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Crawford J, Calle RA, Collins SM, Weng Y, Lubaczewski SL, Buckeridge C, Wang EQ, Harrington MA, Tarachandani A, Rossulek MI, Revkin JH. A Phase Ib First-In-Patient Study Assessing the Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of Ponsegromab in Participants with Cancer and Cachexia. Clin Cancer Res 2024; 30:489-497. [PMID: 37982848 PMCID: PMC10831332 DOI: 10.1158/1078-0432.ccr-23-1631] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/18/2023] [Accepted: 11/16/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Cachexia is common in patients with advanced cancer and is associated with elevated serum growth differentiation factor 15 (GDF-15) concentrations. This first-in-patient (phase Ib), 24-week study assessed use of ponsegromab, a mAb against GDF-15, in adults with advanced cancer, cachexia, and elevated GDF-15 serum concentration. PATIENTS AND METHODS Participants (n = 10) received open-label ponsegromab subcutaneous 200 mg every 3 weeks for 12 weeks in addition to standard-of-care anticancer treatment. Ponsegromab safety, tolerability, and pharmacokinetics were assessed in addition to serum GDF-15 concentrations and exploratory measures of efficacy. RESULTS No treatment-related treatment-emergent adverse events, injection site reactions, or adverse trends in clinical laboratory tests, vital signs, or electrocardiogram parameters attributable to ponsegromab were identified. Median serum unbound GDF-15 concentration at baseline was 2.269 ng/mL. Following initiation of study treatment, median unbound GDF-15 concentrations were below the lower limit of quantification (0.0424 ng/mL) from day 1 (3 hours postdose) through week 15. Increases in body weight were observed at all time points during the treatment and follow-up periods. A least-squares mean (SE) increase of 4.63 (1.98) kg was observed at week 12, an increase of approximately 6.6% relative to baseline. Ponsegromab-mediated improvements in actigraphy-based assessments of physical activity and in quality of life, including appetite as assessed by Functional Assessment of Anorexia-Cachexia Therapy total and subscale scores, were also observed. CONCLUSIONS Ponsegromab was well tolerated, suppressed serum GDF-15 concentrations, and demonstrated preliminary evidence of efficacy. These findings support the continued development of ponsegromab for the treatment of cachexia.
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Affiliation(s)
- Jeffrey Crawford
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Roberto A. Calle
- Internal Medicine Research Unit, Pfizer Inc, Cambridge, Massachusetts
| | - Susie M. Collins
- Global Biometrics and Data Management, Pfizer R&D UK Ltd, Sandwich, Kent, United Kingdom
| | - Yan Weng
- Clinical Pharmacology, Pfizer Inc, Cambridge, Massachusetts
| | - Shannon L. Lubaczewski
- Early Clinical Development Biomedicine Artificial Intelligence, Pfizer Inc, Collegeville, Pennsylvania
| | - Clare Buckeridge
- Internal Medicine Research Unit, Pfizer Inc, Cambridge, Massachusetts
| | - Ellen Q. Wang
- Clinical Pharmacology, Pfizer Inc, New York, New York
| | | | | | | | - James H. Revkin
- Internal Medicine Research Unit, Pfizer Inc, Cambridge, Massachusetts
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2
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Griffith DA, Edmonds DJ, Fortin JP, Kalgutkar AS, Kuzmiski JB, Loria PM, Saxena AR, Bagley SW, Buckeridge C, Curto JM, Derksen DR, Dias JM, Griffor MC, Han S, Jackson VM, Landis MS, Lettiere D, Limberakis C, Liu Y, Mathiowetz AM, Patel JC, Piotrowski DW, Price DA, Ruggeri RB, Tess DA. A Small-Molecule Oral Agonist of the Human Glucagon-like Peptide-1 Receptor. J Med Chem 2022; 65:8208-8226. [PMID: 35647711 PMCID: PMC9234956 DOI: 10.1021/acs.jmedchem.1c01856] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Peptide agonists of the glucagon-like peptide-1 receptor (GLP-1R) have revolutionized diabetes therapy, but their use has been limited because they require injection. Herein, we describe the discovery of the orally bioavailable, small-molecule, GLP-1R agonist PF-06882961 (danuglipron). A sensitized high-throughput screen was used to identify 5-fluoropyrimidine-based GLP-1R agonists that were optimized to promote endogenous GLP-1R signaling with nanomolar potency. Incorporation of a carboxylic acid moiety provided considerable GLP-1R potency gains with improved off-target pharmacology and reduced metabolic clearance, ultimately resulting in the identification of danuglipron. Danuglipron increased insulin levels in primates but not rodents, which was explained by receptor mutagensis studies and a cryogenic electron microscope structure that revealed a binding pocket requiring a primate-specific tryptophan 33 residue. Oral administration of danuglipron to healthy humans produced dose-proportional increases in systemic exposure (NCT03309241). This opens an opportunity for oral small-molecule therapies that target the well-validated GLP-1R for metabolic health.
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Affiliation(s)
- David A Griffith
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - David J Edmonds
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Jean-Philippe Fortin
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Amit S Kalgutkar
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - J Brent Kuzmiski
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Paula M Loria
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Aditi R Saxena
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Scott W Bagley
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Clare Buckeridge
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - John M Curto
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - David R Derksen
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - João M Dias
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Matthew C Griffor
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Seungil Han
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - V Margaret Jackson
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Margaret S Landis
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Daniel Lettiere
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Chris Limberakis
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Yuhang Liu
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - Alan M Mathiowetz
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | | | - David W Piotrowski
- Pfizer Worldwide Research, Development, and Medical, Groton, Connecticut 06340, United States
| | - David A Price
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - Roger B Ruggeri
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
| | - David A Tess
- Pfizer Worldwide Research, Development, and Medical, Cambridge, Massachusetts 02139, United States
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3
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Roeland E, Yennu S, Del Fabbro E, Buckeridge C, Thayer K, Collins S, Lubaczewski S, Wang E, Calle R. 1696TiP Phase Ib study to assess the effect of PF-06946860 on appetite following subcutaneous administration in patients with anorexia and advanced cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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4
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Saxena AR, Gorman DN, Esquejo RM, Bergman A, Chidsey K, Buckeridge C, Griffith DA, Kim AM. Danuglipron (PF-06882961) in type 2 diabetes: a randomized, placebo-controlled, multiple ascending-dose phase 1 trial. Nat Med 2021; 27:1079-1087. [PMID: 34127852 DOI: 10.1038/s41591-021-01391-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/10/2021] [Indexed: 02/07/2023]
Abstract
Agonism of the glucagon-like peptide-1 receptor (GLP-1R) results in glycemic lowering and body weight loss and is a therapeutic strategy to treat type 2 diabetes (T2D) and obesity. We developed danuglipron (PF-06882961), an oral small-molecule GLP-1R agonist and found it had comparable efficacy to injectable peptidic GLP-1R agonists in a humanized mouse model. We then completed a placebo-controlled, randomized, double-blind, multiple ascending-dose phase 1 study ( NCT03538743 ), in which we enrolled 98 patients with T2D on background metformin and randomized them to receive multiple ascending doses of danuglipron or placebo for 28 d, across eight cohorts. The primary outcomes were assessment of adverse events (AEs), safety laboratory tests, vital signs and 12-lead electrocardiograms. Most AEs were mild, with nausea, dyspepsia and vomiting most commonly reported. There were no clinically meaningful AEs in laboratory values across groups. Heart rate generally increased with danuglipron treatment at day 28, but no heart-rate AEs were reported. Systolic blood pressure was slightly decreased and changes in diastolic blood pressure were similar with danuglipron treatment at day 28, compared with placebo. There were no clinically meaningful electrocardiogram findings. In this study in T2D, danuglipron was generally well tolerated, with a safety profile consistent with the mechanism of action of GLP-1R agonism.
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Affiliation(s)
- Aditi R Saxena
- Pfizer Worldwide Research and Development, Cambridge, MA, USA.
| | - Donal N Gorman
- Pfizer Worldwide Research and Development, Cambridge, UK
| | - Ryan M Esquejo
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Arthur Bergman
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Kristin Chidsey
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | | | | | - Albert M Kim
- Pfizer Worldwide Research and Development, Cambridge, MA, USA
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5
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Kelly KL, Reagan WJ, Sonnenberg GE, Clasquin M, Hales K, Asano S, Amor PA, Carvajal-Gonzalez S, Shirai N, Matthews MD, Li KW, Hellerstein MK, Vera NB, Ross TT, Cappon G, Bergman A, Buckeridge C, Sun Z, Qejvanaj EZ, Schmahai T, Beebe D, Pfefferkorn JA, Esler WP. De novo lipogenesis is essential for platelet production in humans. Nat Metab 2020; 2:1163-1178. [PMID: 32929234 DOI: 10.1038/s42255-020-00272-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/06/2020] [Indexed: 02/08/2023]
Abstract
Acetyl-CoA carboxylase (ACC) catalyses the first step of de novo lipogenesis (DNL). Pharmacologic inhibition of ACC has been of interest for therapeutic intervention in a wide range of diseases. We demonstrate here that ACC and DNL are essential for platelet production in humans and monkeys, but in not rodents or dogs. During clinical evaluation of a systemically distributed ACC inhibitor, unexpected dose-dependent reductions in platelet count were observed. While platelet count reductions were not observed in rat and dog toxicology studies, subsequent studies in cynomolgus monkeys recapitulated these platelet count reductions with a similar concentration response to that in humans. These studies, along with ex vivo human megakaryocyte maturation studies, demonstrate that platelet lowering is a consequence of DNL inhibition likely to result in impaired megakaryocyte demarcation membrane formation. These observations demonstrate that while DNL is a minor quantitative contributor to global lipid balance in humans, DNL is essential to specific lipid pools of physiological importance.
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Affiliation(s)
- Kenneth L Kelly
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - William J Reagan
- Drug Safety Research and Development, Pfizer Inc., Groton, CT, USA
| | - Gabriele E Sonnenberg
- Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Michelle Clasquin
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Katherine Hales
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Shoh Asano
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Paul A Amor
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | | | - Norimitsu Shirai
- Drug Safety Research and Development, Pfizer Inc., Groton, CT, USA
| | - Marcy D Matthews
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA, USA
| | - Kelvin W Li
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California at Berkeley, Berkeley, CA, USA
| | - Nicholas B Vera
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Trenton T Ross
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Gregg Cappon
- Drug Safety Research and Development, Pfizer Inc., Groton, CT, USA
| | - Arthur Bergman
- Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Clare Buckeridge
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Zhongyuan Sun
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Enida Ziso Qejvanaj
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | | | - David Beebe
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - Jeffrey A Pfefferkorn
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA
| | - William P Esler
- Internal Medicine Research Unit, Pfizer Worldwide Research and Development, Cambridge, MA, USA.
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6
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Esler WP, Tesz GJ, Hellerstein MK, Beysen C, Sivamani R, Turner SM, Watkins SM, Amor PA, Carvajal-Gonzalez S, Geoly FJ, Biddle KE, Purkal JJ, Fitch M, Buckeridge C, Silvia AM, Griffith DA, Gorgoglione M, Hassoun L, Bosanac SS, Vera NB, Rolph TP, Pfefferkorn JA, Sonnenberg GE. Human sebum requires de novo lipogenesis, which is increased in acne vulgaris and suppressed by acetyl-CoA carboxylase inhibition. Sci Transl Med 2020; 11:11/492/eaau8465. [PMID: 31092695 DOI: 10.1126/scitranslmed.aau8465] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 04/05/2019] [Indexed: 12/28/2022]
Abstract
Sebum plays important physiological roles in human skin. Excess sebum production contributes to the pathogenesis of acne vulgaris, and suppression of sebum production reduces acne incidence and severity. We demonstrate that sebum production in humans depends on local flux through the de novo lipogenesis (DNL) pathway within the sebocyte. About 80 to 85% of sebum palmitate (16:0) and sapienate (16:1n10) were derived from DNL, based on stable isotope labeling, much higher than the contribution of DNL to triglyceride palmitate in circulation (~20%), indicating a minor contribution by nonskin sources to sebum lipids. This dependence on local sebocyte DNL was not recapitulated in two widely used animal models of sebum production, Syrian hamsters and Göttingen minipigs. Confirming the importance of DNL for human sebum production, an acetyl-CoA carboxylase inhibitor, ACCi-1, dose-dependently suppressed DNL and blocked synthesis of fatty acids, triglycerides, and wax esters but not free sterols in human sebocytes in vitro. ACCi-1 dose-dependently suppressed facial sebum excretion by ~50% (placebo adjusted) in human individuals dosed orally for 2 weeks. Sebum triglycerides, wax esters, and free fatty acids were suppressed by ~66%, whereas non-DNL-dependent lipid species, cholesterol, and squalene were not reduced, confirming selective modulation of DNL-dependent lipids. Last, individuals with acne vulgaris exhibited increased sebum production rates relative to individuals with normal skin, with >80% of palmitate and sapienate derived from DNL. These findings highlight the importance of local sebocyte DNL for human skin sebaceous gland biology and illuminate a potentially exploitable therapeutic target for the treatment of acne vulgaris.
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Affiliation(s)
- William P Esler
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA.
| | - Gregory J Tesz
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Marc K Hellerstein
- KineMed Inc., Emeryville, CA 94608, USA.,Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA 94720, USA
| | | | - Raja Sivamani
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, CA 95816, USA
| | | | | | - Paul A Amor
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Santos Carvajal-Gonzalez
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Frank J Geoly
- Drug Safety Research and Development, Pfizer Global Research and Development, Groton, CT 06340, USA
| | - Kathleen E Biddle
- Drug Safety Research and Development, Pfizer Global Research and Development, Groton, CT 06340, USA
| | - Julie J Purkal
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Mark Fitch
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Clare Buckeridge
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Annette M Silvia
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - David A Griffith
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Matthew Gorgoglione
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Lauren Hassoun
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, CA 95816, USA
| | - Suzana S Bosanac
- Department of Dermatology, School of Medicine, University of California, Davis, Davis, CA 95816, USA
| | - Nicholas B Vera
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Timothy P Rolph
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Jeffrey A Pfefferkorn
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
| | - Gabriele E Sonnenberg
- Cardiovascular, Metabolic and Endocrine Diseases Research Unit, Pfizer Global Research and Development, Cambridge, MA 02139, USA
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7
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Qiu R, Liu R, He P, Wills A, Tankisheva E, Alvey C, Buckeridge C, Bednar M, Alexander RC, Chen D. [O2–09–05]: SAFETY, TOLERABILITY, AND PHARMACOKINETIC AND PHARMACODYNAMIC EFFECTS OF PF‐06751979, A POTENT AND SELECTIVE ORAL BACE1 INHIBITOR: RESULTS FROM PHASE1 SINGLE AND MULTIPLE ASCENDING DOSE STUDIES IN HEALTHY YOUNG AND OLDER VOLUNTEERS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ruolun Qiu
- Pfizer Early Clinical DevelopmentCambridgeMAUSA
- Pfizer Inc, Neuroscience & Pain Research UnitCambridgeMAUSA
- Massachusetts General Hospital, NeurologyBostonMAUSA
- Pfizer Clinical Research UnitBrusselsBelgium
- Pfizer Global Product Development, Clinical Sciences and OperationsGrotonCTUSA
| | - Richann Liu
- Pfizer Early Clinical DevelopmentCambridgeMAUSA
| | - Ping He
- Pfizer Early Clinical DevelopmentCambridgeMAUSA
| | | | | | | | | | | | | | - Danny Chen
- Pfizer Early Clinical DevelopmentCambridgeMAUSA
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