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Abstract
Therapeutic monoclonal antibodies (mAbs) are commonly administered to patients through intravenous (IV) infusion, which involves diluting the medication into an infusion solution (e.g., saline and 5% dextrose). Using the wrong diluent can cause product aggregation, which may compromise patient safety. We and others have shown that Herceptin® (trastuzumab) and Avastin® (bevacizumab) undergo rapid aggregation upon mixing with dextrose and human plasma in vitro. In this study, we evaluated the compatibility of a panel of 11 therapeutic mAbs with dextrose or saline and human serum. These mAbs were randomly selected for their distinct formulations and IgG isotypes (IgG1, IgG2, IgG4, and Fc-fusion protein). All the mAbs appeared to be compatible with saline and human serum. However, mAbs that were formulated at acidic pH (≤ 6.5) exclusively formed insoluble aggregates upon mixing with dextrose and serum. Such aggregation was not detected for the mAbs that are at neutral pH (7.2–7.5) or in buffers containing sodium chloride. Mass spectrometric analysis revealed that the insoluble aggregates were composed of mAb molecules and several serum proteins (e.g., complement proteins, apolipoprotein, fibronectin) that are characterized by an isoelectric point of pH 5.4–6.7. At proximate pH to the isoelectric point values, those abundant serum proteins appeared to undergo isoelectric precipitation with mAb molecules. Our observations highlight a potential risk of protein aggregation at the blood-IV interface if a diluent is incompatible with a specific mAb formulation. This information has implications in guiding the design of product formulations and the selection of the right diluent for intravenous infusion of therapeutic mAbs. Abbreviations: ADC: antibody-drug conjugate; D5W: 5% dextrose in water; IM: intramuscular; IV: intravenous; LC-MS/MS: liquid chromatography-tandem mass spectrometry; mAb: monoclonal antibody; SC: subcutaneous; pI: isoelectric point
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Affiliation(s)
- Shen Luo
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Keisha Melodi McSweeney
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Tao Wang
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Silvia M Bacot
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Gerald M Feldman
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Baolin Zhang
- Office of Biotechnology Products; Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Lessel D, Ozel AB, Campbell SE, Saadi A, Arlt MF, McSweeney KM, Plaiasu V, Szakszon K, Szőllős A, Rusu C, Rojas AJ, Lopez-Valdez J, Thiele H, Nürnberg P, Nickerson DA, Bamshad MJ, Li JZ, Kubisch C, Glover TW, Gordon LB. Analyses of LMNA-negative juvenile progeroid cases confirms biallelic POLR3A mutations in Wiedemann-Rautenstrauch-like syndrome and expands the phenotypic spectrum of PYCR1 mutations. Hum Genet 2018; 137:921-939. [PMID: 30450527 PMCID: PMC6652186 DOI: 10.1007/s00439-018-1957-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
Abstract
Juvenile segmental progeroid syndromes are rare, heterogeneous disorders characterized by signs of premature aging affecting more than one tissue or organ starting in childhood. Hutchinson-Gilford progeria syndrome (HGPS), caused by a recurrent de novo synonymous LMNA mutation resulting in aberrant splicing and generation of a mutant product called progerin, is a prototypical example of such disorders. Here, we performed a joint collaborative study using massively parallel sequencing and targeted Sanger sequencing, aimed at delineating the underlying genetic cause of 14 previously undiagnosed, clinically heterogeneous, non-LMNA-associated juvenile progeroid patients. The molecular diagnosis was achieved in 11 of 14 cases (~ 79%). Furthermore, we firmly establish biallelic mutations in POLR3A as the genetic cause of a recognizable, neonatal, Wiedemann-Rautenstrauch-like progeroid syndrome. Thus, we suggest that POLR3A mutations are causal for a portion of under-diagnosed early-onset segmental progeroid syndromes. We additionally expand the clinical spectrum associated with PYCR1 mutations by showing that they can somewhat resemble HGPS in the first year of life. Moreover, our results lead to clinical reclassification in one single case. Our data emphasize the complex genetic and clinical heterogeneity underlying progeroid disorders.
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Affiliation(s)
- Davor Lessel
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Ayse Bilge Ozel
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Susan E Campbell
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI, USA
| | - Abdelkrim Saadi
- Service de neurologie, CHU Ben Aknoun Alger, 2 route des deux Bassins, BenAknoun,, Algers, Algeria
| | - Martin F Arlt
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Keisha Melodi McSweeney
- Oak Ridge Institute for Science and Education, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, 20993, Silver Spring, MD, USA
| | - Vasilica Plaiasu
- Regional Center of Medical Genetics, Alessandrescu-Rusescu INSMC, Bucharest, Romania
| | - Katalin Szakszon
- Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Anna Szőllős
- Department of Pediatrics, University of Debrecen, Debrecen, Hungary
| | - Cristina Rusu
- Department of Genetics, University Hospital Iasi, Iasi, Romania
| | - Armando J Rojas
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jaime Lopez-Valdez
- Department of Genetics, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | - Holger Thiele
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - Peter Nürnberg
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | | | - Michael J Bamshad
- Department of Genome Sciences, University of Washington, Seattle, USA
| | - Jun Z Li
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Christian Kubisch
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Thomas W Glover
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Leslie B Gordon
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Division of Genetics, Hasbro Children's Hospital, Providence, RI, USA
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Petrovski S, Shashi V, Petrou S, Schoch K, McSweeney KM, Dhindsa RS, Krueger B, Crimian R, Case LE, Khalid R, El-Dairi MA, Jiang YH, Mikati MA, Goldstein DB. Exome sequencing results in successful riboflavin treatment of a rapidly progressive neurological condition. Cold Spring Harb Mol Case Stud 2016; 1:a000257. [PMID: 27148561 PMCID: PMC4850896 DOI: 10.1101/mcs.a000257] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Genetically targeted therapies for rare Mendelian conditions are improving patient outcomes. Here, we present the case of a 20-mo-old female suffering from a rapidly progressing neurological disorder. Although diagnosed initially with a possible autoimmune condition, analysis of the child's exome resulted in a diagnosis of Brown–Vialetto–Van Laere syndrome 2 (BVVLS2). This new diagnosis led to a change in the therapy plan from steroids and precautionary chemotherapy to high-dose riboflavin. Improvements were reported quickly, including in motor strength after 1 mo. In this case, the correct diagnosis and appropriate treatment would have been unlikely in the absence of exome sequencing and careful interpretation. This experience adds to a growing list of examples that emphasize the importance of early genome-wide diagnostics.
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Affiliation(s)
- Slavé Petrovski
- Institute for Genomic Medicine, Columbia University, New York, New York 10032, USA;; Department of Medicine, The University of Melbourne, Austin Health and Royal Melbourne Hospital, Melbourne, 3050 Victoria, Australia
| | - Vandana Shashi
- Department of Pediatrics, Division of Genetics, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Steven Petrou
- Ion Channels and Disease Group, Epilepsy Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia
| | - Kelly Schoch
- Department of Pediatrics, Division of Genetics, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | | | - Ryan S Dhindsa
- Institute for Genomic Medicine, Columbia University, New York, New York 10032, USA
| | - Brian Krueger
- Institute for Genomic Medicine, Columbia University, New York, New York 10032, USA
| | - Rebecca Crimian
- Department of Pediatrics, Division of Genetics, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Laura E Case
- Division of Physical Therapy, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - Roha Khalid
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Maysantoine A El-Dairi
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - Yong-Hui Jiang
- Department of Pediatrics, Division of Genetics, Duke University School of Medicine, Durham, North Carolina 27710, USA;; Department of Neurobiology, Duke University, Durham, North Carolina 27710, USA
| | - Mohamad A Mikati
- Department of Pediatrics, Division of Neurology, Duke University School of Medicine, Durham, North Carolina 27710, USA
| | - David B Goldstein
- Institute for Genomic Medicine, Columbia University, New York, New York 10032, USA
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