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Funcke JB, Moepps B, Roos J, von Schnurbein J, Verstraete K, Fröhlich-Reiterer E, Kohlsdorf K, Nunziata A, Brandt S, Tsirigotaki A, Dansercoer A, Suppan E, Haris B, Debatin KM, Savvides SN, Farooqi IS, Hussain K, Gierschik P, Fischer-Posovszky P, Wabitsch M. Rare Antagonistic Leptin Variants and Severe, Early-Onset Obesity. N Engl J Med 2023; 388:2253-2261. [PMID: 37314706 DOI: 10.1056/nejmoa2204041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hormone absence or inactivity is common in congenital disease, but hormone antagonism remains controversial. Here, we characterize two novel homozygous leptin variants that yielded antagonistic proteins in two unrelated children with intense hyperphagia, severe obesity, and high circulating levels of leptin. Both variants bind to the leptin receptor but trigger marginal, if any, signaling. In the presence of nonvariant leptin, the variants act as competitive antagonists. Thus, treatment with recombinant leptin was initiated at high doses, which were gradually lowered. Both patients eventually attained near-normal weight. Antidrug antibodies developed in the patients, although they had no apparent effect on efficacy. No severe adverse events were observed. (Funded by the German Research Foundation and others.).
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Affiliation(s)
- Jan-Bernd Funcke
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Barbara Moepps
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Julian Roos
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Julia von Schnurbein
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Kenneth Verstraete
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Elke Fröhlich-Reiterer
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Katja Kohlsdorf
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Adriana Nunziata
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Stephanie Brandt
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Alexandra Tsirigotaki
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Ann Dansercoer
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Elisabeth Suppan
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Basma Haris
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Klaus-Michael Debatin
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Savvas N Savvides
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - I Sadaf Farooqi
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Khalid Hussain
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Peter Gierschik
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Pamela Fischer-Posovszky
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
| | - Martin Wabitsch
- From the Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine (J.-B.F., J.R., J.S., K.K., A.N., S.B., P.F.-P., M.W.), the Institute of Experimental and Clinical Pharmacology, Toxicology, and Pharmacology of Natural Products (B.M., P.G.), and the Department of Pediatrics and Adolescent Medicine (K.-M.D.), Ulm University Medical Center, Ulm, Germany; the Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas (J.-B.F.); the Unit for Structural Biology, Vlaams Instituut voor Biotechnologie (VIB) Center for Inflammation Research, Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium (K.V., A.T., A.D., S.N.S.); the Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria (E.F.-R., E.S.); the Division of Endocrinology, Department of Pediatrics, Sidra Medicine, Doha, Qatar (B.H., K.H.); and Wellcome Trust-Medical Research Council Institute of Metabolic Science and NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom (I.S.F.)
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Cheong EJY, Nair PC, Neo RWY, Tu HT, Lin F, Chiong E, Esuvaranathan K, Fan H, Szmulewitz RZ, Peer CJ, Figg WD, Chai CLL, Miners JO, Chan ECY. Slow-, Tight-Binding Inhibition of CYP17A1 by Abiraterone Redefines Its Kinetic Selectivity and Dosing Regimen. J Pharmacol Exp Ther 2020; 374:438-451. [PMID: 32554434 DOI: 10.1124/jpet.120.265868] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
Substantial evidence underscores the clinical efficacy of inhibiting CYP17A1-mediated androgen biosynthesis by abiraterone for treatment of prostate oncology. Previous structural analysis and in vitro assays revealed inconsistencies surrounding the nature and potency of CYP17A1 inhibition by abiraterone. Here, we establish that abiraterone is a slow-, tight-binding inhibitor of CYP17A1, with initial weak binding preceding the subsequent slow isomerization to a high-affinity CYP17A1-abiraterone complex. The in vitro inhibition constant of the final high-affinity CYP17A1-abiraterone complex ( ( K i * = 0.39 nM )yielded a binding free energy of -12.8 kcal/mol that was quantitatively consistent with the in silico prediction of -14.5 kcal/mol. Prolonged suppression of dehydroepiandrosterone (DHEA) concentrations observed in VCaP cells after abiraterone washout corroborated its protracted CYP17A1 engagement. Molecular dynamics simulations illuminated potential structural determinants underlying the rapid reversible binding characterizing the two-step induced-fit model. Given the extended residence time (42 hours) of abiraterone within the CYP17A1 active site, in silico simulations demonstrated sustained target engagement even when most abiraterone has been eliminated systemically. Subsequent pharmacokinetic-pharmacodynamic (PK-PD) modeling linking time-dependent CYP17A1 occupancy to in vitro steroidogenic dynamics predicted comparable suppression of downstream DHEA-sulfate at both 1000- and 500-mg doses of abiraterone acetate. This enabled mechanistic rationalization of a clinically reported PK-PD disconnect, in which equipotent reduction of downstream plasma DHEA-sulfate levels was achieved despite a lower systemic exposure of abiraterone. Our novel findings provide the impetus for re-evaluating the current dosing paradigm of abiraterone with the aim of preserving PD efficacy while mitigating its dose-dependent adverse effects and financial burden. SIGNIFICANCE STATEMENT: With the advent of novel molecularly targeted anticancer modalities, it is becoming increasingly evident that optimal dose selection must necessarily be predicated on mechanistic characterization of the relationships between target exposure, drug-target interactions, and pharmacodynamic endpoints. Nevertheless, efficacy has always been perceived as being exclusively synonymous with affinity-based measurements of drug-target binding. This work demonstrates how elucidating the slow-, tight-binding inhibition of CYP17A1 by abiraterone via in vitro and in silico analyses was pivotal in establishing the role of kinetic selectivity in mediating time-dependent CYP17A1 engagement and eventually downstream efficacy outcomes.
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Affiliation(s)
- Eleanor Jing Yi Cheong
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Pramod C Nair
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Rebecca Wan Yi Neo
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Ho Thanh Tu
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Fu Lin
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Edmund Chiong
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Kesavan Esuvaranathan
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Hao Fan
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Russell Z Szmulewitz
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Cody J Peer
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - William D Figg
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Christina Li Lin Chai
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - John O Miners
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
| | - Eric Chun Yong Chan
- Department of Pharmacy, Faculty of Science (E.J.Y.C., R.W.Y.N., H.T.T., C.L.L.C., E.C.Y.C.) and Department of Biological Sciences (H.F.), National University of Singapore, Singapore, Singapore; Department of Clinical Pharmacology and Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, Australia (P.C.N., J.O.M.); Bioinformatics Institute, Biotransformation Innovation Platform (BioTrans) (F.L.) and Bioinformatics Institute (H.F.), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Department of Surgery, National University Health System, Singapore, Singapore (E.C., K.E.); Department of Urology, National University Hospital, Singapore, Singapore (E.C., K.E.); Centre for Computational Biology, DUKE-NUS Medical School, Singapore, Singapore (H.F.); The University of Chicago, Chicago, Illinois (R.Z.S.); National Cancer Institute, Rockville, Maryland (C.J.P., W.D.F.); and National University Cancer Institute, Singapore (NCIS), NUH Medical Centre (NUHMC), Singapore, Singapore (E.C.Y.C.)
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