorenz
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Christoph Heubel
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Ana Villar Garea
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Katrin Schroeter
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Jens Riedel
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Ursula Stock
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Anish Konkar
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
| | - Michael Wagner
- R&D, Sanofi‐Aventis Deutschland GmbH, Industriepark Höchst Frankfurt am Main D‐65926 Germany
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17
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Eriksson O, Velikyan I, Haack T, Bossart M, Evers A, Laitinen I, Larsen PJ, Plettenburg O, Takano A, Halldin C, Antoni G, Johansson L, Pierrou S, Wagner M. Assessment of glucagon receptor occupancy by Positron Emission Tomography in non-human primates. Sci Rep 2019; 9:14960. [PMID: 31628379 PMCID: PMC6800434 DOI: 10.1038/s41598-019-51530-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/02/2019] [Indexed: 11/21/2022] Open
Abstract
The glucagon receptor (GCGR) is an emerging target in anti-diabetic therapy. Reliable biomarkers for in vivo activity on the GCGR, in the setting of dual glucagon-like peptide 1/glucagon (GLP-1/GCG) receptor agonism, are currently unavailable. Here, we investigated [68Ga]Ga-DO3A-S01-GCG as a biomarker for GCGR occupancy in liver, the tissue with highest GCGR expression, in non-human primates (NHP) by PET. [68Ga]Ga-DO3A-S01-GCG was evaluated by dynamic PET in NHPs by a dose escalation study design, where up to 67 µg/kg DO3A-S01-GCG peptide mass was co-injected. The test-retest reproducibility of [68Ga]Ga-DO3A-S01-GCG binding in liver was evaluated. Furthermore, we investigated the effect of pre-treatment with acylated glucagon agonist 1-GCG on [68Ga]Ga-DO3A-S01-GCG binding in liver. [68Ga]Ga-DO3A-S01-GCG bound to liver in vivo in a dose-dependent manner. Negligible peptide mass effect was observed for DO3A-S01-GCG doses <0.2 µg/kg. In vivo Kd for [68Ga]Ga-DO3A-S01-GCG corresponded to 0.7 µg/kg, which indicates high potency. The test-retest reproducibility for [68Ga]Ga-DO3A-S01-GCG binding in liver was 5.7 ± 7.9%. Pre-treatment with 1-GCG, an acylated glucagon agonist, resulted in a GCGR occupancy of 61.5 ± 9.1% in liver. Predicted human radiation dosimetry would allow for repeated annual [68Ga]Ga-DO3A-S01-GCG PET examinations. In summary, PET radioligand [68Ga]Ga-DO3A-S01-GCG is a quantitative biomarker of in vivo GCGR occupancy.
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Affiliation(s)
- Olof Eriksson
- Antaros Medical AB, Mölndal, Sweden. .,Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.
| | - Irina Velikyan
- PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden.,Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Philip J Larsen
- Sanofi-Aventis, Frankfurt, Germany.,Bayer Pharmaceuticals, Wuppertal, Germany
| | - Oliver Plettenburg
- Sanofi-Aventis, Frankfurt, Germany.,Institute of Medicinal Chemistry, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany
| | - Akihiro Takano
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden
| | - Christer Halldin
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gunnar Antoni
- PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden.,Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden
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18
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Zhang C, Rigbolt K, Petersen SL, Biehl Rudkjær LC, Schwahn U, Fernandez-Cachon ML, Bossart M, Falkenhahn M, Theis S, Hübschle T, Schmidt T, Just Larsen P, Vrang N, Jelsing J. The preprohormone expression profile of enteroendocrine cells following Roux-en-Y gastric bypass in rats. Peptides 2019; 118:170100. [PMID: 31212005 DOI: 10.1016/j.peptides.2019.170100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/15/2019] [Accepted: 06/05/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Roux-en-Y gastric bypass (RYGB) leads to rapid remission of type 2 diabetes (T2D) and sustained body weight loss, but the underlying molecular mechanisms are still not fully understood. To further elucidate these mechanisms and identify potentially novel preprohormone encoding genes with anti-diabetic and/or anti-obesity properties, we performed a comprehensive analysis of gene expression changes in enteroendocrine cells after RYGB in diet-induced obese (DIO) rats. METHODS The mRNA expression profiles of enteroendocrine cell enriched samples were characterized at 9, 22 and 60 days after RYGB surgery in a DIO rat model. Enteroendocrine cells were identified by chromogranin A immunohistochemistry and isolated by laser capture microdissection (LCM) from five regions covering the full rostro-caudal extension of the gastrointestinal (GI) tract. RNA sequencing and bioinformatic analyses were subsequently applied to identify differentially expressed preprohormone encoding genes. RESULTS From the analysis of enteroendocrine cell mRNA expression profiles, a total of 54 preprohormones encoding genes were found to be differentially regulated at one or more time-points following RYGB. These included well-known RYGB associated preprohormone genes (e.g. Gcg, Cck, Gip, Pyy and Sct) and less characterized genes with putative metabolic effects (e.g. Nmu, Guca2a, Guca2b, Npw and Adm), but also 16 predicted novel preprohormone genes. Among the list of gene transcripts, Npw, Apln and Fam3d were further validated using in situ mRNA hybridization and corresponding peptides were characterized for acute effects on food intake and glucose tolerance in mice. CONCLUSION We present a comprehensive mRNA expression profile of chromogranin A positive enteroendocrine cells following RYGB in rats. The data provides a region-specific characterization of all regulated preprohormone encoding genes in the rat GI tract including 16 not hitherto known. The comprehensive catalogue of preprohormone expression changes may support our understanding of hormone mediated effects of RYGB on diabetes remission and body weight reduction.
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Affiliation(s)
| | | | | | | | - Uwe Schwahn
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | | | - Martin Bossart
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | | | - Stefan Theis
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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19
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Evers A, Pfeiffer-Marek S, Bossart M, Heubel C, Stock U, Tiwari G, Gebauer B, Elshorst B, Pfenninger A, Lukasczyk U, Hessler G, Kamm W, Wagner M. Peptide Optimization at the Drug Discovery-Development Interface: Tailoring of Physicochemical Properties Toward Specific Formulation Requirements. J Pharm Sci 2019; 108:1404-1414. [DOI: 10.1016/j.xphs.2018.11.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/27/2018] [Indexed: 12/31/2022]
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20
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Velikyan I, Haack T, Bossart M, Evers A, Laitinen I, Larsen P, Plettenburg O, Johansson L, Pierrou S, Wagner M, Eriksson O. First-in-class positron emission tomography tracer for the glucagon receptor. EJNMMI Res 2019; 9:17. [PMID: 30771019 PMCID: PMC6377692 DOI: 10.1186/s13550-019-0482-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/25/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract The glucagon receptor (GCGR) is emerging as an important target in anti-diabetic therapy, especially as part of the pharmacology of dual glucagon-like peptide-1/glucagon (GLP-1/GCG) receptor agonists. However, currently, there are no suitable biomarkers that reliably demonstrate GCG receptor target engagement. Methods Two potent GCG receptor peptide agonists, S01-GCG and S02-GCG, were labeled with positron emission tomography (PET) radionuclide gallium-68. The GCG receptor binding affinity and specificity of the resulting radiopharmaceuticals [68Ga]Ga-DO3A-S01-GCG and [68Ga]Ga-DO3A-S02-GCG were evaluated in HEK-293 cells overexpressing the human GCG receptor and on frozen hepatic sections from human, non-human primate, and rat. In in vivo biodistribution, binding specificity and dosimetry were assessed in rat. Results [68Ga]Ga-DO3A-S01-GCG in particular demonstrated GCG receptor-mediated binding in cells and liver tissue with affinity in the nanomolar range required for imaging. [68Ga]Ga-DO3A-S01-GCG binding was not blocked by co-incubation of a GLP-1 agonist. In vivo binding in rat liver was GCG receptor specific with low non-specific binding throughout the body. Moreover, the extrapolated human effective doses, predicted from rat biodistribution data, allow for repeated PET imaging potentially also in combination with GLP-1R radiopharmaceuticals. Conclusion [68Ga]Ga-DO3A-S01-GCG thus constitutes a first-in-class PET tracer targeting the GCG receptor, with suitable properties for clinical development. This tool has potential to provide direct quantitative evidence of GCG receptor occupancy in humans. Electronic supplementary material The online version of this article (10.1186/s13550-019-0482-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Velikyan
- PET Centre, Centre for Medical Imaging, Uppsala University Hospital, Uppsala, Sweden.,Section of Nuclear Medicine and PET, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Torsten Haack
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany
| | - Martin Bossart
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany
| | - Andreas Evers
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany
| | - Iina Laitinen
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany
| | - Philip Larsen
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany
| | - Oliver Plettenburg
- Institute of Medicinal Chemistry, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,Institute of Organic Chemistry, Leibniz Universität Hannover, Hannover, Germany
| | - Lars Johansson
- Antaros Medical AB, Uppsala Science Park, Dag Hammarskjölds Väg 14B, Mölndal, SE-751 83, Uppsala, Sweden
| | - Stefan Pierrou
- Antaros Medical AB, Uppsala Science Park, Dag Hammarskjölds Väg 14B, Mölndal, SE-751 83, Uppsala, Sweden
| | - Michael Wagner
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, 65926, Frankfurt am Main, Germany.
| | - Olof Eriksson
- Antaros Medical AB, Uppsala Science Park, Dag Hammarskjölds Väg 14B, Mölndal, SE-751 83, Uppsala, Sweden. .,Science For Life Laboratory, Department of Medicinal Chemistry, Uppsala University, Uppsala, Sweden.
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Tillner J, Posch MG, Wagner F, Teichert L, Hijazi Y, Einig C, Keil S, Haack T, Wagner M, Bossart M, Larsen PJ. A novel dual glucagon-like peptide and glucagon receptor agonist SAR425899: Results of randomized, placebo-controlled first-in-human and first-in-patient trials. Diabetes Obes Metab 2019; 21:120-128. [PMID: 30091218 DOI: 10.1111/dom.13494] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/27/2018] [Accepted: 08/05/2018] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the safety, pharmacokinetics and pharmacodynamics of SAR425899, a novel polypeptide, active as an agonist at both the glucagon-like peptide-1 receptor (GLP-1R) and the glucagon receptor (GCR), in healthy volunteers and in overweight/obese patients with type 2 diabetes (T2D). METHODS Subcutaneous administrations of SAR425899 were tested in two randomized, placebo-controlled, double-blind clinical trials. In the first trial, healthy overweight volunteers (body mass index [BMI] 25-30 kg/m2 ; n = 32) received single-ascending doses (0.01-0.1 mg) of SAR425899 or placebo. In the second, a multiple-ascending-dose trial (NCT02411825), healthy normal- to overweight volunteers (BMI 20-30 kg/m2 ; n = 40) and overweight/obese patients with T2D (BMI 28-42 kg/m2 ; n = 36) received daily doses of SAR425899 or placebo over 21 or 28 days, respectively. RESULTS The most frequently reported adverse events were gastrointestinal; gastrointestinal side effects were less pronounced in patients with T2D compared with healthy volunteers. SAR425899 significantly reduced levels of fasting plasma glucose (P < 0.05 vs. placebo) and glycated haemoglobin (P < 0.001 versus placebo) in patients with T2D. Additionally, SAR425899 led to reductions in body weight, with a maximal reduction of 5.32 kg in healthy volunteers and 5.46 kg in patients with T2D (P < 0.001 vs. placebo) at end of treatment. CONCLUSIONS SAR425899 was well tolerated and led to favourable glycaemic effects in patients with T2D and weight reduction in both healthy volunteers and patients. Whether dual GLP-1R/GCR agonism represents a treatment method that is superior to pure GLP-1R agonists for obesity and diabetes treatment remains to be confirmed.
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Affiliation(s)
| | | | - Frank Wagner
- Charité Research Organisation GmbH, Berlin, Germany
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22
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Quaas P, Gitsch G, Bossart M, Klar M, Hasanov MF. Immunohistochemistry as test of cure in an immunodeficient patient with recurrent urogenital ulcers caused by an infection with Aciclovir-resistant herpes simplex virus-2. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671555] [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: 10/28/2022] Open
Affiliation(s)
- P Quaas
- Klinik für Frauenheilkunde Uniklinik Freiburg, Freiburg, Deutschland
| | - G Gitsch
- Klinik für Frauenheilkunde Uniklinik Freiburg, Freiburg, Deutschland
| | - M Bossart
- Klinik für Frauenheilkunde Uniklinik Freiburg, Freiburg, Deutschland
| | - M Klar
- Klinik für Frauenheilkunde Uniklinik Freiburg, Freiburg, Deutschland
| | - MF Hasanov
- Klinik für Frauenheilkunde Uniklinik Freiburg, Freiburg, Deutschland
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23
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Hasenburg A, Sehouli J, Lampe B, Reuss A, Schmalfeldt B, Belau A, Bossart M, Mahner S, Hillemanns P, Petry KU, du Bois A, Herwig U, Hilpert F, Gropp-Meier M, Hanf V, Janni W, Schindelhauer A, Kimmig R, Greimel E, Wagner U, Harter P. LION-PAW – Lymphonodectomy (LNE) in Ovarian Neoplasm – Pleasure Ability of Women Prospektive Substudie der multizentrischen AGO LION Studie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671032] [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: 10/28/2022] Open
Affiliation(s)
- A Hasenburg
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz, Deutschland
| | - J Sehouli
- Charité, Campus Virchow Klinikum, Berlin, Deutschland
| | - B Lampe
- Kaiserswerther Diakonie/Florence Nightingale Krankenhaus, Düsseldorf, Deutschland
| | - A Reuss
- Philipps-University of Marburg, Coordinating Center for Clinical Trials, Marburg, Deutschland
| | - B Schmalfeldt
- Klinikum rechts der Isar; Technical University of Munich, München, Deutschland
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
| | - A Belau
- University of Greifswald, Clinic and Policlinic for Gynecology and Obstetrics, Greifswald, Deutschland
| | - M Bossart
- Universitätsklinik Freiburg, Universitätsfrauenklinik, Freiburg, Deutschland
| | - S Mahner
- University Medical Center Hamburg-Eppendorf, Dept. of Gynecology and Gynecologic Oncology, Hamburg, Deutschland
- Universitätsfrauenklinik LMU München, Geburtshilfe und Frauenheilkunde, München, Deutschland
| | - P Hillemanns
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - KU Petry
- Klinikum Wolfsburg, Frauenklinik, Wolfsburg, Deutschland
| | - A du Bois
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
| | - U Herwig
- Albertinen-Hospital Hamburg, Research Center Gynecology, Hamburg, Deutschland
| | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M Gropp-Meier
- Oberschwabenklinik, Krankenhaus St. Elisabeth, Ravensburg, Deutschland
| | - V Hanf
- Klinikum Fürth, Frauenklinik, Fürth, Deutschland
| | - W Janni
- University of Ulm, Department of Gynecology, Ulm, Deutschland
| | - A Schindelhauer
- Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - R Kimmig
- Universitätsklinikum Essen, Frauenklinik, Essen, Deutschland
| | - E Greimel
- Medical University Graz, Department of Obstetrics and Gynecology, Graz, Österreich
| | - U Wagner
- University of Gießen and Marburg GmbH Site Marburg, Klinik für Gynäkologie, Gyn. Endokrinologie und Onkologie, Marburg, Deutschland
| | - P Harter
- Kliniken Essen-Mitte (KEM) Evang. Huyssens-Stiftung/Knappschaft GmbH, Klinik für Gynäkologie und gyn. Onkologie, Essen, Deutschland
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Elvert R, Bossart M, Herling AW, Weiss T, Zhang B, Kannt A, Wagner M, Haack T, Evers A, Dudda A, Keil S, Lorenz M, Lorenz K, Riz M, Hennerici W, Larsen PJ. Team Players or Opponents: Coadministration of Selective Glucagon and GLP-1 Receptor Agonists in Obese Diabetic Monkeys. Endocrinology 2018; 159:3105-3119. [PMID: 29992313 DOI: 10.1210/en.2018-00399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/03/2018] [Indexed: 01/06/2023]
Abstract
We assessed the therapeutic contribution of the individual components of glucagon-like peptide-1 receptor (GLP-1R) and glucagon receptor (GCGR) agonists alone and in combination upon energy homeostasis and glycemic control in diet-induced obese, diabetic nonhuman primates. The pharmacological active dose ranges of selective agonists were established through a dose-finding study, followed by a 6-week chronic study. Repeated subcutaneous administration of a selective GCGR agonist (30 µg/kg once daily) did not affect food intake or body weight, whereas the selective GLP-1R agonist (3 µg/kg once daily) alone decreased energy intake by 18% and body weight by 3.8% ± 0.9%. Combination of both agonists reduced significantly cumulative food intake by 27% and body weight by 6.6% ± 0.9%. Fasting plasma glucose (FPG) was improved by GLP-1R agonist (baseline vs end of study, 176.7 ± 34.0 vs 115.9 ± 16.1 mg/dL). In contrast, groups exposed to GCGR agonist experienced nonsignificant elevations of FPG. More accurate assessment of therapeutic interventions on glucose homeostasis was tested by an IV glucose tolerance test. Glucose excursion was significantly elevated by chronic GCGR agonist administration, whereas it was significantly decreased in GLP-1R agonist-treated monkeys. In the combination group, a nonsignificant increase of glucose excursion was seen, concomitantly with significantly increased insulin secretion. We conclude that chronic glucagon agonism does not affect energy homeostasis in nonhuman primates. In combination with GLP-1R agonism, glucagon agonism synergistically enhances negative energy balance with resulting larger body weight loss. However, adding GCGR to GLP-1R agonism diminishes glycemic control in diabetic monkeys. Therefore, long-term therapeutic implications of using GLP-1R/GCGR coagonists for weight management in diabetes warrants further scrutiny.
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Affiliation(s)
- Ralf Elvert
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Martin Bossart
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Andreas W Herling
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Tilo Weiss
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | | | - Aimo Kannt
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Wagner
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Torsten Haack
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Andreas Evers
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Angela Dudda
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Stefanie Keil
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Martin Lorenz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Katrin Lorenz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Michela Riz
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Wolfgang Hennerici
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
| | - Philip J Larsen
- Sanofi-Aventis Deutschland GmbH, Industriepark Höchst, Frankfurt, German
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25
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Elvert R, Herling AW, Bossart M, Weiss T, Zhang B, Wenski P, Wandschneider J, Kleutsch S, Butty U, Kannt A, Wagner M, Haack T, Evers A, Dudda A, Lorenz M, Keil S, Larsen PJ. Running on mixed fuel-dual agonistic approach of GLP-1 and GCG receptors leads to beneficial impact on body weight and blood glucose control: A comparative study between mice and non-human primates. Diabetes Obes Metab 2018; 20:1836-1851. [PMID: 29938884 PMCID: PMC6055720 DOI: 10.1111/dom.13212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/11/2017] [Accepted: 12/25/2017] [Indexed: 12/17/2022]
Abstract
AIM We performed acute and chronic studies in healthy and diet-induced obese animals using mouse-specific or monkey-specific dual GLP-1R/GCGR agonists to investigate their effects on food intake, body weight, blood glucose control and insulin secretion. The selective GLP-1R agonist liraglutide was used as comparator. METHODS The mouse-specific dual agonist and liraglutide were tested in lean wild type, GLP-1R knockout and diet-induced obese mice at different doses. A chronic study was performed in DIO mice to investigate the effect on body weight, food consumption and total energy expenditure (TEE) in obese and diabetic monkeys with a focus on body weight and energy intake. RESULTS The mouse-specific dual agonist and liraglutide similarly affected glycaemic control. A higher loss in body weight was measured in dual agonist-treated obese mice. The dual agonist significantly enhanced plasma glucose excursion in overnight fed GLP-1R-/- mice, probably reflecting a potent GCGR agonist activity. It increased TEE and enhanced fat and carbohydrate oxidation, while liraglutide produced no effect on TEE. In obese and diabetic monkeys, treatment with the monkey-specific dual agonist reduced total energy intake to 60%-70% of baseline TEI during chronic treatment. A decrease in body weight and significant improvement in glucose tolerance was observed. CONCLUSIONS In DIO mice and non-human primates, dual agonists elicited robust glycaemic control, similar to the marketed GLP-1R agonist, while eliciting greater effects on body weight. Results from DIO mice suggest that the increase in TEE is caused not only by increased fat oxidation but also by an increase in carbohydrate oxidation.
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MESH Headings
- Animals
- Animals, Outbred Strains
- Appetite Depressants/administration & dosage
- Appetite Depressants/adverse effects
- Appetite Depressants/therapeutic use
- Body Weight/drug effects
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diet, High-Fat/adverse effects
- Dose-Response Relationship, Drug
- Drug Therapy, Combination/adverse effects
- Energy Intake/drug effects
- Energy Metabolism/drug effects
- Female
- Glucagon-Like Peptide-1 Receptor/agonists
- Glucagon-Like Peptide-1 Receptor/genetics
- Glucagon-Like Peptide-1 Receptor/metabolism
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Insulin Secretion/drug effects
- Macaca fascicularis
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Obesity/blood
- Obesity/drug therapy
- Obesity/etiology
- Obesity/metabolism
- Random Allocation
- Receptors, Glucagon/agonists
- Receptors, Glucagon/metabolism
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Affiliation(s)
- Ralf Elvert
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | | | | | - Tilo Weiss
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | | | | | | | | | - Uwe Butty
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
| | - Aimo Kannt
- Sanofi‐Aventis Deutschland GmbHFrankfurtGermany
- Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
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Evers A, Bossart M, Pfeiffer-Marek S, Elvert R, Schreuder H, Kurz M, Stengelin S, Lorenz M, Herling A, Konkar A, Lukasczyk U, Pfenninger A, Lorenz K, Haack T, Kadereit D, Wagner M. Dual Glucagon-like Peptide 1 (GLP-1)/Glucagon Receptor Agonists Specifically Optimized for Multidose Formulations. J Med Chem 2018; 61:5580-5593. [DOI: 10.1021/acs.jmedchem.8b00292] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Andreas Evers
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Martin Bossart
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Stefania Pfeiffer-Marek
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Ralf Elvert
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Herman Schreuder
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Michael Kurz
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Siegfried Stengelin
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Martin Lorenz
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Andreas Herling
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Anish Konkar
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Ulrike Lukasczyk
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Anja Pfenninger
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Katrin Lorenz
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Torsten Haack
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Dieter Kadereit
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
| | - Michael Wagner
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, D-65926 Frankfurt am Main, Germany
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Evers A, Haack T, Lorenz M, Bossart M, Elvert R, Henkel B, Stengelin S, Kurz M, Glien M, Dudda A, Lorenz K, Kadereit D, Wagner M. Correction to Design of Novel Exendin-Based Dual Glucagon-like Peptide 1 (GLP-1)/Glucagon Receptor Agonist. J Med Chem 2017; 60:5941. [DOI: 10.1021/acs.jmedchem.7b00887] [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: 11/28/2022]
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Evers A, Haack T, Lorenz M, Bossart M, Elvert R, Henkel B, Stengelin S, Kurz M, Glien M, Dudda A, Lorenz K, Kadereit D, Wagner M. Design of Novel Exendin-Based Dual Glucagon-like Peptide 1 (GLP-1)/Glucagon Receptor Agonists. J Med Chem 2017; 60:4293-4303. [DOI: 10.1021/acs.jmedchem.7b00174] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Andreas Evers
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Torsten Haack
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Martin Lorenz
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Martin Bossart
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Ralf Elvert
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Bernd Henkel
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Siegfried Stengelin
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Michael Kurz
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Maike Glien
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Angela Dudda
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Katrin Lorenz
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Dieter Kadereit
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
| | - Michael Wagner
- R&D, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst Building G838, D-65926 Frankfurt am Main, Germany
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Thornton SA, Maurer S, Woll J, Markfeld-Erol F, Prömpeler HP, Bossart M. Bauchwandendometriose nach gynäkologischen Eingriffen: eine Fallserie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592864] [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: 10/20/2022] Open
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Hasanov MF, May A, Gitsch G, Bossart M. Die Therapie bei superinfiziertem genitalen Morbus Behçet – Colchicin als Alternative zur Cortisontherapie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592742] [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: 10/20/2022] Open
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Bossart M. Die Bedeutung von ZNF261 und der Lysin-spezifischen Demethylase LSD1 in der Androgenrezeptor-abhängigen und -unabhängigen Kanzerogenese. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0035-1570041] [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: 10/22/2022] Open
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Bossart M, Calley KH, Gurenlian JR, Mason B, Ferguson RE, Peterson T. A pilot study of an HbA1c chairside screening protocol for diabetes in patients with chronic periodontitis: the dental hygienist's role. Int J Dent Hyg 2015; 14:98-107. [PMID: 25809551 DOI: 10.1111/idh.12140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess effectiveness, convenience and cost of point-of-care diabetes screenings performed by a dental hygienist for patients with periodontitis, using a diabetes risk questionnaire, periodontal findings and a glycosylated haemoglobin (HbA1c) analyser. METHODS A purposive sample of 50 participants with periodontitis, never diagnosed with diabetes, reporting ≥one diabetes risk factor, were administered an HbA1c test. Spearman's correlation measured relationships between HbA1c and diabetes risk test scores, numbers of missing teeth, percentage of deep pockets ≥5 mm and percentage of bleeding sites (BOP). Cost and time were assessed. Analyses used 0.05 alpha levels. RESULTS Thirty-two per cent (n = 16) of participants presented HbA1c values indicating prediabetes; one HbA1c value indicated type 2 diabetes, totalling 34% (N = 17). No relationships existed between HbA1c values and diabetes risk scores (rs = 0.153; P = 0.144), numbers of missing teeth (r = 0.190; P = 0.093), percentage of deep pockets (rs = -0.048; P = 0.370) or percentage of BOP sites (rs = 0.066, P = 0.324). Direct cost for each HbA1c was $9US, excluding follow-up medical diagnosis. Mean screening time including patient education was 14 min (SD = 6.2). Fifty-three per cent (n = 9 of 17) of participants with elevated HbA1c values contacted their primary healthcare provider within 2 weeks as recommended. CONCLUSION Point-of-care HbA1c screenings by dental hygienists were effective and convenient for identifying undiagnosed prediabetes and provide opportunity for interprofessional patient care; cost or lack of dental insurance may inhibit implementation. Identification of patients at risk for diabetes requires further evaluation.
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Affiliation(s)
- M Bossart
- Boise State University, Department of Community and Environmental Health, Boise, ID, USA.,Department of Dental Hygiene, College of Southern Idaho, Twin Falls, ID, USA
| | - K H Calley
- Department of Dental Hygiene, Idaho State University, Pocatello, ID, USA
| | - J R Gurenlian
- Department of Dental Hygiene, Idaho State University, Pocatello, ID, USA
| | - B Mason
- College of Pharmacy, Idaho State University, Meridian, ID, USA
| | - R E Ferguson
- Department of Dental Sciences, Idaho State University, Meridian, ID, USA
| | - T Peterson
- Idaho Center for Health Research, Idaho State University, Pocatello, ID, USA
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Pang YT, Bossart M, Eisaman MD. Index-matched IWKB method for the measurement of spatially varying refractive index profiles within thin-film photovoltaics. Opt Express 2014; 22 Suppl 1:A188-A197. [PMID: 24921995 DOI: 10.1364/oe.22.00a188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In many thin-film photovoltaic devices, the photoactive layer has a spatially varying refractive index in the substrate-normal direction, but measurement of this variation with high spatial resolution is difficult due to the thinness of these layers (typically 200 nm for organic photovoltaics). We demonstrate a new method for reconstructing the depth-dependent refractive-index profile with high spatial resolution (~10 nm at a wavelength of 500 nm) in thin (200 nm) photoactive layers by depositing a relatively thick index-matched layer (1-10 μm) adjacent to the photoactive layer and applying the Inverse Wentzel-Kramers-Brillouin (IWKB) method. This novel technique, which we refer to as index-matched IWKB (IM-IWKB), is applicable to any thin film, including the photoactive layers of a broad range of thin-film photovoltaics.
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Manchanda R, Godfrey M, Wong-Taylor L, Halaska M, Burnell M, Grabowski J, Gultekin M, Haidopoulos D, Zapardiel I, Vranes B, Kesic V, Zola P, Colombo N, Verheijen R, Bossart M, Piek J. The need for accredited training in gynaecological oncology: a report from the European Network of Young Gynaecological Oncologists (ENYGO). Ann Oncol 2013; 24:944-52. [DOI: 10.1093/annonc/mds588] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bossart M, Hadji P, Kieback D, Hasenburg A. 443 The German Cohort of the TEAM Trial: Does Prior Chemotherapy Affect the Efficacy of Endocrine Therapy? Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70509-9] [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: 10/28/2022]
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Bossart M, Beussel S, Hadji P, Hasenburg A. Frühes Mammakarzinom – Lebensqualität nach Switch von Tamoxifen auf Exemestan. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1280244] [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: 10/15/2022] Open
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Klar M, Bossart M, Stickeler E, Brink I, Orlowska-Volk M, Denschlag D. Sentinel lymph node detection in patients with vulvar carcinoma; Feasibility of intra-operative mapping with technetium-99m-labeled nanocolloid. Eur J Surg Oncol 2011; 37:818-23. [PMID: 21782373 DOI: 10.1016/j.ejso.2011.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 06/26/2011] [Accepted: 06/28/2011] [Indexed: 11/25/2022] Open
Abstract
AIMS Sentinel lymph node (SLN) mapping appears to be feasible in patients with primary vulvar cancer. Previous protocols describe the injection of the technetium-99m-nanocolloid at least 3 h before surgery which involves two invasive procedures for the patient. In this study, we assessed the feasibility, safety, and accuracy of an intra-operative rather than preoperative SLN mapping in patients with primary vulvar cancer. METHODS Patients with histologically confirmed squamous cell vulvar cancer and clinically FIGO stage Ib disease underwent intra-operative SLN mapping by intradermal injection of the nanocolloid around the tumor. SLN were identified and removed before a complete inguinofemoral lymphnode dissection was performed. Surgical and pathologic data on all patients were prospectively entered into a database. RESULTS An SLN procedure was performed in 16 patients; 3 patients received unilateral lymphadenectomy, and 13 women underwent surgery on both groins. In all groins but 4 at least one SLN was clearly identified (detection rate 25/29, 86%). A median number of 2 SLN and 4 non-SLN per groin were removed. 3 of 16 patients (19%) had metastatic disease in the lymph nodes. There was no false negative SLN result. CONCLUSION Intra-operative SLN detection seems feasible in patients with early stage vulvar cancer. More patients need to be enrolled in this ongoing study before this more convenient technique can be considered safe.
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Affiliation(s)
- M Klar
- Department of Obstetrics and Gynaecology, University of Freiburg, Medical School, Hugstetter Str. 55, 79106 Freiburg, Germany
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Handa M, Scheidt KA, Bossart M, Zheng N, Roush WR. Studies on the Synthesis of Apoptolidin A. 1. Synthesis of the C(1)−C(11) Fragment. J Org Chem 2007; 73:1031-5. [DOI: 10.1021/jo702250z] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Masaki Handa
- Department of Chemistry, Scripps-Florida, Jupiter, Florida 33458, and Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109
| | - Karl A. Scheidt
- Department of Chemistry, Scripps-Florida, Jupiter, Florida 33458, and Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109
| | - Martin Bossart
- Department of Chemistry, Scripps-Florida, Jupiter, Florida 33458, and Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109
| | - Nan Zheng
- Department of Chemistry, Scripps-Florida, Jupiter, Florida 33458, and Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109
| | - William R. Roush
- Department of Chemistry, Scripps-Florida, Jupiter, Florida 33458, and Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109
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Abstract
Highly diastereoselective radical 1,5 phenyl migration reactions from silicon in diarylsilyl ethers to various C-centered radicals to form the corresponding 3-phenylated alcohols are described. Functionalized aryl groups can also be transferred. The effect of the variation of the attacking radical on the aryl transfer reaction is discussed. Best results are obtained for the phenyl migration to nucleophilic secondary alkyl radicals, where high yields (up to 81%) and high selectivities (up to 95% ds) have been obtained. The mechanism of the process is discussed and a model to explain the stereochemical outcome of the reaction is presented. Finally, stereoselective 1,4 aryl migration reactions from Si to C, including a new method for the alpha-arylation of esters, are presented.
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Affiliation(s)
- S Amrein
- Laboratorium für Organische Chemie, Eidgenössische Technische Hochschule, ETH Zentrum, Zürich, Switzerland
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McAllister HA, Seger J, Bossart M, Ferrans VJ. Restrictive cardiomyopathy with kappa light chain deposits in myocardium as a complication of multiple myeloma. Histochemical and electron microscopic observations. Arch Pathol Lab Med 1988; 112:1151-4. [PMID: 3140760] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
kappa Light chain deposits occurring in myocardium as a complication of multiple myeloma were identified ultrastructurally and immunohistochemically in a right ventricular endomyocardial biopsy specimen from a patient who presented with clinical and hemodynamic findings of restrictive cardiomyopathy. These deposits were not evident on routine histopathologic examination; they were Congo red-negative and gave a positive immunoperoxidase reaction for kappa light chains and a negative reaction for lambda chains. They consisted of amorphous, electron-dense granules that formed discontinuous layers adjacent to the plasma membranes of cardiac myocytes, arteriolar endothelial and smooth-muscle cells, and neural elements. These observations underscore the need for critical study of endomyocardial biopsy specimens, using electron microscopy and immunohistochemical reagents, for the precise identification of protein components in tissue deposits in patients suspected of having cardiac amyloidosis or related disorders.
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Affiliation(s)
- H A McAllister
- Department of Pathology, St. Luke's Episcopal Hospital, Houston, TX 77030
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