1
|
Oronsky B, Takahashi L, Gordon R, Cabrales P, Caroen S, Reid T. RRx-001: a chimeric triple action NLRP3 inhibitor, Nrf2 inducer, and nitric oxide superagonist. Front Oncol 2023; 13:1204143. [PMID: 37313460 PMCID: PMC10258348 DOI: 10.3389/fonc.2023.1204143] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
RRx-001 is a shape shifting small molecule with Fast Track designation for the prevention/amelioration of chemoradiation-induced severe oral mucositis (SOM) in newly diagnosed Head and Neck cancer. It has been intentionally developed or "engineered" as a chimeric single molecular entity that targets multiple redox-based mechanisms. Like an antibody drug conjugate (ADC), RRx-001 contains, at one end a "targeting" moiety, which binds to the NLRP3 inflammasome and inhibits it as well as Kelch-like ECH-associated protein 1 (KEAP1), the negative regulator of Nrf2, and, at the other end, a conformationally constrained, dinitro containing 4 membered ring, which fragments under conditions of hypoxia and reduction to release therapeutically active metabolites i.e., the payload. This "payload", which is delivered specifically to hypoperfused and inflamed areas, includes nitric oxide, nitric oxide related species and carbon-centered radicals. As observed with ADCs, RRx-001 contains a backbone amide "linker" attached to a binding site, which correlates with the Fab region of an antibody, and to the dinitroazetidine payload, which is microenvironmentally activated. However, unlike ADCs, whose large size impacts their pharmacokinetic properties, RRx-001 is a nonpolar small molecule that easily crosses cell membranes and the blood brain barrier (BBB) and distributes systemically. This short review is organized around the de novo design and in vivo pro-oxidant/pro-inflammatory and antioxidant/anti-inflammatory activity of RRx-001, which, in turn, depends on the reduced to oxidized glutathione ratio and the oxygenation status of tissues.
Collapse
Affiliation(s)
- Bryan Oronsky
- Drug Development, EpicentRx, Torrey Pines, CA, United States
| | - Lori Takahashi
- Drug Development, EpicentRx, Torrey Pines, CA, United States
| | - Richard Gordon
- Department of Translational Neuroscience, University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Pedro Cabrales
- Department of Bioengineering, University of California at San Diego, La Jolla, CA, United States
| | - Scott Caroen
- Drug Development, EpicentRx, Torrey Pines, CA, United States
| | - Tony Reid
- Drug Development, EpicentRx, Torrey Pines, CA, United States
| |
Collapse
|
2
|
Hammond TC, Lee RC, Oronsky B, Reid TR, Caroen S, Juarez TM, Gill J, Heng A, Kesari S. Clinical Course of Two Patients with COVID-19 Respiratory Failure After Administration of the Anticancer Small Molecule, RRx-001. Int Med Case Rep J 2022; 15:735-738. [PMID: 36545548 PMCID: PMC9762260 DOI: 10.2147/imcrj.s389690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Two critically ill COVID-19 infected patients, who had exhausted all available treatment options, were treated with the small-molecule RRx-001 with subsequent improvement. RRx-001, a first-in-class small molecule with anti-inflammatory, vascular normalizing and macrophage-repolarizing properties, has been safely administered 300+ patients in clinical trials. This is the first report of RRx-001 treatment of COVID-19.
Collapse
Affiliation(s)
- Terese Catherine Hammond
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Raymond C Lee
- Providence St. Johns Health Center, Santa Monica, CA, USA,Cardiovascular Thoracic Institute, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Bryan Oronsky
- EpicentRx, Inc., La Jolla, CA, USA,Correspondence: Bryan Oronsky, EpicentRx, Inc, 11099 North Torrey Pines Road, La Jolla, CA, 92037, USA, Tel +1 858 947-6635, Fax +1 858 724-3080, Email
| | | | | | | | - Jaya Gill
- Pacific Neuroscience Institute, Santa Monica, CA, USA
| | - Annie Heng
- John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Santosh Kesari
- Providence St. Johns Health Center, Santa Monica, CA, USA,John Wayne Cancer Institute, Santa Monica, CA, USA,Pacific Neuroscience Institute, Santa Monica, CA, USA
| |
Collapse
|
3
|
Oronsky B, Caroen S, Abrouk N, Reid TR. RRx-001 and the "Right stuff": Protection and treatment in outer space. LIFE SCIENCES IN SPACE RESEARCH 2022; 35:69-75. [PMID: 36336372 DOI: 10.1016/j.lssr.2022.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 05/09/2022] [Indexed: 06/16/2023]
Abstract
From antibiotics to aspirin to antimalarials and to anticancer agents, about half of the world's best-selling drugs are derived from nature. However, accelerating climatic disruption, habitat destruction, pollution, and biodiversity loss all negatively impact the potential of natural sources to continue to serve as repositories of novel pharmaceuticals. On that basis, the final frontier for drug development is perhaps not the rainforests, coral reefs, and other natural habitats but rather the aerospace industry with its virtually unlimited and inexhaustible man-made 'library' of potentially bioactive compounds. The first aerospace-sourced therapeutic to reach the clinic is RRx-001, an inhibitor of the NOD-like receptor - Nucleotide-binding oligomerization domain with Leucine rich Repeat and Pyrin domain (NLRP3) inflammasome in a Phase 3 trial for the treatment of small cell lung cancer (SCLC) and in a soon-to-start Phase 3 trial for protection against chemoradiotherapy-induced severe oral mucositis in first line head and neck cancer. As manned missions to the Moon, Mars, and asteroids as well as space tourism beckon, it is perhaps fitting that a compound like RRx-001, which is derived from 1,3,3-Trinitroazetidine (TNAZ), an explosive propellant for rockets, is a potential "all purpose" option to mitigate the major biomedical effects of space radiation exposures including cancer development and other tissue degenerations both within mission and after mission. This article highlights the promise of RRx-001 to attenuate the acute and late effects of radiation exposure on astronauts including the development of cancer.
Collapse
|
4
|
Oronsky B, Guo X, Wang X, Cabrales P, Sher D, Cannizzo L, Wardle B, Abrouk N, Lybeck M, Caroen S, Oronsky A, Reid TR. Discovery of RRx-001, a Myc and CD47 Downregulating Small Molecule with Tumor Targeted Cytotoxicity and Healthy Tissue Cytoprotective Properties in Clinical Development. J Med Chem 2021; 64:7261-7271. [PMID: 34043360 DOI: 10.1021/acs.jmedchem.1c00599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
After extensive screening of aerospace compounds in an effort to source a novel anticancer agent, RRx-001, a first-in-class dinitroazetidine small molecule, was selected for advancement into preclinical and clinical development. RRx-001 is a minimally toxic small molecule with a distinct chemical structure and mechanism of action. The paradox of RRx-001 is that it mediates both antitumor cytotoxicity and normal tissue protection. The question of exactly how RRx-001 does this, and by means of what mechanism(s), depending on the route of delivery, intravenous or intratumoral, are explored. RRx-001 is currently in phase 2 and 3 clinical trials for the treatment of multiple solid tumor malignancies and as a supportive care drug.
Collapse
Affiliation(s)
- Bryan Oronsky
- EpicentRx Inc., 11099 North Torrey Pines Road, Suite 160, La Jolla, California 92037, United States
| | - XiaoNing Guo
- SciClone Pharmaceuticals Co., Ltd., 22 Floor, Shanghai Central Plaza, No. 381 Middle Huaihai Road, Huangpu, Shanghai 200020, China
| | - XiaoHui Wang
- SciClone Pharmaceuticals Co., Ltd., 22 Floor, Shanghai Central Plaza, No. 381 Middle Huaihai Road, Huangpu, Shanghai 200020, China
| | - Pedro Cabrales
- Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, California 92093, United States
| | - David Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Road, Dallas, Texas 75390, United States
| | - Lou Cannizzo
- Department of Space Systems, Northrop Grumman Corporation, 2980 Fairview Park Drive, Falls Church, Virginia 22042, United States
| | - Bob Wardle
- Department of Space Systems, Northrop Grumman Corporation, 2980 Fairview Park Drive, Falls Church, Virginia 22042, United States
| | - Nacer Abrouk
- EpicentRx Inc., 11099 North Torrey Pines Road, Suite 160, La Jolla, California 92037, United States
| | - Michelle Lybeck
- EpicentRx Inc., 11099 North Torrey Pines Road, Suite 160, La Jolla, California 92037, United States
| | - Scott Caroen
- EpicentRx Inc., 11099 North Torrey Pines Road, Suite 160, La Jolla, California 92037, United States
| | - Arnold Oronsky
- InterWest Partners, 467 First Street, Suite 201, Los Altos, California 94022, United States
| | - Tony R Reid
- EpicentRx Inc., 11099 North Torrey Pines Road, Suite 160, La Jolla, California 92037, United States
| |
Collapse
|
5
|
Oronsky B, Knox S, Cabrales P, Oronsky A, Reid TR. Desperate Times, Desperate Measures: The Case for RRx-001 in the Treatment of COVID-19. Semin Oncol 2020; 47:305-308. [PMID: 32718560 PMCID: PMC7341953 DOI: 10.1053/j.seminoncol.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 01/10/2023]
Abstract
This article summarizes the likely attenuation properties of RRx-001 in COVID-19 based on its mechanism of action and the putative pathogenesis of the disease, which appears to activate inflammatory, oxidative, and immune cascades with the potential to culminate in acute respiratory distress syndrome, cytokine storm and death. An ongoing pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19 appears to present with 3 major patterns of clinical symptomatology: (1) mild upper respiratory tract infection, (2) non–life-threatening pneumonia, and (3) severe pneumonia and acute respiratory distress syndrome that initially manifest as a mild prodrome lasting for 7–8 days before rapid clinical and radiological deterioration requiring ICU transfer. RRx-001 is a targeted nitric oxide donor. This small molecule, which has been evaluated in multiple Phase 1–2 clinical trials for cancer as well as a Phase 3 clinical trial for the treatment of small cell lung cancer called REPLATINUM (NCT03699956), is minimally toxic and demonstrates clear evidence of antitumor activity. During the course of these clinical trials it was noted that the rate of chronic obstructive pulmonary disease exacerbation and pneumonia in actively smoking small cell lung cancer patients treated with RRx-001 is less than 1%. Due to extensive history of tobacco use, 40%–70% of patients with lung cancer have chronic obstructive pulmonary disease and the expected rate of pulmonary infection in this population is 50%–70%, which was not observed in RRx-001 clinical trials. Moreover, in preclinical studies of pulmonary hypertension, RRx-001 was found to be comparable with or more effective than the FDA approved agent, Bosentan. The potential pulmonary protective effects of RRx-001 in patients with recurrent lung infections coupled with preclinical models demonstrating RRx-001-mediated reversal of pulmonary hypertension suggests RRx-001 may have therapeutic activity in patients with acute respiratory symptoms due to COVID 19. Clinical trials have been initiated to confirm the hypothesis that RRx-001 may be repurposed to treat SARS-CoV-2 infection.
Collapse
|
6
|
Feng Q, Li Y, Wang N, Hao Y, Chang J, Wang Z, Zhang X, Zhang Z, Wang L. A Biomimetic Nanogenerator of Reactive Nitrogen Species Based on Battlefield Transfer Strategy for Enhanced Immunotherapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2002138. [PMID: 32468692 DOI: 10.1002/smll.202002138] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Currently, cell membrane is always utilized for the construction of biomimetic nanoparticles. By contrast, mimicking the intracellular activity seems more meaningful. Inspired by the specific killing mechanism of deoxy-hemoglobin (Hb) dependent drug (RRx-001) in hypoxic red blood cells (RBC), this work aims to develop an inner and outer RBC-biomimetic antitumor nanoplatform that replicates both membrane surface properties and intracellularly certain therapeutic mechanisms of RRx-001 in hypoxic RBC. Herein, RRx-001 and Hb are introduced into RBC membrane camouflaged TiO2 nanoparticles. Upon arrival at hypoxic tumor microenvironment (TME), the biomimetic nanoplatform (R@HTR) is activated and triggers a series of reactions to generate reactive nitrogen species (RNS). More importantly, the potent antitumor immunity and immunomodulatory function of RNS in TME are demonstrated. Such an idea would transfer the battlefield of RRx-001 from hypoxic RBC to hypoxic TME, enhancing its combat capability. As a proof of concept, this biomimetic nanoreactor of RNS exhibits efficient tumor regression and metastasis prevention. The battlefield transfer strategy would not only present meaningful insights for immunotherapy, but also realize substantial breakthroughs in biomimetic nanotechnology.
Collapse
Affiliation(s)
- Qianhua Feng
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
- Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, 450001, China
- Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou, Henan Province, 450001, China
- School of Chemistry and Molecular Engineering, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, China
| | - Yuzhen Li
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-Sen University, 132 Waihuan East Road, Guangzhou, 510006, China
| | - Ning Wang
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
| | - Yutong Hao
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
| | - Junbiao Chang
- School of Chemistry and Molecular Engineering, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, China
| | - Zeying Wang
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
| | - Xueli Zhang
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
| | - Zhenzhong Zhang
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
- Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, 450001, China
- Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou, Henan Province, 450001, China
| | - Lei Wang
- School of Pharmaceutical Sciences, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, P. R. China
- Collaborative Innovation Center of New Drug Research and Safety Evaluation, Zhengzhou, Henan Province, 450001, China
- Key Laboratory of Targeting Therapy and Diagnosis for Critical Diseases, Zhengzhou, Henan Province, 450001, China
| |
Collapse
|
7
|
Oronsky B, Carter CA, Caroen S, Scribner C, Oronsky A, Reid TR. RRx-001, a first-in-class small molecule inhibitor of MYC and a downregulator of CD47, is an "erythrophagoimmunotherapeutic". Oncoimmunology 2020; 9:1746172. [PMID: 33457091 PMCID: PMC7790525 DOI: 10.1080/2162402x.2020.1746172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The main mechanism of action of RRx-001, a pharmaceutically unprecedented sui generis Phase 3 small molecule that is derived from the aerospace industry, is clarified. RRx-001 has demonstrated anticancer activity through antiangiogenic, immune, epigenetic, antioxidant, apoptotic and nitric oxide (NO) pathways, resulting in its pleiomorphic description as an antiangiogenic/vascular normalizer.
Collapse
Affiliation(s)
- Bryan Oronsky
- Clinical and Scientific Department, EpicentRx, Inc, La Jolla, CA, USA
| | - Corey A Carter
- Clinical and Scientific Department, EpicentRx, Inc, La Jolla, CA, USA
| | - Scott Caroen
- Clinical and Scientific Department, EpicentRx, Inc, La Jolla, CA, USA
| | - Curtis Scribner
- Clinical and Scientific Department, EpicentRx, Inc, La Jolla, CA, USA
| | - Arnold Oronsky
- Clinical and Scientific Department, InterWest Partners, Menlo Park, CA, USA
| | - Tony R Reid
- Clinical and Scientific Department, EpicentRx, Inc, La Jolla, CA, USA
| |
Collapse
|
8
|
Cirrik S, Ugurel E, Aksu AC, Oronsky B, Cabrales P, Yalcin O. Nitrite may serve as a combination partner and a biomarker for the anti-cancer activity of RRx-001. Biorheology 2019; 56:221-235. [DOI: 10.3233/bir-190213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Elif Ugurel
- Koc University School of Medicine, , , Turkey
| | | | | | | | | |
Collapse
|
9
|
Oronsky B, Oronsky N, Cabrales P. Platelet inhibitory effects of the Phase 3 anticancer and normal tissue cytoprotective agent, RRx-001. J Cell Mol Med 2018; 22:5076-5082. [PMID: 30010241 PMCID: PMC6156345 DOI: 10.1111/jcmm.13791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023] Open
Abstract
The platelet inhibitory effects of the Phase 3 anticancer agent and nitric oxide (NO) donor, RRx-001, (1-bromoacetyl-3,3-dinitroazetidine) were examined ex vivo and compared with the diazeniumdiolate NO donor, diethylenetriamine NONOate (DETA-NONOate), which spontaneously releases nitric oxide in aqueous solution. In the absence of red blood cells and in a dose-dependent manner, DETA-NONOate strongly inhibited platelet aggregation induced by several stimuli (ADP, epinephrine and collagen) whereas RRx-001 only slightly inhibited platelet aggregation under the same conditions in a dose-dependent manner; these antiaggregant effects were blocked when both DETA-NONOate and RRx-001 were co-incubated with carboxy-PTIO (CPTIO 0.01-100 micromol), a widely accepted NO scavenger. However, in the presence of red blood cells from healthy human donors, RRx-001, which binds covalently to haemoglobin (Hb) and catalyses the production of NO from endogenous nitrite, more strongly inhibited the aggregation of platelets than DETA-NONOate in a dose-dependent manner likely because haemoglobin avidly scavenges nitric oxide and reduces its half-life; the RRx-001-mediated platelet inhibitory effect was increased in the presence of nitrite. The results of this study suggest that RRx-001-bound Hb (within RBCs) plays an important role in the bioconversion of NO2- to NO. , which makes RRx-001 a more physiologically relevant inhibitor of platelet aggregation than other nitric oxide donors, whose effects are attenuated in the presence of red blood cells. Therefore, RRx-001-mediated platelet inhibition is a potentially useful therapeutic property, especially in hypercoagulable cancer patients that are at an increased risk of thrombotic complications.
Collapse
Affiliation(s)
| | | | - Pedro Cabrales
- Department of Bioengineering, University of California San Diego, La Jolla, California
| |
Collapse
|