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Agoulnik IU, Kaftanovskaya EM, Myhr C, Bathgate RAD, Kocan M, Peng Y, Lindsay RM, DiStefano PS, Agoulnik AI. Engineering a long acting, non-biased relaxin agonist using Protein-in-Protein technology. Biochem Pharmacol 2024; 227:116401. [PMID: 38945278 DOI: 10.1016/j.bcp.2024.116401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
The peptide hormone relaxin plays a critical role in tissue remodeling in a variety of tissues through activation of its cognate receptor, RXFP1. Relaxin's ability to modify extracellular matrices has provided a strong rationale for treating fibrosis in a variety of tissues. Treatment with recombinant relaxin peptides in clinical studies of heart failure has not yet proven useful, likely due to the short half-life of infused peptide. To circumvent this particular pharmacokinetic pitfall we have used a Protein-in-Protein (PiP) antibody technology described previously, to insert a single-chain human relaxin construct into the complementarity-determining region (CDR) of an immunoglobulin G (IgG) backbone, creating a relaxin molecule with a half-life of ∼4-5 days in mice. Relaxin-PiP biologics displaced Europium-labeled human relaxin in RXFP1-expressing cells and demonstrated full agonist activity on both human and mouse RXFP1 receptors. Relaxin-PiPs did not show signal transduction bias, as they activated cAMP in THP-1 cells, and cGMP and pERK signaling in primary human cardiac fibroblasts. In an induced carbon tetrachloride mouse model of liver fibrosis one relaxin-PiP, R2-PiP, caused reduction of liver lesions, ameliorated collagen accumulation in the liver with the corresponding reduction of Collagen1a1 gene expression, and increased cell proliferation in hepatic parenchyma. These relaxin biologics represent a novel approach to the design of a long-acting RXFP1 agonist to probe the clinical utility of relaxin/RXFP1 signaling to treat a variety of human fibrotic diseases.
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Affiliation(s)
- Irina U Agoulnik
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Elena M Kaftanovskaya
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Courtney Myhr
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Ross A D Bathgate
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia; Department of Biochemistry and Pharmacology, The University of Melbourne, Victoria 3010, Australia
| | - Martina Kocan
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - Yingjie Peng
- Scripps Research, 10550 N Torrey Pines Rd, La Jolla, CA 92037 USA
| | - Ronald M Lindsay
- Zebra Biologics, Inc., 1041 Old Marlboro Road, Concord, MA 01742 USA
| | - Peter S DiStefano
- Zebra Biologics, Inc., 1041 Old Marlboro Road, Concord, MA 01742 USA.
| | - Alexander I Agoulnik
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
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Poirier B, Pasquier O, Chenede X, Corbier A, Prigent P, Azam A, Bernard C, Guillotel M, Gillot F, Riva L, Briand V, Ingenito R, Gauzy-Lazo L, Duclos O, Philippo C, Maillere B, Bianchi E, Mallart S, Janiak P, Illiano S. R2R01: A long-acting single-chain peptide agonist of RXFP1 for renal and cardiovascular diseases. Br J Pharmacol 2024; 181:1993-2011. [PMID: 38450758 DOI: 10.1111/bph.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The therapeutic potential of relaxin for heart failure and renal disease in clinical trials is hampered by the short half-life of serelaxin. Optimization of fatty acid-acetylated single-chain peptide analogues of relaxin culminated in the design and synthesis of R2R01, a potent and selective RXFP1 agonist with subcutaneous bioavailability and extended half-life. EXPERIMENTAL APPROACH Cellular assays and pharmacological models of RXFP1 activation were used to validate the potency and selectivity of R2R01. Increased renal blood flow was used as a translational marker of R2R01 activity. Human mastocytes (LAD2 cells) were used to study potential pseudo-allergic reactions and CD4+ T-cells to study immunogenicity. The pharmacokinetics of R2R01 were characterized in rats and minipigs. KEY RESULTS In vitro, R2R01 had comparable potency and efficacy to relaxin as an agonist for human RXFP1. In vivo, subcutaneous administration of R2R01 increased heart rate and renal blood flow in normotensive and hypertensive rat and did not show evidence of tachyphylaxis. R2R01 also increased nipple length in rats, used as a chronic model of RXFP1 engagement. Pharmacokinetic studies showed that R2R01 has a significantly extended terminal half-life. The in vitro assays with LAD2 cells and CD4+ T-cells showed that R2R01 had low potential for pseudo-allergic and immunogenic reactions, respectively. CONCLUSION AND IMPLICATIONS R2R01 is a potent RXFP1 agonist with an extended half-life that increases renal blood flow in various settings including normotensive and hypertensive conditions. The preclinical efficacy and safety data supported clinical development of R2R01 as a potential new therapy for renal and cardiovascular diseases.
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Affiliation(s)
- Bruno Poirier
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | | | - Xavier Chenede
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Alain Corbier
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Philippe Prigent
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | | | - Carine Bernard
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Michel Guillotel
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Florence Gillot
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Laurence Riva
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Veronique Briand
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Raffaele Ingenito
- Peptides and Small Molecules R&D Department, IRBM Spa, Pomezia, Rome, Italy
| | - Laurence Gauzy-Lazo
- Département Médicaments et Technologies pour la Santé, Université de Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Olivier Duclos
- Département Médicaments et Technologies pour la Santé, Université de Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | | | | | - Elisabetta Bianchi
- Peptides and Small Molecules R&D Department, IRBM Spa, Pomezia, Rome, Italy
| | - Sergio Mallart
- Département Médicaments et Technologies pour la Santé, Université de Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Philip Janiak
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
| | - Stephane Illiano
- Cardio-Vascular and metabolism, Sanofi R&D, Chilly Mazarin, France
- Investigative Toxicology, Sanofi R&D, Chilly Mazarin, France
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3
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Verdino P, Lee SL, Cooper FN, Cottle SR, Grealish PF, Hu CC, Meyer CM, Lin J, Copeland V, Porter G, Schroeder RL, Thompson TD, Porras LL, Dey A, Zhang HY, Beebe EC, Matkovich SJ, Coskun T, Balciunas AM, Ferrante A, Siegel R, Malherbe L, Bivi N, Paavola CD, Hansen RJ, Abernathy MM, Nwosu SO, Carr MC, Heuer JG, Wang X. Development of a long-acting relaxin analogue, LY3540378, for treatment of chronic heart failure. Br J Pharmacol 2023. [PMID: 36780899 DOI: 10.1111/bph.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND AND PURPOSE Chronic heart failure, a progressive disease with limited treatment options currently available, especially in heart failure with preserved ejection fraction (HFpEF), represents an unmet medical need as well as an economic burden. The development of a novel therapeutic to slow or reverse disease progression would be highly impactful to patients and society. Relaxin-2 (relaxin) is a human hormone regulating cardiovascular, renal, and pulmonary adaptations during pregnancy. A short-acting recombinant relaxin, Serelaxin, demonstrated short-term heart failure symptom relief and biomarker improvement in acute heart failure trials. Here, we present the development of a long-acting relaxin analogue to be tested in the treatment of chronic heart failure. EXPERIMENTAL APPROACH LY3540378 is a long-acting protein therapeutic composed of a human relaxin analogue and a serum albumin-binding VHH domain. KEY RESULTS LY3540378 is a potent agonist of the relaxin family peptide receptor 1 (RXFP1) and maintains selectivity against RXFP2/3/4 comparable to native relaxin. The half-life of LY3540378 in preclinical species is extended through high affinity binding of the albumin-binding VHH domain to serum albumin. When tested in a single dose administration, LY3540378 elicited relaxin-mediated pharmacodynamic responses, such as reduced serum osmolality and increased renal blood flow in rats. In an isoproterenol-induced cardiac hypertrophy mouse model, treatment with LY3540378 significantly reduced cardiac hypertrophy and improved isovolumetric relaxation time. In a monkey cardiovascular safety study, there were no adverse observations from administration of LY3540378. CONCLUSION AND IMPLICATIONS LY3540378 demonstrated to be a suitable clinical development candidate, and is progressing in clinical trials.
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Affiliation(s)
- Petra Verdino
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Stacey L Lee
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Fariba N Cooper
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Steven R Cottle
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Patrick F Grealish
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Charlie C Hu
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Catalina M Meyer
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Joanne Lin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Victoria Copeland
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Gina Porter
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Richard L Schroeder
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Tyran D Thompson
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Leah L Porras
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Asim Dey
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Hong Y Zhang
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Emily C Beebe
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Scot J Matkovich
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Tamer Coskun
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Aldona M Balciunas
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Andrea Ferrante
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Robert Siegel
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Laurent Malherbe
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Nicoletta Bivi
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Chad D Paavola
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ryan J Hansen
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Matthew M Abernathy
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Sylvia O Nwosu
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Molly C Carr
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Josef G Heuer
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Xiaojun Wang
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
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4
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Characterization of a new potent and long-lasting single chain peptide agonist of RXFP1 in cells and in vivo translational models. Sci Rep 2022; 12:20435. [PMID: 36443381 PMCID: PMC9705314 DOI: 10.1038/s41598-022-24716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
Despite beneficial effects in acute heart failure, the full therapeutic potential of recombinant relaxin-2 has been hampered by its short half-life and the need for intravenous administration limiting its use to intensive care units. A multiparametric optimization of the relaxin B-chain led to the identification of single chain lipidated peptide agonists of RXFP1 like SA10SC-RLX with subcutaneous bioavailability and extended half-life. SA10SC-RLX has sub nanomolar activity on cells expressing human RXFP1 and molecular modeling associated with the study of different RXFP1 mutants was used to decipher the mechanism of SA10SC-RLX interaction with RXFP1. Telemetry was performed in rat where SA10SC-RLX was able to engage RXFP1 after subcutaneous administration without tachyphylaxis after repeated dosing. Renal blood flow was then used as a translational model to evaluate RXFP1 activation. SA10SC-RLX increased renal blood flow and decreased renal vascular resistance in rats as reported for relaxin in humans. In conclusion, SA10SC-RLX mimics relaxin activity in in vitro and in vivo models of acute RXFP1 engagement. SA10SC-RLX represents a new class of long-lasting RXFP1 agonist, suitable for once daily subcutaneous administration in patients and potentially paving the way to new treatments for chronic fibrotic and cardiovascular diseases.
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5
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Relaxin-2 as a Potential Biomarker in Cardiovascular Diseases. J Pers Med 2022; 12:jpm12071021. [PMID: 35887517 PMCID: PMC9317583 DOI: 10.3390/jpm12071021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
The pleiotropic hormone relaxin-2 plays a pivotal role in the physiology and pathology of the cardiovascular system. Relaxin-2 exerts relevant regulatory functions in cardiovascular tissues through the specific receptor relaxin family peptide receptor 1 (RXFP1) in the regulation of cardiac metabolism; the induction of vasodilatation; the reversion of fibrosis and hypertrophy; the reduction of inflammation, oxidative stress, and apoptosis; and the stimulation of angiogenesis, with inotropic and chronotropic effects as well. Recent preclinical and clinical outcomes have encouraged the potential use of relaxin-2 (or its recombinant form, known as serelaxin) as a therapeutic strategy during cardiac injury and/or in patients suffering from different cardiovascular disarrangements, especially heart failure. Furthermore, relaxin-2 has been proposed as a promising biomarker of cardiovascular health and disease. In this review, we emphasize the relevance of the endogenous hormone relaxin-2 as a useful diagnostic biomarker in different backgrounds of cardiovascular pathology, such as heart failure, atrial fibrillation, myocardial infarction, ischemic heart disease, aortic valve disease, hypertension, and atherosclerosis, which could be relevant in daily clinical practice and could contribute to comprehending the specific role of relaxin-2 in cardiovascular diseases.
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6
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Ng HH, Soula M, Rivas B, Wilson KJ, Marugan JJ, Agoulnik AI. Anti-apoptotic and Matrix Remodeling Actions of a Small Molecule Agonist of the Human Relaxin Receptor, ML290 in Mice With Unilateral Ureteral Obstruction. Front Physiol 2021; 12:650769. [PMID: 34305630 PMCID: PMC8293094 DOI: 10.3389/fphys.2021.650769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Diseases, such as diabetes and hypertension, often lead to chronic kidney failure. The peptide hormone relaxin has been shown to have therapeutic effects in various organs. In the present study, we tested the hypothesis that ML290, a small molecule agonist of the human relaxin receptor (RXFP1), is able to target the kidney to remodel the extracellular matrix and reduce apoptosis induced by unilateral ureteral obstruction (UUO). UUO was performed on the left kidney of humanized RXFP1 mice, where the right kidneys served as contralateral controls. Mice were randomly allocated to receive either vehicle or ML290 (30 mg/kg) via daily intraperitoneal injection, and kidneys were collected for apoptosis, RNA, and protein analyses. UUO significantly increased expression of pro-apoptotic markers in both vehicle- and ML290-treated mice when compared to their contralateral control kidneys. Specifically, Bax expression and Erk1/2 activity were upregulated, accompanied by an increase of TUNEL-positive cells in the UUO kidneys. Additionally, UUO induced marked increase in myofibroblast differentiation and aberrant remodeling on the extracellular matrix. ML290 suppressed these processes by promoting a reduction of pro-apoptotic, fibroblastic, and inflammatory markers in the UUO kidneys. Finally, the potent effects of ML290 to remodel the extracellular matrix were demonstrated by its ability to reduce collagen gene expression in the UUO kidneys. Our data indicate that daily administration of ML290 has renal protective effects in the UUO mouse model, specifically through its anti-apoptotic and extracellular matrix remodeling properties.
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Affiliation(s)
- Hooi Hooi Ng
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Mariluz Soula
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Bryan Rivas
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Kenneth J Wilson
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Juan J Marugan
- NIH Chemical Genomics Center, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, United States
| | - Alexander I Agoulnik
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
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7
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Martins RC, Pintalhão M, Leite-Moreira A, Castro-Chaves P. Relaxin and the Cardiovascular System: from Basic Science to Clinical Practice. Curr Mol Med 2021; 20:167-184. [PMID: 31642776 DOI: 10.2174/1566524019666191023121607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/07/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
The peptide hormone relaxin was originally linked to reproductive physiology, where it is believed to mediate systemic and renal hemodynamic adjustments to pregnancy. Recently, its broad range of effects in the cardiovascular system has been the focus of intensive research regarding its implications under pathological conditions and potential therapeutic potential. An understanding of the multitude of cardioprotective actions prompted the study of serelaxin, recombinant human relaxin-2, for the treatment of acute heart failure. Despite early promising results from phase II studies, recently revealed RELAX-AHF-2 outcomes were rather disappointing and the treatment for acute heart failure remains an unmet medical need. This article reviews the physiologic actions of relaxin on the cardiovascular system and its relevance in the pathophysiology of cardiovascular disease. We summarize the most updated clinical data and discuss future directions of serelaxin for the treatment of acute heart failure. This should encourage additional work to determine how can relaxin's beneficial effects be exploited for the treatment of cardiovascular disease.
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Affiliation(s)
- Rafael Clara Martins
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
| | - Mariana Pintalhão
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Cardiothoracic Surgery Department, São João Hospital Centre, Porto, Portugal
| | - Paulo Castro-Chaves
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiovascular Research Centre, Porto, Portugal.,Internal Medicine Department, São João Hospital Centre, Porto, Portugal
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8
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Corcoran D, Radjenovic A, Mordi IR, Nazir SA, Wilson SJ, Hinder M, Yates DP, Machineni S, Alcantara J, Prescott MF, Gugliotta B, Pang Y, Tzemos N, Semple SI, Newby DE, McCann GP, Squire I, Berry C. Vascular effects of serelaxin in patients with stable coronary artery disease: a randomized placebo-controlled trial. Cardiovasc Res 2021; 117:320-329. [PMID: 32065620 PMCID: PMC7797213 DOI: 10.1093/cvr/cvz345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/20/2019] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The effects of serelaxin, a recombinant form of human relaxin-2 peptide, on vascular function in the coronary microvascular and systemic macrovascular circulation remain largely unknown. This mechanistic, clinical study assessed the effects of serelaxin on myocardial perfusion, aortic stiffness, and safety in patients with stable coronary artery disease (CAD). METHODS AND RESULTS In this multicentre, double-blind, parallel-group, placebo-controlled study, 58 patients were randomized 1:1 to 48 h intravenous infusion of serelaxin (30 µg/kg/day) or matching placebo. The primary endpoints were change from baseline to 47 h post-initiation of the infusion in global myocardial perfusion reserve (MPR) assessed using adenosine stress perfusion cardiac magnetic resonance imaging, and applanation tonometry-derived augmentation index (AIx). Secondary endpoints were: change from baseline in AIx and pulse wave velocity, assessed at 47 h, Day 30, and Day 180; aortic distensibility at 47 h; pharmacokinetics and safety. Exploratory endpoints were the effect on cardiorenal biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), endothelin-1, and cystatin C]. Of 58 patients, 51 were included in the primary analysis (serelaxin, n = 25; placebo, n = 26). After 2 and 6 h of serelaxin infusion, mean placebo-corrected blood pressure reductions of -9.6 mmHg (P = 0.01) and -13.5 mmHg (P = 0.0003) for systolic blood pressure and -5.2 mmHg (P = 0.02) and -8.4 mmHg (P = 0.001) for diastolic blood pressure occurred. There were no between-group differences from baseline to 47 h in global MPR (-0.24 vs. -0.13, P = 0.44) or AIx (3.49% vs. 0.04%, P = 0.21) with serelaxin compared with placebo. Endothelin-1 and cystatin C levels decreased from baseline in the serelaxin group, and there were no clinically relevant changes observed with serelaxin for NT-proBNP or hsTnT. Similar numbers of serious adverse events were observed in both groups (serelaxin, n = 5; placebo, n = 7) to 180-day follow-up. CONCLUSION In patients with stable CAD, 48 h intravenous serelaxin reduced blood pressure but did not alter myocardial perfusion.
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Affiliation(s)
- David Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
| | - Aleksandra Radjenovic
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Ify R Mordi
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
| | - Sheraz A Nazir
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Simon J Wilson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Markus Hinder
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Denise P Yates
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Jose Alcantara
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | | | - Yinuo Pang
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Niko Tzemos
- London Health Science Centre, University of Western Ontario, London, Ontario, Canada
| | - Scott I Semple
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Glasgow, UK
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9
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Serelaxin activates eNOS, suppresses inflammation, attenuates developmental delay and improves cognitive functions of neonatal rats after germinal matrix hemorrhage. Sci Rep 2020; 10:8115. [PMID: 32415164 PMCID: PMC7229117 DOI: 10.1038/s41598-020-65144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Germinal matrix hemorrhage (GMH) is a detrimental form of neonatal CNS injury. Following GMH-mediated eNOS inhibition, inflammation arises, contributing to GMH-induced brain injury. We investigated the beneficial effects of Serelaxin, a clinical tested recombinant Relaxin-2 protein, on brain injury after GMH in rats. We investigated whether effects of Serelaxin are mediated by its ability to activate the GMH-suppressed eNOS pathway resulting in attenuation of inflammatory marker overproduction. GMH was induced by intraparenchymal injection of bacterial collagenase (0.3U). Seven day old Sprague–Dawley rat pups (P7) were used (n = 63). GMH animals were divided in vehicle or serelaxin treated (3 µg once, 30 µg once, 30 µg multiple, i.p., starting 30 after GMH and then daily). Sham operated animals were used. We monitored the developmental profile working memory and spatial function (T-maze and open field test respectively). At day 28, all rats underwent MRI-scans for assessment of changes in cortical thickness and white matter loss. Effects of Serelaxin on eNOS pathway activation and post-GMH inflammation were evaluated. We demonstrated that Serelaxin dose-dependently attenuated GMH-induced developmental delay, protected brain and improved cognitive functions of rats after GMH. That was associated with the decreased post-GMH inflammation, mediated at least partly by amelioration of GMH-induced eNOS inhibition.
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10
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Teerlink JR, Davison BA, Cotter G, Maggioni AP, Sato N, Chioncel O, Ertl G, Felker GM, Filippatos G, Greenberg BH, Pang PS, Ponikowski P, Edwards C, Senger S, Teichman SL, Nielsen OW, Voors AA, Metra M. Effects of serelaxin in patients admitted for acute heart failure: a meta-analysis. Eur J Heart Fail 2019; 22:315-329. [PMID: 31886953 DOI: 10.1002/ejhf.1692] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/07/2022] Open
Abstract
AIMS The effectiveness and safety of 48 h intravenous 30 μg/kg/day serelaxin infusion in acute heart failure (AHF) has been studied in six randomized, controlled clinical trials. METHODS AND RESULTS We conducted a fixed-effect meta-analysis including all studies of intravenous serelaxin initiated within the first 16 h of admission for AHF. Endpoints considered were the primary and secondary endpoints examined in the serelaxin phase III studies. In six randomized controlled trials, 6105 total patients were randomized to receive intravenous serelaxin 30 μg/kg/day and 5254 patients to control. Worsening heart failure to day 5 occurred in 6.0% and 8.1% of patients randomized to serelaxin and control, respectively (hazard ratio 0.77, 95% confidence interval 0.67-0.89; P = 0.0002). Serelaxin had no statistically significant effect on length of stay, or cardiovascular death, or heart or renal failure rehospitalization. Serelaxin administration resulted in statistically significant improvement in markers of renal function and reductions in both N-terminal pro-B-type natriuretic peptide and troponin. No significant adverse outcomes were noted with serelaxin. Through the last follow-up, which occurred at an average of 4.5 months (1-6 months), serelaxin administration was associated with a reduction in all-cause mortality, with an estimated hazard ratio of 0.87 (95% confidence interval 0.77-0.98; P = 0.0261). CONCLUSIONS Administration of intravenous serelaxin to patients admitted for AHF was associated with a highly significant reduction in the risk of 5-day worsening heart failure and in changes in renal function markers, but not length of stay, or cardiovascular death, or heart or renal failure rehospitalization. Serelaxin administration was safe and associated with a significant reduction in all-cause mortality.
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Gad Cotter
- Momentum Research, Inc., Durham, NC, USA
| | - Aldo P Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Center, Florence, Italy
| | - Naoki Sato
- Cardiology and Intensive Care Unit, Nippon Medical School, Musashi-Kosugi Hospital, Kawasaki, Japan
| | | | - Georg Ertl
- Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Barry H Greenberg
- Division of Cardiology, University of California, San Diego, CA, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Piotr Ponikowski
- Department of Heart Diseases, Medical University, Military Hospital, Wroclaw, Poland
| | | | | | | | - Olav Wendelboe Nielsen
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Adriaan A Voors
- University Medical Center Groningen, Groningen, The Netherlands
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Blessing WA, Okajima SM, Cubria MB, Villa-Camacho JC, Perez-Viloria M, Williamson PM, Sabogal AN, Suarez S, Ang LH, White S, Flynn E, Rodriguez EK, Grinstaff MW, Nazarian A. Intraarticular injection of relaxin-2 alleviates shoulder arthrofibrosis. Proc Natl Acad Sci U S A 2019; 116:12183-12192. [PMID: 31160441 PMCID: PMC6589647 DOI: 10.1073/pnas.1900355116] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Arthrofibrosis is a prevalent condition affecting greater than 5% of the general population and leads to a painful decrease in joint range of motion (ROM) and loss of independence due to pathologic accumulation of periarticular scar tissue. Current treatment options are limited in effectiveness and do not address the underlying cause of the condition: accumulation of fibrotic collagenous tissue. Herein, the naturally occurring peptide hormone relaxin-2 is administered for the treatment of adhesive capsulitis (frozen shoulder) and to restore glenohumeral ROM in shoulder arthrofibrosis. Recombinant human relaxin-2 down-regulates type I collagen and α smooth muscle actin production and increases intracellular cAMP concentration in human fibroblast-like synoviocytes, consistent with a mechanism of extracellular matrix degradation and remodeling. Pharmacokinetic profiling of a bolus administration into the glenohumeral joint space reveals the brief systemic and intraarticular (IA) half-lives of relaxin-2: 0.96 h and 0.62 h, respectively. Furthermore, using an established, immobilization murine model of shoulder arthrofibrosis, multiple IA injections of human relaxin-2 significantly improve ROM, returning it to baseline measurements collected before limb immobilization. This is in contrast to single IA (sIA) or multiple i.v. (mIV) injections of relaxin-2 with which the ROM remains constrained. The histological hallmarks of contracture (e.g., fibrotic adhesions and reduced joint space) are absent in the animals treated with multiple IA injections of relaxin-2 compared with the untreated control and the sIA- and mIV-treated animals. As these findings show, local delivery of relaxin-2 is an innovative treatment of shoulder arthrofibrosis.
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Affiliation(s)
- William A Blessing
- Department of Biomedical Engineering, Boston University, Boston, MA 02215
- Department of Chemistry, Boston University, Boston, MA 02215
- Department of Medicine, Boston University, Boston, MA 02215
| | - Stephen M Okajima
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - M Belen Cubria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Juan C Villa-Camacho
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Miguel Perez-Viloria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Patrick M Williamson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Angie N Sabogal
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Sebastian Suarez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Lay-Hong Ang
- Confocal Imaging and IHC Core, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Suzanne White
- Confocal Imaging and IHC Core, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115
| | - Evelyn Flynn
- Orthopedic Research Laboratories, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115
| | - Edward K Rodriguez
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115;
| | - Mark W Grinstaff
- Department of Biomedical Engineering, Boston University, Boston, MA 02215;
- Department of Chemistry, Boston University, Boston, MA 02215
- Department of Medicine, Boston University, Boston, MA 02215
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115;
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan 0025, Armenia
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12
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Ng HH, Esteban-Lopez M, Agoulnik AI. Targeting the relaxin/insulin-like family peptide receptor 1 and 2 with small molecule compounds. Mol Cell Endocrinol 2019; 487:40-44. [PMID: 30590098 PMCID: PMC6451876 DOI: 10.1016/j.mce.2018.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 11/21/2022]
Abstract
The peptide hormone relaxin has beneficial roles in several organs through its action on its cognate G protein-coupled receptor, RXFP1. Relaxin administration is limited to intravenous, subcutaneous, intramuscular, or spinal injection. Another drawback of peptide-based therapy is the short half-life, which requires continuous delivery of the drug to achieve efficient concentration in target organs. The discovery of a non-peptide small molecule agonist of RXFP1, ML290, provides an alternative to the natural ligand. This review summarizes the development of ML290 and its potential future therapeutic applications in various diseases, including liver fibrosis and cardiovascular diseases. We also discuss the development of small molecule agonists targeting the insulin-like 3 receptor, RXFP2, and propose the potential use of these small molecules in the context of bone and muscle remodeling.
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Affiliation(s)
- Hooi Hooi Ng
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
| | - Maria Esteban-Lopez
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
| | - Alexander I Agoulnik
- Department of Human and Molecular Genetics, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
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13
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Stewart DR. Commercial immunoassays for human relaxin-2. Mol Cell Endocrinol 2019; 487:94-97. [PMID: 30633956 DOI: 10.1016/j.mce.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/06/2019] [Accepted: 01/07/2019] [Indexed: 01/29/2023]
Abstract
Several different immunoassays have been used in the commercial pharmaceutical development of serelaxin. These assays have been well validated for submission of GLP preclinical and clinical studies to the FDA and EU regulatory bodies. The requirements for these assays exceed that of most research assays commonly developed in academic research but have been and are currently available to academic researchers. Additionally, many human relaxin immunoassays are commercially available from a variety of vendors. Validation procedures for immunoassays are well understood and documented, however validation of these assays is often lacking or completely absent. The data derived from these assays must be questioned if the investigator does not supply information on the validation of the assay used, either from the supplier or through their own efforts. Many recent papers on determination of serum relaxin in clinical settings have recently been published. The assay used for this determination varies but generally is one of two commercially available. These manuscripts and the assay used is discussed. Direct comparisons of assays are lacking but some general conclusions can be drawn by comparing results from similar studies using different assays. There is disagreement among the results of the concentrations of serum relaxin from the use of different assays that raise questions on assay reliability. The differences in the quality of immunoassays used for detection of serum relaxin should be part of the decisions making process in choosing an assay. While the end user bears the ultimate responsibility to demonstrate the assay is valid for the stated claims, reviewers and editors also share responsibility for quality of published results.
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Affiliation(s)
- Dennis R Stewart
- Molecular Medicine Research Institute, 428 Oakmead Pkwy, Sunnyvale, CA, 94085, USA.
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14
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Soubret A, Pang Y, Yu J, Dahlke M. Population pharmacokinetics of serelaxin in patients with acute or chronic heart failure, hepatic or renal impairment, or portal hypertension and in healthy subjects. Br J Clin Pharmacol 2018; 84:2572-2585. [PMID: 30014598 DOI: 10.1111/bcp.13714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 12/18/2022] Open
Abstract
AIMS Serelaxin is a recombinant human relaxin-2 peptide being developed for the treatment of acute heart failure (AHF). The present analyses aimed to evaluate serelaxin pharmacokinetics following intravenous administration and to identify covariates that may explain pharmacokinetic variability in healthy subjects and patients. METHODS Serum concentration-time data for 613 subjects from nine phase I and II studies were analysed using a nonlinear mixed-effects model to estimate population pharmacokinetics and identify significant covariates. A quantile regression analysis was also conducted to assess the relationship between clearance and covariates by including sparse data from a phase III study. RESULTS A three-compartment disposition model was established to describe serelaxin pharmacokinetics. Three out of 23 covariates, including baseline body mass index (BMI) and estimated glomerular filtration rate (eGFR) and study A1201, were identified as significant covariates for clearance but with a moderate impact on steady-state concentration, reducing the intersubject variability from 44% in the base model to 41% in the final model with covariates. The steady-state volume of distribution (Vss) was higher in patients with AHF (544 ml kg-1 ) or chronic heart failure (434 ml kg-1 ), compared with typical nonheart failure subjects (347 ml kg-1 ). Quantile regression analysis showed that a 20% increase in BMI or a 20% decrease in eGFR decreased serelaxin clearance by 9.2% or 5.2%, respectively. CONCLUSIONS Patients with HF showed higher Vss but similar clearance (and therefore steady-state exposure) vs. non nonheart failure subjects. BMI and eGFR were identified as the main covariates explaining intersubject variability in clearance; however, the impact of these covariates on steady-state concentration was moderate and therefore unlikely to be clinically relevant.
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Affiliation(s)
- Antoine Soubret
- Disease Modeling - Clinical Pharmacology, Roche Pharma Research and Early Development, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Yinuo Pang
- AbbVie Clinical Pharmacology and Pharmacometrics, AbbVie Inc., Chicago, IL, USA
| | - Jing Yu
- Pharmacometrics, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Marion Dahlke
- Translational Medicine, Novartis Pharma A.G., Basel, Switzerland
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15
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Yu L, Cao L, Sun J, Li Z, Yao F, Zhou Y. Serelaxin, recombinant human relaxin-2, for heart failure patients: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11010. [PMID: 29923986 PMCID: PMC6023957 DOI: 10.1097/md.0000000000011010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Serelaxin, recombinant human relaxin-2, is a hormone with vasodilatory and end-organ protective effects. Recently, it has been licensed to treat acute decompensated heart failure. Here, a systematic review and meta-analysis on randomized controlled trials (RCTs) was performed to assess the effect of serelaxin on mortality and dyspnea improvement in patients with heart failure. METHODS RCTs comparing serelaxin treatment to other heart failure treatments were searched in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. The main endpoints were mortality and dyspnea improvement. Pooled data were assessed by using a random effects model. RESULTS A total of 451 studies were identified, of which 8 studies (8477 participants) were eligible and included in our analysis. Compared with other heart failure treatment group, serelaxin group had no effect on 30-day, 60-day, and 180-day mortality (OR, 0.79; 95% CI, 0.65-0.96). Compared with control group, there was no effect on dyspnea improvement. CONCLUSION Serelaxin treatment is irrelevant with the mortality, and it cannot improve dyspnea of heart failure patients.
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Affiliation(s)
- Ling Yu
- Heilongjiang University of Traditional Chinese Medicine
| | - Lijuan Cao
- Heilongjiang University of Traditional Chinese Medicine
| | - Jing Sun
- Second Department of Cardiovascular, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province
| | - Zhongyi Li
- Department of Obstetrics and Gynecology, The First Clinical Medical College of Jinan University, Guangzhou, Guangdong Province, China
| | - Fengzhen Yao
- Heilongjiang University of Traditional Chinese Medicine
| | - Yabin Zhou
- Second Department of Cardiovascular, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province
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16
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Teneggi V, Sivakumar N, Chen D, Matter A. Drugs’ development in acute heart failure: what went wrong? Heart Fail Rev 2018; 23:667-691. [DOI: 10.1007/s10741-018-9707-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Miró Ò, Herrero-Puente P, Prieto B, García-García M, García-Hernández P, Martín-Sánchez FJ, Jacob J, Ríos J, Romero R, Gil V, Gayat É, Llorens P, Mebazaa A. The subset of patients with acute heart failure able to secrete relaxin-2 at pregnancy concentrations could have a longer survival: a pilot study. Biomarkers 2018; 23:573-579. [PMID: 29716428 DOI: 10.1080/1354750x.2018.1463564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate how many patients with acute heart failure (AHF) hypersecrete relaxin-2 concentrations similar to those of pregnant women and determine their long-term outcome. METHODS In consecutive AHF patients relaxin-2 was quantified by ELISA sandwich method. Patients were divided into pregnancy-like group (PLG, relaxin-2 ≥ 500 pg/mL) and control group (CG, relaxin-2 < 500 pg/mL). The primary outcome was all-cause death during follow-up. Secondary endpoints were prolonged hospitalisation (>10 days), combined endpoint (death, rehospitalisation, ED revisit) 30 days after discharge, and 30-day, one-year and three-year death rates. RESULTS We included 814 patients [81 (SD = 9) years; 53.0% women] followed during 1.9 (SD 2.8) years; 517 (63.5%) died. Twenty patients (2.5%) formed the PLG (median relaxin-2 = 1459 pg/mL; IQR = 1722) and 794 the CG (median = 26; IQR = 44). There was no interaction with variables included on adjustment (age, sex, ischaemic cardiomyopathy, NT-proBNP, glycaemia, and sodium). PLG patients did not have better short-term secondary endpoints, but did show a significantly lower three-year mortality [ORadjusted = 0.17 (0.05-0.5), p = 0.003]. CONCLUSIONS The small proportion of AHF patients achieving relaxin-2 concentrations similar to those observed in pregnancy may survive longer.
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Affiliation(s)
- Òscar Miró
- a Department of Emergency , Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona , Barcelona , Catalonia , Spain.,b The Global REsearch on Acute conditions Team (GREAT) network
| | - Pablo Herrero-Puente
- c Department of Emergency , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Belén Prieto
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - María García-García
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Pablo García-Hernández
- d Biochemistry Laboratory , Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (IISPA) , Oviedo , Spain
| | - Francisco J Martín-Sánchez
- e Department of Emergency , Hospital Clínico San Carlos, Universidad Complutense de Madrid , Madrid , Spain
| | - Javier Jacob
- f Department of Emergency , Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Catalonia , Spain
| | - José Ríos
- g Laboratory of Biostatistics and Epidemiology , Universitat Autonoma de Barcelona; Medical Statistics Core Facility, IDIBAPS, Hospital Clinic , Barcelona , Catalonia , Spain
| | - Rodolfo Romero
- h Department of Emergency Department , Hospital de Getafe , Madrid , Spain
| | - Víctor Gil
- a Department of Emergency , Hospital Clínic, Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, University of Barcelona , Barcelona , Catalonia , Spain
| | - Étienne Gayat
- b The Global REsearch on Acute conditions Team (GREAT) network.,i U942 INSERM, Department of Anesthesiology and Critical Care Medicine , Saint Louis Lariboisière University Hospital, Université Paris Diderot , Paris , France
| | - Pere Llorens
- j Department of Emergency, Home Hospitalization and Short Stay Unit , Hospital General de Alicante , Alicante , Spain
| | - Alexandre Mebazaa
- b The Global REsearch on Acute conditions Team (GREAT) network.,i U942 INSERM, Department of Anesthesiology and Critical Care Medicine , Saint Louis Lariboisière University Hospital, Université Paris Diderot , Paris , France
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18
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A validated UPLC-MS/MS method coupled with protein precipitation and ion exchange solid phase extraction for the quantitation of porcine relaxin B29 in dog plasma and its application to a pharmacokinetic study. Anal Bioanal Chem 2017; 409:6559-6565. [DOI: 10.1007/s00216-017-0604-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 12/28/2022]
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19
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Stewart DR. Concentración de relaxina en pacientes con insuficiencia cardiaca aguda. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Unemori E. Serelaxin in clinical development: past, present and future. Br J Pharmacol 2017; 174:921-932. [PMID: 28009437 DOI: 10.1111/bph.13695] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/18/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022] Open
Abstract
The availability of highly purified recombinant human relaxin, serelaxin, has allowed clinical trials to be conducted in several indications and the elucidation of its pharmacology in human subjects. These studies have demonstrated that serelaxin has unique haemodynamic properties that are likely to contribute to organ protection and long-term outcome benefits in acute heart failure. Clinical observations support its consideration for therapeutic use in other patient populations, including those with chronic heart failure, coronary artery disease, portal hypertension and acute renal failure. LINKED ARTICLES This article is part of a themed section on Recent Progress in the Understanding of Relaxin Family Peptides and their Receptors. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.10/issuetoc.
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21
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Relaxin Concentrations in Acute Heart Failure Patients. ACTA ACUST UNITED AC 2017; 70:516. [PMID: 28109848 DOI: 10.1016/j.rec.2016.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 11/21/2022]
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Wong ASY, Ho ENM, Kwok WH, Leung GNW, Shen Y, Qi RZ, Yue SK, Wan TSM. Identification of porcine relaxin in plasma by liquid chromatography-high resolution mass spectrometry. Drug Test Anal 2016; 9:1412-1420. [PMID: 27928890 DOI: 10.1002/dta.2143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/14/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
Affiliation(s)
- April S. Y. Wong
- Racing Laboratory; The Hong Kong Jockey Club; Sha Tin Racecourse Sha Tin N.T. Hong Kong, China
| | - Emmie N. M. Ho
- Racing Laboratory; The Hong Kong Jockey Club; Sha Tin Racecourse Sha Tin N.T. Hong Kong, China
| | - W. H. Kwok
- Racing Laboratory; The Hong Kong Jockey Club; Sha Tin Racecourse Sha Tin N.T. Hong Kong, China
| | - Gary N. W. Leung
- Racing Laboratory; The Hong Kong Jockey Club; Sha Tin Racecourse Sha Tin N.T. Hong Kong, China
| | - Yuehong Shen
- Division of Life Science; The Hong Kong University of Science and Technology; Hong Kong, China
| | - Robert Z. Qi
- Division of Life Science; The Hong Kong University of Science and Technology; Hong Kong, China
| | - Samuel K. Yue
- Minnesota Pain Center; Suite 122, 225 University Ave West St Paul MN 55103 USA
| | - Terence S. M. Wan
- Racing Laboratory; The Hong Kong Jockey Club; Sha Tin Racecourse Sha Tin N.T. Hong Kong, China
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Ghosh RK, Banerjee K, Tummala R, Ball S, Ravakhah K, Gupta A. Serelaxin in acute heart failure: Most recent update on clinical and preclinical evidence. Cardiovasc Ther 2016; 35:55-63. [DOI: 10.1111/1755-5922.12231] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Raktim Kumar Ghosh
- Department of Cardiovascular Medicine; St. Vincent Charity Medical Center; A Teaching Hospital affiliated to Case Western Reserve University; Cleveland OH USA
| | | | - Ramyashree Tummala
- Department of Internal Medicine; St. Vincent Charity Medical Center; A Teaching Hospital affiliated to Case Western Reserve University; Cleveland OH USA
| | - Somedeb Ball
- Department of Internal Medicine; St Francis Hospital and Medical Center; Hartford CT USA
| | - Keyvan Ravakhah
- Department of Internal Medicine; St. Vincent Charity Medical Center; A Teaching Hospital affiliated to Case Western Reserve University; Cleveland OH USA
| | - Anjan Gupta
- Department of Cardiovascular Medicine; St. Vincent Charity Medical Center; A Teaching Hospital affiliated to Case Western Reserve University; Cleveland OH USA
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24
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Sato N, Lam CSP, Teerlink JR, Greenberg BH, Tsutsui H, Oh BH, Zhang J, Lefkowitz M, Hua TA, Holbro T, Marshood M, Wang XL, Ge J. Evaluating the Efficacy, Safety, and Tolerability of Serelaxin When Added to Standard Therapy in Asian Patients With Acute Heart Failure: Design and Rationale of RELAX-AHF-ASIA Trial. J Card Fail 2016; 23:63-71. [PMID: 27825893 DOI: 10.1016/j.cardfail.2016.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acute heart failure (AHF), a common and growing health concern worldwide, is associated with high risk of post-discharge rehospitalization and mortality. Existing evidence indicates potential therapeutic benefits of serelaxin in Caucasian AHF patients, but corresponding data in Asians remain scarce. RELAX-AHF-ASIA, a multinational, randomized, double-blind, placebo-controlled, phase III trial, will evaluate the effects of serelaxin on symptom relief and clinical outcomes in Asian AHF patients, with the use of novel assessments. METHODS AND RESULTS Patients with AHF, systolic blood pressure ≥125 mm Hg, and mild to moderate renal dysfunction will be randomized within 16 hours of presentation to receive 48-hour intravenous infusion of 30 µg ⋅ kg-1 ⋅ d-1 serelaxin or placebo in addition to standard therapy. The composite primary end point includes: (1) treatment success (moderate/marked improvement in patient-reported dyspnea and physician-assessed signs of congestion on day 2); (2) treatment failure (in-hospital worsening of signs and/or symptoms of heart failure [HF] requiring intensification of intravenous HF therapy or mechanical ventilation, renal/circulatory support, rehospitalization due to HF/renal-failure, or death through day 5); and (3) unchanged status. Secondary end points include time to in-hospital worsening HF through day 5 and all-cause and cardiovascular deaths through day 180. CONCLUSIONS RELAX-AHF-ASIA, the largest randomized clinical trial in Asian AHF patients to date, has a novel composite primary end point and the potential to become a hallmark of AHF trials.
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Affiliation(s)
- Naoki Sato
- Cardiology and Intensive Care Unit, Nippon Medical School, Musashi-Kosugi Hospital, Kawasaki, Japan.
| | | | - John R Teerlink
- University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, Los Angeles, California
| | - Barry H Greenberg
- Division of Cardiology, University of California, San Diego, La Jolla, California
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, South Korea
| | - Jian Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | | | - Tsushung A Hua
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Miriam Marshood
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Xing Li Wang
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
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Pintalhao M, Castro‐Chaves P, Vasques‐Novoa F, Gonçalves F, Mendonça L, Fontes‐Carvalho R, Lourenço P, Almeida P, Leite‐Moreira A, Bettencourt P. Relaxin serum levels in acute heart failure are associated with pulmonary hypertension and right heart overload. Eur J Heart Fail 2016; 19:218-225. [DOI: 10.1002/ejhf.611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Mariana Pintalhao
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Paulo Castro‐Chaves
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Francisco Vasques‐Novoa
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Francisco Gonçalves
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
| | - Luís Mendonça
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Ricardo Fontes‐Carvalho
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
- Cardiology DepartmentGaia Hospital Centre Gaia Portugal
| | - Patrícia Lourenço
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
| | - Pedro Almeida
- Cardiology DepartmentSão João Hospital Centre Porto Portugal
| | - Adelino Leite‐Moreira
- Department of Physiology and Cardiothoracic SurgeryFaculty of Medicine, University of Porto Portugal
- Cardiovascular Research Centre Portugal
- Cardiothoracic Surgery DepartmentSão João Hospital Centre Porto Portugal
| | - Paulo Bettencourt
- Internal Medicine DepartmentSão João Hospital Centre Porto Portugal
- Cardiovascular Research Centre Portugal
- Department of Medicine, Faculty of MedicineUniversity of Porto Portugal
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Abstract
Outcomes for patients with acute heart failure remain suboptimal and treatments principally target improvement of symptoms. To date there has been no therapy approved for acute heart failure shown to improve mortality or readmission risk post-discharge. Serelaxin, a recombinant form of the naturally occurring polypeptide hormone relaxin, has demonstrated promise in preclinical and early clinical trials as a potentially novel therapy for acute heart failure. It is postulated through its anti-fibrotic and vasodilatory effects that this agent can improve outcomes in both the short and long term in these patients. Randomized clinical data has suggested that the medication is safe and well tolerated. However, definitive outcomes data is currently being assessed in a large multi-center trial.
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Affiliation(s)
- Danyaal S Moin
- a Division of Cardiology , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Michelle W Bloom
- a Division of Cardiology , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Lampros Papadimitriou
- a Division of Cardiology , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Javed Butler
- a Division of Cardiology , Stony Brook University School of Medicine , Stony Brook , NY , USA
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27
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Dahlke M, Halabi A, Canadi J, Tsubouchi C, Machineni S, Pang Y. Pharmacokinetics of serelaxin in patients with severe renal impairment or end-stage renal disease requiring hemodialysis: A single-dose, open-label, parallel-group study. J Clin Pharmacol 2015; 56:474-83. [PMID: 26239266 PMCID: PMC5063144 DOI: 10.1002/jcph.607] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 07/31/2015] [Indexed: 11/08/2022]
Abstract
Serelaxin, a recombinant human relaxin-2 hormone, is in clinical development for treating acute heart failure. This open-label, parallel-group study investigated serelaxin pharmacokinetics (PK) after a single 4-hour intravenous infusion (10 µg/kg) in patients with severe renal impairment (n = 6) or end-stage renal disease (ESRD) requiring hemodialysis (PK on the day of dialysis [n = 6] or during dialysis-free interval [n = 6]), compared with matched healthy subjects (n = 18). In all participants, serum serelaxin concentration peaked at the end of infusion and subsequently declined with mean terminal elimination half-life of 6.5-8.8 hours. Compared with healthy subjects, a moderate decrease in serelaxin systemic clearance (37%-52%) and increase in its exposure (30%-115%) were observed in all patients. During the 4-hour hemodialysis in ESRD patients, 30% serelaxin was removed, with hemodialysis clearance constituting approximately 52% of total systemic clearance. Serelaxin was well tolerated with no deaths, serious adverse events (AE), or AE-related discontinuations. Antiserelaxin antibodies were not detected in any participant. Given the shallow dose-response relationship observed with serelaxin in clinical studies and its wide therapeutic window, the observed PK differences in patients with severe renal impairment compared with healthy subjects are unlikely to pose a safety risk and do not warrant a predefined dosage adjustment in such patients.
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Affiliation(s)
| | - Atef Halabi
- Clinical Research Services GmbH, Kiel, Germany
| | | | | | | | - Yinuo Pang
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
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28
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Sato N, Takahashi W, Hirayama A, Ajioka M, Takahashi N, Okishige K, Wang X, Maki A, Maruyama H, Ebinger U, Yamaguchi M, Pang Y, Matsumoto H, Kawana M. Multicenter, Randomized, Double-Blinded, Placebo-Controlled Phase II Study of Serelaxin in Japanese Patients With Acute Heart Failure. Circ J 2015; 79:1237-47. [PMID: 25912697 DOI: 10.1253/circj.cj-15-0227] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Serelaxin, a recombinant form of human relaxin-2, is in development for treating acute heart failure (AHF) and a Phase II study in Japanese AHF patients was conducted. METHODS AND RESULTS A randomized, double-blind, placebo-controlled study of serelaxin at 10 and 30 µg·kg(-1)·day(-1)continuous intravenous infusion for up to 48 h, added to standard care for Japanese AHF patients. Primary endpoints were adverse events (AEs) through Day 5, serious AEs (SAEs) through Day 14, and serelaxin pharmacokinetics. Secondary endpoints included changes in systolic blood pressure (SBP) and cardiorenal biomarkers. A total of 46 patients received the study drug and were followed for 60 days. The observed AE profile was comparable between the groups, with no AEs of concern. Dose-dependent increase in the serum concentration of serelaxin was observed across the 2 dose rates of serelaxin. A greater reduction in SBP was observed with serelaxin 30 µg·kg(-1)·day(-1)vs. placebo (-7.7 [-16.4, 1.0] mmHg). A greater reduction in NT-proBNP was noted with serelaxin (-50.8% and -54.9% for 10 and 30 µg·kg(-1)·day(-1), respectively at Day 2). CONCLUSIONS Serelaxin was well tolerated in this study with Japanese AHF patients, with no AEs of concern and favorable beneficial trends on efficacy. These findings support further evaluation of serelaxin 30 µg·kg(-1)·day(-1)in this patient population.
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Affiliation(s)
- Naoki Sato
- Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital
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