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Gras-Colomer E, Mangas-Sanjuán V, Martínez-Gómez MA, Climente-Martí M, Merino-Sanjuan M. Quantitative assessment of the exposure-efficacy relationship of glucocerebrosidase using Markovian elements in Gaucher patients treated with enzyme replacement therapy. Br J Clin Pharmacol 2021; 88:2727-2737. [PMID: 34957594 DOI: 10.1111/bcp.15198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/11/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS The aims of this study are (i) to develop a population pharmacokinetic model of enzyme activity in Gaucher-type 1 (GD1) patients after intravenous administration of enzyme replacement therapy (ERT) and, (ii) to establish an exposure-efficacy relationship for bone marrow infiltration to propose dose adjustments according to patient covariate values. MATERIALS AND METHODS A prospective follow-up, semi-experimental multi-centre study was conducted in four hospitals to evaluate the pharmacokinetics, efficacy and safety of ERT in GD1 patients. 25 individuals with 266 glucocerebrosidase (GCase) observations in plasma and leukocytes and 14 individuals with 68 Spanish Magnetic Resonance Imaging (S-MRI) observations were enrolled. RESULTS A two concatenated compartments with zero-order endogenous production and first-order distribution (CL1 =3.85 x10-1 L/d) and elimination (CL2 = 1.25 L/d) allowed to describe GCase observations in plasma and leucocytes, respectively. An exponential time-dependency (kT =6.14 x10-1 d-1 ) effect on CL1 was incorporated. The final exposure-efficacy model was a longitudinal logistic regression model with a first-order Markov element. An Emax function (EC50 =15.73 U/L and Emax=2.33) linked steady-state concentrations of GCase in leucocytes to the probability of transition across the different S-MRI stages. CONCLUSION A population pharmacokinetic model successfully characterized the leukocyte activity-time profiles of GCase following intravenous administration of ERT in GD1 patients together with an exposure-efficacy relationship in bone marrow using markovian elements. The information obtained from this study could be of high clinical relevance in individualization of ERT in GD1 patients, as this could lead to anticipate decision-making regarding clinical response in bone and optimal dosing strategy. NONSTANDARD ABBREVIATIONS: -2LL: -2xlog(likelihood); ERT: enzyme replacement therapy; GCase: glucocerebrosidase activity; GD1: Gaucher disease type 1; GOF: goodness-of-fit plots; IIV: inter-individual variability; NLME: non-linear mixed effects modelling; OFV: objective function value; pc-VPC: prediction-corrected visual predictive check; PK: pharmacokinetic; RSE: relative standard error; RUV: residual unexplained variability, S-MRI: Spanish Magnetic Resonance Imaging, TDM: therapeutic drug monitoring.
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Affiliation(s)
| | - Víctor Mangas-Sanjuán
- Department of Pharmacy Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Valencia, Spain.,Interuniversity Institute of Recognition Research Molecular and Technological Development
| | - María-Amparo Martínez-Gómez
- Pharmacy Department, University Hospital Doctor Peset of Valencia, Spain.,Foundation for the Promotion of Healthcare and Biomedical Research in the Valencian Community (FISABIO), Valencia, Spain
| | - Mónica Climente-Martí
- Department of Pharmacy Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Valencia, Spain.,Pharmacy Department, University Hospital Doctor Peset of Valencia, Spain
| | - Matilde Merino-Sanjuan
- Department of Pharmacy Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Valencia, Spain.,Interuniversity Institute of Recognition Research Molecular and Technological Development
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Huebner T, Scholl C, Steffens M. Cytogenetic and Biochemical Genetic Techniques for Personalized Drug Therapy in Europe. Diagnostics (Basel) 2021; 11:diagnostics11071169. [PMID: 34206978 PMCID: PMC8303692 DOI: 10.3390/diagnostics11071169] [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: 05/21/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
For many authorized drugs, accumulating scientific evidence supports testing for predictive biomarkers to apply personalized therapy and support preventive measures regarding adverse drug reactions and treatment failure. Here, we review cytogenetic and biochemical genetic testing methods that are available to guide therapy with drugs centrally approved in the European Union (EU). We identified several methods and combinations of techniques registered in the Genetic Testing Registry (GTR), which can be used to guide therapy with drugs for which pharmacogenomic-related information is provided in the European public assessment reports. Although this registry provides information on genetic tests offered worldwide, we identified limitations regarding standard techniques applied in clinical practice and the information on test validity rarely provided in the according sections.
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Benz J, Rufer AC, Huber S, Ehler A, Hug M, Topp A, Guba W, Hofmann EC, Jagasia R, Rodríguez Sarmiento RM. Novel β-Glucocerebrosidase Activators That Bind to a New Pocket at a Dimer Interface and Induce Dimerization. Angew Chem Int Ed Engl 2021; 60:5436-5442. [PMID: 33238058 DOI: 10.1002/anie.202013890] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/08/2022]
Abstract
Genetic, preclinical and clinical data link Parkinson's disease and Gaucher's disease and provide a rational entry point to disease modification therapy via enhancement of β-Glucocerebrosidase (GCase) activity. We discovered a new class of pyrrolo[2,3-b]pyrazine activators effecting both Vmax and Km. They bind to human GCase and increase substrate metabolism in the lysosome in a cellular assay. We obtained the first crystal structure for an activator and identified a novel non-inhibitory binding mode at the interface of a dimer, rationalizing the observed structure-activity relationship (SAR). The compound binds GCase inducing formation of a dimeric state at both endoplasmic reticulum (ER) and lysosomal pHs, as confirmed by analytical ultracentrifugation. Importantly, the pyrrolo[2,3-b]pyrazines have central nervous system (CNS) drug-like properties. Our findings are important for future drug discovery efforts in the field of GCase activation and provide a deeper mechanistic understanding of the requirements for enzymatic activation, pointing to the relevance of dimerization.
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Affiliation(s)
- Joerg Benz
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Arne C Rufer
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Sylwia Huber
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Andreas Ehler
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Melanie Hug
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Andreas Topp
- Lead Discovery, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Wolfgang Guba
- CADD, Roche Innovation Center Basel, Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Eva Carolina Hofmann
- Roche Pharma Research and Early Development, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Ravi Jagasia
- NRD, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
| | - Rosa María Rodríguez Sarmiento
- Medicinal Chemistry, Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070, Basel, Switzerland
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Benz J, Rufer AC, Huber S, Ehler A, Hug M, Topp A, Guba W, Hofmann EC, Jagasia R, Rodríguez Sarmiento RM. Novel β‐Glucocerebrosidase Activators That Bind to a New Pocket at a Dimer Interface and Induce Dimerization. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202013890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joerg Benz
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Arne C. Rufer
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Sylwia Huber
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Andreas Ehler
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Melanie Hug
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Andreas Topp
- Lead Discovery Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Wolfgang Guba
- CADD Roche Innovation Center Basel Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Eva Carolina Hofmann
- Roche Pharma Research and Early Development Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Ravi Jagasia
- NRD Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
| | - Rosa María Rodríguez Sarmiento
- Medicinal Chemistry Roche Pharma Research and Early Development (pRED) Roche Innovation Center Basel F. Hoffmann-La Roche Ltd. Grenzacherstrasse 124 4070 Basel Switzerland
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Torralba-Cabeza MÁ, Olivera-González S, Sierra-Monzón JL. The Importance of a Multidisciplinary Approach in the Management of a Patient with Type I Gaucher Disease. Diseases 2018; 6:diseases6030069. [PMID: 30049986 PMCID: PMC6164989 DOI: 10.3390/diseases6030069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 01/17/2023] Open
Abstract
Managing the multisystemic symptoms of type I Gaucher Disease (GD) requires a multidisciplinary team approach that includes disease-specific treatments, as well as supportive care. This involves a range of medical specialists, general practitioners, supportive care providers, and patients. Phenotype classification and the setting of treatment goals are important for optimizing the management of type I GD, and for providing personalized care. The ability to classify disease severity using validated measurement tools allows the standardization of patient monitoring, and the measurement of disease progression and treatment response. Defining treatment goals is useful to provide a benchmark for assessing treatment response and managing the expectations of patients and their families. Although treatment goals will vary depending on disease severity, they include the stabilization, improvement or reversal (if possible) of clinical manifestations. Enzyme replacement therapy (ERT) is the standard care for patients with type I GD, but a novel substrate reduction therapy (SRT), Eliglustat, has demonstrated safety and efficacy in selected patients. To ensure that treatment goals are being achieved, regular and comprehensive follow up are necessary.
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Affiliation(s)
- Miguel-Ángel Torralba-Cabeza
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
| | - Susana Olivera-González
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
| | - José-Luis Sierra-Monzón
- Aragon Health Research Institute (ISS Aragón), Department of Internal Medicine, Unit of Rare Disorders, "Lozano Blesa" University Hospital, 15th San Juan Bosco Avenue, 50009 Zaragoza, Spain.
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