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Emson C, Han JK, Hopkins C, Asimus S, Cann JA, Chain D, Wu Y, Reddy Y, McCrae C, Cohen D, Kreindler JL, Werkström V, Jison M, Wagenmann M, Bachert C. Pharmacokinetics/pharmacodynamics of benralizumab in chronic rhinosinusitis with nasal polyps: Phase III, randomized, placebo-controlled OSTRO trial. Br J Clin Pharmacol 2024; 90:1952-1963. [PMID: 38715387 DOI: 10.1111/bcp.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS Benralizumab, a humanized, afucosylated monoclonal antibody against the interleukin 5 receptor, α subunit, causes rapid depletion of eosinophils by antibody-dependent cellular cytotoxicity. We investigated the pharmacokinetic and pharmacodynamic effects of benralizumab in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) from the phase III OSTRO trial. METHODS Patients received a placebo or 30 mg of benralizumab by subcutaneous injection every 8 weeks (first three doses every 4 weeks) to week 48; a subset of patients continued in an extended follow-up period to assess treatment durability to week 80. Serum benralizumab concentrations and blood eosinophil and basophil counts were assessed to week 80. Biomarker assessments were performed on nasal polyp tissue biopsies at week 56 and nasal lining fluid at weeks 24 and 56 to examine changes in immune cells and inflammatory mediators. RESULTS Among 185 patients in this analysis, 93 received benralizumab. Serum benralizumab concentrations reached a steady state by week 24 (median concentration 385.52 ng mL-1); blood eosinophils were almost fully depleted and blood basophils were reduced between weeks 16 and 56. Nasal polyp tissue eosinophils decreased with benralizumab from 57.6 cells mm-2 at baseline to 0 cells mm-2 at week 56 (P < .001 vs placebo), and tissue mast cells were numerically reduced. In nasal lining fluid, eosinophil-derived neurotoxin was significantly reduced at weeks 24 and 56 (P < .001) and interleukin-17 at week 56 (P < .05) with benralizumab. CONCLUSION Benralizumab treatment led to rapid, sustained, nearly complete depletion of eosinophils from blood and nasal polyp tissue in patients with CRSwNP.
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Affiliation(s)
| | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | | | | | | | | | - Yuling Wu
- AstraZeneca, Gaithersburg, Maryland, USA
| | - Yasa Reddy
- AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | - James L Kreindler
- Department of Medical Affairs, Vertex Pharmaceuticals, Boston, Massachusetts, USA
| | | | | | - Martin Wagenmann
- Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Claus Bachert
- University Hospital of Münster, Münster, Germany
- First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium
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Birkmann K, Jebbawi F, Waldern N, Hug S, Inversini V, Keller G, Holm A, Grest P, Canonica F, Schmid-Grendelmeier P, Fettelschoss-Gabriel A. Eosinophils Play a Surprising Leading Role in Recurrent Urticaria in Horses. Vaccines (Basel) 2024; 12:562. [PMID: 38932291 PMCID: PMC11209473 DOI: 10.3390/vaccines12060562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
Urticaria, independent of or associated with allergies, is commonly seen in horses and often shows a high reoccurrence rate. Managing these horses is discouraging, and efficient treatment options are lacking. Due to an incidental finding in a study on horses affected by insect bite hypersensitivity using the eosinophil-targeting eIL-5-CuMV-TT vaccine, we observed the prevention of reoccurring seasonal urticaria in four subsequent years with re-vaccination. In an exploratory case series of horses affected with non-seasonal urticaria, we aimed to investigate the role of eosinophils in urticaria. Skin punch biopsies for histology and qPCR of eosinophil associated genes were performed. Further, two severe, non-seasonal, recurrent urticaria-affected horses were vaccinated using eIL-5-CuMV-TT, and urticaria flare-up was followed up with re-vaccination for several years. Eotaxin-2, eotaxin-3, IL-5, CCR5, and CXCL10 showed high sensitivity and specificity for urticarial lesions, while eosinophils were present in 50% of histological tissue sections. The eIL-5-CuMV-TT vaccine reduced eosinophil counts in blood, cleared clinical signs of urticaria, and even prevented new episodes of urticaria in horses with non-seasonal recurrent urticaria. This indicates that eosinophils play a leading role in urticaria in horses, and targeting eosinophils offers an attractive new treatment option, replacing the use of corticosteroids.
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Affiliation(s)
- Katharina Birkmann
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Equine Department, Veterinary Faculty, Ludwig Maximilians University Munich LMU, Sonnenstrasse 14, 85764 Oberschleißheim, Germany
| | - Fadi Jebbawi
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Nina Waldern
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
| | - Sophie Hug
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
| | - Victoria Inversini
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Giulia Keller
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Anja Holm
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Central VetPharma Consultancy, Hauchsvej 7, 4180 Sorø, Denmark
| | - Paula Grest
- Vetsuisse Faculty, Institute of Veterinary Pathology, University of Zurich, Winterthurerstrasse 268, 8057 Zurich, Switzerland;
| | - Fabia Canonica
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Peter Schmid-Grendelmeier
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital Zurich, The Circle 59, 8058 Zurich-Airport, Switzerland
| | - Antonia Fettelschoss-Gabriel
- Evax AG, Im Binz 3, 8357 Guntershausen, Switzerland; (K.B.); (F.J.); (N.W.); (F.C.)
- Department of Dermatology, University Hospital Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland;
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
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Hussain M, Liu G. Eosinophilic Asthma: Pathophysiology and Therapeutic Horizons. Cells 2024; 13:384. [PMID: 38474348 PMCID: PMC10931088 DOI: 10.3390/cells13050384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is a prevalent chronic non-communicable disease, affecting approximately 300 million people worldwide. It is characterized by significant airway inflammation, hyperresponsiveness, obstruction, and remodeling. Eosinophilic asthma, a subtype of asthma, involves the accumulation of eosinophils in the airways. These eosinophils release mediators and cytokines, contributing to severe airway inflammation and tissue damage. Emerging evidence suggests that targeting eosinophils could reduce airway remodeling and slow the progression of asthma. To achieve this, it is essential to understand the immunopathology of asthma, identify specific eosinophil-associated biomarkers, and categorize patients more accurately based on the clinical characteristics (phenotypes) and underlying pathobiological mechanisms (endotypes). This review delves into the role of eosinophils in exacerbating severe asthma, exploring various phenotypes and endotypes, as well as biomarkers. It also examines the current and emerging biological agents that target eosinophils in eosinophilic asthma. By focusing on these aspects, both researchers and clinicians can advance the development of targeted therapies to combat eosinophilic pathology in severe asthma.
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Affiliation(s)
- Musaddique Hussain
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Gang Liu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Puzzovio PG, Levi-Schaffer F. The allergic effector unit: From basic science to drug-targetable mast cell-eosinophil interactions in patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3845-3846. [PMID: 34627540 DOI: 10.1016/j.jaip.2021.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/02/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Pier Giorgio Puzzovio
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Francesca Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, School of Pharmacy, Institute for Drug Research, Faculty of Medicine, the Hebrew University of Jerusalem, Jerusalem, Israel.
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