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Zhang Q, Li Y, Liu Y, Wang X, Yang Y, Shi L. The cGAS/STING signaling pathway is involved in sevoflurane induced neuronal necroptosis via regulating microglia M1 polarization. Cell Signal 2024; 119:111195. [PMID: 38688381 DOI: 10.1016/j.cellsig.2024.111195] [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: 03/06/2024] [Revised: 04/20/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE The specific mechanisms of sevoflurane-induced neurotoxicity are still undetermined. The aim of the current study was to investigate the role of the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling pathway in sevoflurane-induced neuronal necroptosis. METHODS BV2 microglial cells were divided into a control group and a 4% sevoflurane exposure group. Western blotting was used to detect expression of the M1 polarization marker inducible nitric oxide synthase (iNOS). RNA was collected for RNA sequencing analysis. After STING knockdown in microglia, western blotting was performed to examine expression of the pro-inflammatory markers CD16 and CD32. The tumor necrosis factor-α (TNF-α) level in media was detected using an enzyme-linked immunosorbent assay. BV2 microglia conditioned media was collected to incubate HT22 neuronal cells, and their cell activity was measured using a CCK8 assay. Calcium was observed by fluorescence. Western blotting was performed to evaluate receptor-interacting protein kinase 1 (RIPK1), RIPK3, and mixed lineage kinase domain-like (MLKL) expression. Neuronal necroptosis rate were detected using flow cytometry. RESULTS Sevoflurane exposure promoted microglial M1 polarization. The cGAS/STING pathway was screened and identified by RNA sequencing analysis of sevoflurane-exposed microglia and the control group. Compared with the control group, STING knockdown in microglia rescued the amoeboid morphology, inhibited TNF-α release, and significantly decreased iNOS, CD16, and CD32 expression. Moreover, calcium ions and necroptosis within neurons were decreased, and RIPK1, RIPK3, and p-MLKL expression was markedly decreased in microglia media culture with STING knockdown. CONCLUSION These results suggest that sevoflurane can regulate microglial M1 polarization by activating the cGAS/STING signaling pathway and increasing immune factor release, thus accelerating the neuronal necroptosis induced by calcium overload.
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Affiliation(s)
- Qi Zhang
- Department of Anesthesiology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Hebei 050031, China
| | - Yanan Li
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Hebei 050051, China
| | - Yanqin Liu
- Department of Anesthesiology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Hebei 050031, China
| | - Xin Wang
- Department of Neurology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Hebei 050031, China
| | - Yonghui Yang
- Department of Pathology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Hebei 050031, China.
| | - Lei Shi
- Department of Anesthesiology, Children's Hospital of Hebei Province Affiliated to Hebei Medical University, Hebei 050031, China.
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Chisari CG, Toscano S, D’Amico E, Lo Fermo S, Zanghì A, Arena S, Zappia M, Patti F. An update on the safety of treating relapsing-remitting multiple sclerosis. Expert Opin Drug Saf 2019; 18:925-948. [DOI: 10.1080/14740338.2019.1658741] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Clara G. Chisari
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Simona Toscano
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Emanuele D’Amico
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Salvatore Lo Fermo
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Aurora Zanghì
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Sebastiano Arena
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Mario Zappia
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - Francesco Patti
- Department “GF Ingrassia”, Section of Neurosciences, Multiple Sclerosis Center, University of Catania, Catania, Italy
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Physicochemical and Biological Examination of Two Glatiramer Acetate Products. Biomedicines 2019; 7:biomedicines7030049. [PMID: 31277332 PMCID: PMC6783967 DOI: 10.3390/biomedicines7030049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Abstract
Herein we compared 40 mg/mL lots of the active ingredient, glatiramer acetate, manufactured by Mylan/Natco to the active ingredient, glatiramer acetate in Copaxone (Teva Pharmaceuticals, Ltd., Netanya Israel) using physicochemical (PCC) methods and biological assays. No differences were seen between the Mylan/Natco and Teva lots with some low resolution release PCC assays (amino acid analysis, molecular weight distribution, interaction with Coomassie Brilliant Blue G-250). Changes in polydispersity between Mylan/Natco and Copaxone lots were found using size exclusion chromatography and the high resolution PCC method, known as Viscotek, and suggestive of a disparity in the homogeneity of mixture, with a shift towards high molecular weight polypeptides. Using RPLC-2D MALLS, 5 out of 8 Mylan/Natco lots fell outside the Copaxone range, containing a high molecular weight and high hydrophobicity subpopulation of polypeptides not found in Copaxone lots. Cation exchange chromatography showed differences in the surface charge distribution between the Copaxone and Mylan/Natco lots. The Mylan/Natco lots were found to be within Copaxone specifications for the EAE model, monoclonal and polyclonal binding assays and the in vitro cytotoxicity assay, however higher IL-2 secretion was shown for three Mylan/Natco lots in a potency assay. These observations provide data to inform the ongoing scientific discussion about the comparability of glatiramer acetate in Copaxone and follow-on products.
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Melamed-Gal S, Loupe P, Timan B, Weinstein V, Kolitz S, Zhang J, Funt J, Komlosh A, Ashkenazi N, Bar-Ilan O, Konya A, Beriozkin O, Laifenfeld D, Hasson T, Zeskind B, Hayden M, Nock S, Grossman I. Response to the Letter-to-the Editor by Cohen et al. concerning our eNeurologicalSci article, Melamed-Gal, et al. Physicochemical, biological, functional and toxicological characterization of the European follow-on glatiramer acetate product as compared with Copaxone. eNeurologicalSci 2018;12:19-30.https://doi.org/10.1016/j.ensci.2018.05.006. eNeurologicalSci 2018; 13:53-55. [PMID: 30547104 PMCID: PMC6284183 DOI: 10.1016/j.ensci.2018.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/17/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sigal Melamed-Gal
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Pippa Loupe
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Bracha Timan
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Vera Weinstein
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | | | | | | | - Arthur Komlosh
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Nurit Ashkenazi
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Oren Bar-Ilan
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Attila Konya
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Olga Beriozkin
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Daphna Laifenfeld
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Tal Hasson
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | | | - Michael Hayden
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Steffen Nock
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - Iris Grossman
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
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5
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Comi G, Nicoletti F, Canonico PL, Centonze D. Letter to the Editor Regarding: A Comprehensive Review on Copemyl ®. Neurol Ther 2018; 7:385-390. [PMID: 30415356 PMCID: PMC6283790 DOI: 10.1007/s40120-018-0115-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Giancarlo Comi
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Ferdinando Nicoletti
- Department of Physiology and Pharmacology, University of Rome "La Sapienza", Rome, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Pier Luigi Canonico
- DISCAFF Department, University of Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Diego Centonze
- Neurology and Neurorehabilitation Units, IRCCS Neuromed, Pozzilli, IS, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Melamed-Gal S, Loupe P, Timan B, Weinstein V, Kolitz S, Zhang J, Funt J, Komlosh A, Ashkenazi N, Bar-Ilan O, Konya A, Beriozkin O, Laifenfeld D, Hasson T, Krispin R, Molotsky T, Papir G, Sulimani L, Zeskind B, Liu P, Nock S, Hayden M, Gilbert A, Grossman I. Physicochemical, biological, functional and toxicological characterization of the European follow-on glatiramer acetate product as compared with Copaxone. eNeurologicalSci 2018; 12:19-30. [PMID: 30094354 PMCID: PMC6073084 DOI: 10.1016/j.ensci.2018.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/29/2018] [Indexed: 01/14/2023] Open
Abstract
For more than 20 years, Copaxone (glatiramer acetate, Teva), a non-biological complex drug, has been a safe and effective treatment option for multiple sclerosis. In 2016, a follow-on glatiramer acetate product (FOGA, Synthon) was approved in the EU. Traditional bulk-based methods and high-resolution assays were employed to evaluate the physicochemical, functional, and bio-recognition attributes, as well as the in vivo toxicity profile of the active substances in Copaxone and Synthon EU FOGA lots. These tests included quality control tests applied routinely in release of Copaxone lots, as well as additional characterization assays, gene expression studies and a rat toxicity study. Even though the Synthon FOGA was designed to copy and compete with Copaxone, the active substances were found to be similar in only 7 of the tested 14 (50%) methods (similar is defined as within approved specifications or within the inherent microheterogeneity range of tested Copaxone batches, or not showing statistically significant differences). With additional methods applied, consistent compositional differences in attributes of surface charge distribution, molecular size, and spatial arrangement were observed. These marked differences were concordantly observed with higher biological activity of some of the Synthon EU FOGA lots compared with Copaxone lots, including potency and cytotoxicity activities as well as gene expression of pathways that regulate apoptosis, IL-2, and inflammation signaling. These observations raise concerns for immunogenicity differences, particularly in (repeated) substitution settings. Another orthogonal finding demonstrated increased frequency of injection-site local toxicity observations for the Synthon EU FOGA in an in vivo daily dosing rat study, thus warranting further qualification of the link between compositional and functional differences in immunogenicity, and potential impact on long-term efficacy and safety.
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Affiliation(s)
- S. Melamed-Gal
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - P. Loupe
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - B. Timan
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - V. Weinstein
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - S. Kolitz
- Immuneering Corporation, Boston, MA, USA
| | - J. Zhang
- Immuneering Corporation, Boston, MA, USA
| | - J. Funt
- Immuneering Corporation, Boston, MA, USA
| | - A. Komlosh
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - N. Ashkenazi
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - O. Bar-Ilan
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - A. Konya
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - O. Beriozkin
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - D. Laifenfeld
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - T. Hasson
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - R. Krispin
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - T. Molotsky
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - G. Papir
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - L. Sulimani
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - B. Zeskind
- Immuneering Corporation, Boston, MA, USA
| | - P. Liu
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - S. Nock
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - M.R. Hayden
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - A. Gilbert
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
| | - I. Grossman
- Global Research and Development, Teva Pharmaceutical Industries, Netanya, Israel
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7
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D Alessandro J, Garofalo K, Zhao G, Honan C, Duffner J, Capila I, Fier I, Kaundinya G, Kantor D, Ganguly T. Demonstration of Biological and Immunological Equivalence of a Generic Glatiramer Acetate. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2018; 16:714-723. [PMID: 28240190 PMCID: PMC5684786 DOI: 10.2174/1871527316666170223162747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In April 2015, the US Food and Drug Administration approved the first generic glatiramer acetate, Glatopa® (M356), as fully substitutable for Copaxone® 20 mg/mL for relapsing forms of multiple sclerosis (MS). This approval was accomplished through an Abbreviated New Drug Application that demonstrated equivalence to Copaxone. METHOD This article will provide an overview of the methods used to establish the biological and immunological equivalence of the two glatiramer acetate products, including methods evaluating antigenpresenting cell (APC) biology, T-cell biology, and other immunomodulatory effects. RESULTS In vitro and in vivo experiments from multiple redundant orthogonal assays within four biological processes (aggregate biology, APC biology, T-cell biology, and B-cell biology) modulated by glatiramer acetate in MS established the biological and immunological equivalence of Glatopa and Copaxone and are described. The following were observed when comparing Glatopa and Copaxone in these experiments: equivalent delays in symptom onset and reductions in "disease" intensity in experimental autoimmune encephalomyelitis; equivalent dose-dependent increases in Glatopa- and Copaxone- induced monokine-induced interferon-gamma release from THP-1 cells; a shift to a T helper 2 phenotype resulting in the secretion of interleukin (IL)-4 and downregulation of IL-17 release; no differences in immunogenicity and the presence of equivalent "immunofingerprints" between both versions of glatiramer acetate; and no stimulation of histamine release with either glatiramer acetate in basophilic leukemia 2H3 cell lines. CONCLUSION In summary, this comprehensive approach across different biological and immunological pathways modulated by glatiramer acetate consistently supported the biological and immunological equivalence of Glatopa and Copaxone.
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Affiliation(s)
| | - Kevin Garofalo
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Ganlin Zhao
- Division of Bioequivalence I, Office of Generic Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD. United States
| | - Christopher Honan
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Jay Duffner
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Ishan Capila
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Ian Fier
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Ganesh Kaundinya
- Research Department, Momenta Pharmaceuticals, Inc., Cambridge, MA. United States
| | - Daniel Kantor
- Division of Neurology, Florida Atlantic University, Boca Raton, FL. United States
| | - Tanmoy Ganguly
- Momenta Pharmaceuticals, Inc., 675 West Kendall Street, Cambridge, MA 02142. United States
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Grossman I, Kolitz S, Komlosh A, Zeskind B, Weinstein V, Laifenfeld D, Gilbert A, Bar-Ilan O, Fowler KD, Hasson T, Konya A, Wells-Knecht K, Loupe P, Melamed-Gal S, Molotsky T, Krispin R, Papir G, Sahly Y, Hayden MR. Compositional differences between Copaxone and Glatopa are reflected in altered immunomodulation ex vivo in a mouse model. Ann N Y Acad Sci 2017; 1407:75-89. [PMID: 29168242 DOI: 10.1111/nyas.13547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/06/2017] [Accepted: 10/15/2017] [Indexed: 12/30/2022]
Abstract
Copaxone (glatiramer acetate, GA), a structurally and compositionally complex polypeptide nonbiological drug, is an effective treatment for multiple sclerosis, with a well-established favorable safety profile. The short antigenic polypeptide sequences comprising therapeutically active epitopes in GA cannot be deciphered with state-of-the-art methods; and GA has no measurable pharmacokinetic profile and no validated pharmacodynamic markers. The study reported herein describes the use of orthogonal standard and high-resolution physicochemical and biological tests to characterize GA and a U.S. Food and Drug Administration-approved generic version of GA, Glatopa (USA-FoGA). While similarities were observed with low-resolution or destructive tests, differences between GA and USA-FoGA were measured with high-resolution methods applied to an intact mixture, including variations in surface charge and a unique, high-molecular-weight, hydrophobic polypeptide population observed only in some USA-FoGA lots. Consistent with published reports that modifications in physicochemical attributes alter immune-related processes, genome-wide expression profiles of ex vivo activated splenocytes from mice immunized with either GA or USA-FoGA showed that 7-11% of modulated genes were differentially expressed and enriched for immune-related pathways. Thus, differences between USA-FoGA and GA may include variations in antigenic epitopes that differentially activate immune responses. We propose that the assays reported herein should be considered during the regulatory assessment process for nonbiological complex drugs such as GA.
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Affiliation(s)
- Iris Grossman
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Sarah Kolitz
- Immuneering Corporation, Cambridge, Massachusetts
| | - Arthur Komlosh
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | | | - Vera Weinstein
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Daphna Laifenfeld
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Adrian Gilbert
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Oren Bar-Ilan
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | | | - Tal Hasson
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Attila Konya
- Teva Pharmaceutical Works Ltd., Gödöllő, Hungary
| | - Kevin Wells-Knecht
- Research and Development, Teva Pharmaceutical Industries, West Chester, Pennsylvania
| | - Pippa Loupe
- Research and Development, Teva Pharmaceutical Industries, Overland Park, Kansas
| | - Sigal Melamed-Gal
- Research and Development, Teva Pharmaceutical Industries, Frazer, Pennsylvania
| | - Tatiana Molotsky
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Revital Krispin
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Galia Papir
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Yousif Sahly
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
| | - Michael R Hayden
- Research and Development, Teva Pharmaceutical Industries, Petach Tikva, Israel
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Ross CJ, Towfic F, Shankar J, Laifenfeld D, Thoma M, Davis M, Weiner B, Kusko R, Zeskind B, Knappertz V, Grossman I, Hayden MR. A pharmacogenetic signature of high response to Copaxone in late-phase clinical-trial cohorts of multiple sclerosis. Genome Med 2017; 9:50. [PMID: 28569182 PMCID: PMC5450152 DOI: 10.1186/s13073-017-0436-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/08/2017] [Indexed: 01/18/2023] Open
Abstract
Background Copaxone is an efficacious and safe therapy that has demonstrated clinical benefit for over two decades in patients with relapsing forms of multiple sclerosis (MS). On an individual level, patients show variability in their response to Copaxone, with some achieving significantly higher response levels. The involvement of genes (e.g., HLA-DRB1*1501) with high inter-individual variability in Copaxone’s mechanism of action (MoA) suggests the potential contribution of genetics to treatment response. This study aimed to identify genetic variants associated with Copaxone response in patient cohorts from late-phase clinical trials. Methods Single nucleotide polymorphisms (SNPs) associated with high and low levels of response to Copaxone were identified using genome-wide SNP data in a discovery cohort of 580 patients from two phase III clinical trials of Copaxone. Multivariable Bayesian modeling on the resulting SNPs in an expanded discovery cohort with 1171 patients identified a multi-SNP signature of Copaxone response. This signature was examined in 941 Copaxone-treated MS patients from seven independent late-phase trials of Copaxone and assessed for specificity to Copaxone in 310 Avonex-treated and 311 placebo-treated patients, also from late-phase trials. Results A four-SNP signature consisting of rs80191572 (in UVRAG), rs28724893 (in HLA-DQB2), rs1789084 (in MBP), and rs139890339 (in ZAK(CDCA7)) was identified as significantly associated with Copaxone response. Copaxone-treated signature-positive patients had a greater reduction in annualized relapse rate (ARR) compared to signature-negative patients in both discovery and independent cohorts, an effect not observed in Avonex-treated patients. Additionally, signature-positive placebo-treated cohorts did not show a reduction in ARR, demonstrating the predictive as opposed to prognostic nature of the signature. A 10% subset of patients, delineated by the signature, showed marked improvements across multiple clinical parameters, including ARR, MRI measures, and higher proportion with no evidence of disease activity (NEDA). Conclusions This study is the largest pharmacogenetic study in MS reported to date. Gene regions underlying the four-SNP signature have been linked with pathways associated with either Copaxone’s MoA or the pathophysiology of MS. The pronounced association of the four-SNP signature with clinical improvements in a ~10% subset of the MS patient population demonstrates the complex interplay of immune mechanisms and the individualized nature of response to Copaxone. Electronic supplementary material The online version of this article (doi:10.1186/s13073-017-0436-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin J Ross
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | | | | | | | | | | | - Iris Grossman
- Teva Pharmaceutical Industries Ltd, Petach Tikva, Israel.
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10
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Grossman I, Knappertz V, Laifenfeld D, Ross C, Zeskind B, Kolitz S, Ladkani D, Hayardeny L, Loupe P, Laufer R, Hayden M. Pharmacogenomics strategies to optimize treatments for multiple sclerosis: Insights from clinical research. Prog Neurobiol 2017; 152:114-130. [DOI: 10.1016/j.pneurobio.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 02/10/2016] [Accepted: 02/27/2016] [Indexed: 12/13/2022]
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Hussaarts L, Mühlebach S, Shah VP, McNeil S, Borchard G, Flühmann B, Weinstein V, Neervannan S, Griffiths E, Jiang W, Wolff-Holz E, Crommelin DJA, de Vlieger JSB. Equivalence of complex drug products: advances in and challenges for current regulatory frameworks. Ann N Y Acad Sci 2017; 1407:39-49. [PMID: 28445611 DOI: 10.1111/nyas.13347] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/09/2017] [Indexed: 12/18/2022]
Abstract
Biotechnology and nanotechnology provide a growing number of innovator-driven complex drug products and their copy versions. Biologics exemplify one category of complex drugs, but there are also nonbiological complex drug products, including many nanomedicines, such as iron-carbohydrate complexes, drug-carrying liposomes or emulsions, and glatiramoids. In this white paper, which stems from a 1-day conference at the New York Academy of Sciences, we discuss regulatory frameworks in use worldwide (e.g., the U.S. Food and Drug Administration, the European Medicines Agency, the World Health Organization) to approve these complex drug products and their follow-on versions. One of the key questions remains how to assess equivalence of these complex products. We identify a number of points for which consensus was found among the stakeholders who were present: scientists from innovator and generic/follow-on companies, academia, and regulatory bodies from different parts of the world. A number of topics requiring follow-up were identified: (1) assessment of critical attributes to establish equivalence for follow-on versions, (2) the need to publish scientific findings in the public domain to further progress in the field, (3) the necessity to develop worldwide consensus regarding nomenclature and labeling of these complex products, and (4) regulatory actions when substandard complex drug products are identified.
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Affiliation(s)
| | | | - Vinod P Shah
- Pharmaceutical Consultant, North Potomac, Maryland
| | - Scott McNeil
- Nanotechnology Characterization Laboratory, Frederick, Maryland
| | - Gerrit Borchard
- University of Geneva-University of Lausanne, Geneva, Switzerland
| | | | | | | | - Elwyn Griffiths
- Member of the WHO Advisory Panel on Biological Standardization, Kingston upon Thames, Surrey, United Kingdom
| | - Wenlei Jiang
- United States Food and Drug Administration, Silver Spring, Maryland
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12
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Crommelin DJA, Broich K, Holloway C, Meesen B, Lizrova Preiningerova J, Prugnaud JL, Silva-Lima B. The regulator’s perspective: How should new therapies and follow-on products for MS be clinically evaluated in the future? Mult Scler 2016; 22:47-59. [DOI: 10.1177/1352458516650744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/23/2016] [Indexed: 11/16/2022]
Abstract
Background: Although there is still no cure for multiple sclerosis (MS), the introduction of several innovative drugs with modes of action different from that of the existing drug arsenal and the progress in monitoring disease progression by imaging and using biomarkers are currently causing a knowledge surge. This provides opportunities for improving patient disease management. New therapies are also under development and pose challenges to the regulatory bodies regarding the optimal design of clinical trials with more patient-focused clinical endpoints. Moreover, with the upcoming patent expiry of some of the key first-line MS treatments in Europe, regulatory bodies will also face the challenge of recommending marketing authorisation for generic and abridged versions based on appropriate requirements for demonstrating equality/similarity to the innovator’s product. Objective: The goal of this article is to improve the understanding of the relevant guidance documents of the European Medicines Agency (EMA) on clinical investigation of medicinal products and to highlight the issues that the agency will need to clarify regarding follow-on products of first-line MS treatments. Conclusion: Today, it is clear that close collaboration between patients, healthcare professionals, regulatory bodies and industry is crucial for developing new safe and effective drugs, which satisfy the needs of MS patients.
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Affiliation(s)
- Daan JA Crommelin
- Department of Pharmaceutics, Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Sciences, Utrecht University, Utrecht, The Netherlands
| | - Karl Broich
- President and Head of the Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Germany
| | - Chris Holloway
- European Regulatory Consultant, Chief Scientific Officer of ERA Consulting GmbH, Walsrode, Germany
| | - Bianca Meesen
- Managing Director at Ismar Healthcare, Lier, Belgium
| | - Jana Lizrova Preiningerova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jean-Louis Prugnaud
- Expert Involved in the Development of Recommendations Related to Drug Registrations, Paris, France
| | - Beatriz Silva-Lima
- iMed.ULisboa, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
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Functional effects of the antigen glatiramer acetate are complex and tightly associated with its composition. J Neuroimmunol 2016; 290:84-95. [DOI: 10.1016/j.jneuroim.2015.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 11/23/2022]
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14
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Luxenhofer R. Polymers and nanomedicine: considerations on variability and reproducibility when combining complex systems. Nanomedicine (Lond) 2015; 10:3109-19. [DOI: 10.2217/nnm.15.139] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hot topics in polymer science in the recent years and decades included macromolecular engineering enabled by controlled and living polymerization, use of polymers in biomedical applications. Control over polymerization and the structure of polymers increased tremendously. Despite the increased control over various polymerization techniques, polymers are intrinsically statistical in nature leading to a structural variability. As researchers combine polymers and biological systems, we combine two complex systems. Interestingly though, only the study of biological assays is subject to systematic scrutiny with respect to their reproducibility and variability. Here, it is argued that polymer synthesis should also be considered with systematic variability analysis, in particular in connection with downstream processes such as biological assays.
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Affiliation(s)
- Robert Luxenhofer
- Functional Polymer Materials, Chair for Chemical Technology of Materials Synthesis, University Würzburg, Röntgenring 11, 97070 Würzburg, Germany
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