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Short NJ, Daver N, Dinardo CD, Kadia T, Nasr LF, Macaron W, Yilmaz M, Borthakur G, Montalban-Bravo G, Garcia-Manero G, Issa GC, Chien KS, Jabbour E, Nasnas C, Huang X, Qiao W, Matthews J, Stojanik CJ, Patel KP, Abramova R, Thankachan J, Konopleva M, Kantarjian H, Ravandi F. Azacitidine, Venetoclax, and Gilteritinib in Newly Diagnosed and Relapsed or Refractory FLT3-Mutated AML. J Clin Oncol 2024; 42:1499-1508. [PMID: 38277619 DOI: 10.1200/jco.23.01911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 01/28/2024] Open
Abstract
PURPOSE Azacitidine plus venetoclax is a standard of care for patients with newly diagnosed AML who are unfit for intensive chemotherapy. However, FLT3 mutations are a common mechanism of resistance to this regimen. The addition of gilteritinib, an oral FLT3 inhibitor, to azacitidine and venetoclax may improve outcomes in patients with FLT3-mutated AML. METHODS This phase I/II study evaluated azacitidine, venetoclax, and gilteritinib in two cohorts: patients with (1) newly diagnosed FLT3-mutated AML who were unfit for intensive chemotherapy or (2) relapsed/refractory FLT3-mutated AML (ClinicalTrials.gov identifier: NCT04140487). The primary end points were the maximum tolerated dose of gilteritinib (phase I) and the combined complete remission (CR)/CR with incomplete hematologic recovery (CRi) rate (phase II). RESULTS Fifty-two patients were enrolled (frontline [n = 30]; relapsed/refractory [n = 22]). The recommended phase II dose was gilteritinib 80 mg once daily in combination with azacitidine and venetoclax. In the frontline cohort, the median age was 71 years and 73% of patients had an FLT3-internal tandem duplication (ITD) mutation. The CR/CRi rate was 96% (CR, 90%; CRi, 6%). Sixty-five percent of evaluable patients achieved FLT3-ITD measurable residual disease <5 × 10-5 within four cycles. With a median follow-up of 19.3 months, the median relapse-free survival (RFS) and overall survival (OS) have not been reached and the 18-month RFS and OS rates are 71% and 72%, respectively. In the relapsed/refractory cohort, the CR/CRi rate was 27%; nine additional patients (41%) achieved a morphologic leukemia-free state. The most common grade 3 or higher nonhematologic adverse events were infection (62%) and febrile neutropenia (38%), which were more frequent in the relapsed/refractory cohort. CONCLUSION The combination of azacitidine, venetoclax, and gilteritinib resulted in high rates of CR/CRi, deep FLT3 molecular responses, and encouraging survival in newly diagnosed FLT3-mutated AML. Myelosuppression was manageable with mitigative dosing strategies.
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney D Dinardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tapan Kadia
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lewis F Nasr
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Walid Macaron
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Musa Yilmaz
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly S Chien
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cedric Nasnas
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuelin Huang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jairo Matthews
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Keyur P Patel
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Regina Abramova
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Thankachan
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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Talele S, Zhang W, Burgenske DM, Kim M, Mohammad AS, Dragojevic S, Gupta SK, Bindra RS, Sarkaria JN, Elmquist WF. Brain Distribution of Berzosertib: An Ataxia Telangiectasia and Rad3-Related Protein Inhibitor for the Treatment of Glioblastoma. J Pharmacol Exp Ther 2021; 379:343-357. [PMID: 34556535 PMCID: PMC9351722 DOI: 10.1124/jpet.121.000845] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
The effective treatment of brain tumors is a considerable challenge in part because of the presence of the blood-brain barrier (BBB) that limits drug delivery. Glioblastoma multiforme (GBM) is an aggressive and infiltrative primary brain tumor with an extremely poor prognosis after standard-of-care therapy with surgery, radiotherapy (RT), and chemotherapy. DNA damage response (DDR) pathways play a critical role in DNA repair in cancer cells, and inhibition of these pathways can potentially augment RT and chemotherapy tumor cell toxicity. The ataxia telangiectasia and Rad3-related protein (ATR) kinase is a key regulator of the DDR network and is potently and selectively inhibited by the ATR inhibitor berzosertib. Although in vitro studies demonstrate a synergistic effect of berzosertib in combination with temozolomide, in vivo efficacy studies have yet to recapitulate this observation using intracranial tumor models. In the current study, we demonstrate that delivery of berzosertib to the brain is restricted by efflux at the BBB. Berzosertib has a high binding affinity to brain tissue compared with plasma, thereby leading to low free drug concentrations in the brain. Berzosertib distribution is heterogenous within the tumor, wherein concentrations are substantially lower in normal brain and invasive tumor rim (wherein the BBB is intact) when compared with those in the tumor core (wherein the BBB is leaky). These results demonstrate that high tissue binding and limited and heterogenous brain distribution of berzosertib may be important factors that influence the efficacy of berzosertib therapy in GBM. SIGNIFICANCE STATEMENT: This study examined the brain delivery and efficacy of berzosertib in patient-derived xenograft models of glioblastoma multiforme (GBM). Berzosertib is actively effluxed at the blood-brain barrier and is highly bound to brain tissue, leading to low free drug concentrations in the brain. Berzosertib is heterogeneously distributed into different regions of the brain and tumor and, in this study, was not efficacious in vivo when combined with temozolomide. These factors inform the future clinical utility of berzosertib for GBM.
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Affiliation(s)
- Surabhi Talele
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Wenjuan Zhang
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Danielle M Burgenske
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Minjee Kim
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Afroz S Mohammad
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Sonja Dragojevic
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Shiv K Gupta
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Ranjit S Bindra
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (S.T., W.Z., M.K., A.S.M., W.F.E.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (D.M.B., S.D., S.K.G., J.N.S.); and Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (R.S.B.)
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Byrd JC, Hillmen P, Ghia P, Kater AP, Chanan-Khan A, Furman RR, O'Brien S, Yenerel MN, Illés A, Kay N, Garcia-Marco JA, Mato A, Pinilla-Ibarz J, Seymour JF, Lepretre S, Stilgenbauer S, Robak T, Rothbaum W, Izumi R, Hamdy A, Patel P, Higgins K, Sohoni S, Jurczak W. Acalabrutinib Versus Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia: Results of the First Randomized Phase III Trial. J Clin Oncol 2021; 39:3441-3452. [PMID: 34310172 PMCID: PMC8547923 DOI: 10.1200/jco.21.01210] [Citation(s) in RCA: 232] [Impact Index Per Article: 77.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Among Bruton's tyrosine kinase inhibitors, acalabrutinib has greater selectivity than ibrutinib, which we hypothesized would improve continuous therapy tolerability. We conducted an open-label, randomized, noninferiority, phase III trial comparing acalabrutinib and ibrutinib in patients with chronic lymphocytic leukemia (CLL). METHODS Patients with previously treated CLL with centrally confirmed del(17)(p13.1) or del(11)(q22.3) were randomly assigned to oral acalabrutinib 100 mg twice daily or ibrutinib 420 mg once daily until progression or unacceptable toxicity. The primary end point was independent review committee-assessed noninferiority of progression-free survival (PFS). RESULTS Overall, 533 patients (acalabrutinib, n = 268; ibrutinib, n = 265) were randomly assigned. At the data cutoff, 124 (46.3%) acalabrutinib patients and 109 (41.1%) ibrutinib patients remained on treatment. After a median follow-up of 40.9 months, acalabrutinib was determined to be noninferior to ibrutinib with a median PFS of 38.4 months in both arms (95% CI acalabrutinib, 33.0 to 38.6 and ibrutinib, 33.0 to 41.6; hazard ratio: 1.00; 95% CI, 0.79 to 1.27). All-grade atrial fibrillation/atrial flutter incidence was significantly lower with acalabrutinib versus ibrutinib (9.4% v 16.0%; P = .02); among other selected secondary end points, grade 3 or higher infections (30.8% v 30.0%) and Richter transformations (3.8% v 4.9%) were comparable between groups and median overall survival was not reached in either arm (hazard ratio, 0.82; 95% CI, 0.59 to 1.15), with 63 (23.5%) deaths with acalabrutinib and 73 (27.5%) with ibrutinib. Treatment discontinuations because of adverse events occurred in 14.7% of acalabrutinib-treated patients and 21.3% of ibrutinib-treated patients. CONCLUSION In this first direct comparison of less versus more selective Bruton's tyrosine kinase inhibitors in CLL, acalabrutinib demonstrated noninferior PFS with fewer cardiovascular adverse events.
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Affiliation(s)
- John C. Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Paolo Ghia
- Università Vita-Salute San Raffaele, Milano, Italy
- IRCCS Ospedale San Raffaele, Milano, Italy
| | - Arnon P. Kater
- Amsterdam University Medical Centers, University of Amsterdam, on behalf of Hovon, Amsterdam, the Netherlands
| | | | - Richard R. Furman
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California-Irvine, Irvine, CA
| | | | | | - Neil Kay
- Mayo Clinic Rochester, Rochester, MN
| | | | | | | | - John F. Seymour
- Peter MacCallum Cancer Centre, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Stephane Lepretre
- Centre Henri Becquerel, Rouen, France
- Normandie University UNIROUEN, Rouen, France
| | | | | | | | | | | | | | | | | | - Wojciech Jurczak
- Maria Sklodowska-Curie National Research Institute of Oncology, Krakow, Poland
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Özlüşen B, Kozan Ş, Akcan RE, Kalender M, Yaprak D, Peltek İB, Keske Ş, Gönen M, Ergönül Ö. Effectiveness of favipiravir in COVID-19: a live systematic review. Eur J Clin Microbiol Infect Dis 2021; 40:2575-2583. [PMID: 34347191 PMCID: PMC8335450 DOI: 10.1007/s10096-021-04307-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022]
Abstract
We performed a systematic review and meta-analysis for the effectiveness of Favipiravir on the fatality and the requirement of mechanical ventilation for the treatment of moderate to severe COVID-19 patients. We searched available literature and reported it by using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Until June 1, 2021, we searched PubMed, bioRxiv, medRxiv, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar by using the keywords “Favipiravir” and terms synonymous with COVID-19. Studies for Favipiravir treatment compared to standard of care among moderate and severe COVID-19 patients were included. Risk of bias assessment was performed using Revised Cochrane risk of bias tool for randomized trials (RoB 2) and ROBINS-I assessment tool for non-randomized studies. We defined the outcome measures as fatality and requirement for mechanical ventilation. A total of 2702 studies were identified and 12 clinical trials with 1636 patients were analyzed. Nine out of 12 studies were randomized controlled trials. Among the randomized studies, one study has low risk of bias, six studies have moderate risk of bias, and 2 studies have high risk of bias. Observational studies were identified as having moderate risk of bias and non-randomized study was found to have serious risk of bias. Our meta-analysis did not reveal any significant difference between the intervention and the comparator on fatality rate (OR 1.11, 95% CI 0.64–1.94) and mechanical ventilation requirement (OR 0.50, 95% CI 0.13–1.95). There is no significant difference in fatality rate and mechanical ventilation requirement between Favipiravir treatment and the standard of care in moderate and severe COVID-19 patients.
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Affiliation(s)
- Batu Özlüşen
- School of Medicine, Koç University, Istanbul, Turkey
| | - Şima Kozan
- School of Medicine, Koç University, Istanbul, Turkey
| | | | | | | | | | - Şiran Keske
- School of Medicine, Koç University, Istanbul, Turkey
- Koç University İşBank Center for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Mehmet Gönen
- School of Medicine, Koç University, Istanbul, Turkey
- Koç University İşBank Center for Infectious Diseases (KUISCID), Istanbul, Turkey
- Department of Industrial Engineering, College of Engineering, Koç University, Istanbul, Turkey
| | - Önder Ergönül
- School of Medicine, Koç University, Istanbul, Turkey.
- Koç University İşBank Center for Infectious Diseases (KUISCID), Istanbul, Turkey.
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Middleton MR, Dean E, Evans TRJ, Shapiro GI, Pollard J, Hendriks BS, Falk M, Diaz-Padilla I, Plummer R. Phase 1 study of the ATR inhibitor berzosertib (formerly M6620, VX-970) combined with gemcitabine ± cisplatin in patients with advanced solid tumours. Br J Cancer 2021; 125:510-519. [PMID: 34040175 PMCID: PMC8368196 DOI: 10.1038/s41416-021-01405-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 11/05/2020] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Berzosertib (formerly M6620, VX-970) is a highly potent and selective, first-in-class inhibitor of ataxia telangiectasia and Rad3-related protein kinase (ATR). We assessed multiple ascending doses of berzosertib + gemcitabine ± cisplatin in patients with resistant/refractory advanced solid tumours. METHODS We evaluated the safety, tolerability, pharmacokinetics (PK) and preliminary efficacy of intravenous berzosertib + gemcitabine ± cisplatin using a standard 3 + 3 dose-escalation design. The starting doses were berzosertib 18 mg/m2, gemcitabine 875 mg/m2 and cisplatin 60 mg/m2. RESULTS Fifty-two patients received berzosertib + gemcitabine and eight received berzosertib + gemcitabine + cisplatin. Four patients receiving berzosertib + gemcitabine had a total of seven dose-limiting toxicities (DLTs) and three receiving berzosertib + gemcitabine + cisplatin had a total of three DLTs. Berzosertib 210 mg/m2 (days 2 and 9) + gemcitabine 1000 mg/m2 (days 1 and 8) Q3W was established as the recommended Phase 2 dose (RP2D); no RP2D was determined for berzosertib + gemcitabine + cisplatin. Neither gemcitabine nor cisplatin affected berzosertib PK. Most patients in both arms achieved a best response of either partial response or stable disease. CONCLUSIONS Berzosertib + gemcitabine was well tolerated in patients with advanced solid tumours and showed preliminary efficacy signs. CLINICAL TRIAL IDENTIFIER NCT02157792.
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Affiliation(s)
| | - Emma Dean
- Experimental Cancer Medicine Team, The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
- AstraZeneca, Cambridge and Alderley Park, UK
| | - Thomas R J Evans
- Institute of Cancer Sciences, University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - John Pollard
- Biological Sciences, Vertex Pharmaceuticals Europe Ltd, Abingdon, UK
- Bayer plc, Reading, UK
| | - Bart S Hendriks
- Clinical Pharmacology, EMD Serono Research & Development Institute Inc., Billerica, MA, USA, an affiliate of Merck KGaA, Darmstadt, Germany
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Martin Falk
- Oncology Global Clinical Development, Merck KGaA, Darmstadt, Germany
- CureVac, Tübingen, Germany
| | - Ivan Diaz-Padilla
- Oncology Global Clinical Development, Ares Trading SA, Eysins, Switzerland, an affiliate of Merck KGaA, Darmstadt, Germany
- GlaxoSmithKline, Zug, Switzerland
| | - Ruth Plummer
- Translational and Clinical Research Institute, Newcastle University and Northern Centre for Cancer Care, Newcastle Hospitals NHS Trust, Newcastle Upon Tyne, UK.
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English AW, Berglund K, Carrasco D, Goebel K, Gross RE, Isaacson R, Mistretta OC, Wynans C. Bioluminescent Optogenetics: A Novel Experimental Therapy to Promote Axon Regeneration after Peripheral Nerve Injury. Int J Mol Sci 2021; 22:ijms22137217. [PMID: 34281270 PMCID: PMC8269199 DOI: 10.3390/ijms22137217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Functional recovery after peripheral nerve injury (PNI) is poor, mainly due to the slow and incomplete regeneration of injured axons. Experimental therapies that increase the excitability of the injured axons have proven remarkably successful in promoting regeneration, but their clinical applicability has been limited. Bioluminescent optogenetics (BL-OG) uses luminopsins, fusion proteins of light-generating luciferase and light-sensing ion channels that could be used to increase neuronal excitability if exposed to a suitable substrate. Excitatory luminopsins were expressed in motoneurons of transgenic mice and in wildtype mice transduced with adeno-associated viral vectors. Intraperitoneal administration of coelenterazine (CTZ), a known luciferase substrate, generated intense bioluminescence in peripheral axons. This bioluminescence increased motoneuron excitability. A single administration of CTZ immediately after sciatic nerve transection and repair markedly enhanced motor axon regeneration. Compound muscle action potentials were 3–4 times larger than controls by 4 weeks after injury. The results observed with transgenic mice were comparable to those of mice in which the luminopsin was expressed using viral vectors. Significantly more motoneurons had successfully reinnervated muscle targets four weeks after nerve injury in BL-OG treated mice than in controls. Bioluminescent optogenetics is a promising therapeutic approach to enhancing axon regeneration after PNI.
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Affiliation(s)
- Arthur W. English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- Correspondence:
| | - Ken Berglund
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.B.); (R.E.G.)
| | - Dario Carrasco
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
| | - Katharina Goebel
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
| | - Robert E. Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA; (K.B.); (R.E.G.)
| | - Robin Isaacson
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
| | - Olivia C. Mistretta
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
| | - Carly Wynans
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA 30322, USA; (D.C.); (K.G.); (R.I.); (O.C.M.); (C.W.)
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Kato H, Takayama-Ito M, Satoh M, Kawahara M, Kitaura S, Yoshikawa T, Fukushi S, Nakajima N, Komeno T, Furuta Y, Saijo M. Favipiravir treatment prolongs the survival in a lethal mouse model intracerebrally inoculated with Jamestown Canyon virus. PLoS Negl Trop Dis 2021; 15:e0009553. [PMID: 34214091 PMCID: PMC8281987 DOI: 10.1371/journal.pntd.0009553] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 07/15/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Jamestown Canyon virus (JCV) is a mosquito-borne orthobunyavirus that causes acute febrile illness, meningitis, and meningoencephalitis, primarily in North American adults. Currently, there are no available vaccines or specific treatments against JCV infections. Methodology/Principal findings The antiviral efficacy of favipiravir (FPV) against JCV infection was evaluated in vitro and in vivo in comparison with that of ribavirin (RBV) and 2’-fluoro-2’-deoxycytidine (2’-FdC). The in vitro inhibitory effect of these drugs on JCV replication was evaluated in Vero and Neuro-2a (N2A) cells. The efficacy of FPV in the treatment of JCV infection in vivo was evaluated in C57BL/6J mice inoculated intracerebrally with JCV, as per the survival, viral titers in the brain, and viral RNA load in the blood. The 90% inhibitory concentrations (IC90) of FPV, RBV, and 2’-FdC were 41.0, 61.8, and 13.6 μM in Vero cells and 20.7, 25.8, and 8.8 μM in N2A cells, respectively. All mice infected with 1.0×104 TCID50 died or were sacrificed within 10 days post-infection (dpi) without treatment. However, mice treated with FPV for 5 days [initiated either 2 days prior to infection (−2 dpi–2 dpi) or on the day of infection (0 dpi–4 dpi)] survived significantly longer than control mice, administered with PBS (p = 0.025 and 0.011, respectively). Moreover, at 1 and 3 dpi, the virus titers in the brain were significantly lower in FPV-treated mice (0 dpi–4 dpi) versus PBS-treated mice (p = 0.002 for both 1 and 3 dpi). Conclusions/Significance Although the intracerebral inoculation route is thought to be a challenging way to evaluate drug efficacy, FPV inhibits the in vitro replication of JCV and prolongs the survival of mice intracerebrally inoculated with JCV. These results will enable the development of a specific antiviral treatment against JCV infections and establishment of an effective animal model. Jamestown Canyon virus (JCV) is a mosquito-borne virus (arbovirus) classified into the California serogroup. JCV is distributed widely throughout North America and is considered one of the potentially re-emerging viruses due to the recent spurt in JCV cases in the region. JCV infection often leads to an acute febrile illness, meningitis, and meningoencephalitis mainly among adults. Currently, no antiviral therapy against JCV is approved. In this study, we evaluated the antiviral efficacy of favipiravir (FPV), ribavirin (RBV), and 2’-fluoro-2’-deoxycytidine (2’-FdC) against JCV infection in cultured cells and mice. As a result, FPV, RBV, and 2’-FdC effectively inhibited JCV replication in Vero and Neuro-2a cells. Furthermore, FPV delayed the onset of neurological symptoms in mice intracerebrally inoculated with JCV. Notably, although most patients infected with JCV do not present severe disease, neuroinvasive cases are not rare and may result in residual neurological sequelae such as persisting cognitive deficits. Therefore, this study contributes to the development of a specific antiviral treatment for patients with JCV infection.
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Affiliation(s)
- Hirofumi Kato
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Mutsuyo Takayama-Ito
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
- * E-mail:
| | - Masaaki Satoh
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Madoka Kawahara
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Kitaura
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Internal Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shuetsu Fukushi
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | | | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
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8
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Eryavuz Onmaz D, Abusoglu S, Onmaz M, Yerlikaya FH, Unlu A. Development and validation of a sensitive, fast and simple LC-MS / MS method for the quantitation of favipiravir in human serum. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1176:122768. [PMID: 34052564 PMCID: PMC8133798 DOI: 10.1016/j.jchromb.2021.122768] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 12/12/2022]
Abstract
Favipiravir is a broad-spectrum inhibitor of viral RNA polymerase. It is currently used as a possible treatment for coronavirus disease 2019 (COVID-19). Pre-clinical or clinical trials of favipiravir require robust, sensitive, and accurate bioanalytical methods for quantitation of favipiravir levels. Recently, several studies have been reported about developing a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for measuring favipiravir levels. However, these methods were validated predominantly for plasma samples, electrospray ionization was operated only in negative or positive mode, and clinical application of these methods has not been applied for patients with COVID-19. This study aimed was to develop a validated LC-MS/MS method for the measurement of favipiravir levels in positive and negative electrospray ionization mode and to perform a pilot study in patients with COVID-19 receiving favipiravir to demonstrate the applicability of this method in biological samples. Simple protein precipitation was used for the extraction of favipiravir from the desired matrix. Favipiravir levels were quantitated using MS / MS with an electrospray ionization source in positive and negative multiple reaction monitoring (MRM) mode. The chromatographic detection was performed on a reverse-phase Phenomenex C18 column (50 mm × 4.6 mm, 5 µm, 100 Å) with gradient elution using 0.1% formic acid in water and 0.1% formic acid in methanol as mobile phase. The method was linear over the concentration ranges of 0.048-50 µg/mL (in negative ionization mode) and 0.062-50 µg/mL (in positive ionization mode) with a correlation coefficient (r2) better than 0.998. The total run time was 3.5 min. The intra-assay and inter-assay %CV values were less than 7.2% and 8.0%, respectively. A simple, rapid and robust LC-MS / MS method was developed for the measurement of favipiravir and validation studies were performed. The validated method was successfully applied for drug level measurement in COVID-19 patients receiving favipiravir.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Selcuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey.
| | - Sedat Abusoglu
- Selcuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
| | - Mustafa Onmaz
- Necmettin Erbakan University Faculty of Medicine, Department of Family Medicine, Konya, Turkey
| | | | - Ali Unlu
- Selcuk University Faculty of Medicine, Department of Biochemistry, Konya, Turkey
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9
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Byrd JC, Woyach JA, Furman RR, Martin P, O'Brien S, Brown JR, Stephens DM, Barrientos JC, Devereux S, Hillmen P, Pagel JM, Hamdy A, Izumi R, Patel P, Wang MH, Jain N, Wierda WG. Acalabrutinib in treatment-naive chronic lymphocytic leukemia. Blood 2021; 137:3327-3338. [PMID: 33786588 PMCID: PMC8670015 DOI: 10.1182/blood.2020009617] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/20/2021] [Indexed: 01/20/2023] Open
Abstract
Acalabrutinib has demonstrated significant efficacy and safety in relapsed chronic lymphocytic leukemia (CLL). Efficacy and safety of acalabrutinib monotherapy were evaluated in a treatment-naive CLL cohort of a single-arm phase 1/2 trial (ACE-CL-001). Adults were eligible for enrollment if chemotherapy was declined or deemed inappropriate due to comorbidities (N = 99). Patients had a median age of 64 years and 47% had Rai stage III/IV disease. Acalabrutinib was administered orally 200 mg once daily, or 100 mg twice daily until progression or intolerance. A total of 99 patients were treated; 57 (62%) had unmutated immunoglobulin heavy-chain variable gene, and 12 (18%) had TP53 aberrations. After median follow-up of 53 months, 85 patients remain on treatment; 14 discontinued treatment, mostly because of adverse events (AEs) (n = 6) or disease progression (n = 3). Overall response rate was 97% (90% partial response; 7% complete response), with similar outcomes among all prognostic subgroups. Because of improved trough BTK occupancy with twice-daily dosing, all patients were transitioned to 100 mg twice daily. Median duration of response (DOR) was not reached; 48-month DOR rate was 97% (95% confidence interval, 90-99). Serious AEs were reported in 38 patients (38%). AEs required discontinuation in 6 patients (6%) because of second primary cancers (n = 4) and infection (n = 2). Grade ≥3 events of special interest included infection (15%), hypertension (11%), bleeding events (3%), and atrial fibrillation (2%). Durable efficacy and long-term safety of acalabrutinib in this trial support its use in clinical management of symptomatic, untreated patients with CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Benzamides/administration & dosage
- Benzamides/adverse effects
- Benzamides/pharmacokinetics
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Mutation
- Neoplasm Staging
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Pyrazines/pharmacokinetics
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Richard R Furman
- Division of Hematology and Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Peter Martin
- Division of Hematology and Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Susan O'Brien
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, CA
| | | | | | | | - Stephen Devereux
- College Hospital, NHS Foundation Trust Denmark Hill, London, United Kingdom
| | - Peter Hillmen
- St James's University Hospital, Leeds, United Kingdom
| | | | | | | | | | | | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William G Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Yuno A, Kenmotsu Y, Takahashi Y, Nomoto H, Kameda H, Cho KY, Nakamura A, Yamashita Y, Nakamura J, Nakakubo S, Kamada K, Suzuki M, Sugino H, Inoshita N, Konno S, Miyoshi H, Atsumi T, Sawamura Y, Shimatsu A. Successful management of a patient with active Cushing's disease complicated with coronavirus disease 2019 (COVID-19) pneumonia. Endocr J 2021; 68:477-484. [PMID: 33361650 DOI: 10.1507/endocrj.ej20-0613] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 12/15/2022] Open
Abstract
We provide the details of the successful management of a patient with active Cushing's disease complicated with coronavirus disease 2019 (COVID-19) pneumonia. The patient was a 27-year-old Japanese female healthcare worker who was scheduled to undergo pituitary surgery for Cushing's disease. She had been in close contact with an undiagnosed patient infected with COVID-19 and then developed COVID-19 pneumonia. Despite a lack of known risk factors associated with severe COVID-19 infection, the patient's dyspnea worsened and her respiratory condition deteriorated, as indicated by the need for 7 L/min oxygen supply by mask to maintain her oxygen saturation at >90%. Medical treatment was initiated to control hypercortisolism by the 'block and replace' regimen using steroidogenesis inhibitors and hydrocortisone. The COVID-19 pneumonia improved with multi-modal treatment including antiviral therapy. One month later, after a negative severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) test result and with appropriate protection against virus transmission to medical staff in the operating room and daily medical care nurses, trans-sphenoidal surgery was performed by our highly experienced pituitary surgeon. One month after the surgery, the patient's basal ACTH and cortisol levels and urinary free cortisol were all under the detection limit. Surgical remission was expected. Since hypercortisolism due to active Cushing's disease may worsen a COVID-19 infection, multi-disciplinary management that includes appropriate and prompt treatment strategies is mandatory in such cases.
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Affiliation(s)
- Akiko Yuno
- Department of Internal Medicine, Kin-ikyo Chuo Hospital, Sapporo 007-8505, Japan
| | - Yoshiyuki Kenmotsu
- Department of Internal Medicine, Kin-ikyo Chuo Hospital, Sapporo 007-8505, Japan
| | - Yuka Takahashi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Hiroshi Nomoto
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Kyu Yong Cho
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Akinobu Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Yu Yamashita
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Sho Nakakubo
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Keisuke Kamada
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Hirokazu Sugino
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Naoko Inoshita
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo 173-0015, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Hideaki Miyoshi
- Division of Diabetes and Obesity, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo 060-8648, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | | | - Akira Shimatsu
- Advanced Medical Care Center, Kusatsu General Hospital, Kusatsu 525-8585, Japan
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11
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Singh RSP, Pradhan V, Roberts ES, Scaramozza M, Kieras E, Gale JD, Peeva E, Vincent MS, Banerjee A, Fensome A, Dowty ME, Winkle P, Tehlirian C. Safety and Pharmacokinetics of the Oral TYK2 Inhibitor PF-06826647: A Phase I, Randomized, Double-Blind, Placebo-Controlled, Dose-Escalation Study. Clin Transl Sci 2021; 14:671-682. [PMID: 33290616 PMCID: PMC7993274 DOI: 10.1111/cts.12929] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/25/2020] [Indexed: 12/31/2022] Open
Abstract
Selective inhibition of tyrosine kinase 2 (TYK2) may offer therapeutic promise in inflammatory conditions, with its role in downstream pro-inflammatory cytokine signaling. In this first-in-human study, we evaluated the safety, tolerability, and pharmacokinetics (PK) of a novel TYK2 inhibitor, PF-06826647, in healthy participants. This phase I, randomized, double-blind, placebo-controlled, parallel-group study included two treatment periods (single ascending dose (SAD) and multiple ascending dose (MAD)) in healthy participants and a cohort of healthy Japanese participants receiving 400 mg q.d. or placebo in the MAD period (NCT03210961). Participants were randomly assigned to PF-06826647 or placebo (3:1). Participants received a single oral study drug dose of 3, 10, 30, 100, 200, 400, or 1,600 mg (SAD period), then 30, 100, 400, or 1,200 mg q.d. or 200 mg b.i.d. for 10 days (MAD period). Safety (adverse events (AEs), vital signs, and clinical laboratory parameters), tolerability, and PK were assessed. Overall, 69 participants were randomized to treatment, including six Japanese participants. No deaths, serious AEs, severe AEs, or AEs leading to dose reduction or temporary/permanent discontinuation were observed. All AEs were mild in severity. No clinically relevant laboratory abnormalities or changes in vital signs were detected. PF-06826647 was rapidly absorbed with a median time to maximum plasma concentration of 2 hours in a fasted state, with modest accumulation (< 1.5-fold) after multiple dosing and low urinary recovery. PF-06826647 was well-tolerated, with an acceptable safety profile for doses up to 1,200 mg q.d. for 10 days, supporting further testing in patients.
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12
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Suemori K, Saijo M, Yamanaka A, Himeji D, Kawamura M, Haku T, Hidaka M, Kamikokuryo C, Kakihana Y, Azuma T, Takenaka K, Takahashi T, Furumoto A, Ishimaru T, Ishida M, Kaneko M, Kadowaki N, Ikeda K, Sakabe S, Taniguchi T, Ohge H, Kurosu T, Yoshikawa T, Shimojima M, Yasukawa M. A multicenter non-randomized, uncontrolled single arm trial for evaluation of the efficacy and the safety of the treatment with favipiravir for patients with severe fever with thrombocytopenia syndrome. PLoS Negl Trop Dis 2021; 15:e0009103. [PMID: 33617533 PMCID: PMC7899362 DOI: 10.1371/journal.pntd.0009103] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a bunyavirus infection with high mortality. Favipiravir has shown effectiveness in preventing and treating SFTS virus (SFTSV) infection in animal models. A multicenter non-randomized, uncontrolled single arm trial was conducted to collect data on the safety and the effectiveness of favipiravir in treatment of SFTS patients. All participants received favipiravir orally (first-day loading dose of 1800 mg twice a day followed by 800 mg twice a day for 7–14 days in total). SFTSV RT-PCR and biochemistry tests were performed at designated time points. Outcomes were 28-day mortality, clinical improvement, viral load evolution, and adverse events (AEs). Twenty-six patients were enrolled, of whom 23 were analyzed. Four of these 23 patients died of multi-organ failure within one week (28-day mortality rate: 17.3%). Oral favipiravir was well tolerated in the surviving patients. AEs (abnormal hepatic function and insomnia) occurred in about 20% of the patients. Clinical symptoms improved in all patients who survived from a median of day 2 to day10. SFTSV RNA levels in the patients who died were significantly higher than those in the survivors (p = 0.0029). No viral genomes were detectable in the surviving patients a median of 8 days after favipiravir administration. The 28-day mortality rate in this study was lower than those of the previous studies in Japan. The high frequency of hepatic dysfunction as an AE was observed. However, it was unclear whether this was merely a side effect of favipiravir, because liver disorders are commonly seen in SFTS patients. The results of this trial support the effectiveness of favipiravir for patients with SFTS. Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne virus infection caused by Dabie bandavirus (formerly SFTS virus, SFTSV), which belongs to the Bandavirus genus of the Phenuiviridae family. The case fatality rate of patients with SFTS is high ranging from 16.2% to 47%. SFTS is endemic to East and Southeast Asia. Favipiravir, an antiviral agent with an inhibitory activity on the RNA-dependent RNA polymerase, inhibited replication of SFTSV in vitro and in vivo. It was suggested that favipiravir treatment lowered the case fatality rate of patients with SFTS by approximately 10% in comparison with those reported so far through epidemiological survey in Japan. People living in the SFTS-endemic regions can not escape from the risk of being infected with SFTSV. Favipiravir might be an effective drug for treatment of patients with SFTS and reduces the mortality and morbidity of patients with SFTS.
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Affiliation(s)
- Koichiro Suemori
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masayuki Saijo
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
- * E-mail:
| | - Atsushi Yamanaka
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Daisuke Himeji
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Masafumi Kawamura
- Division of Internal Medicine, Kochi Prefectural Hata Kenmin Hospital, Sukumo, Kochi, Japan
| | - Takashi Haku
- Department of Respiratory Medicine, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Chinatsu Kamikokuryo
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Kagoshima, Japan
| | - Taichi Azuma
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Katsuto Takenaka
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
| | - Toru Takahashi
- Department of Hematology, Yamaguchi Grand Medical Center, Hofu, Japan
| | - Akitsugu Furumoto
- Division of Infectious Diseases, Department of Internal Medicine, Nagasaki Rosai Hospital, Nagasaki, Japan
| | - Toshiyuki Ishimaru
- Department of Infectious Diseases, The Japanese Red Cross Fukuoka Hospital, Hakata, Japan
| | - Masayuki Ishida
- Department of Infectious Diseases, Chikamori Hospital, Kochi, Kochi, Japan
| | - Masahiko Kaneko
- Department of Internal Medicine, Uwajima City Hospital, Uwajima, Japan
| | | | - Kenichi Ikeda
- Department of Internal Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Shigetoshi Sakabe
- Department of Infectious Diseases, Ise Red Cross Hospital, Ise, Japan
| | - Tomohiro Taniguchi
- Division of General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Takeshi Kurosu
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Tomoki Yoshikawa
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Masayuki Shimojima
- Department of Virology I, National Institute of Infectious Diseases, Shinjuku, Japan
| | - Masaki Yasukawa
- Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan
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13
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Pal SK, Tangen C, Thompson IM, Balzer-Haas N, George DJ, Heng DYC, Shuch B, Stein M, Tretiakova M, Humphrey P, Adeniran A, Narayan V, Bjarnason GA, Vaishampayan U, Alva A, Zhang T, Cole S, Plets M, Wright J, Lara PN. A comparison of sunitinib with cabozantinib, crizotinib, and savolitinib for treatment of advanced papillary renal cell carcinoma: a randomised, open-label, phase 2 trial. Lancet 2021; 397:695-703. [PMID: 33592176 PMCID: PMC8687736 DOI: 10.1016/s0140-6736(21)00152-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [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: 12/31/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND MET (also known as hepatocyte growth factor receptor) signalling is a key driver of papillary renal cell carcinoma (PRCC). Given that no optimal therapy for metastatic PRCC exists, we aimed to compare an existing standard of care, sunitinib, with the MET kinase inhibitors cabozantinib, crizotinib, and savolitinib for treatment of patients with PRCC. METHODS We did a randomised, open-label, phase 2 trial done in 65 centres in the USA and Canada. Eligible patients were aged 18 years or older with metastatic PRCC who had received up to one previous therapy (excluding vascular endothelial growth factor-directed and MET-directed agents). Patients were randomly assigned to receive sunitinib, cabozantinib, crizotinib, or savolitinib, with stratification by receipt of previous therapy and PRCC subtype. All drug doses were administered orally: sunitinib 50 mg, 4 weeks on and 2 weeks off (dose reductions to 37·5 mg and 25 mg allowed); cabozantinib 60 mg daily (reductions to 40 mg and 20 mg allowed); crizotinib 250 mg twice daily (reductions to 200 mg twice daily and 250 mg once daily allowed); and savolitinib 600 mg daily (reductions to 400 mg and 200 mg allowed). Progression-free survival (PFS) was the primary endpoint. Analyses were done in an intention-to-treat population, with patients who did not receive protocol therapy excluded from safety analyses. This trial is registered with ClinicalTrials.gov, NCT02761057. FINDINGS Between April 5, 2016, and Dec 15, 2019, 152 patients were randomly assigned to one of four study groups. Five patients were identified as ineligible post-randomisation and were excluded from these analyses, resulting in 147 eligible patients. Assignment to the savolitinib (29 patients) and crizotinib (28 patients) groups was halted after a prespecified futility analysis; planned accrual was completed for both sunitinib (46 patients) and cabozantinib (44 patients) groups. PFS was longer in patients in the cabozantinib group (median 9·0 months, 95% CI 6-12) than in the sunitinib group (5·6 months, 3-7; hazard ratio for progression or death 0·60, 0·37-0·97, one-sided p=0·019). Response rate for cabozantinib was 23% versus 4% for sunitinib (two-sided p=0·010). Savolitinib and crizotinib did not improve PFS compared with sunitinib. Grade 3 or 4 adverse events occurred in 31 (69%) of 45 patients receiving sunitinib, 32 (74%) of 43 receiving cabozantinib, ten (37%) of 27 receiving crizotinib, and 11 (39%) of 28 receiving savolitinib; one grade 5 thromboembolic event was recorded in the cabozantinib group. INTERPRETATION Cabozantinib treatment resulted in significantly longer PFS compared with sunitinib in patients with metastatic PRCC. FUNDING National Institutes of Health and National Cancer Institute.
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Affiliation(s)
- Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Catherine Tangen
- SWOG Statistics and Data Management Center, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ian M Thompson
- CHRISTUS Santa Rosa Medical Center Hospital, San Antonio, TX, USA
| | - Naomi Balzer-Haas
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J George
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | - Brian Shuch
- Institute of Urologic Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mark Stein
- Department of Medicine, Columbia University, New York, NY, USA
| | - Maria Tretiakova
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Peter Humphrey
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | - Vivek Narayan
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ulka Vaishampayan
- Department of Medicine, Wayne State University, Detroit, MI, USA; Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ajjai Alva
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tian Zhang
- Alliance for Clinical Trials in Oncology, Duke Cancer Research Institute, Durham, NC, USA
| | - Scott Cole
- Oklahoma Cancer Specialists and Research Institute, NRG Oncology, Tulsa, OK, USA
| | - Melissa Plets
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - John Wright
- Cancer Therapy Evaluation Program, Investigational Drug Branch, National Cancer Institute, Bethesda, MD, USA
| | - Primo N Lara
- University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Ye T, Li Y, Xiong D, Gong S, Zhang L, Li B, Pan J, Wang Y, Qian J, Qu H. Combination of Danshen and ligustrazine has dual anti-inflammatory effect on macrophages and endothelial cells. J Ethnopharmacol 2021; 266:113425. [PMID: 33010405 DOI: 10.1016/j.jep.2020.113425] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Salvia Miltiorrhiza Radix et Rhizoma (Danshen) and Chuanxiong Rhizoma (Chuanxiong) are both traditional Chinese medicines with vascular protective effects, and their combination is widely used in China to treat occlusive or ischemic diseases of the cerebrovascular or cardiovascular system. Although it is widely accepted that these diseases have high relevance to inflammation, little is known about the anti-inflammatory effect of Danshen, Chuanxiong, and their combination. AIM OF STUDY We aimed to investigate the complex mode of action of Danshen, Chuanxiong, and their combination and the molecular mechanisms underlying their anti-inflammatory activity. Specifically, toll-like receptor (TLR1/2, 3, and 4)-triggered macrophages and endothelial cells, the two major cell players in atherosclerosis as well as in related cardiovascular and cerebrovascular injuries, were emphasized. METHODS TLR1/2-, TLR3-, and TLR4-induced bone marrow macrophages (BMMs) and human umbilical vein endothelial cells (HUVECs) were treated with Danshen extract (S. miltiorrhiza extract, SME), ligustrazine (2, 3, 5, 6-tetramethylpyrazine, TMP), and their combination (S. miltiorrhiza and TMP injection, SLI), respectively. The proinflammatory cytokines interleukin 6 (IL-6), IL-12, and tumor necrosis factor alpha (TNF-α) were detected as the preliminary indicators of inflammation. In addition, RNA sequencing (RNA-seq)-based transcriptional profiling analyses were conducted for TLR2-activated BMMs to determine the molecular mode of action of SLI as well as the contribution of SME to SLI activity. RESULTS SLI mitigated inflammation in both BMMs and HUVECs. Refer to the combination, SME had pronounced anti-inflammatory effect on BMMs but had only a slight effect on HUVECs. In contrast, TMP had considerable anti-inflammatory effect on HUVECs but not on BMMs. Bioinformatic analysis identified a broad spectrum of regulatory genes, in addition to IL-6 gene, and C-X-C motif chemokine ligand 10 (CXCL10) appeared to be another key molecule involved in the mechanism underlying SLI and SME effects. At the molecular level, SME was a major contributor of the anti-inflammatory activity of SLI. CONCLUSIONS In TLR-activated inflammation, SLI exhibits a "multiple ingredient-multiple target" effect, with SME primarily affecting macrophages and TMP affecting HUVECs. Our study provides evidence for the clinical application of SLI in treating complex diseases involving inflammation-induced injury of both macrophages and epithelial cells. Further bioinformatics studies are required to reveal the entire molecular network involved in TMP, SME, and SLI activity.
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Affiliation(s)
- Tingting Ye
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yufei Li
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | | | - Shuqing Gong
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Luquan Zhang
- Guizhou Baite Pharmaceutical Co., Ltd., Guizhou, China
| | - Bailing Li
- Guizhou Baite Pharmaceutical Co., Ltd., Guizhou, China
| | - Jianyang Pan
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Yi Wang
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
| | - Jing Qian
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China.
| | - Haibin Qu
- Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
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Vu SH, Bernardo Reyes AW, Ngoc Huy TX, Min W, Lee HJ, Kim HJ, Lee JH, Kim S. Prostaglandin I2 (PGI 2) inhibits Brucella abortus internalization in macrophages via PGI 2 receptor signaling, and its analogue affects immune response and disease outcome in mice. Dev Comp Immunol 2021; 115:103902. [PMID: 33091457 DOI: 10.1016/j.dci.2020.103902] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
To date, the implications of prostaglandin I2 (PGI2), a prominent lipid mediator for modulation of immune responses, has not been clearly understood in Brucella infection. In this study, we found that cyclooxygenase-2 (COX-2) was significantly expressed in both infected bone marrow-derived macrophages (BMMs) and RAW 264.7 cells. Prostaglandin I2 synthase (PTGIS) expression was not significantly changed, and PGI2receptor (PTGIR) expression was downregulated in BMMs but upregulated in RAW 264.7 macrophages at late infection. Here, we presented that PGI2, a COX-derived metabolite, was produced by macrophages during Brucella infection and its production was regulated by COX-2 and IL-10. We suggested that PGI2 and selexipag, a potent PGI2 analogue, inhibited Brucella internalization through IP signaling which led to down-regulation of F-actin polymerization and p38α MAPK activity. Administration with selexipag suppressed immune responses and resulted in a notable reduction in bacterial burden in spleen of Brucella-challenged mice. Taken together, our study is the first to characterize PGI2 synthesis and its effect in evasion strategy of macrophages against Brucella infection.
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Affiliation(s)
- Son Hai Vu
- Institute of Applied Sciences, Ho Chi Minh City University of Technology - HUTECH, 475A Dien Bien Phu St., Ward 25, Binh Thanh District, Ho Chi Minh City, Viet Nam; Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | | | - Tran Xuan Ngoc Huy
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Wongi Min
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Hu Jang Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - Hyun-Jin Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea
| | - John Hwa Lee
- College of Veterinary Medicine, Chonbuk National University, Iksan, 54596, Republic of Korea
| | - Suk Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju, 52828, Republic of Korea.
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16
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Lin Y, Wan Y, Du X, Li J, Wei J, Li T, Li C, Liu Z, Zhou M, Zhong Z. TAT-modified serum albumin nanoparticles for sustained-release of tetramethylpyrazine and improved targeting to spinal cord injury. J Nanobiotechnology 2021; 19:28. [PMID: 33478501 PMCID: PMC7819157 DOI: 10.1186/s12951-020-00766-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/01/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Spinal Cord injury (SCI) is a kind of severe traumatic disease. The inflammatory response is a significant feature after SCI. Tetramethylpyrazine (TMP), a perennial herb of umbelliferae, is an alkaloid extracted from ligustici. TMP can inhibit the production of nitric oxide and reduce the inflammatory response in peripheral tissues. It can be seen that the therapeutic effect of TMP on SCI is worthy of affirmation. TMP has defects such as short half-life and poor water-solubility. In addition, the commonly used dosage forms of TMP include tablets, dropping pills, injections, etc., and its tissue and organ targeting is still a difficult problem to solve. To improve the solubility and targeting of TMP, here, we developed a nanotechnology-based drug delivery system, TMP-loaded nanoparticles modified with HIV trans-activator of transcription (TAT-TMP-NPs). RESULTS The nanoparticles prepared in this study has integrated structure. The hemolysis rate of each group is less than 5%, indicating that the target drug delivery system has good safety. The results of in vivo pharmacokinetic studies show that TAT-TMP-NPs improves the bioavailability of TMP. The quantitative results of drug distribution in vivo show that TAT-TMP-NPs is more distributed in spinal cord tissue and had higher tissue targeting ability compared with other treatment groups. CONCLUSIONS The target drug delivery system can overcome the defect of low solubility of TMP, achieve the targeting ability, and show the further clinical application prospect.
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Affiliation(s)
- Yan Lin
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yujie Wan
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Xingjie Du
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jian Li
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jun Wei
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ting Li
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Chunhong Li
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhongbing Liu
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Meiling Zhou
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Zhirong Zhong
- Department of Pharmaceutical Sciences, School of Pharmacy, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Joshi S, Parkar J, Ansari A, Vora A, Talwar D, Tiwaskar M, Patil S, Barkate H. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis 2021; 102:501-508. [PMID: 33130203 PMCID: PMC7831863 DOI: 10.1016/j.ijid.2020.10.069] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [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] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) outbreak all over the world has led the researchers to strive to develop drugs or vaccines to prevent or halt the progression of this ailment. To hasten the treatment process, repurposed drugs are being evaluated. Favipiravir is one such oral drug that was approved for new and reemerging pandemic influenza in Japan in 2014 and has shown potent in vitro activity against severe acute respiratory syndrome coronavirus-2. It has a wide therapeutic safety margin indicated by a wide CC50/EC50 ratio for a high dose. From the clinical studies in COVID-19, it has shown rapid viral clearance as compared to lopinavir/ritonavir (LPV/RTV) and superior recovery rate than umifenovir. Overall, favipiravir has shown promising results in clinical studies in China, Russia, and Japan, and more trials are underway in multiple countries, including USA, UK, and India. Recently, treatment guidelines from many countries and some states from India have included favipiravir in the treatment protocol. This review provides insights into the evidence-based evolving role of favipiravir in the management of COVID-19 infection with emphasis on benefits of initiating an early antiviral therapy with special focus on favipiravir, its pharmacodynamic, pharmacokinetic, in vitro, clinical data, and inclusion in the treatment protocols of COVID-19.
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Affiliation(s)
- Shashank Joshi
- Joshi Clinic and Lilavati Hospital and Research Center, Mumbai, India
| | - Jalil Parkar
- Lilavati Hospital and Research Center, Mumbai, India
| | - Abdul Ansari
- Critical Care Services, Nanavati Super Specialty Hospital, Mumbai, India
| | | | | | | | - Saiprasad Patil
- Global Medical Affairs, India Formulations, Glenmark Pharmaceuticals Ltd., Mumbai, India.
| | - Hanmant Barkate
- Global Medical Affairs, India Formulations and Middle East Africa, Glenmark Pharmaceuticals Ltd., Mumbai, India
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18
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Khamis F, Al Naabi H, Al Lawati A, Ambusaidi Z, Al Sharji M, Al Barwani U, Pandak N, Al Balushi Z, Al Bahrani M, Al Salmi I, Al-Zakwani I. Randomized controlled open label trial on the use of favipiravir combined with inhaled interferon beta-1b in hospitalized patients with moderate to severe COVID-19 pneumonia. Int J Infect Dis 2021; 102:538-543. [PMID: 33181328 PMCID: PMC7833906 DOI: 10.1016/j.ijid.2020.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the therapeutic effectiveness of favipiravir combined with inhaled interferon beta-1b in adult patients hospitalized with moderate to severe COVID-19 pneumonia. METHODS A randomized, open-label controlled trial of oral favipiravir in adults hospitalized with moderate to severe COVID-19 pneumonia from June 22nd 2020 to August 13th 2020 was conducted. Patients were randomly assigned to receive either a combination of favipiravir with interferon beta-1b by inhalation aerosol or hydroxychloroquine (HCQ). The outcome endpoints included improvement in inflammatory markers, lower length of hospital stay (LOS), discharges and lower overall 14-day mortality. RESULTS A total of 89 patients underwent randomization with 49% (n = 44) assigned to favipiravir and 51% (n = 45) assigned HCQ. The overall mean age was 55 ± 14 years and 58% (n = 52) were males. There were no significant differences in the inflammatory biomarkers at hospital discharge between the two groups; C-reactive protein (p = 0.413), ferritin (p = 0.968), lactate dehydrogenase (p = 0.259) and interleukin 6 (p = 0.410). There were also no significant differences between the two groups with regards to the overall LOS (7 vs 7 days; p = 0.948), transfers to the ICU (18.2% vs 17.8%; p = 0.960), discharges (65.9% vs 68.9%; p = 0.764) and overall mortality (11.4% vs 13.3%; p = 0.778). CONCLUSIONS No differences in clinical outcomes were found between favipiravir plus inhaled interferon beta-1b and hydroxychloroquine in adults hospitalized with moderate to severe COVID-19 pneumonia.
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Affiliation(s)
- Faryal Khamis
- Infection Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | - Hanan Al Naabi
- Acute Medicine Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | - Adil Al Lawati
- Acute Medicine Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | - Zaiyana Ambusaidi
- Acute Medicine Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | | | | | - Nenad Pandak
- Infection Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | - Zakariya Al Balushi
- Infection Diseases Unit, Department of Medicine, Royal Hospital, Muscat, Oman.
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman.
| | - Issa Al Salmi
- Department of Nephrology, Royal Hospital, Muscat, Oman.
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman.
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Chakraborty U, Ghosh S, Chandra A, Ray AK. Subacute thyroiditis as a presenting manifestation of COVID-19: a report of an exceedingly rare clinical entity. BMJ Case Rep 2020; 13:e239953. [PMID: 33370933 PMCID: PMC10577769 DOI: 10.1136/bcr-2020-239953] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
The SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. The symptoms of this disease may range from mild influenza-like symptoms to severe acute respiratory distress syndrome with high morbidity and mortality. With improved diagnostic techniques and better disease understanding, an increased number of cases are being reported with extrapulmonary manifestations of this disease ranging from renal and gastrointestinal to cardiac, hepatic, neurological and haematological dysfunction. Subacute thyroiditis is a self-limiting and painful thyroid gland inflammation most often secondary to viral infections. We report a case of subacute thyroiditis in a 58-year-old gentleman presenting with a painful swelling in the neck who was subsequently detected to be positive for SARS-CoV-2. We seek to highlight the broad clinical spectrum of the COVID-19 by reporting probably the first case of subacute thyroiditis possibly induced by SARS-CoV-2 infection from India.
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Affiliation(s)
- Uddalak Chakraborty
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Shrestha Ghosh
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Aritra Kumar Ray
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Silva Arouche TD, Reis AF, Martins AY, S Costa JF, Carvalho Junior RN, J C Neto AM. Interactions Between Remdesivir, Ribavirin, Favipiravir, Galidesivir, Hydroxychloroquine and Chloroquine with Fragment Molecular of the COVID-19 Main Protease with Inhibitor N3 Complex (PDB ID:6LU7) Using Molecular Docking. J Nanosci Nanotechnol 2020; 20:7311-7323. [PMID: 32711596 DOI: 10.1166/jnn.2020.18955] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We started a study on the molecular docking of six potential pharmacologically active inhibitors compounds that can be used clinically against the COVID-19 virus, in this case, remdesivir, ribavirin, favipiravir, galidesivir, hydroxychloroquine and chloroquine interacting with the main COVID-19 protease in complex with a COVID-19 N3 protease inhibitor. The highest values of affinity energy found in order from highest to lowest were chloroquine (CHL), hydroxychloroquine (HYC), favipiravir (FAV), galidesivir (GAL), remdesivir (REM) and ribavirin (RIB). The possible formation of hydrogen bonds, associations through London forces and permanent electric dipole were analyzed. The values of affinity energy obtained for the hydroxychloroquine ligands was -9.9 kcal/mol and for the chloroquine of -10.8 kcal/mol which indicate that the coupling contributes to an effective improvement of the affinity energies with the protease. Indicating that, the position chosen to make the substitutions may be a pharmacophoric group, and cause changes in the protease.
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Affiliation(s)
- Tiago da Silva Arouche
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Para, C. P. 479, 66075-110, Belem, PA, Brazil
| | - Arthur Ferreira Reis
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Para, C. P. 479, 66075-110, Belem, PA, Brazil
| | - Anderson Yuri Martins
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Para, C. P. 479, 66075-110, Belem, PA, Brazil
| | - Jose Francisco S Costa
- Universidade Federal do Para, Campus Abaetetuba, Ramal Manoel de Abreu, S/n . Mutirao, 68440-000, Abaetetuba, Para, Brazil
| | - Raul Nunes Carvalho Junior
- Pos-Graduate Program in Engineering of Natural Resources of the Amazon, ITEC, Federal University of Para, C. P. 2626, 66.050-540, Belem, PA, Brazil
| | - Antonio Maia J C Neto
- Laboratory of Preparation and Computation of Nanomaterials (LPCN), Federal University of Para, C. P. 479, 66075-110, Belem, PA, Brazil
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Hanna CR, Blyth KG, Burley G, Carmichael S, Evans C, Hinsley S, Khadra I, Khoo S, Lewsley LA, Jones RR, Sharma R, Taladriz-Sender A, Thomson EC, Scott JT. Glasgow Early Treatment Arm Favirpiravir (GETAFIX) for adults with early stage COVID-19: A structured summary of a study protocol for a randomised controlled trial. Trials 2020; 21:935. [PMID: 33213530 PMCID: PMC7675389 DOI: 10.1186/s13063-020-04891-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The GETAFIX trial will test the hypothesis that favipiravir is a more effective treatment for COVID-19 infection in patients who have early stage disease, compared to current standard of care. This study will also provide an important opportunity to investigate the safety and tolerability of favipiravir, the pharmacokinetic and pharmacodynamic profile of this drug and mechanisms of resistance in the context of COVID-19 infection, as well as the effect of favipiravir on hospitalisation duration and the post COVID-19 health and psycho-social wellbeing of patients recruited to the study. TRIAL DESIGN GETAFIX is an open label, parallel group, two arm phase II/III randomised trial with 1:1 treatment allocation ratio. Patients will be randomised to one of two arms and the primary endpoint will assess the superiority of favipiravir plus standard treatment compared to standard treatment alone. PARTICIPANTS This trial will recruit adult patients with confirmed positive valid COVID-19 test, who are not pregnant or breastfeeding and have no prior major co-morbidities. This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. Patients must meet all of the following criteria: 1. Age 16 or over at time of consent 2. Exhibiting symptoms associated with COVID-19 3. Positive for SARS-CoV-2 on valid COVID-19 test 4. Point 1, 2, 3, or 4 on the WHO COVID-19 ordinal severity scale at time of randomisation. (Asymptomatic with positive valid COVID-19 test, Symptomatic Independent, Symptomatic assistance needed, Hospitalized, with no oxygen therapy) 5. Have >=10% risk of death should they be admitted to hospital as defined by the ISARIC4C risk index: https://isaric4c.net/risk 6. Able to provide written informed consent 7. Negative pregnancy test (women of childbearing potential*) 8. Able to swallow oral medication Patients will be excluded from the trial if they meet any of the following criteria: 1. Renal impairment requiring, or likely to require, dialysis or haemofiltration 2. Pregnant or breastfeeding 3. Of child bearing potential (women), or with female partners of child bearing potential (men) who do not agree to use adequate contraceptive measures for the duration of the study and for 3 months after the completion of study treatment 4. History of hereditary xanthinuria 5. Other patients judged unsuitable by the Principal Investigator or sub-Investigator 6. Known hypersensitivity to favipiravir, its metabolites or any excipients 7. Severe co-morbidities including: patients with severe hepatic impairment, defined as: • greater than Child-Pugh grade A • AST or ALT > 5 x ULN • AST or ALT >3 x ULN and Total Bilirubin > 2xULN 8. More than 96 hours since first positive COVID-19 test sample was taken 9. Unable to discontinue contra-indicated concomitant medications This is a multi-centre trial, patients will be recruited from in-patients and outpatients from three Glasgow hospitals: Royal Alexandra Hospital; Queen Elizabeth University Hospital; and the Glasgow Royal Infirmary. INTERVENTION AND COMPARATOR Patients randomised to the experimental arm of GETAFIX will receive standard treatment for COVID-19 at the discretion of the treating clinician plus favipiravir. These patients will receive a loading dose of favipiravir on day 1 of 3600mg (1800mg 12 hours apart). On days 2-10, patients in the experimental arm will receive a maintenance dose of favipiravir of 800mg 12 hours apart (total of 18 doses). Patients randomised to the control arm of the GETAFIX trial will receive standard treatment for COVID-19 at the discretion of the treating clinician. MAIN OUTCOMES The primary outcome being assessed in the GETAFIX trial is the efficacy of favipiravir in addition to standard treatment in patients with COVID-19 in reducing the severity of disease compared to standard treatment alone. Disease severity will be assessed using WHO COVID 10 point ordinal severity scale at day 15 +/- 48 hours. All randomised participants will be followed up until death or 60 days post-randomisation (whichever is sooner). RANDOMISATION Patients will be randomised 1:1 to the experimental versus control arm using computer generated random sequence allocation. A minimisation algorithm incorporating a random component will be used to allocate patients. The factors used in the minimisation will be: site, age (16-50/51-70/71+), history of hypertension or currently obsess (BMI>30 or obesity clinically evident; yes/no), 7 days duration of symptoms (yes/no/unknown), sex (male/female), WHO COVID-19 ordinal severity score at baseline (1/2or 3/4). BLINDING (MASKING) No blinding will be used in the GETAFIX trial. Both participants and those assessing outcomes will be aware of treatment allocation. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) In total, 302 patients will be randomised to the GETAFIX trial: 151 to the control arm and 151 to the experimental arm. There will be an optional consent form for patients who may want to contribute to more frequent PK and PD sampling. The maximum number of patients who will undergo this testing will be sixteen, eight males and eight females. This option will be offered to all patients who are being treated in hospital at the time of taking informed consent, however only patients in the experimental arm of the trial will be able to undergo this testing. TRIAL STATUS The current GETAFIX protocol is version 4.0 12th September 2020. GETAFIX opened to recruitment on 26th October 2020 and will recruit patients over a period of approximately six months. TRIAL REGISTRATION GETAFIX was registered on the European Union Drug Regulating Authorities Clinical Trials (EudraCT) Database on 15th April 2020; Reference number 2020-001904-41 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001904-41/GB ). GETAFIX was registered on ISRCTN on 7th September 2020; Reference number ISRCTN31062548 ( https://www.isrctn.com/ISRCTN31062548 ). FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (see Additional file 2).
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Affiliation(s)
- Catherine R. Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kevin G. Blyth
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Carol Evans
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | | | | | - Saye Khoo
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | | | - Robert R. Jones
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
- NHS Greater Glasgow & Clyde, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Raman Sharma
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Emma C. Thomson
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Janet T. Scott
- NHS Greater Glasgow & Clyde, Glasgow, UK
- MRC-University of Glasgow Centre for Virus Research, Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Watson WD, Timm KN, Lewis AJ, Miller JJJ, Emmanuel Y, Clarke K, Neubauer S, Tyler DJ, Rider OJ. Nicotinic acid receptor agonists impair myocardial contractility by energy starvation. FASEB J 2020; 34:14878-14891. [PMID: 32954525 DOI: 10.1096/fj.202000084rr] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 08/08/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022]
Abstract
Nicotinic acid receptor agonists have previously been shown to cause acute reductions in cardiac contractility. We sought to uncover the changes in cardiac metabolism underlying these alterations in function. In nine humans, we recorded cardiac energetics and function before and after a single oral dose of nicotinic acid using cardiac MRI to demonstrate contractile function and Phosphorus-31 (31 P) magnetic resonance spectroscopy to demonstrate myocardial energetics. Nicotinic Acid 400 mg lowered ejection fraction by 4% (64 ± 8% to 60 ± 7%, P = .03), and was accompanied by a fall in phosphocreatine/ATP ratio by 0.4 (2.2 ± 0.4 to 1.8 ± 0.1, P = .04). In four groups of eight Wistar rats, we used pyruvate dehydrogenase (PDH) flux studies to demonstrate changes in carbohydrate metabolism induced by the nicotinic acid receptor agonist, Acipimox, using hyperpolarized Carbon-13 (13 C) magnetic resonance spectroscopy. In rats which had been starved overnight, Acipimox caused a fall in ejection fraction by 7.8% (67.5 ± 8.9 to 60 ± 3.1, P = .03) and a nearly threefold rise in flux through PDH (from 0.182 ± 0.114 to 0.486 ± 0.139, P = .002), though this rise did not match pyruvate dehydrogenase flux observed in rats fed carbohydrate rich chow (0.726 ± 0.201). In fed rats, Acipimox decreased pyruvate dehydrogenase flux (to 0.512 ± 0.13, P = .04). Concentration of plasma insulin fell by two-thirds in fed rats administered Acipimox (from 1695 ± 891 ng/L to 550 ± 222 ng/L, P = .005) in spite of glucose concentrations remaining the same. In conclusion, we demonstrate that nicotinic acid receptor agonists impair cardiac contractility associated with a decline in cardiac energetics and show that the mechanism is likely a combination of reduced fatty acid availability and a failure to upregulate carbohydrate metabolism, essentially starving the heart of fuel.
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Affiliation(s)
- William D Watson
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Kerstin N Timm
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Andrew J Lewis
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Jack J J Miller
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
- Department of Physics, University of Oxford, Oxford, UK
| | - Yaso Emmanuel
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Kieran Clarke
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Damian J Tyler
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Oliver J Rider
- Department of Cardiovascular Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
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Yap TA, O’Carrigan B, Penney MS, Lim JS, Brown JS, de Miguel Luken MJ, Tunariu N, Perez-Lopez R, Rodrigues DN, Riisnaes R, Figueiredo I, Carreira S, Hare B, McDermott K, Khalique S, Williamson CT, Natrajan R, Pettitt SJ, Lord CJ, Banerji U, Pollard J, Lopez J, de Bono JS. Phase I Trial of First-in-Class ATR Inhibitor M6620 (VX-970) as Monotherapy or in Combination With Carboplatin in Patients With Advanced Solid Tumors. J Clin Oncol 2020; 38:3195-3204. [PMID: 32568634 PMCID: PMC7499606 DOI: 10.1200/jco.19.02404] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Preclinical studies demonstrated that ATR inhibition can exploit synthetic lethality (eg, in cancer cells with impaired compensatory DNA damage responses through ATM loss) as monotherapy and combined with DNA-damaging drugs such as carboplatin. PATIENTS AND METHODS This phase I trial assessed the ATR inhibitor M6620 (VX-970) as monotherapy (once or twice weekly) and combined with carboplatin (carboplatin on day 1 and M6620 on days 2 and 9 in 21-day cycles). Primary objectives were safety, tolerability, and maximum tolerated dose; secondary objectives included pharmacokinetics and antitumor activity; exploratory objectives included pharmacodynamics in timed paired tumor biopsies. RESULTS Forty patients were enrolled; 17 received M6620 monotherapy, which was safe and well tolerated. The recommended phase II dose (RP2D) for once- or twice-weekly administration was 240 mg/m2. A patient with metastatic colorectal cancer harboring molecular aberrations, including ATM loss and an ARID1A mutation, achieved RECISTv1.1 complete response and maintained this response, with a progression-free survival of 29 months at last assessment. Twenty-three patients received M6620 with carboplatin, with mechanism-based hematologic toxicities at higher doses, requiring dose delays and reductions. The RP2D for combination therapy was M6620 90 mg/m2 with carboplatin AUC5. A patient with advanced germline BRCA1 ovarian cancer achieved RECISTv1.1 partial response and Gynecologic Cancer Intergroup CA125 response despite being platinum refractory and PARP inhibitor resistant. An additional 15 patients had RECISTv1.1 stable disease as best response. Pharmacokinetics were dose proportional and exceeded preclinical efficacious levels. Pharmacodynamic studies demonstrated substantial inhibition of phosphorylation of CHK1, the downstream ATR substrate. CONCLUSION To our knowledge, this report is the first of an ATR inhibitor as monotherapy and combined with carboplatin. M6620 was well tolerated, with target engagement and preliminary antitumor responses observed.
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Affiliation(s)
- Timothy A. Yap
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Brent O’Carrigan
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Joline S. Lim
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Jessica S. Brown
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | | | | | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | - Saira Khalique
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Chris T. Williamson
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Rachael Natrajan
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Stephen J. Pettitt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Christopher J. Lord
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
- CRUK Gene Function Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - John Pollard
- Vertex Pharmaceuticals, Oxfordshire, United Kingdom
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
| | - Johann S. de Bono
- Drug Development Unit, Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
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24
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Morimoto Y, Takada K, Takeuchi O, Watanabe K, Hirohara M, Hamamoto T, Masuda Y. Bcl-2/Bcl-xL inhibitor navitoclax increases the antitumor effect of Chk1 inhibitor prexasertib by inducing apoptosis in pancreatic cancer cells via inhibition of Bcl-xL but not Bcl-2. Mol Cell Biochem 2020; 472:187-198. [PMID: 32567031 DOI: 10.1007/s11010-020-03796-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/13/2020] [Indexed: 12/21/2022]
Abstract
In our previous study, we showed that prexasertib, a checkpoint kinase 1 (Chk1) inhibitor, enhances the effects of standard drugs for pancreatic cancer, including gemcitabine (GEM), S-1, and the combination of GEM and S-1 (GS). The combination of prexasertib and GS has a strong antitumor effect and induces apoptosis in pancreatic cancer cells by downregulating anti-apoptotic protein Bcl-2. In the present study, we investigated the combined effect of GEM, S-1, and prexasertib with a selective Bcl-2 inhibitor (venetoclax) and a non-selective Bcl-2 inhibitor (navitoclax) in SUIT-2 pancreatic cancer cells. An MTT assay revealed that the combination of prexasertib with navitoclax showed a synergistic effect but the combination with venetoclax did not. Investigation of the pancreatic cancer cell lines SUIT-2, MIA PaCa-2, and BxPC-3 revealed that BxPC-3 also showed a high synergistic effect when combined with prexasertib and navitoclax but not venetoclax. Mechanistic analysis of the combined effect showed that apoptosis was induced. Bcl-2 knockdown with siRNA and prexasertib treatment did not induce apoptosis, whereas Bcl-xL knockdown with siRNA and prexasertib treatment resulted in strong induction of apoptosis. In addition, among the three cell lines, the combined effect of prexasertib and navitoclax resulted in increased apoptotic cell death because the protein expression levels of Bcl-xL and Chk1 were higher. Our results demonstrate that the combination of prexasertib and navitoclax has a strong antitumor effect and induces apoptosis in pancreatic cancer cells by downregulating Bcl-xL. Simultaneous inhibition of Chk1 and Bcl-xL could be a new strategy for treating pancreatic cancer.
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Affiliation(s)
- Yoshihito Morimoto
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan.
| | - Kimihiko Takada
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Osamu Takeuchi
- BioMedical Laboratory, Department of Research, Kitasato Institute Hospital, Tokyo, 108-8642, Japan
| | - Kazuhiro Watanabe
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Masayoshi Hirohara
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Tomoyuki Hamamoto
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Yutaka Masuda
- Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
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Yamashita Y, Morita S, Hosoi H, Kobata H, Kishimoto S, Ishibashi T, Mishima H, Kinoshita A, Backes BJ, Yoshiura KI, Papa FR, Sonoki T, Tamura S. Targeting Adaptive IRE1α Signaling and PLK2 in Multiple Myeloma: Possible Anti-Tumor Mechanisms of KIRA8 and Nilotinib. Int J Mol Sci 2020; 21:ijms21176314. [PMID: 32878237 PMCID: PMC7504392 DOI: 10.3390/ijms21176314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Inositol-requiring enzyme 1α (IRE1α), along with protein kinase R-like endoplasmic reticulum kinase (PERK), is a principal regulator of the unfolded protein response (UPR). Recently, the 'mono'-specific IRE1α inhibitor, kinase-inhibiting RNase attenuator 6 (KIRA6), demonstrated a promising effect against multiple myeloma (MM). Side-stepping the clinical translation, a detailed UPR phenotype in patients with MM and the mechanisms of how KIRA8 works in MM remains unclear. METHODS We characterized UPR phenotypes in the bone marrow of patients with newly diagnosed MM. Then, in human MM cells we analyzed the possible anti-tumor mechanisms of KIRA8 and a Food and Drug Administration (FDA)-approved drug, nilotinib, which we recently identified as having a strong inhibitory effect against IRE1α activity. Finally, we performed an RNA-sequence analysis to detect key IRE1α-related molecules against MM. RESULTS We illustrated the dominant induction of adaptive UPR markers under IRE1α over the PERK pathway in patients with MM. In human MM cells, KIRA8 decreased cell viability and induced apoptosis, along with the induction of C/EBP homologous protein (CHOP); its combination with bortezomib exhibited more anti-myeloma effects than KIRA8 alone. Nilotinib exerted a similar effect compared with KIRA8. RNA-sequencing identified Polo-like kinase 2 (PLK2) as a KIRA8-suppressed gene. Specifically, the IRE1α overexpression induced PLK2 expression, which was decreased by KIRA8. KIRA8 and PLK2 inhibition exerted anti-myeloma effects with apoptosis induction and the regulation of cell proliferation. Finally, PLK2 was pathologically confirmed to be highly expressed in patients with MM. CONCLUSION Dominant activation of adaptive IRE1α was established in patients with MM. Both KIRA8 and nilotinib exhibited anti-myeloma effects, which were enhanced by bortezomib. Adaptive IRE1α signaling and PLK2 could be potential therapeutic targets and biomarkers in MM.
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Affiliation(s)
- Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan; (Y.Y.); (H.H.); (H.K.); (T.S.)
| | - Shuhei Morita
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (S.K.); (T.I.)
- Correspondence: (S.M.); (S.T.); Tel.: +81-73-441-0625 (S.M.); +81-73-441-0665 (S.T.); Fax: +81-73-445-9436 (S.M.); +81-73-441-0653 (S.T.)
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan; (Y.Y.); (H.H.); (H.K.); (T.S.)
| | - Hiroshi Kobata
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan; (Y.Y.); (H.H.); (H.K.); (T.S.)
| | - Shohei Kishimoto
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (S.K.); (T.I.)
| | - Tatsuya Ishibashi
- First Department of Internal Medicine, Wakayama Medical University, Wakayama 641-8509, Japan; (S.K.); (T.I.)
| | - Hiroyuki Mishima
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan; (H.M.); (A.K.); (K.-I.Y.)
| | - Akira Kinoshita
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan; (H.M.); (A.K.); (K.-I.Y.)
| | - Bradley J. Backes
- Department of Medicine, University of California, San Francisco, CA 94158, USA; (B.J.B.); (F.R.P.)
- Diabetes Center, University of California, San Francisco, CA 94158, USA
| | - Koh-Ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan; (H.M.); (A.K.); (K.-I.Y.)
| | - Feroz R. Papa
- Department of Medicine, University of California, San Francisco, CA 94158, USA; (B.J.B.); (F.R.P.)
- Diabetes Center, University of California, San Francisco, CA 94158, USA
- Quantitative Biosciences Institute, University of California, San Francisco, CA 94158, USA
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan; (Y.Y.); (H.H.); (H.K.); (T.S.)
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan; (Y.Y.); (H.H.); (H.K.); (T.S.)
- Correspondence: (S.M.); (S.T.); Tel.: +81-73-441-0625 (S.M.); +81-73-441-0665 (S.T.); Fax: +81-73-445-9436 (S.M.); +81-73-441-0653 (S.T.)
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26
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Wilson AJ, Troy‐Barnes E, Subhan M, Clark F, Gupta R, Fielding AK, Kottaridis P, Mansour MR, O'Nions J, Payne E, Chavda N, Baker R, Thomson K, Khwaja A. Successful remission induction therapy with gilteritinib in a patient with de novo FLT3-mutated acute myeloid leukaemia and severe COVID-19. Br J Haematol 2020; 190:e189-e191. [PMID: 32584418 PMCID: PMC7362128 DOI: 10.1111/bjh.16962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew J. Wilson
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Ethan Troy‐Barnes
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Maryam Subhan
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Fiona Clark
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Rajeev Gupta
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Adele K. Fielding
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | | | - Marc R. Mansour
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Jenny O'Nions
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Elspeth Payne
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
| | - Naina Chavda
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Robert Baker
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
| | - Kirsty Thomson
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
| | - Asim Khwaja
- Department of HaematologyUniversity College London Hospital (UCLH)LondonUK
- Department of HaematologyUniversity College London Cancer InstituteLondonUK
- UCLH Specialist Integrated Haematology Malignancy Diagnostic ServiceHealth Services LaboratoriesLondonUK
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Arab-Zozani M, Hassanipour S, Ghoddoosi-Nejad D. Favipiravir for treating patients with novel coronavirus (COVID-19): protocol for a systematic review and meta-analysis of randomised clinical trials. BMJ Open 2020; 10:e039730. [PMID: 32737100 PMCID: PMC7397976 DOI: 10.1136/bmjopen-2020-039730] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION An outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China, in mid-December 2019, and declared a pandemic by the WHO on 11 March 2020. Due to the unknown nature of the disease and the lack of specific drugs, several potential treatments were used for patients. This systematic review and meta-analysis will evaluate studies of the effects of favipiravir in COVID-19 pneumonia. METHODS AND ANALYSIS We will search electronic databases including LitCovid hub, PubMed, Scopus, ISI Web of Sciences, Cochrane and Embase using keywords related to COVID-19 and favipiravir. We will search the reference lists of all included studies and reviews. We will also search for clinical trial registries, such as ClinicalTrials.gov, for the ongoing clinical trials. All randomised clinical trials investigating the safety and efficacy of favipiravir compared with other control groups for the treatment of patients with confirmed infection with SARS-CoV-2 will be included. Patients' survival at the end of the treatment as well as the follow-up will be the primary outcome of the treatment, followed by the time and rate of the patient with a negative COVID-19 test. The desired secondary outcome will consist of a decreased rate of symptoms, proportion of intensive care unit (ICU) transfers, length of the hospital stay, ICU treatments, the quality of life and additional adverse events. Data synthesis will be conducted using CMA V.2. Two independent investigators will be screening titles, abstracts and full texts of included studies, based on eligibility criteria. These investigators will then independently extract the data and appraise the quality of said studies. All potential discrepancies will be resolved through consultation with the third reviewer. Statistical heterogeneity will be assessed using a standard I2 test. A funnel plot, Egger's test and Begg's test will be used for detecting asymmetry to explore possible publication bias. ETHICS AND DISSEMINATION All findings of this systematic review and meta-analysis will help identify the safety and efficacy of favipiravir for patients with COVID-19. Given that the design of the study is a systematic review, there is no need to follow the code of ethics protocol. The results of this study will be published in a reputable journal. PROSPERO REGISTRATION NUMBER CRD42020180032.
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Affiliation(s)
- Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Djavad Ghoddoosi-Nejad
- Department of Public Health, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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28
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Konstantinopoulos PA, Cheng SC, Wahner Hendrickson AE, Penson RT, Schumer ST, Doyle LA, Lee EK, Kohn EC, Duska LR, Crispens MA, Olawaiye AB, Winer IS, Barroilhet LM, Fu S, McHale MT, Schilder RJ, Färkkilä A, Chowdhury D, Curtis J, Quinn RS, Bowes B, D'Andrea AD, Shapiro GI, Matulonis UA. Berzosertib plus gemcitabine versus gemcitabine alone in platinum-resistant high-grade serous ovarian cancer: a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2020; 21:957-968. [PMID: 32553118 PMCID: PMC8023719 DOI: 10.1016/s1470-2045(20)30180-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND High-grade serous ovarian cancers show increased replication stress, rendering cells vulnerable to ATR inhibition because of near universal loss of the G1/S checkpoint (through deleterious TP53 mutations), premature S phase entry (due to CCNE1 amplification, RB1 loss, or CDKN2A mRNA downregulation), alterations of homologous recombination repair genes, and expression of oncogenic drivers (through MYC amplification and other mechanisms). We hypothesised that the combination of the selective ATR inhibitor, berzosertib, and gemcitabine could show acceptable toxicity and superior efficacy to gemcitabine alone in high-grade serous ovarian cancer. METHODS In this multicentre, open-label, randomised, phase 2 study, 11 different centres in the US Experimental Therapeutics Clinical Trials Network enrolled women (aged ≥18 years) with recurrent, platinum-resistant high-grade serous ovarian cancer (determined histologically) and Eastern Cooperative Oncology Group performance status of 0 or 1, who had unlimited previous lines of cytotoxic therapy in the platinum-sensitive setting but no more than one line of cytotoxic therapy in the platinum-resistant setting. Eligible patients were randomly assigned (1:1) to receive intravenous gemcitabine (1000 mg/m2) on day 1 and day 8, or gemcitabine plus intravenous berzosertib (210 mg/m2) on day 2 and day 9 of a 21-day cycle until disease progression or intolerable toxicity. Randomisation was done centrally using the Theradex Interactive Web Response System, stratified by platinum-free interval, and with a permuted block size of six. Following central randomisation, patients and investigators were not masked to treatment assignment. The primary endpoint was investigator-assessed progression-free survival, and analyses included all patients who received at least one dose of the study drugs. The study is registered with ClinicalTrials.gov, NCT02595892, and is active but closed to enrolment. FINDINGS Between Feb 14, 2017, and Sept 7, 2018, 88 patients were assessed for eligibility, of whom 70 were randomly assigned to treatment with gemcitabine alone (36 patients) or gemcitabine plus berzosertib (34 patients). At the data cutoff date (Feb 21, 2020), the median follow-up was 53·2 weeks (25·6-81·8) in the gemcitabine plus berzosertib group and 43·0 weeks (IQR 23·2-69·1) in the gemcitabine alone group. Median progression-free survival was 22·9 weeks (17·9-72·0) for gemcitabine plus berzosertib and 14·7 weeks (90% CI 9·7-36·7) for gemcitabine alone (hazard ratio 0·57, 90% CI 0·33-0·98; one-sided log-rank test p=0·044). The most common treatment-related grade 3 or 4 adverse events were decreased neutrophil count (14 [39%] of 36 patients in the gemcitabine alone group vs 16 [47%] of 34 patients in the gemcitabine plus berzosertib group) and decreased platelet count (two [6%] vs eight [24%]). Serious adverse events were observed in ten (28%) patients in the gemcitabine alone group and nine (26%) patients in the gemcitabine plus berzosertib group. There was one treatment-related death in the gemcitabine alone group due to sepsis and one treatment-related death in the gemcitabine plus berzosertib group due to pneumonitis. INTERPRETATION To our knowledge, this is the first randomised study of an ATR inhibitor in any tumour type. This study shows a benefit of adding berzosertib to gemcitabine in platinum-resistant high-grade serous ovarian cancer. This combination warrants further investigation in this setting. FUNDING US National Cancer Institute.
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Affiliation(s)
| | - Su-Chun Cheng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Richard T Penson
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Susan T Schumer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - L Austin Doyle
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Elizabeth K Lee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elise C Kohn
- Department of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Linda R Duska
- Department of Obstetrics and Gynecology, Cancer Center, University of Virginia, Charlottesville, VA, USA
| | - Marta A Crispens
- Department of Obstetrics and Gynecology, Ingram Cancer Center, Vanderbilt University Nashville, TN, USA
| | - Alexander B Olawaiye
- Department of Obstetrics and Gynecology, University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ira S Winer
- Department of Obstetrics and Gynecology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Lisa M Barroilhet
- Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T McHale
- Department of Obstetrics and Gynecology, Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Russell J Schilder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anniina Färkkilä
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dipanjan Chowdhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jennifer Curtis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Roxanne S Quinn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Brittany Bowes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alan D D'Andrea
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Geoffrey I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Alexopoulos SJ, Chen SY, Brandon AE, Salamoun JM, Byrne FL, Garcia CJ, Beretta M, Olzomer EM, Shah DP, Philp AM, Hargett SR, Lawrence RT, Lee B, Sligar J, Carrive P, Tucker SP, Philp A, Lackner C, Turner N, Cooney GJ, Santos WL, Hoehn KL. Mitochondrial uncoupler BAM15 reverses diet-induced obesity and insulin resistance in mice. Nat Commun 2020; 11:2397. [PMID: 32409697 PMCID: PMC7224297 DOI: 10.1038/s41467-020-16298-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [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: 08/25/2019] [Accepted: 04/23/2020] [Indexed: 12/12/2022] Open
Abstract
Obesity is a health problem affecting more than 40% of US adults and 13% of the global population. Anti-obesity treatments including diet, exercise, surgery and pharmacotherapies have so far failed to reverse obesity incidence. Herein, we target obesity with a pharmacotherapeutic approach that decreases caloric efficiency by mitochondrial uncoupling. We show that a recently identified mitochondrial uncoupler BAM15 is orally bioavailable, increases nutrient oxidation, and decreases body fat mass without altering food intake, lean body mass, body temperature, or biochemical and haematological markers of toxicity. BAM15 decreases hepatic fat, decreases inflammatory lipids, and has strong antioxidant effects. Hyperinsulinemic-euglycemic clamp studies show that BAM15 improves insulin sensitivity in multiple tissue types. Collectively, these data demonstrate that pharmacologic mitochondrial uncoupling with BAM15 has powerful anti-obesity and insulin sensitizing effects without compromising lean mass or affecting food intake.
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Affiliation(s)
- Stephanie J Alexopoulos
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Sing-Young Chen
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Amanda E Brandon
- Sydney Medical School, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Joseph M Salamoun
- Department of Chemistry and Virginia Tech Centre for Drug Discovery, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Frances L Byrne
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Christopher J Garcia
- Department of Chemistry and Virginia Tech Centre for Drug Discovery, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Martina Beretta
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ellen M Olzomer
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Divya P Shah
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ashleigh M Philp
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Stefan R Hargett
- Department of Pharmacology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Robert T Lawrence
- Department of Pharmacology, University of Virginia, Charlottesville, VA, 22908, USA
| | - Brendan Lee
- Biological Resources Imaging Laboratory, University of New South Wales, Sydney, NSW, 2052, Australia
| | - James Sligar
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Pascal Carrive
- Department of Anatomy, School of Medical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Simon P Tucker
- Continuum Biosciences Pty Ltd., Sydney, NSW, 2035, Australia
| | - Andrew Philp
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Carolin Lackner
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Nigel Turner
- Department of Pharmacology, School of Medical Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gregory J Cooney
- Sydney Medical School, Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Webster L Santos
- Department of Chemistry and Virginia Tech Centre for Drug Discovery, Virginia Tech, Blacksburg, VA, 24061, USA.
- Continuum Biosciences Pty Ltd., Sydney, NSW, 2035, Australia.
| | - Kyle L Hoehn
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW, 2052, Australia.
- Department of Pharmacology, University of Virginia, Charlottesville, VA, 22908, USA.
- Continuum Biosciences Pty Ltd., Sydney, NSW, 2035, Australia.
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Sharman JP, Egyed M, Jurczak W, Skarbnik A, Pagel JM, Flinn IW, Kamdar M, Munir T, Walewska R, Corbett G, Fogliatto LM, Herishanu Y, Banerji V, Coutre S, Follows G, Walker P, Karlsson K, Ghia P, Janssens A, Cymbalista F, Woyach JA, Salles G, Wierda WG, Izumi R, Munugalavadla V, Patel P, Wang MH, Wong S, Byrd JC. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial. Lancet 2020; 395:1278-1291. [PMID: 32305093 PMCID: PMC8151619 DOI: 10.1016/s0140-6736(20)30262-2] [Citation(s) in RCA: 347] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acalabrutinib is a selective, covalent Bruton tyrosine-kinase inhibitor with activity in chronic lymphocytic leukaemia. We compare the efficacy of acalabrutinib with or without obinutuzumab against chlorambucil with obinutuzumab in patients with treatment-naive chronic lymphocytic leukaemia. METHODS ELEVATE TN is a global, phase 3, multicentre, open-label study in patients with treatment-naive chronic lymphocytic leukaemia done at 142 academic and community hospitals in 18 countries. Eligible patients had untreated chronic lymphocytic leukaemia and were aged 65 years or older, or older than 18 years and younger than 65 years with creatinine clearance of 30-69 mL/min (calculated by use of the Cockcroft-Gault equation) or Cumulative Illness Rating Scale for Geriatrics score greater than 6. Additional criteria included an Eastern Cooperative Oncology Group performance status score of 2 or less and adequate haematologic, hepatic, and renal function. Patients with significant cardiovascular disease were excluded, and concomitant treatment with warfarin or equivalent vitamin K antagonists was prohibited. Patients were randomly assigned (1:1:1) centrally via an interactive voice or web response system to receive acalabrutinib and obinutuzumab, acalabrutinib monotherapy, or obinutuzumab and oral chlorambucil. Treatments were administered in 28-day cycles. To reduce infusion-related reactions, acalabrutinib was administered for one cycle before obinutuzumab administration. Oral acalabrutinib was administered (100 mg) twice a day until progressive disease or unacceptable toxic effects occurred. In the acalabrutinib-obinutuzumab group, intravenous obinutuzumab was given on days 1 (100 mg), 2 (900 mg), 8 (1000 mg), and 15 (1000 mg) of cycle 2 and on day 1 (1000 mg) of cycles 3-7. In the obinutuzumab-chlorambucil group, intravenous obinutuzumab was given on days 1 (100 mg), 2 (900 mg), 8 (1000 mg), and 15 (1000 mg) of cycle 1 and on day 1 (1000 mg) of cycles 2-6. Oral chlorambucil was given (0·5 mg/kg) on days 1 and 15 of each cycle, for six cycles. The primary endpoint was progression-free survival between the two combination-therapy groups, assessed by independent review committee. Crossover to acalabrutinib was allowed in patients who progressed on obinutuzumab-chlorambucil. Safety was assessed in all patients who received at least one dose of treatment. Enrolment for this trial is complete, and the study is registered at ClinicalTrials.gov, NCT02475681. FINDINGS Between Sept 14, 2015, and Feb 8, 2017, we recruited 675 patients for assessment. 140 patients did not meet eligibility criteria, and 535 patients were randomly assigned to treatment. 179 patients were assigned to receive acalabrutinib-obinutuzumab, 179 patients were assigned to receive acalabrutinib monotherapy, and 177 patients were assigned to receive obinutuzumab-chlorambucil. At median follow-up of 28·3 months (IQR 25·6-33·1), median progression-free survival was longer with acalabrutinib-obinutuzumab and acalabrutinib monotherapy, compared with obinutuzumab-chlorambucil (median not reached with acalabrutinib and obinutuzumab vs 22·6 months with obinutuzumab, hazard ratio [HR] 0·1; 95% CI 0·06-0·17, p<0·0001; and not reached with acalabrutinib monotherapy vs 22·6 months with obinutuzumab, 0·20; 0·13-0·3, p<0·0001). Estimated progression-free survival at 24 months was 93% with acalabrutinib-obinutuzumab (95% CI 87-96%), 87% with acalabrutinib monotherapy (81-92%), and 47% with obinutuzumab-chlorambucil (39-55%). The most common grade 3 or higher adverse event across groups was neutropenia (53 [30%] of 178 patients in the acalabrutinib-obinutuzumab group, 17 [9%] of 179 patients in the acalabrutinib group, and 70 [41%] of 169 patients in the obinutuzumab-chlorambucil group). All-grade infusion reactions were less frequent with acalabrutinib-obinutuzumab (24 [13%] of 178 patients) than obinutuzumab-chlorambucil (67 [40%] of 169 patients). Grade 3 or higher infections occurred in 37 (21%) patients given acalabrutinib-obinutuzumab, 25 (14%) patients given acalabrutinib monotherapy, and 14 (8%) patients given obinutuzumab-chlorambucil. Deaths occurred in eight (4%) patients given acalabrutinib-obinutuzumab, 12 (7%) patients given acalabrutinib, and 15 (9%) patients given obinutuzumab-chlorambucil. INTERPRETATION Acalabrutinib with or without obinutuzumab significantly improved progression-free survival over obinutuzumab-chlorambucil chemoimmunotherapy, providing a chemotherapy-free treatment option with an acceptable side-effect profile that was consistent with previous studies. These data support the use of acalabrutinib in combination with obinutuzumab or alone as a new treatment option for patients with treatment-naive symptomatic chronic lymphocytic leukaemia. FUNDING Acerta Pharma, a member of the AstraZeneca Group, and R35 CA198183 (to JCB).
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Affiliation(s)
- Jeff P Sharman
- Willamette Valley Cancer Institute/US Oncology, Eugene, OR, USA
| | - Miklos Egyed
- Department of Hematology, Somogy County Mór Kaposi General Hospital, Kaposvár, Hungary
| | - Wojciech Jurczak
- Maria Sklodowska-Curie National Institute of Oncology, Kraków, Poland
| | - Alan Skarbnik
- Department of Medicine, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA; Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte NC, USA
| | - John M Pagel
- Swedish Cancer Institute, Center for Blood Disorders and Stem Cell Transplantation, Seattle, WA, USA
| | - Ian W Flinn
- Sarah Cannon Research Institute, Tennessee Oncology Nashville, Nashville, TN, USA
| | - Manali Kamdar
- Division of Hematology, Hematologic Malignancies and Stem Cell Transplantation, University of Colorado Cancer Center, Aurora, CO, USA
| | - Talha Munir
- Haematological Malignancy Diagnostic Service (HMDS), St James's Institute of Oncology, Leeds, UK
| | - Renata Walewska
- Molecular Pathology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Gillian Corbett
- Department of Medicine, Tauranga Hospital, Tauranga, New Zealand
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Versha Banerji
- Departments of Internal Medicine, Biochemistry & Medical Genetics, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Steven Coutre
- Stanford University School of Medicine, Stanford, CA, USA
| | - George Follows
- Department of Haematology, Addenbrooke's Hospital NHS Trust, Cambridge, UK
| | - Patricia Walker
- Peninsula Health, and Peninsula Private Hospital, Frankston, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Karin Karlsson
- Department of Haematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Paolo Ghia
- Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milano, Italy
| | - Ann Janssens
- Hematology Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, OH, USA
| | - Gilles Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service d'Hématologie Clinique, Pierre-Bénite, France
| | - William G Wierda
- Department of Leukemia, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Raquel Izumi
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | | | - Priti Patel
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - Min Hui Wang
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - Sofia Wong
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, CA, USA
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center and Division of Hematology, Columbus, OH, USA.
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Xie J, Chen S, Ding S. Efficacy and safety of the injection of the traditional Chinese medicine salviae miltiorrhizae and ligustrazine hydrochloride for the treatment of perioperative period of fracture: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19777. [PMID: 32311985 PMCID: PMC7220772 DOI: 10.1097/md.0000000000019777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The injection of the traditional Chinese patent medicine salviae miltiorrhizae and ligustrazine hydrochloride injection (SMLHI) has been widely used in treatment of various diseases such as angina pectoris or ischemic stroke in China. We aim to evaluate the efficacy and safety of SMLHI for the treatment of perioperative period of fracture. METHODS A systematic literature search was performed in seven medical databases from their inception until February 2019. 16 studies with randomized controlled trials, totaling 1589 patients, were included in this meta-analysis. The included studies were assessed by the cochrane risk of bias and analyzed by Review Manager 5.3 software. RESULTS The meta-analysis showed that SMLHI for the treatment of perioperative period of fracture was significantly better compared with the control group in terms of the total effective rate. The result showed that SMLHI could significantly reduce the risk of deep vein thrombosis and inflammatory cytokines. Furthermore, the result showed that SMLHI could significantly improve the coagulation function indexes such as prothrombin time, plasma fibrinogen and D-Dimer (P < .0001). CONCLUSIONS This meta-analysis demonstrated that SMLHI may be more effective and safe for the treatment of perioperative period of fracture. However, further and higher quality randomized controlled trials are required to prove treatment outcome.
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Mallefet J, Duchatelet L, Coubris C. Bioluminescence induction in the ophiuroid Amphiura filiformis (Echinodermata). J Exp Biol 2020; 223:jeb218719. [PMID: 31974222 DOI: 10.1242/jeb.218719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/14/2019] [Accepted: 01/16/2020] [Indexed: 08/26/2023]
Abstract
Bioluminescence is a widespread phenomenon in the marine environment. Among luminous substrates, coelenterazine is the most widespread luciferin, found in eight phyla. The wide phylogenetic coverage of this light-emitting molecule has led to the hypothesis of its dietary acquisition, which has so far been demonstrated in one cnidarian and one lophogastrid shrimp species. Within Ophiuroidea, the dominant class of luminous echinoderms, Amphiura filiformis is a model species known to use coelenterazine as substrate of a luciferin/luciferase luminous system. The aim of this study was to perform long-term monitoring of A. filiformis luminescent capabilities during captivity. Our results show (i) depletion of luminescent capabilities within 5 months when the ophiuroid was fed a coelenterazine-free diet and (ii) a quick recovery of luminescent capabilities when the ophiuroid was fed coelenterazine-supplemented food. The present work demonstrates for the first time a trophic acquisition of coelenterazine in A. filiformis to maintain light emission capabilities.
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Affiliation(s)
- Jerome Mallefet
- Marine Biology Laboratory, Earth and Life Institute, Université Catholique de Louvain, Croix du Sud 3, 1348 Louvain-La-Neuve, Belgium
| | - Laurent Duchatelet
- Marine Biology Laboratory, Earth and Life Institute, Université Catholique de Louvain, Croix du Sud 3, 1348 Louvain-La-Neuve, Belgium
| | - Constance Coubris
- Marine Biology Laboratory, Earth and Life Institute, Université Catholique de Louvain, Croix du Sud 3, 1348 Louvain-La-Neuve, Belgium
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Ha YN, Song S, Orlikova-Boyer B, Cerella C, Christov C, Kijjoa A, Diederich M. Petromurin C Induces Protective Autophagy and Apoptosis in FLT3-ITD-Positive AML: Synergy with Gilteritinib. Mar Drugs 2020; 18:md18010057. [PMID: 31963113 PMCID: PMC7024157 DOI: 10.3390/md18010057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/25/2022] Open
Abstract
Treatment of acute myeloid leukemia (AML) remains inefficient due to drug resistance and relapse, particularly in patients with FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication (ITD). Marine-derived natural products have recently been used for drug development against AML. We show in this study that petromurin C, which was isolated from the culture extract of the marine-derived fungus Aspergillus candidus KUFA0062, isolated from the marine sponge Epipolasis sp., induces early autophagy followed by apoptotic cell death via activation of the intrinsic cell death pathway concomitant with mitochondrial stress and downregulation of Mcl-1 in FLT3-ITD mutated MV4-11 cells. Moreover, petromurin C synergized with the clinically-used FLT3 inhibitor gilteritinib at sub-toxic concentrations. Altogether, our results provide preliminary indications that petromurin C provides anti-leukemic effects alone or in combination with gilteritinib.
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MESH Headings
- Aniline Compounds/administration & dosage
- Aniline Compounds/pharmacology
- Animals
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Apoptosis/drug effects
- Aquatic Organisms/chemistry
- Autophagy/drug effects
- Biological Products/administration & dosage
- Biological Products/pharmacology
- Cell Line, Tumor
- Down-Regulation/drug effects
- Drug Resistance, Neoplasm
- Drug Synergism
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Pyrazines/administration & dosage
- Pyrazines/pharmacology
- Signal Transduction/drug effects
- U937 Cells
- Zebrafish
- fms-Like Tyrosine Kinase 3/genetics
- fms-Like Tyrosine Kinase 3/metabolism
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Affiliation(s)
- You Na Ha
- Department of Pharmacy, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08626, Korea; (Y.N.H.); (S.S.)
| | - Sungmi Song
- Department of Pharmacy, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08626, Korea; (Y.N.H.); (S.S.)
| | - Barbora Orlikova-Boyer
- Laboratoire de Biologie Moléculaire du Cancer, Hôpital Kirchberg, 9, rue Edward Steichen, L-2540 Luxembourg, Luxembourg; (B.O.-B.); (C.C.)
| | - Claudia Cerella
- Laboratoire de Biologie Moléculaire du Cancer, Hôpital Kirchberg, 9, rue Edward Steichen, L-2540 Luxembourg, Luxembourg; (B.O.-B.); (C.C.)
| | - Christo Christov
- Service d’Histologie, Faculté de Médicine, Université de Lorraine, INSERM U1256 NGERE, 54000 Nancy, France;
| | - Anake Kijjoa
- ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal;
- Interdisciplinary Centre of Marine and Environmental Research (CIIMAR), Terminal de Cruzeiros do Porto de Lexões, Av. General Norton de Matos s/n, 4450-208 Matosinhos, Portugal
| | - Marc Diederich
- Department of Pharmacy, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08626, Korea; (Y.N.H.); (S.S.)
- Correspondence: ; Tel.: +82-2-880-8919
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Woyach JA, Blachly JS, Rogers KA, Bhat SA, Jianfar M, Lozanski G, Weiss DM, Andersen BL, Gulrajani M, Frigault MM, Hamdy A, Izumi R, Munugalavadla V, Quah C, Wang MH, Byrd JC. Acalabrutinib plus Obinutuzumab in Treatment-Naïve and Relapsed/Refractory Chronic Lymphocytic Leukemia. Cancer Discov 2020; 10:394-405. [PMID: 31915195 DOI: 10.1158/2159-8290.cd-19-1130] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/05/2019] [Accepted: 01/02/2020] [Indexed: 11/16/2022]
Abstract
Acalabrutinib is a selective irreversible Bruton tyrosine kinase (BTK) inhibitor that does not affect IL2-associated tyrosine kinase or antibody-dependent cellular cytotoxicity, making it an attractive candidate for combination therapy with anti-CD20 antibodies. We investigated acalabrutinib plus obinutuzumab in a phase Ib/II study (NCT02296918) of patients with treatment-naïve or relapsed/refractory chronic lymphocytic leukemia (CLL). Nineteen treatment-naïve and 26 relapsed/refractory patients were treated with acalabrutinib (100 mg twice daily) until progression and obinutuzumab (cycle 1: 100 mg day 1, 900 mg day 2, 1000 mg days 8 and 15; cycles 2-6: 1,000 mg day 1). Grade 3/4 adverse events occurred in 71% of patients. Overall response rates were 95% (treatment-naïve) and 92% (relapsed/refractory). Thirty-two percent of treatment-naïve and 8% of relapsed/refractory patients achieved complete remission. At 36 months, 94% (treatment-naïve) and 88% (relapsed/refractory) were progression free. Acalabrutinib plus obinutuzumab was well tolerated, producing high and durable responses in treatment-naïve and relapsed/refractory CLL. SIGNIFICANCE: Rituximab plus the less selective BTK inhibitor ibrutinib has not shown benefit in CLL; however, the selective BTK inhibitor acalabrutinib plus the antibody-dependent cellular cytotoxicity-enhanced antibody obinutuzumab yielded durable responses that deepened over time in treatment-naïve and relapsed/refractory CLL, supporting the evaluation of this approach in larger, comparative studies in CLL.This article is highlighted in the In This Issue feature, p. 327.
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MESH Headings
- Adult
- Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors
- Agammaglobulinaemia Tyrosine Kinase/genetics
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Benzamides/administration & dosage
- Benzamides/adverse effects
- Cell Proliferation/drug effects
- Drug Administration Schedule
- Female
- Humans
- Interleukin-2/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Pyrazines/administration & dosage
- Pyrazines/adverse effects
- Rituximab/administration & dosage
- Treatment Outcome
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Affiliation(s)
- Jennifer A Woyach
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
| | - James S Blachly
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Kerry A Rogers
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Seema A Bhat
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mojgan Jianfar
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Gerard Lozanski
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - David M Weiss
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Michael Gulrajani
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Melanie M Frigault
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Ahmed Hamdy
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Raquel Izumi
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | | | - Cheng Quah
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - Min-Hui Wang
- Acerta Pharma, a member of the AstraZeneca Group, South San Francisco, California
| | - John C Byrd
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Liang R, Weigand I, Lippert J, Kircher S, Altieri B, Steinhauer S, Hantel C, Rost S, Rosenwald A, Kroiss M, Fassnacht M, Sbiera S, Ronchi CL. Targeted Gene Expression Profile Reveals CDK4 as Therapeutic Target for Selected Patients With Adrenocortical Carcinoma. Front Endocrinol (Lausanne) 2020; 11:219. [PMID: 32373071 PMCID: PMC7176906 DOI: 10.3389/fendo.2020.00219] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 11/28/2019] [Accepted: 03/26/2020] [Indexed: 12/29/2022] Open
Abstract
Adrenocortical carcinomas (ACC) are aggressive tumors with a heterogeneous prognosis and limited therapeutic options for advanced stages. This study aims to identify novel drug targets for a personalized treatment in ACC. RNA was isolated from 40 formalin-fixed paraffin-embedded ACC samples. We evaluated gene expression of 84 known cancer drug targets by reverse transcriptase quantitative real time-PCR and calculated fold change using 5 normal adrenal glands as reference (overexpression by fold change >2.0). The most promising candidate cyclin-dependent kinase 4 (CDK4) was investigated at protein level in 104 ACC samples and tested by in vitro experiments in two ACC cell lines (NCI-H295R and MUC1). The most frequently overexpressed genes were TOP2A (100% of cases, median fold change = 16.5), IGF2 (95%, fold change = 52.9), CDK1 (80%, fold change = 6.7), CDK4 (62%, fold change = 2.6), PLK4 (60%, fold change = 2.8), and PLK1 (52%, fold change = 2.3). CDK4 was chosen for functional validation, as it is actionable by approved CDK4/6-inhibitors (e.g., palbociclib). Nuclear immunostaining of CDK4 significantly correlated with mRNA expression (R = 0.52, P < 0.005). We exposed both NCI-H295R and MUC1 cell lines to palbociclib and found a concentration- and time-dependent reduction of cell viability, which was more pronounced in the NCI-H295R cells in line with higher CDK4 expression. Furthermore, we tested palbociclib in combination with insulin-like growth factor 1/insulin receptor inhibitor linsitinib showing an additive effect. In conclusion, we demonstrate that RNA profiling is useful to discover potential drug targets and that CDK4/6 inhibitors are promising candidates for treatment of selected patients with ACC.
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Affiliation(s)
- Raimunde Liang
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - Isabel Weigand
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - Juliane Lippert
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
- Institute of Human Genetics, University of Wuerzburg, Würzburg, Germany
| | - Stefan Kircher
- Institute of Pathology, University of Wuerzburg, Würzburg, Germany
| | - Barbara Altieri
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
- Department of Clinical Medicine and Surgery, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Sonja Steinhauer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - Constanze Hantel
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
- Medizinische Klinik und Poliklinik III, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Simone Rost
- Institute of Human Genetics, University of Wuerzburg, Würzburg, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Wuerzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Wuerzburg, Würzburg, Germany
| | - Matthias Kroiss
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - Martin Fassnacht
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital of Wuerzburg, Würzburg, Germany
| | - Silviu Sbiera
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - Cristina L. Ronchi
- Division of Endocrinology and Diabetology, Department of Internal Medicine, University Hospital of Wuerzburg, Würzburg, Germany
- Institute of Metabolism and System Research (IMSR), University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Cristina L. Ronchi ;
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Xiao S, Yan Y, Zhao J, Zhang Y, Feng N. Increased microneedle-mediated transdermal delivery of tetramethylpyrazine to the brain, combined with borneol and iontophoresis, for MCAO prevention. Int J Pharm 2019; 575:118962. [PMID: 31857187 DOI: 10.1016/j.ijpharm.2019.118962] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 12/20/2022]
Abstract
The aim of this research was to improve transdermal delivery and distribution of tetramethylpyrazine (TMP) in the brain, by adding borneol (BN) and iontophoresis (ITP), and using microneedles (MN), to prevent middle cerebral artery occlusion (MCAO). BN was encapsulated into sulfobutylated-β-cyclodextrin (BN-SBE-β-CD), and then dispersed together with TMP. Four delivery groups were tested: passive (with no ITP and MN), ITP, MN, and MN combined with ITP (MN-ITP). In vitro transdermal fluxes of the drugs in those groups and in that corresponding order were 79.12 ± 14.5, 395.43 ± 12.37, 319.16 ± 29.99, and 1018.07 ± 108.92 μg/cm2 (for TMP), and 39.34 ± 1.31, 202.81 ± 53.56, 715.47 ± 75.52, and 1088.60 ± 53.90 μg/cm2 (for BN), respectively, which indicated that the use of MN-ITP greatly enhanced transdermal TMP and BN delivery compared to the other groups. The AUC0-t for the combined use of TMP and BN drugs was measured using two in vivo studies, cutaneous microdialysis and pharmacodynamic, yielding increased folds of 3.69 and 1.98 in ITP, 6.05 and 2.73 in MN, and 12.43 and 7.47 in MN-ITP groups, respectively, as compared to those in the passive group. In addition, the combined use of TMP and BN increased TMP distribution in the heart and the brain, indicated by TMP Cmax of 1.76- and 1.59-fold higher (p < 0.05), and TMP AUC0-t of 1.50 times and 1.19-fold higher (p < 0.01), than with administration of TMP in absence of BN, respectively. The brain infarction area and IL-β expression in the MCAO rat were significantly decreased in the MN-ITP group, compared with the control group (p < 0.05). In conclusion, combination of MN and ITP resulted in a synergistic enhancement of transdermal delivery and distribution of TMP in the brain, when in combination with BN, thereby significantly decreasing the infarct volumes and improving the neurological scores of MCAO.
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Affiliation(s)
- Sirui Xiao
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yulu Yan
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jihui Zhao
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yongtai Zhang
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Nianping Feng
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Mao D, Li F, Ma Q, Dai M, Zhang H, Bai L, He N. Intraocular administration of tetramethylpyrazine hydrochloride to rats: a direct delivery pathway for brain targeting? Drug Deliv 2019; 26:841-848. [PMID: 31401891 PMCID: PMC6713146 DOI: 10.1080/10717544.2019.1650849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022] Open
Abstract
The purpose of this study was to compare the pharmacokinetic profile of tetramethylpyrazine hydrochloride (TMPH) in rat plasma and tissues following intravenous (iv), intragastric (ig) and intraocular (io) administration. After io, ig and iv administration of a single dose at 10 mg/kg, tissue and plasma samples drawn from the femoral artery were collected at timed intervals. The concentration of TMPH in the samples was analyzed using high-performance liquid chromatography (HPLC). The area under the concentration-time curve (AUC) and the drug targeting efficiency percentage (DTE(%)) were calculated to evaluate the targeting efficiency of the drug with the three different administration routes. After io administration, TMPH was rapidly absorbed to reach its peak plasma and brain concentration within 5 min. The systemic bioavailability obtained with io administration was greater than that obtained through the ig route (63.22% vs. 16.88%). The AUCt rank order of the iv administration group was AUCkidney >AUCheart >AUCliver >AUCbrain >AUCspleen >AUClung; that of the ig administration group as AUCkidney >AUCliver >AUCheart >AUCspleen >AUCbrain >AUClung; while that of the io administration group was AUCkidney >AUCbrain >AUCheart >AUCliver >AUCspleen >AUClung. The ratio of the AUCbrain value between the io route and iv injection was 1.05, which was greater than that obtained after ig administration (0.30). The DTE after io administration was calculated: brain (165.72%), heart (97.76%), liver (113.06%), spleen (105.31%), lung (163.40%) and kidney (135.31%). The io administration group showed obvious drug transport to the brain. These results indicate that TMPH is rapidly absorbed from the eye into the systemic circulation, and there may be a direct translocation pathway for TMPH from the eye to the brain. Therefore, io administration of TMPH could be a promising alternative to intravenous and oral approaches.
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Affiliation(s)
- Dan Mao
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
- The fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fang Li
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Qun Ma
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Manman Dai
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Huimin Zhang
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Luyu Bai
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
| | - Ning He
- Department of Pharmaceutics, School of Pharmacy, Anhui University of Chinese Medicine, Hefei, China
- Institute of Pharmaceutics, Anhui Academy of Chinese Medical Sciences, Hefei, China
- Anhui Province Key Laboratory of Chinese Medicinal Formula, Hefei, China
- Engineering Technology Research Center of Modernized Pharmaceutics Education Office of Anhui Province, Hefei, China
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Vreman RA, Geenen JW, Hövels AM, Goettsch WG, Leufkens HGM, Al MJ. Phase I/II Clinical Trial-Based Early Economic Evaluation of Acalabrutinib for Relapsed Chronic Lymphocytic Leukaemia. Appl Health Econ Health Policy 2019; 17:883-893. [PMID: 31317510 PMCID: PMC6885502 DOI: 10.1007/s40258-019-00496-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES The objective of this study was to construct an early economic evaluation for acalabrutinib for relapsed chronic lymphocytic leukaemia (CLL) to assist early reimbursement decision making. Scenarios were assessed to find the relative impact of critical parameters on incremental costs and quality-adjusted life-years (QALYs). METHODS A partitioned survival model was constructed comparing acalabrutinib and ibrutinib from a UK national health service perspective. This model included states for progression-free survival (PFS), post-progression survival (PPS) and death. PFS and overall survival (OS) were parametrically extrapolated from ibrutinib publications and a preliminary hazard ratio based on phase I/II data was applied for acalabrutinib. Deterministic and probabilistic sensitivity analyses were performed, and 1296 scenarios were assessed. RESULTS The base-case incremental cost-effectiveness ratio (ICER) was £61,941/QALY, with 3.44 incremental QALYs and incremental costs of £213,339. Deterministic sensitivity analysis indicated that survival estimates, utilities and treatment costs of ibrutinib and acalabrutinib and resource use during PFS have the greatest influence on the ICER. Probabilistic results under different development scenarios indicated that greater efficacy of acalabrutinib would decrease the likelihood of cost effectiveness (from 63% at no effect to 2% at maximum efficacy). Scenario analyses showed that a reduction in PFS did not lead to great QALY differences (- 8 to - 14% incremental QALYs) although it did greatly affect costs (- 47 to - 122% incremental pounds). For OS, the opposite was true (- 89 to - 93% QALYs and - 7 to - 39% pounds). CONCLUSIONS Acalabrutinib is not likely to be cost effective compared with ibrutinib under current development scenarios. The conflicting effects of OS, PFS, drug costs and utility during PFS show that determining the cost effectiveness of acalabrutinib without insight into all parameters complicates health technology assessment decision making. Early assessment of the cost effectiveness of new products can support development choices and reimbursement processes through effective early dialogues between stakeholders.
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Affiliation(s)
- Rick A Vreman
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- The National Health Care Institute (ZIN), Diemen, The Netherlands.
| | - Joost W Geenen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Wim G Goettsch
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
- The National Health Care Institute (ZIN), Diemen, The Netherlands.
| | - Hubert G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Maiwenn J Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Yamada K, Noguchi K, Kimitsuki K, Kaimori R, Saito N, Komeno T, Nakajima N, Furuta Y, Nishizono A. Reevaluation of the efficacy of favipiravir against rabies virus using in vivo imaging analysis. Antiviral Res 2019; 172:104641. [PMID: 31672666 DOI: 10.1016/j.antiviral.2019.104641] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 08/06/2019] [Revised: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 12/30/2022]
Abstract
Rabies virus (RABV) is a highly neurotropic virus and the causative agent of rabies, an encephalitis with an almost 100% case-fatality rate that remains incurable after the onset of symptoms. Favipiravir (T-705), a broad-spectrum antiviral drug against RNA viruses, has been shown to be effective against RABV in vitro but ineffective in vivo. We hypothesized that favipiravir is effective in infected mice when RABV replicates in the peripheral tissues/nerves but not after virus neuroinvasion. We attempted to clarify this point in this study using in vivo bioluminescence imaging. We generated a recombinant RABV from the field isolate 1088, which expressed red firefly luciferase (1088/RFLuc). This allowed semiquantitative detection and monitoring of primary replication at the inoculation site and viral spread in the central nervous system (CNS) in the same mice. Bioluminescence imaging revealed that favipiravir (300 mg/kg/day) treatment commencing 1 h after intramuscular inoculation of RABV efficiently suppressed viral replication at the inoculation site and the subsequent replication in the CNS. However, virus replication in the CNS was not inhibited when the treatment began 2 days after inoculation. We also found that higher doses (600 or 900 mg/kg/day) of favipiravir could suppress viral replication in the CNS even when administration started 2 days after inoculation. These results support our hypothesis and suggest that a highly effective drug-delivery system into the CNS and/or the enhancement of favipiravir conversion to its active form are required to improve favipiravir treatment of rabies. Furthermore, the bioluminescence imaging system established in this study will facilitate the development of treatment for symptomatic rabies.
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Affiliation(s)
- Kentaro Yamada
- Research Promotion Institute, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Kazuko Noguchi
- Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan; Department of Food Science and Technology, Minami Kyushu University, 5-1-2 Kirishima, Miyazaki City, Miyazaki, 880-0031, Japan
| | - Kazunori Kimitsuki
- Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Ryo Kaimori
- Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Nobuo Saito
- Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan
| | - Takashi Komeno
- FUJIFILM Toyama Chemical Co.,Ltd, 2-4-1 Shimookui, Toyama City, Toyama, 930-8508, Japan
| | - Nozomi Nakajima
- FUJIFILM Toyama Chemical Co.,Ltd, 2-4-1 Shimookui, Toyama City, Toyama, 930-8508, Japan
| | - Yousuke Furuta
- FUJIFILM Toyama Chemical Co.,Ltd, 2-4-1 Shimookui, Toyama City, Toyama, 930-8508, Japan
| | - Akira Nishizono
- Research Promotion Institute, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan; Department of Microbiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita, 879-5593, Japan.
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Wolin E, Mita A, Mahipal A, Meyer T, Bendell J, Nemunaitis J, Munster PN, Paz-Ares L, Filvaroff EH, Li S, Hege K, de Haan H, Mita M. A phase 2 study of an oral mTORC1/mTORC2 kinase inhibitor (CC-223) for non-pancreatic neuroendocrine tumors with or without carcinoid symptoms. PLoS One 2019; 14:e0221994. [PMID: 31527867 PMCID: PMC6748410 DOI: 10.1371/journal.pone.0221994] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/20/2019] [Indexed: 02/07/2023] Open
Abstract
Second-generation mammalian target of rapamycin (mTOR) inhibitors such as CC-223 may have theoretical advantages over first-generation drugs by inhibiting TOR kinase in mTOR complex 1 (mTORC1) and 2 (mTORC2), potentially improving clinical efficacy for well-differentiated neuroendocrine tumors (NET).Enrolled patients had metastatic, well-differentiated NET of non-pancreatic gastrointestinal or unknown origin, with/without carcinoid symptoms, had failed ≥1 systemic chemotherapy, and were taking a somatostatin analog (SSA). Oral once-daily CC-223 was administered in 28-day cycles starting at 45 mg (n = 24), with a subsequent cohort starting at 30 mg (n = 23). Objectives were to evaluate tolerability, preliminary efficacy, and pharmacokinetic and biomarker profiles of CC-223. Forty-seven patients completed the study, with mean treatment duration of 378 days and mean dose of 26 mg; 26% of patients remained on the starting dose. Most frequent grade ≥3 toxicities were diarrhea (38%), fatigue (21%), and stomatitis (11%). By investigator, 3 of 41 evaluable patients (7%) showed partial response (PR) and 34 (83%) had stable disease (SD) for a disease control rate (DCR) of 90% (95% confidence interval [CI] 76.9–97.3%). Duration of PR was 125–401 days; median SD duration was 297 days (min–max, 50–1519 days). Median progression-free survival was 19.5 months (95% CI 10.4–28.5 months). Carcinoid symptoms of flushing, diarrhea, or both improved in 50%, 41%, and 39% of affected patients, respectively. For the first time, this study describes that a second-generation mTOR pathway inhibitor can result in highly durable tumor regression and control of NET carcinoid symptoms. The manageable safety profile, high DCR, and durable response, coupled with reduction in carcinoid symptoms refractory to SSA, make CC-223 a promising agent for further development.
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Affiliation(s)
- Edward Wolin
- Experimental Therapeutics Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
- * E-mail:
| | - Alain Mita
- Experimental Therapeutics Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Amit Mahipal
- Phase 1 Clinical Trials Program, Mayo Clinic, Rochester, MN, United States of America
| | - Tim Meyer
- Experimental Cancer Medicine, University College Hospital, London, United Kingdom
| | - Johanna Bendell
- GI Oncology Research, Sarah Cannon Research Institute/Tennessee Oncology, Nashville, TN, United States of America
| | - John Nemunaitis
- Department of Oncology, Mary Crowley Cancer Research Center, Dallas, TX, United States of America
| | - Pam N. Munster
- Early Phase Clinical Research Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, United States of America
| | - Luis Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre, CNIO, Universidad Complutense and CiberOnc, Madrid, Spain
| | - Ellen H. Filvaroff
- Translational Medicine, Celgene Corporation, San Francisco, CA, United States of America
| | - Shaoyi Li
- Department of Statistics, Celgene Corporation, Summit, NJ, United States of America
| | - Kristen Hege
- Translational Medicine, Celgene Corporation, San Francisco, CA, United States of America
| | - Hans de Haan
- Translational Medicine, Celgene Corporation, San Francisco, CA, United States of America
| | - Monica Mita
- Experimental Therapeutics Program, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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Vichinsky E, Hoppe CC, Ataga KI, Ware RE, Nduba V, El-Beshlawy A, Hassab H, Achebe MM, Alkindi S, Brown RC, Diuguid DL, Telfer P, Tsitsikas DA, Elghandour A, Gordeuk VR, Kanter J, Abboud MR, Lehrer-Graiwer J, Tonda M, Intondi A, Tong B, Howard J. A Phase 3 Randomized Trial of Voxelotor in Sickle Cell Disease. N Engl J Med 2019; 381:509-519. [PMID: 31199090 DOI: 10.1056/nejmoa1903212] [Citation(s) in RCA: 343] [Impact Index Per Article: 68.6] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deoxygenated sickle hemoglobin (HbS) polymerization drives the pathophysiology of sickle cell disease. Therefore, direct inhibition of HbS polymerization has potential to favorably modify disease outcomes. Voxelotor is an HbS polymerization inhibitor. METHODS In a multicenter, phase 3, double-blind, randomized, placebo-controlled trial, we compared the efficacy and safety of two dose levels of voxelotor (1500 mg and 900 mg, administered orally once daily) with placebo in persons with sickle cell disease. The primary end point was the percentage of participants who had a hemoglobin response, which was defined as an increase of more than 1.0 g per deciliter from baseline at week 24 in the intention-to-treat analysis. RESULTS A total of 274 participants were randomly assigned in a 1:1:1 ratio to receive a once-daily oral dose of 1500 mg of voxelotor, 900 mg of voxelotor, or placebo. Most participants had sickle cell anemia (homozygous hemoglobin S or hemoglobin Sβ0-thalassemia), and approximately two thirds were receiving hydroxyurea at baseline. In the intention-to-treat analysis, a significantly higher percentage of participants had a hemoglobin response in the 1500-mg voxelotor group (51%; 95% confidence interval [CI], 41 to 61) than in the placebo group (7%; 95% CI, 1 to 12). Anemia worsened between baseline and week 24 in fewer participants in each voxelotor dose group than in those receiving placebo. At week 24, the 1500-mg voxelotor group had significantly greater reductions from baseline in the indirect bilirubin level and percentage of reticulocytes than the placebo group. The percentage of participants with an adverse event that occurred or worsened during the treatment period was similar across the trial groups. Adverse events of at least grade 3 occurred in 26% of the participants in the 1500-mg voxelotor group, 23% in the 900-mg voxelotor group, and 26% in the placebo group. Most adverse events were not related to the trial drug or placebo, as determined by the investigators. CONCLUSIONS In this phase 3 randomized, placebo-controlled trial involving participants with sickle cell disease, voxelotor significantly increased hemoglobin levels and reduced markers of hemolysis. These findings are consistent with inhibition of HbS polymerization and indicate a disease-modifying potential. (Funded by Global Blood Therapeutics; HOPE ClinicalTrials.gov number, NCT03036813.).
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Affiliation(s)
- Elliott Vichinsky
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Carolyn C Hoppe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Kenneth I Ataga
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Russell E Ware
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Videlis Nduba
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Amal El-Beshlawy
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Hoda Hassab
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Maureen M Achebe
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Salam Alkindi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - R Clark Brown
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - David L Diuguid
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Paul Telfer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Dimitris A Tsitsikas
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Ashraf Elghandour
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Victor R Gordeuk
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Julie Kanter
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Miguel R Abboud
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Joshua Lehrer-Graiwer
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Margaret Tonda
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Allison Intondi
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Barbara Tong
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
| | - Jo Howard
- From the University of California, San Francisco (UCSF) Benioff Children's Hospital Oakland, Oakland (E.V.), and Global Blood Therapeutics, South San Francisco (C.C.H., J.L.-G., M.T., A.I., B.T.) - both in California; the University of Tennessee Health Science Center at Memphis, Memphis (K.I.A.); Cincinnati Children's Hospital and University of Cincinnati, Cincinnati (R.E.W.); Kenya Medical Research Institute, Kisumu, Kenya (V.N.); Cairo University, Cairo (A.E.-B.), and the Pediatric Department and Clinical Research Center, Faculty of Medicine (H.H.), and the Faculty of Medicine (A.E.), Alexandria University, Alexandria - all in Egypt; Brigham and Women's Hospital and Harvard Medical School, Boston (M.M.A.); Sultan Qaboos University, Muscat, Oman (S.A.); Emory University and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta (R.C.B.); New York-Presbyterian/Columbia University Medical Center, New York (D.L.D.); Barts Health NHS Trust (P.T.), Homerton University Hospital NHS Foundation Trust (D.A.T.), and Guy's and St. Thomas' NHS Foundation Trust and King's College (J.H.) - all in London; the University of Illinois at Chicago, Chicago (V.R.G.); the University of Alabama at Birmingham, Birmingham (J.K.); and the American University of Beirut Medical Center, Beirut, Lebanon (M.R.A.)
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Vestergaard ET, Hjelholt AJ, Kuhre RE, Møller N, Larraufie P, Gribble FM, Reimann F, Jessen N, Holst JJ, Jørgensen JOL. Acipimox Acutely Increases GLP-1 Concentrations in Overweight Subjects and Hypopituitary Patients. J Clin Endocrinol Metab 2019; 104:2581-2592. [PMID: 30726969 PMCID: PMC7212086 DOI: 10.1210/jc.2018-02503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/20/2018] [Accepted: 02/01/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Glucagon-like peptide-1 (GLP-1) is an incretin hormone used therapeutically in type 2 diabetes and obesity. The interplay between ambient free fatty acids (FFAs) and GLP-1 remains unclear. Acipimox suppresses adipose tissue lipolysis via activation of the PUMA-G (also known as HCA2 and GPR109a) receptor. OBJECTIVE To investigate whether lowering of serum FFA level with acipimox affects GLP-1 secretion. DESIGN Two randomized crossover studies were performed in human subjects. Rat intestine was perfused intra-arterially and intraluminally, and l-cells were incubated with acipimox. PARTICIPANTS The participants were healthy overweight subjects and hypopituitary adult patients. INTERVENTIONS The overweight participants received acipimox 250 mg 60 minutes before an oral glucose test. The hypopituitary patients received acipimox 250 mg 12, 9, and 2 hours before and during the metabolic study day, when they were studied in the basal state and during a hyperinsulinemic euglycemic clamp. RESULTS Acipimox suppressed FFA but did not affect insulin in the clinical trials. In overweight subjects, the GLP-1 increase after the oral glucose tolerance test (area under the curve) was more than doubled [4119 ± 607 pmol/L × min (Acipimox) vs 1973 ± 375 pmol/L × min (control), P = 0.004]. In hypopituitary patients, acipimox improved insulin sensitivity (4.7 ± 0.8 mg glucose/kg/min (Acipimox) vs 3.1 ± 0.5 mg glucose/kg/min (control), P = 0.005], and GLP-1 concentrations increased ~40%. An inverse correlation between FFA and GLP-1 concentrations existed in both trials. In rat intestine, acipimox did not affect GLP-1 secretion, and l-cells did not consistently express the putative receptor for acipimox. CONCLUSIONS Acipimox treatment increases systemic GLP-1 levels in both obese subjects and hypopituitary patients. Our in vitro data indicate that the underlying mechanisms are indirect.
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Affiliation(s)
- Esben Thyssen Vestergaard
- Medical Research Laboratories Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Pediatrics, Randers Regional Hospital, 8930 Randers
| | - Astrid Johanneson Hjelholt
- Medical Research Laboratories Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Diabetes and Endocrinology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Rune E. Kuhre
- Department of Biomedical Sciences and NNF Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Møller
- Medical Research Laboratories Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Diabetes and Endocrinology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Pierre Larraufie
- Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, CB2 0QQ, UK
| | - Fiona M. Gribble
- Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, CB2 0QQ, UK
| | - Frank Reimann
- Metabolic Research Laboratories and Medical Research Council Metabolic Diseases Unit, Wellcome Trust-Medical Research Council Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, CB2 0QQ, UK
| | - Niels Jessen
- Medical Research Laboratories Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Research Laboratory for Biochemical Pathology, Aarhus University Hospital, 8000 Aarhus C, Denmark
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences and NNF Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Otto Lunde Jørgensen
- Medical Research Laboratories Aarhus University, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Diabetes and Endocrinology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Sempere RN, Arias A. Establishment of a Cell Culture Model of Persistent Flaviviral Infection: Usutu Virus Shows Sustained Replication during Passages and Resistance to Extinction by Antiviral Nucleosides. Viruses 2019; 11:E560. [PMID: 31212939 PMCID: PMC6630443 DOI: 10.3390/v11060560] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/02/2019] [Accepted: 06/15/2019] [Indexed: 12/30/2022] Open
Abstract
Chronic viral disease constitutes a major global health problem, with several hundred million people affected and an associated elevated number of deaths. An increasing number of disorders caused by human flaviviruses are related to their capacity to establish a persistent infection. Here we show that Usutu virus (USUV), an emerging zoonotic flavivirus linked to sporadic neurologic disease in humans, can establish a persistent infection in cell culture. Two independent lineages of Vero cells surviving USUV lytic infection were cultured over 82 days (41 cell transfers) without any apparent cytopathology crisis associated. We found elevated titers in the supernatant of these cells, with modest fluctuations during passages but no overall tendency towards increased or decreased infectivity. In addition to full-length genomes, viral RNA isolated from these cells at passage 40 revealed the presence of defective genomes, containing different deletions at the 5' end. These truncated transcripts were all predicted to encode shorter polyprotein products lacking membrane and envelope structural proteins, and most of non-structural protein 1. Treatment with different broad-range antiviral nucleosides revealed that USUV is sensitive to these compounds in the context of a persistent infection, in agreement with previous observations during lytic infections. The exposure of infected cells to prolonged treatment (10 days) with favipiravir and/or ribavirin resulted in the complete clearance of infectivity in the cellular supernatants (decrease of ~5 log10 in virus titers and RNA levels), although modest changes in intracellular viral RNA levels were recorded (<2 log10 decrease). Drug withdrawal after treatment day 10 resulted in a relapse in virus titers. These results encourage the use of persistently-infected cultures as a surrogate system in the identification of improved antivirals against flaviviral chronic disease.
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Affiliation(s)
- Raquel Navarro Sempere
- Life Science & Bioengineering Building, Technical University of Denmark, 2800 Kongens Lyngby, Denmark.
- Abiopep Sociedad Limitada, Parque Científico de Murcia, 30100 Murcia, Spain.
| | - Armando Arias
- Life Science & Bioengineering Building, Technical University of Denmark, 2800 Kongens Lyngby, Denmark.
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De Martino MC, van Koetsveld PM, Feelders RA, de Herder WW, Dogan F, Janssen JAMJL, Hofste Op Bruinink D, Pivonello C, Waaijers AM, Colao A, de Krijger RR, Pivonello R, Hofland LJ. IGF and mTOR pathway expression and in vitro effects of linsitinib and mTOR inhibitors in adrenocortical cancer. Endocrine 2019; 64:673-684. [PMID: 30838516 PMCID: PMC6551351 DOI: 10.1007/s12020-019-01869-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/08/2018] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
PURPOSE The IGF and mTOR-pathways are considered as potential targets for therapy in patients with adrenocortical carcinoma (ACC). This study aims to describe the IGF pathway in ACC and to explore the response to the combined treatment with the IGF1R/IR inhibitor linsitinib, and mTOR inhibitors (sirolimus and everolimus) in in vitro models of ACC. METHODS The protein expression level of IGF2, IGF1R and IGF2R was evaluated by immunohistochemistry in 17 human ACCs and the mRNA expression level of IGF1, IGF2, IGF1R, IR isoforms A and B, IGF2R, IGF-Binding-Proteins[IGFBP]-1, 2, 3 and 6 was evaluated by RT-qPCR in 12 samples. In H295R and HAC15 ACC cell lines the combined effects of linsitinib and sirolimus or everolimus on cell survival were evaluated. RESULTS A high protein expression of IGF2, IGF1R and IGF2R was observed in 82, 65 and 100% of samples, respectively. A high relative expression of IGF2 mRNA was found in the majority of samples. The mRNA levels of the IRA were higher than that of IRB and IGF1R in the majority of samples (75%). Linsitinib inhibits cell growth in the H295R and HAC15 cell lines and, combined with sirolimus or everolimus, linsitinib showed a significant additive effect. CONCLUSIONS In addition to IGF2 and IGF1R, ACC express IGF2R, IRA and several IGFBPs, suggesting that the interplay between the different components of the IGF pathway in ACC could be more complex than previously considered. The addition of mTOR inhibitors to linsitinib may have stronger antiproliferative effects than linsitinib alone.
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Affiliation(s)
- Maria Cristina De Martino
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Peter M van Koetsveld
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Richard A Feelders
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wouter W de Herder
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fadime Dogan
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joseph A M J L Janssen
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Davine Hofste Op Bruinink
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - A Marlijn Waaijers
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Ronald R de Krijger
- Departments of Pathology, Erasmus Medical Center, Rotterdam, and University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Naples, Italy
| | - Leo J Hofland
- Department of Internal Medicine, Division Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Appleby N, Eyre TA, Cabes M, Jackson A, Boucher R, Yates F, Fox S, Rawstron A, Hillmen P, Schuh A. The STELLAR trial protocol: a prospective multicentre trial for Richter's syndrome consisting of a randomised trial investigation CHOP-R with or without acalabrutinib for newly diagnosed RS and a single-arm platform study for evaluation of novel agents in relapsed disease. BMC Cancer 2019; 19:471. [PMID: 31109313 PMCID: PMC6528290 DOI: 10.1186/s12885-019-5717-y] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transformation of chronic lymphocytic leukaemia (CLL) to diffuse large B-cell lymphoma (DLCBL) type Richter's syndrome (RS) carries a dismal prognosis. Standard-of-care chemoimmunotherapy for de novo RS is inadequate with median survival of less than one year. Patients are frequently elderly or have co-morbidities limiting dose-intense chemotherapy. Treatment of relapsed/refractory (R/R) RS and RS emerging after CLL-directed therapy represent urgent unmet clinical needs. Agents targeting Bruton's tyrosine kinase (BTK) deliver improved outcomes for patients with high-risk CLL and expand effective treatments to frailer patients. Acalabrutinib is an oral, second-generation BTK inhibitor with a favourable toxicity profile and demonstrated activity in CLL and B-cell lymphomas. Combination of acalabrutinib with standard-of-care CHOP-R chemoimmunotherapy offers a sound rationale to test in a prospective trial for de novo RS. METHODS The prospective multicentre STELLAR study is designed in two elements, consisting of a randomised study to evaluate the safety and activity of CHOP-R chemoimmunotherapy in combination with acalabrutinib in newly diagnosed RS and single-arm studies of novel agents for other RS patient cohorts. Eligible patients with newly diagnosed DLBCL-type RS are randomised between six cycles of CHOP-R therapy and six cycles CHOP-R plus acalabrutinib, followed by acalabrutinib maintenance. The primary endpoint of the randomised component is progression free survival (PFS). Cohort 1 enrols RS patients with progressive disease following chemoimmunotherapy for acalabrutinib monotherapy. Patients with RS diagnosed while on ibrutinib may enrol in Cohort 2, a single-arm study of CHOP-R plus acalabrutinib. The primary endpoint for the single-arm studies is overall response rate (ORR). Secondary endpoints for all cohorts are overall survival (OS), quality of life and proportion of patients proceeding to stem cell transplantation. The study will be accompanied by exploratory analysis of the mutational landscape of RS and the relationship between dynamic changes in sequential circulating tumour DNA samples and clinical outcomes. DISCUSSION The STELLAR randomised trial evaluates the role of CHOP-R plus acalabrutinib in newly diagnosed RS patients. The single-arm platform studies enable the incorporation of promising novel therapies into the protocol. The STELLAR study has potential to identify novel biomarkers of treatment response in this high-risk malignancy. TRIAL REGISTRATION EudraCT: 2017-004401-40 , registered on the 31-Oct-2017. IRSCTN: https://www.isrctn.com/ISRCTN52839057 , registered on the 04-Mar-2019. ClinicalTrials.gov : NCT03899337 , registered on 02-April-2019.
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Affiliation(s)
- Niamh Appleby
- Molecular Diagnostic Centre, Department of Oncology, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Toby A. Eyre
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maite Cabes
- Molecular Diagnostic Centre, Department of Oncology, University of Oxford, Oxford, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rebecca Boucher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Francesca Yates
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Sonia Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Peter Hillmen
- St. James’s Institute of Oncology, Leeds, UK
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Anna Schuh
- Molecular Diagnostic Centre, Department of Oncology, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
- Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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Nagel R, Avelar AT, Aben N, Proost N, van de Ven M, van der Vliet J, Cozijnsen M, de Vries H, Wessels LFA, Berns A. Inhibition of the Replication Stress Response Is a Synthetic Vulnerability in SCLC That Acts Synergistically in Combination with Cisplatin. Mol Cancer Ther 2019; 18:762-770. [PMID: 30872379 DOI: 10.1158/1535-7163.mct-18-0972] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/20/2018] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
Small cell lung cancer (SCLC) is generally regarded as very difficult to treat, mostly due to the development of metastases early in the disease and a quick relapse with resistant disease. SCLC patients initially show a good response to treatment with the DNA damaging agents cisplatin and etoposide. This is, however, quickly followed by the development of resistant disease, which urges the development of novel therapies for this type of cancer. In this study, we set out to compile a comprehensive overview of the vulnerabilities of SCLC. A functional genome-wide screen where all individual genes were knocked out was performed to identify novel vulnerabilities of SCLC. By analysis of the knockouts that were lethal to these cancer cells, we identified several processes to be synthetic vulnerabilities in SCLC. We were able to validate the vulnerability to inhibition of the replication stress response machinery by use of Chk1 and ATR inhibitors. Strikingly, SCLC cells were more sensitive to these inhibitors than nontransformed cells. In addition, these inhibitors work synergistically with either etoposide and cisplatin, where the interaction is largest with the latter. ATR inhibition by VE-822 treatment in combination with cisplatin also outperforms the combination of cisplatin with etoposide in vivo Altogether, our study uncovered a critical dependence of SCLC on the replication stress response and urges the validation of ATR inhibitors in combination with cisplatin in a clinical setting.
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Affiliation(s)
- Remco Nagel
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ana Teresa Avelar
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nanne Aben
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Natalie Proost
- Preclinical Intervention Unit of the Mouse Clinic for Cancer and Ageing, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marieke van de Ven
- Preclinical Intervention Unit of the Mouse Clinic for Cancer and Ageing, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan van der Vliet
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Miranda Cozijnsen
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hilda de Vries
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Lodewyk F A Wessels
- Oncode Institute, Amsterdam, the Netherlands
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anton Berns
- Oncode Institute, Amsterdam, the Netherlands.
- Division of Molecular Genetics, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Gampa G, Kim M, Mohammad AS, Parrish KE, Mladek AC, Sarkaria JN, Elmquist WF. Brain Distribution and Active Efflux of Three panRAF Inhibitors: Considerations in the Treatment of Melanoma Brain Metastases. J Pharmacol Exp Ther 2019; 368:446-461. [PMID: 30622172 PMCID: PMC6374543 DOI: 10.1124/jpet.118.253708] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022] Open
Abstract
Targeted inhibition of RAF and MEK by molecularly targeted agents has been employed as a strategy to block aberrant mitogen-activated protein kinase (MAPK) signaling in melanoma. While the use of BRAF and MEK inhibitors, either as a single agent or in combination, improved efficacy in BRAF-mutant melanoma, initial responses are often followed by relapse due to acquired resistance. Moreover, some BRAF inhibitors are associated with paradoxical activation of the MAPK pathway, causing the development of secondary malignancies. The use of panRAF inhibitors, i.e., those that target all isoforms of RAF, may overcome paradoxical activation and resistance. The purpose of this study was to perform a quantitative assessment and evaluation of the influence of efflux mechanisms at the blood-brain barrier (BBB), in particular, Abcb1/P-glycoprotein (P-gp) and Abcg2/breast cancer resistance protein (Bcrp), on the brain distribution of three panRAF inhibitors: CCT196969 [1-(3-(tert-butyl)-1-phenyl-1H-pyrazol-5-yl)-3-(2-fluoro-4-((3-oxo-3,4-dihydropyrido[2,3-b]pyrazin-8-yl)oxy)phenyl)urea], LY3009120 1-(3,3-Dimethylbutyl)-3-(2-fluoro-4-methyl-5-(7-methyl-2-(methylamino)pyrido(2,3-d)pyrimidin-6-yl)phenyl)urea, and MLN2480 [4-pyrimidinecarboxamide, 6-amino-5-chloro-N-[(1R)-1-[5-[[[5-chloro-4-(trifluoromethyl)-2-pyridinyl]amino]carbonyl]-2-thiazolyl]ethyl]-]. In vitro studies using transfected Madin-Darby canine kidney II cells indicate that only LY3009120 and MLN2480 are substrates of Bcrp, and none of the three inhibitors are substrates of P-gp. The three panRAF inhibitors show high nonspecific binding in brain and plasma. In vivo studies in mice show that the brain distribution of CCT196969, LY3009120, and MLN2480 is limited, and is enhanced in transgenic mice lacking P-gp and Bcrp. While MLN2480 has a higher brain distribution, LY3009120 exhibits superior in vitro efficacy in patient-derived melanoma cell lines. The delivery of a drug to the site of action residing behind a functionally intact BBB, along with drug potency against the target, collectively play a critical role in determining in vivo efficacy outcomes.
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Affiliation(s)
- Gautham Gampa
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - Minjee Kim
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - Afroz S Mohammad
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - Karen E Parrish
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - Ann C Mladek
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - Jann N Sarkaria
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
| | - William F Elmquist
- Brain Barriers Research Center, Department of Pharmaceutics, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota (G.G., M.K., A.S.M., K.E.P., W.F.E.); and Radiation Oncology, Mayo Clinic, Rochester, Minnesota (A.C.M., J.N.S.)
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Surendran S, Paul D, Pokharkar S, Choulwar S, Deshpande A, Giri S, Satheeshkumar N. Novel Bruton tyrosine kinase inhibitor acalabrutinib quantification by validated LC-MS/MS method: An application to pharmacokinetic study in Sprague Dawley rats. J Pharm Biomed Anal 2019; 164:509-513. [PMID: 30453157 DOI: 10.1016/j.jpba.2018.11.012] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 12/29/2022]
Abstract
USFDA has approved a novel Bruton tyrosine kinase (BTK) inhibitor acalabrutinib (ACA) for the treatment of mantle cell lymphoma in adults. ACA is more potent and selective with fewer side effects compared to other Bruton tyrosine kinase inhibitors. In the current work a highly sensitive, selective and specific LC-MS/MS method for the estimation of acalabrutinib (ACA) in rat plasma was developed. Agilent Eclipse Plus C 8 column (50 mm × 4.6 mm, μm), with gradient elution using 10 mM ammonium formate and acetonitrile as mobile phase at a flow rate of 0.6 mL/min was used for the chromatographic separation. The ion transitions were quantified in positive mode with MRM transition of 466.1→372.3 for ACA and 236.8→194.0 for internal standard (IS). Solid phase extraction process was used as sample preparation approach. The method was validated according to USFDA bioanalytical guidelines. The method provided good linearity over the range of 0.2-199.14 ng/mL for ACA with short run time of 4 min. The method offers very high sensitivity (0.2 ng/mL) and was free from matrix interferences. The validated LC-MS/MS method was successfully applied for in vivo pharmacokinetic study in Sprague Dawley rats. The Cmax of ACA was found to be 25.56 ng/mL reaching at time of 0.5 h. The developed analytical method can also be utilized for bioequivalence studies and/or for pharmacokinetic studies in clinics.
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Affiliation(s)
- Shruti Surendran
- Drug Metabolism and Interactions Research Lab, Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana, 500037, India
| | - David Paul
- Drug Metabolism and Interactions Research Lab, Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana, 500037, India
| | - Sunil Pokharkar
- Drug Metabolism and Pharmacokinetic Department, Aurigene Discovery Technologies Limited, Bollaram Road, Miyapur, Hyderabad, 500049, Telangana, India
| | - Sagar Choulwar
- Drug Metabolism and Pharmacokinetic Department, Aurigene Discovery Technologies Limited, Bollaram Road, Miyapur, Hyderabad, 500049, Telangana, India
| | - Abhijeet Deshpande
- Drug Metabolism and Pharmacokinetic Department, Aurigene Discovery Technologies Limited, Bollaram Road, Miyapur, Hyderabad, 500049, Telangana, India
| | - Sanjeev Giri
- Drug Metabolism and Pharmacokinetic Department, Aurigene Discovery Technologies Limited, Bollaram Road, Miyapur, Hyderabad, 500049, Telangana, India.
| | - N Satheeshkumar
- Drug Metabolism and Interactions Research Lab, Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana, 500037, India.
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Beghetti M, Channick RN, Chin KM, Di Scala L, Gaine S, Ghofrani H, Hoeper MM, Lang IM, McLaughlin VV, Preiss R, Rubin LJ, Simonneau G, Sitbon O, Tapson VF, Galiè N. Selexipag treatment for pulmonary arterial hypertension associated with congenital heart disease after defect correction: insights from the randomised controlled GRIPHON study. Eur J Heart Fail 2019; 21:352-359. [PMID: 30632656 PMCID: PMC6607487 DOI: 10.1002/ejhf.1375] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 05/04/2018] [Revised: 10/30/2018] [Accepted: 11/03/2018] [Indexed: 11/07/2022] Open
Abstract
Aims Patients with pulmonary arterial hypertension associated with congenital heart disease (CHD‐PAH) after defect correction have a poor prognosis compared with other CHD‐PAH patients. Therefore, it is important that these patients are treated as early and effectively as possible. Evidence supporting the use of PAH therapies in patients with corrected CHD‐PAH from randomised controlled trials is limited. The purpose of these analyses was to characterise the corrected CHD‐PAH patients from the GRIPHON study and examine the response to selexipag. Methods and results Out of the 110 patients diagnosed with corrected CHD‐PAH, 55 had atrial septal defects, 38 had ventricular septal defects, 14 had persistent ducti arteriosus, and 3 had defects not further specified. Hazard ratios (HR) and 95% confidence intervals (CI) for the primary composite endpoint were calculated using Cox proportional hazard models. Compared with the non‐CHD patients from GRIPHON, patients with corrected CHD‐PAH were slightly younger, with a greater proportion being treatment‐naive and in World Health Organization functional class I/II. The rate of the primary composite endpoint of morbidity/mortality was lower in patients with corrected CHD‐PAH who were treated with selexipag compared with those treated with placebo (HR 0.58; 95% CI 0.25, 1.37). The most common adverse events were those known to be related to selexipag. Conclusions These post‐hoc analyses of GRIPHON provide valuable information about a large population of patients with corrected CHD‐PAH, and suggest that selexipag may delay disease progression and was well‐tolerated in patients with corrected CHD‐PAH.
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Affiliation(s)
- Maurice Beghetti
- Pediatric Cardiology UnitCentre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, University of Geneva and LausanneLausanneSwitzerland
| | - Richard N. Channick
- David Geffen School of Medicine, University of California Los AngelesLos AngelesCAUSA
| | - Kelly M. Chin
- Division of Internal MedicineUniversity of Texas SouthwesternDallasTXUSA
| | | | - Sean Gaine
- National Pulmonary Hypertension UnitMater Misericordiae University HospitalDublinIreland
| | - Hossein‐Ardeschir Ghofrani
- University of Giessen and Marburg Lung Center, Giessen, Germany, member of the German Center of Lung Research, and Department of MedicineImperial College LondonLondonUK
| | - Marius M. Hoeper
- Department of Respiratory MedicineHannover Medical School and German Centre for Lung ResearchHannoverGermany
| | - Irene M. Lang
- Department of Internal Medicine II, Division of CardiologyMedical University of ViennaViennaAustria
| | | | - Ralph Preiss
- Actelion Pharmaceuticals LtdAllschwilSwitzerland
| | - Lewis J. Rubin
- Department of MedicineUniversity of CaliforniaSan DiegoCAUSA
| | - Gérald Simonneau
- APHP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, CHU BicêtreUniversité Paris-Sud, Le Kremlin-BicêtreParisFrance
| | - Olivier Sitbon
- APHP, Centre de Référence de l'Hypertension Pulmonaire, Service de Pneumologie et Soins Intensifs, CHU BicêtreUniversité Paris-Sud, Le Kremlin-BicêtreParisFrance
| | - Victor F. Tapson
- Division of Pulmonary and Critical Care Medicine, Department of MedicineCedars Sinai Medical CenterLos AngelesCAUSA
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES)Bologna University HospitalBolognaItaly
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Nicolson PLR, Hughes CE, Watson S, Nock SH, Hardy AT, Watson CN, Montague SJ, Clifford H, Huissoon AP, Malcor JD, Thomas MR, Pollitt AY, Tomlinson MG, Pratt G, Watson SP. Inhibition of Btk by Btk-specific concentrations of ibrutinib and acalabrutinib delays but does not block platelet aggregation mediated by glycoprotein VI. Haematologica 2018; 103:2097-2108. [PMID: 30026342 PMCID: PMC6269309 DOI: 10.3324/haematol.2018.193391] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/18/2018] [Indexed: 12/24/2022] Open
Abstract
Ibrutinib and acalabrutinib are irreversible inhibitors of Bruton tyrosine kinase used in the treatment of B-cell malignancies. They bind irreversibly to cysteine 481 of Bruton tyrosine kinase, blocking autophosphorylation on tyrosine 223 and phosphorylation of downstream substrates including phospholipase C-γ2. In the present study, we demonstrate that concentrations of ibrutinib and acalabrutinib that block Bruton tyrosine kinase activity, as shown by loss of phosphorylation at tyrosine 223 and phospholipase C-γ2, delay but do not block aggregation in response to a maximally-effective concentration of collagen-related peptide or collagen. In contrast, 10- to 20-fold higher concentrations of ibrutinib or acalabrutinib block platelet aggregation in response to glycoprotein VI agonists. Ex vivo studies on patients treated with ibrutinib, but not acalabrutinib, showed a reduction of platelet aggregation in response to collagen-related peptide indicating that the clinical dose of ibrutinib but not acalabrutinib is supramaximal for Bruton tyrosine kinase blockade. Unexpectedly, low concentrations of ibrutinib inhibited aggregation in response to collagen-related peptide in patients deficient in Bruton tyrosine kinase. The increased bleeding seen with ibrutinib over acalabrutinib is due to off-target actions of ibrutinib that occur because of unfavorable pharmacodynamics.
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Affiliation(s)
- Phillip L R Nicolson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Craig E Hughes
- Institute for Cardiovascular and Metabolic Research, Harborne Building, University of Reading, UK
| | - Stephanie Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Sophie H Nock
- Institute for Cardiovascular and Metabolic Research, Harborne Building, University of Reading, UK
| | - Alexander T Hardy
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Callum N Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Samantha J Montague
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
| | - Hayley Clifford
- Department of Immunology, Heartlands Hospital, Birmingham, UK
| | | | | | - Mark R Thomas
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Alice Y Pollitt
- Institute for Cardiovascular and Metabolic Research, Harborne Building, University of Reading, UK
| | - Michael G Tomlinson
- Department of Biosciences, College of Life and Environmental Sciences, University of Birmingham, UK
| | - Guy Pratt
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Steve P Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
- Centre of Membrane Proteins and Receptors (COMPARE), Universities of Birmingham and Nottingham, Midlands, UK
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