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Prencipe F, Barzan C, Savian C, Spalluto G, Carosati E, De Amici M, Mosconi G, Gianferrara T, Federico S, Da Ros T. Gaucher Disease: A Glance from a Medicinal Chemistry Perspective. ChemMedChem 2024; 19:e202300641. [PMID: 38329692 DOI: 10.1002/cmdc.202300641] [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: 11/17/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/09/2024]
Abstract
Rare diseases are particular pathological conditions affecting a limited number of people and few drugs are known to be effective as therapeutic treatment. Gaucher disease, caused by a deficiency of the lysosomal enzyme glucocerebrosidase, belongs to this class of disorders, and it is considered the most common among the Lysosomal Storage Diseases. The two main therapeutic approaches are the Enzyme Replacement Therapy (ERT) and the Substrate Reduction Therapy (SRT). ERT, consisting in replacing the defective enzyme by administering a recombinant enzyme, is effective in alleviating the visceral symptoms, hallmarks of the most common subtype of the disease whereas it has no effects when symptoms involve CNS, since the recombinant protein is unable to significantly cross the Blood Brain Barrier. The SRT strategy involves inhibiting glucosylceramide synthase (GCS), the enzyme responsible for the production of the associated storage molecule. The rational design of new inhibitors of GCS has been hampered by the lack of either the crystal structure of the enzyme or an in-silico model of the active site which could provide important information regarding the interactions of potential inhibitors with the target, but, despite this, interesting results have been obtained and are herein reviewed.
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Affiliation(s)
- Filippo Prencipe
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Chiara Barzan
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
- Molecular Genetics Institute, CNR Via Abbiategrasso 207, 27100, Pavia, Italy
| | - Chiara Savian
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Giampiero Spalluto
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Emanuele Carosati
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Marco De Amici
- Department of Pharmaceutical Sciences, University of Milano Via Luigi Mangiagalli 25, 20133, Milano, Italy
| | - Giorgio Mosconi
- Fidia Farmaceutici Via Ponte della Fabbrica 3/A, 35021, Abano Terme, Italy
| | - Teresa Gianferrara
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Stephanie Federico
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
| | - Tatiana Da Ros
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via Licio Giorgieri 1, 34127, Trieste, Italy
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Feng S, Rcheulishvili N, Jiang X, Zhu P, Pan X, Wei M, Wang PG, Ji Y, Papukashvili D. A review on Gaucher disease: therapeutic potential of β-glucocerebrosidase-targeted mRNA/saRNA approach. Int J Biol Sci 2024; 20:2111-2129. [PMID: 38617529 PMCID: PMC11008270 DOI: 10.7150/ijbs.87741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Gaucher disease (GD), a rare hereditary lysosomal storage disorder, occurs due to a deficiency in the enzyme β-glucocerebrosidase (GCase). This deficiency leads to the buildup of substrate glucosylceramide (GlcCer) in macrophages, eventually resulting in various complications. Among its three types, GD2 is particularly severe with neurological involvements. Current treatments, such as enzyme replacement therapy (ERT), are not effective for GD2 and GD3 due to their inability to cross the blood-brain barrier (BBB). Other treatment approaches, such as gene or chaperone therapies are still in experimental stages. Additionally, GD treatments are costly and can have certain side effects. The successful use of messenger RNA (mRNA)-based vaccines for COVID-19 in 2020 has sparked interest in nucleic acid-based therapies. Remarkably, mRNA technology also offers a novel approach for protein replacement purposes. Additionally, self-amplifying RNA (saRNA) technology shows promise, potentially producing more protein at lower doses. This review aims to explore the potential of a cost-effective mRNA/saRNA-based approach for GD therapy. The use of GCase-mRNA/saRNA as a protein replacement therapy could offer a new and promising direction for improving the quality of life and extending the lifespan of individuals with GD.
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Affiliation(s)
- Shunping Feng
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Nino Rcheulishvili
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | | | - Pan Zhu
- Cheerland Biomedicine, Shenzhen, China
| | - Xuehua Pan
- Shenzhen Pengbo Biotech Co. Ltd, Shenzhen, China
| | - Meilan Wei
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Peng George Wang
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Yang Ji
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
| | - Dimitri Papukashvili
- Department of Pharmacology, School of Medicine, Southern University of Science and Technology, Shenzhen 518000, China
- Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
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3
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Serrano-Gonzalo I, de Frutos LL, Lahoz-Gil C, Delgado-Mateos F, Fernández-Galán MÁ, Morales-Conejo M, Calle-Gordo MV, Ibarretxe-Gerediaga D, Madinaveitia-Ochoa A, Albarracin-Arraigosa A, Balanzat-Muñoz J, Correcher-Medina P, García-Frade LJ, Hernández-Rivas JM, Labbadia F, López-Dupla JM, Lozano-Almela ML, Mora-Casterá E, Noya-Pereira MS, Ruíz-Guinaldo MÁ, Del Mar Tormo-Díaz M, Vitoria-Miñana I, Arévalo-Vargas I, Andrade-Campos M, Giraldo P. Real life data: follow-up assessment on Spanish Gaucher disease patients treated with eliglustat. TRAZELGA project. Orphanet J Rare Dis 2023; 18:390. [PMID: 38102667 PMCID: PMC10722815 DOI: 10.1186/s13023-023-02939-4] [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: 03/09/2023] [Accepted: 10/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The availability of multiple treatments for type 1 Gaucher disease increases the need for real-life studies to evaluate treatment efficacy and safety and provide clinicians with more information to choose the best personalized therapy for their patients. AIMS To determine whether treatment with eliglustat produces, in adult GD1 patients, ans optimal response in daily clinical practice. METHODS We designed a real-life study with 2 years of follow-up (TRAZELGA [GEE-ELI-2017-01]) to uniformly evaluate the response and adverse events to eliglustat treatment. This study, conducted in 30 patients across Spain and previously treated with other therapies, included the evaluation of safety and efficacy by assessing visceral enlargement, bone disease (DEXA and T and Z scores), concomitant treatments and adverse events, as well as a quality of life evaluation (SF-36). In addition, the quantification of classical biomarkers (chitotriosidase activity, CCL18/PARC and glucosylsphingosine (GluSph)) and new candidates for GD biomarkers (YKL-40, cathepsin S, hepcidin and lipocalin-2 determined by immunoassay) were also assessed. Non-parametric statistical analysis was performed and p < 0.05 was considered statistically significant. MAIN RESULTS Thirty patients were enrolled in the study. The median age was 41.5 years and the male-female ratio was 1.1:1. 84% of the patients had received ERT and 16% SRT as previous treatment. The most common symptoms at baseline were fatigue (42%) and bone pain (38%), no patient had a bone crisis during the study, and two years after switching, 37% had reduced their use of analgesics. Patient-reported outcomes showed a significant increase in physical function scores (p = 0.027) and physical pain scores (p = 0.010). None of the enrolled patients discontinued treatment due to adverse events, which were mild and transient in nature, mainly gastrointestinal and skin dryness. None of the biomarkers show a significant increase or decompensation after switching. CCL18/PARC (p = 0.0012), YKL-40 (p = 0.00004) and lipocalin-2 (p = 0.0155) improved after two years and GluSph after one year (p = 0.0008) and two years (p = 0.0245) of oral therapy. CONCLUSION In summary, this real-life study, showed that eliglustat maintains stability and can improve quality of life with few side effects. Significant reductions in classic and other novel biomarkers were observed after two years of therapy.
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Affiliation(s)
- Irene Serrano-Gonzalo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo de Investigación de Enfermedad de Gaucher (GIIS-012), Instituto de Investigación Sanitaria de Aragón, Saragossa, Spain
| | - Laura López de Frutos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
| | - Carlos Lahoz-Gil
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
| | - Francisco Delgado-Mateos
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Punta de Europa, Cádiz, Spain
| | - María Ángeles Fernández-Galán
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Virgen del Puerto, Plasencia, Spain
| | | | - María Victoria Calle-Gordo
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital de Torrecardenas, Almería, Spain
| | - Daiana Ibarretxe-Gerediaga
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca en Lípids i Arteriosclerosis, Hospital Universitari San Joan, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | | | | | - José Balanzat-Muñoz
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Can Misses, Ibiza, Spain
| | | | - Luis Javier García-Frade
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jesús María Hernández-Rivas
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Departamento de Medicina, Universidad de Salamanca and Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesca Labbadia
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital de La Vega Lorenzo Guirao, Murcia, Spain
| | | | - María Luisa Lozano-Almela
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital General Universitario Morales Meseguer, IMIB-Pascual Parrilla, CIBERER-U765, Murcia, Spain
| | - Elvira Mora-Casterá
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Soledad Noya-Pereira
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Teresa Herrera, A Coruña, Spain
| | - María Ángeles Ruíz-Guinaldo
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Comarcal Francesc de Borja, Valencia, Spain
| | - María Del Mar Tormo-Díaz
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
- Servicio de Hematología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Isidro Vitoria-Miñana
- Unidad de Nutrición y Metabolopatías, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Isidro Arévalo-Vargas
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo de Investigación de Enfermedad de Gaucher (GIIS-012), Instituto de Investigación Sanitaria de Aragón, Saragossa, Spain
| | - Marcio Andrade-Campos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain
| | - Pilar Giraldo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras lisosomales (FEETEG), Saragossa, Spain.
- Grupo Español de Enfermedades de Depósito Lisosomal (GEEDL), Sociedad Española de Hematología y Hemoterapia, Saragossa, Spain.
- Servicio de Hematología, Hospital QuirónSalud, Saragossa, Spain.
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Van Baelen A, Roosens L, Devos S, Verhulst S, Eyskens F. A new multiplex analysis of glucosylsphingosine and globotriaosylsphingosine in dried blood spots by tandem mass spectrometry. Mol Genet Metab Rep 2023; 37:100993. [PMID: 37649874 PMCID: PMC10462886 DOI: 10.1016/j.ymgmr.2023.100993] [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: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023] Open
Abstract
Background Gaucher's and Fabry's disease are two of the most common treatable lysosomal storage diseases, and have a wide spectrum of clinical symptoms. Early detection is important, because timely initiation of treatments can improve the disease status and prevent complications. However disease manifestations develop in childhood, diagnosis is delayed until adulthood partly due to the limitations of the currently used diagnostic pathway. The aim of this research is to develop and validate a multiplex assay and defining reference ranges, which do not exist at this moment, to improve and facilitate the entire diagnostic work up and enable treatment in an earlier stage of disease. Methods and findings Biomarkers glucosylsphingosine (GlcSph) and globotriaosylsphingosine (Lyso-Gb3) were detected and quantified using LC-MS/MS on dried blood spots. We developed an improved and new extraction method that allowed to measure GlcSph and Lyso-Gb3 in a multiplex analytical platform. After validation of the method, samples of 1480 individuals with normal enzymatic activity were collected to determine age and gender-related reference ranges.Our combination method showed a good linearity, precision, accuracy and limit of quantification with lack of carry-over following the specific international CLSI guidelines. The suggested protocol is robust, efficient, sensitive, specific, comprehensive and relatively cheap in order to accelerate the diagnostic process for both lysosomal storage diseases. The samples, with normal enzymatic activity, defined statistical relevant and clinical correct reference ranges for each specific age group by gender. Conclusion We report a multiplex LC-MS/MS method and relevant reference ranges that are appropriate for the targeted screening, diagnosis and follow-up of Fabry and Gaucher disease.
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Affiliation(s)
- Amber Van Baelen
- Center of Inherited Metabolic Diseases, UZA, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
- Pediatric Department, UZA, Antwerp, Belgium
| | | | | | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
- Pediatric Department, UZA, Antwerp, Belgium
| | - François Eyskens
- Center of Inherited Metabolic Diseases, UZA, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
- Pediatric Department, UZA, Antwerp, Belgium
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Giuffrida G, Markovic U, Condorelli A, Calafiore V, Nicolosi D, Calagna M, Grasso S, Ragusa MTV, Gentile J, Napolitano M. Glucosylsphingosine (Lyso-Gb1) as a reliable biomarker in Gaucher disease: a narrative review. Orphanet J Rare Dis 2023; 18:27. [PMID: 36782327 PMCID: PMC9926807 DOI: 10.1186/s13023-023-02623-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Gaucher disease (GD) is a rare, inherited, autosomal recessive disorder caused by a deficiency of the lysosomal enzyme, acid β-glucosidase. Its diagnosis is achieved via measurements of acid β-glucosidase activity in either fresh peripheral blood leukocytes or dried blood spots, and confirmed by identifying characteristic mutations in the GBA1 gene. Currently, several biomarkers are available for disease monitoring. Chitotriosidase has been used over the last 20 years to assess the severity of GD, but lacks specificity in GD patients. Conversely, the deacylated form of glucosylceramide, glucosylsphingosine (also known as lyso-Gb1), represents a more reliable biomarker characterized by its high sensitivity and specificity in GD. MAIN TEXT Herein, we review the current literature on lyso-Gb1 and describe evidence supporting its usefulness as a biomarker for diagnosing and evaluating disease severity in GD and monitoring treatment efficacy. CONCLUSION Lyso-Gb1 is the most promising biomarker of GD, as demonstrated by its reliability in reflecting disease burden and monitoring treatment response. Furthermore, lyso-Gb1 may play an important role in the onset of monoclonal gammopathy of uncertain significance, multiple myeloma, and Parkinson's disease in GD patients.
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Affiliation(s)
- Gaetano Giuffrida
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy.
| | - Uros Markovic
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy ,Oncohematology and BMT Unit, Mediterranean Institute of Oncology, Viagrande, Italy ,grid.10438.3e0000 0001 2178 8421Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Annalisa Condorelli
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy ,grid.8158.40000 0004 1757 1969Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Valeria Calafiore
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Daniela Nicolosi
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Marianna Calagna
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy ,grid.8158.40000 0004 1757 1969Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Stephanie Grasso
- grid.412844.f0000 0004 1766 6239Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | - Mariasanta Napolitano
- grid.10776.370000 0004 1762 5517Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Sahasrabudhe SA, Cheng S, Al‐Kofahi M, Jarnes JR, Weinreb NJ, Kartha RV. Physiologically-Based Pharmacokinetic Model Development, Validation, and Application for Prediction of Eliglustat Drug-Drug Interactions. Clin Pharmacol Ther 2022; 112:1254-1263. [PMID: 36056771 PMCID: PMC9828395 DOI: 10.1002/cpt.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/24/2022] [Indexed: 01/31/2023]
Abstract
Eliglustat is a glucosylceramide synthase inhibitor indicated as a long-term substrate reduction therapy for adults with type 1 Gaucher disease, a lysosomal rare disease. It is primarily metabolized by cytochrome P450 2D6 (CYP2D6), and variants in the gene encoding this enzyme are important determinants of eliglustat pharmacokinetics (PK) and drug-drug interactions (DDIs). The existing drug label addresses the DDIs to some extent but has omitted scenarios where both metabolizing CYPs (2D6 and 3A4) are mildly or moderately inhibited. The objectives of this study were (i) to develop and validate an eliglustat physiologically-based pharmacokinetic (PBPK) model with and without drug interactions, (ii) to simulate untested DDI scenarios, and (iii) to explore potential dosing flexibility using lower dose strength of eliglustat (commercially not available). PK data from healthy adults receiving eliglustat with or without interacting drugs were obtained from literature and used for the PBPK model development and validation. The model-predicted single-dose and steady-state maximum concentration (Cmax ) and area under the concentration-time curve (AUC) of eliglustat were within 50-150% of the observed values when eliglustat was administered alone or coadministered with ketoconazole or paroxetine. Then as model-based simulations, we illustrated eliglustat exposure as a victim of interaction when coadministered with fluvoxamine following the US Food and Drug Administration (FDA) dosing recommendations. Second, we showed that with lower eliglustat doses (21 mg, 42 mg once daily) the exposure in participants of intermediate and poor metabolizer phenotypes was within the outlined safety margin (Cmax <250 ng/mL) when eliglustat was administered with ketoconazole, where the current recommendation is a contraindication of coadministration (84 mg). The present study demonstrated that patients with CYP2D6 deficiency may benefit from lower doses of eliglustat.
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Affiliation(s)
- Siddhee A. Sahasrabudhe
- Center for Orphan Drug Research, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA,Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Shen Cheng
- Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA,Present address:
Metrum Research GroupTariffvilleConnecticutUSA
| | - Mahmoud Al‐Kofahi
- Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jeanine R. Jarnes
- Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Neal J. Weinreb
- Department of Human GeneticsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Reena V. Kartha
- Center for Orphan Drug Research, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA,Department of Experimental and Clinical Pharmacology, College of PharmacyUniversity of MinnesotaMinneapolisMinnesotaUSA
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7
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Istaiti M, Becker-Cohen M, Dinur T, Revel-Vilk S, Zimran A. Real-Life Experience with Oral Eliglustat in Patients with Gaucher Disease Previously Treated with Enzyme Replacement Therapy. J Clin Med 2022; 11:6265. [PMID: 36362492 PMCID: PMC9659144 DOI: 10.3390/jcm11216265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 08/21/2023] Open
Abstract
Three types of enzyme replacement therapies (ERTs) and two substrate reduction therapies (SRTs) are approved for symptomatic patients with type 1 Gaucher disease (GD1). Eliglustat is the second SRT approved, yet the first to be approved as first-line therapy for any adult patients with compatible CYP2D6 metabolizer genotype. Herein we report safety and efficacy data of the first 29 patients switched from ERT to eliglustat from the Gaucher Unit at Shaare Zedek Medical Center (SZMC) between 07/2017 and 06/2022; the median (range) time on ERT was 13 (0.66-30) years, and the median (range) time on eliglustat was 7 (1-52) months. Most patients switched due to oral preference or sub-optimal response to low-dose ERT. Twelve patients stopped eliglustat after a median (range) of 4 (1-18) months; 11 due to adverse events (AEs) and one due to personal request. There were no drug-related serious AEs and no drug-related cardiac events. Most AEs were mild and transient, mainly dyspepsia. Efficacy achievements were reflected by maintaining stability. We concluded that switching from ERT to eliglustat is safe if choosing the appropriate patients. Reassuring patients to tolerate early AEs may reduce discontinuation. Following the response and compliance to therapy is important to ensure long-term efficacy.
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Affiliation(s)
- Majdolen Istaiti
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | | | - Tama Dinur
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
| | - Ari Zimran
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University, Jerusalem 91120, Israel
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8
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Switching between Enzyme Replacement Therapies and Substrate Reduction Therapies in Patients with Gaucher Disease: Data from the Gaucher Outcome Survey (GOS). J Clin Med 2022; 11:jcm11175158. [PMID: 36079085 PMCID: PMC9457166 DOI: 10.3390/jcm11175158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022] Open
Abstract
Switching between enzyme replacement therapies (ERT) and substrate reduction therapies (SRT) in patients with type 1 Gaucher disease (GD1) is not uncommon; however, the reasons for switchng treatments have not been explored in detail. Data from the Gaucher Outcome Survey (GOS), an international registry for patients with confirmed GD, were used to evaluate the reasons for, and consequences of, switching between these treatment types. Of the 1843 patients enrolled in GOS on 25 February 2020, 245 had undergone a treatment switch: 222 from initial ERT to SRT (of whom 88 later switched back to ERT) and 23 from initial SRT to ERT. The most common reasons for ERT–SRT switching were duration of infusion (25.4%), drug shortage (22.0%), and adverse events (AEs; 11.9%), and for SRT–ERT switching, AEs (63.6%), lack of beneficial effect (16.4%), and participation in a clinical trial (9.1%). Bodyweight and hematologic parameters largely remained stable before and after switching between ERT and SRT, although with substantial variation between patients. These findings contribute to understanding why treatment switching occurs in patients with GD, and may help physicians recognize the real-world impact of treatment switching between ERT and SRT for patients with GD.
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