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van Dijk MJ, Ruiter TJJ, van der Veen S, Rab MAE, van Oirschot BA, Bos J, Derichs C, Rijneveld AW, Cnossen MH, Nur E, Biemond BJ, Bartels M, Schutgens REG, van Solinge WW, Jans JJM, van Beers EJ, van Wijk R. Metabolic blood profile and response to treatment with the pyruvate kinase activator mitapivat in patients with sickle cell disease. Hemasphere 2024; 8:e109. [PMID: 38919958 PMCID: PMC11196954 DOI: 10.1002/hem3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/10/2024] [Accepted: 05/01/2024] [Indexed: 06/27/2024] Open
Abstract
Mitapivat is an investigational, oral, small-molecule allosteric activator of pyruvate kinase (PK). PK is a regulatory glycolytic enzyme that is key in providing the red blood cell (RBC) with sufficient amounts of adenosine triphosphate (ATP). In sickle cell disease (SCD), decreased 2,3-DPG levels increase the oxygen affinity of hemoglobin, thereby preventing deoxygenation and polymerization of sickle hemoglobin. The PK activator mitapivat has been shown to decrease levels of 2,3-DPG and increase levels of ATP in RBCs in patients with SCD. In this phase 2, investigator-initiated, open-label study (https://www.clinicaltrialsregister.eu/ NL8517; EudraCT 2019-003438-18), untargeted metabolomics was used to explore the overall metabolic effects of 8-week treatment with mitapivat in the dose-finding period. In total, 1773 unique metabolites were identified in dried blood spots of whole blood from ten patients with SCD and 42 healthy controls (HCs). The metabolic phenotype of patients with SCD revealed alterations in 139/1773 (7.8%) metabolites at baseline when compared to HCs (false discovery rate-adjusted p < 0.05), including increases of (derivatives of) polyamines, purines, and acyl carnitines. Eight-week treatment with mitapivat in nine patients with SCD altered 85/1773 (4.8%) of the total metabolites and 18/139 (12.9%) of the previously identified altered metabolites in SCD (unadjusted p < 0.05). Effects were observed on a broad spectrum of metabolites and were not limited to glycolytic intermediates. Our results show the relevance of metabolic profiling in SCD, not only to unravel potential pathophysiological pathways and biomarkers in multisystem diseases but also to determine the effect of treatment.
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Affiliation(s)
- Myrthe J. van Dijk
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Titine J. J. Ruiter
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Section Metabolic Diagnostics, Department of GeneticsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Sigrid van der Veen
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Section Metabolic Diagnostics, Department of GeneticsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Minke A. E. Rab
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- Department of Hematology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Brigitte A. van Oirschot
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Jennifer Bos
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Cleo Derichs
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Anita W. Rijneveld
- Department of Hematology, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's HospitalUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Erfan Nur
- Department of HematologyAmsterdam University Medical Center, University of AmsterdamAmsterdamThe Netherlands
- Department of Blood Cell Research, Sanquin ResearchAmsterdamThe Netherlands
| | - Bart J. Biemond
- Department of HematologyAmsterdam University Medical Center, University of AmsterdamAmsterdamThe Netherlands
| | - Marije Bartels
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Roger E. G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Wouter W. van Solinge
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Judith J. M. Jans
- Section Metabolic Diagnostics, Department of GeneticsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Eduard J. van Beers
- Center for Benign Hematology, Thrombosis and Hemostasis—Van CreveldkliniekUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | - Richard van Wijk
- Central Diagnostic Laboratory and ResearchUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
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Kuo KH. Pyruvate kinase activators: targeting red cell metabolism in thalassemia. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:114-120. [PMID: 38066911 PMCID: PMC10727068 DOI: 10.1182/hematology.2023000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Thalassemia is an inherited red blood cell disorder whereby the qualitative and/or quantitative imbalance in α- to β-globin ratio results in hemolysis and ineffective erythropoiesis. Oxidative stress, from the precipitated excess globin and free iron, is a major factor that drives hemolysis and ineffective erythropoiesis. Pyruvate kinase activity and adenosine triphosphate availability are reduced due to the overwhelmed cellular antioxidant system from the excessive oxidative stress. Mitapivat, a pyruvate kinase activator in development as a treatment for thalassemia, was shown to increase hemoglobin and reduce hemolysis in a small phase 2 single-arm trial of patients with α- and β-thalassemia. The ongoing phase 3 studies with mitapivat and the phase 2 study with etavopivat will examine the role of pyruvate kinase activators as disease modifying agents in thalassemia.
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Affiliation(s)
- Kevin H.M. Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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