1
|
Rudra A, Li J, Shakur R, Bhagchandani S, Langer R. Trends in Therapeutic Conjugates: Bench to Clinic. Bioconjug Chem 2020; 31:462-473. [PMID: 31990184 DOI: 10.1021/acs.bioconjchem.9b00828] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In recent years, therapeutic conjugates have attracted considerable attention as a new class of drug due to their unique pharmacological properties, especially from the pharmaceutical community. Their molecular structure tunability, improved targeting specificity, and therapeutic efficacy have been demonstrated in a wide range of research and clinical applications. In this topical review, we summarize selected recent advances in bioconjugation strategies for the development of therapeutic conjugates, their emerging application in clinical settings, as well as perspectives on the direction of future research.
Collapse
Affiliation(s)
- Arnab Rudra
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Junwei Li
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Rameen Shakur
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Sachin Bhagchandani
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Robert Langer
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115, United States.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States.,Harvard and MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| |
Collapse
|
2
|
Oldenburg J, Young G, Santagostino E, Escuriola Ettingshausen C. The importance of inhibitor eradication in clinically complicated hemophilia A patients. Expert Rev Hematol 2018; 11:857-862. [DOI: 10.1080/17474086.2018.1521718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Guy Young
- Hemostasis and Thrombosis Center Children’s Hospital, Los Angeles, CA, USA
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Elena Santagostino
- Foundation IRCCS Ca' Granda, Maggiore Hospital Policlinico, Milan, Italy
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | | |
Collapse
|
3
|
D'Angiolella LS, Cortesi PA, Rocino A, Coppola A, Hassan HJ, Giampaolo A, Solimeno LP, Lafranconi A, Micale M, Mangano S, Crotti G, Pagliarin F, Cesana G, Mantovani LG. The socioeconomic burden of patients affected by hemophilia with inhibitors. Eur J Haematol 2018; 101:435-456. [DOI: 10.1111/ejh.13108] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/19/2023]
Affiliation(s)
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Angiola Rocino
- Hemophilia & Thrombosis Centre; San Giovanni Bosco Hospital; Naples Italy
| | - Antonio Coppola
- Regional Reference Center for Inherited Bleeding Disorders; University Hospital of Parma; Parma Italy
| | - Hamisa J. Hassan
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Adele Giampaolo
- Department of Oncology and Molecular Medicine; Istituto Superiore di Sanità; Rome Italy
| | - Luigi P. Solimeno
- Division of Orthopaedic Surgery and Traumatology; Fondazione IRCCS Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | - Mariangela Micale
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Sveva Mangano
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giacomo Crotti
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Federica Pagliarin
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| | - Lorenzo G. Mantovani
- Research Centre on Public Health (CESP); University of Milano Bicocca; Monza Italy
| |
Collapse
|
4
|
Santagostino E, Young G, Carcao M, Mannucci PM, Halimeh S, Austin S. A contemporary look at FVIII inhibitor development: still a great influence on the evolution of hemophilia therapies. Expert Rev Hematol 2018; 11:87-97. [PMID: 29258406 DOI: 10.1080/17474086.2018.1419862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The development of inhibitors against factor VIII (FVIII) replacement therapy remains the most important challenge for clinicians in the treatment of hemophilia patients. This review focusses on risk factors and management of FVIII inhibitors, particularly in light of SIPPET study findings and subsequent analyses. Areas covered: A brief history and evolution of hemophilia therapies is provided, including an overview of conventional and new (including investigational) therapeutic approaches for the treatment of hemophilia. The SIPPET study, the first randomized clinical trial to demonstrate a lower incidence of inhibitors in previously untreated patients treated with plasma-derived FVIII products compared with recombinant FVIII products, has generated much debate. We review the SIPPET trial and reactions, in addition to preliminary observations from a single center's experience, the cost impact of inhibitors, recent findings from SIPPET subanalyses, and inhibitor development in previously-treated patients. Expert commentary: Despite recent advances in potential new treatment options for hemophilia, conventional factor replacement concentrates currently remain the cornerstone of treatment. It is paramount that clinicians familiarize themselves with the findings from the SIPPET trial and substudies, in order to better inform their patients and families on inhibitor risk factors and to aid the treatment decision-making process.
Collapse
Affiliation(s)
- Elena Santagostino
- a Angelo Bianchi Bonomi Hemophilia and Thrombosis Center , University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Guy Young
- b Hemostasis and Thrombosis Center, Children's Hospital Los Angeles , University of Southern California Keck School of Medicine , Los Angeles , CA , USA
| | - Manuel Carcao
- c Division of Hematology/Oncology; Department of Pediatrics and Child Health Evaluative Sciences , Research Institute Hospital for Sick Children , Toronto , ON , Canada
| | - Pier Mannuccio Mannucci
- d Scientific Direction , IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan , Milan , Italy
| | - Susan Halimeh
- e Gerinnungszentrum Rhein-Ruhr (GZRR) , Duisburg , Germany
| | - Steve Austin
- f St. George's Healthcare NHS Trust Haemophilia Centre , London , UK
| |
Collapse
|
5
|
Peyvandi F, Ettingshausen CE, Goudemand J, Jiménez-Yuste V, Santagostino E, Makris M. New findings on inhibitor development: from registries to clinical studies. Haemophilia 2017; 23 Suppl 1:4-13. [PMID: 27990784 DOI: 10.1111/hae.13137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 02/06/2023]
Abstract
The high incidence of inhibitors against factor VIII (FVIII) concentrates in patients with haemophilia A has encouraged debate as to whether product-type plays a role. There is debate in the literature as to whether rFVIII concentrates are associated with a higher incidence of inhibitors compared to pdFVIII products. The management of haemophilia in patients with inhibitors includes on-demand/prophylaxis treatment with bypassing agents, and/or immune tolerance induction (ITI). However, these options create an economic and emotional burden on patients, their families and healthcare practitioners. Although ITI eliminates inhibitors successfully in 60-80% of cases, it is costly. Despite high costs, preliminary data from a decision analytical model have indicated that ITI is economically advantageous compared with on-demand/prophylactic treatment with bypassing agents. In patients with persistent inhibitors and those who are not candidates for ITI or have failed ITI, bleeding-related mortality and morbidity increase and quality of life decreases, compared with non-inhibitor patients. This article provides an update on the risk of inhibitor development and discusses best management approaches for patients with high-risk factors for inhibitor development.
Collapse
Affiliation(s)
- F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - J Goudemand
- School of Medicine, University of Lille, Lille, France
| | - V Jiménez-Yuste
- Department of Haematology, Autónoma University Madrid and La Paz University Hospital, Madrid, Spain
| | - E Santagostino
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
| |
Collapse
|
6
|
Kulkarni R, Presley RJ, Lusher JM, Shapiro AD, Gill JC, Manco-Johnson M, Koerper MA, Abshire TC, DiMichele D, Hoots WK, Mathew P, Nugent DJ, Geraghty S, Evatt BL, Soucie JM. Complications of haemophilia in babies (first two years of life): a report from the Centers for Disease Control and Prevention Universal Data Collection System. Haemophilia 2016; 23:207-214. [PMID: 27813214 DOI: 10.1111/hae.13081] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 12/11/2022]
Abstract
AIM To describe the prevalence and complications in babies ≤2 years with haemophilia. METHODS We used a standardized collection tool to obtain consented data on eligible babies aged ≤2 years with haemophilia enrolled in the Centers for Disease Control and Prevention Universal Data Collection System surveillance project at US Hemophilia Treatment Centers (HTCs). RESULTS Of 547 babies, 82% had haemophilia A, and 70% were diagnosed within one month of birth. Diagnosis was prompted by known maternal carrier status (40%), positive family history (23%), bleeding (35%) and unknown 2%; 81% bled during the first two years. The most common events were bleeding (circumcision, soft tissue, oral bleeding) and head injury. There were 46 episodes of intracranial haemorrhage (ICH) in 37 babies (7%): 18 spontaneous, 14 delivery related, 11 traumatic, 2 procedure related and 1 unknown cause. Of the 176 central venous access devices (CVADs) in 148 (27%) babies, there were 137 ports, 22 surgically inserted central catheters and 20 peripherally inserted central catheters. Ports had the lowest complication rates. Inhibitors occurred in 109 (20%) babies who experienced higher rates of ICH (14% vs. 5%; P = 0.002), CVAD placement (61% vs. 19%; P < 0.001) and CVAD complications (44% vs. 26%; P < 0.001). The most common replacement therapy was recombinant clotting factor concentrates. CONCLUSION Bleeding events in haemophilic babies ≤2 years were common; no detectable difference in the rates of ICH by the mode of delivery was noted. Neonatal factor exposure did not affect the inhibitor rates. Minor head trauma, soft tissue and oropharyngeal bleeding were the leading indications for treatment.
Collapse
Affiliation(s)
- R Kulkarni
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - R J Presley
- Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J M Lusher
- Department of Pediatric Hematology, Children's Hospital of Michigan Wayne State Medical Center, Detroit, MI, USA
| | - A D Shapiro
- Indiana Hemophilia and Thrombosis Center, Indianapolis, IN, USA
| | - J C Gill
- Comprehensive Center for Bleeding Disorders, Blood Center of Wisconsin, Milwaukee, WI, USA
| | - M Manco-Johnson
- Department of Pediatrics, University of Colorado, Aurora, CO, USA
| | | | - T C Abshire
- Blood Center of Wisconsin, Milwaukee, WI, USA
| | - D DiMichele
- Division of Blood Diseases and Resources, Bethesda, MD, USA
| | - W K Hoots
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - P Mathew
- Department of Pediatric Hematology/Oncology, University of New Mexico, Albuquerque, NM, USA
| | - D J Nugent
- Center for Inherited Blood Disorders, Children's Hospital of Orange County, Orange, CA, USA
| | - S Geraghty
- University of Colorado Denver, Aurora, CO, USA
| | - B L Evatt
- Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J M Soucie
- Division of Blood Disorders Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
7
|
Abstract
The introduction of clotting factor concentrates has transformed the lives of persons with inherited bleeding disorders. With the use of prophylactic treatment, it is now possible to prevent bleeding in these individuals. The early concentrates were contaminated with the HIV and hepatitis C viruses (HCV) and resulted in major morbidity and mortality in the recipients. Current products are much safer, especially in terms of infectious agents, but other adverse events such as alloantibodies (inhibitors), allergic reactions and thrombotic risks remain of concern. Approximately 30% of previously untreated patients with severe haemophilia A develop inhibitors, making this the most important issue in haemophilia care today. Recently, it was suggested that one of the most commonly used concentrates was associated with a higher inhibitor risk, but this was not supported by the evidence from all studies. Good safety surveillance systems are essential for all diseases and products but are particularly so in the group of individuals with inherited bleeding disorders treated with clotting factor concentrates who have suffered disproportionately from the adverse effects of their treatment. National and multinational systems are now in place to allow reporting of adverse events in patients with inherited bleeding disorders. All clinicians treating individuals with inherited bleeding disorders should prospectively report adverse events to treatment even if they are believed to be common and well recognized.
Collapse
Affiliation(s)
- R Lassila
- Helsinki University Hospital, Coagulation Disorders, Hematology and Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
| | - M Makris
- Department of Cardiovascular Science, Medical School, University of Sheffield, Sheffield, UK.,Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK
| |
Collapse
|
8
|
Lövgren KM, Søndergaard H, Skov S, Weldingh KN, Tranholm M, Wiinberg B. Antibody response to recombinant human coagulation factor VIII in a new rat model of severe hemophilia A. J Thromb Haemost 2016; 14:747-56. [PMID: 26784374 DOI: 10.1111/jth.13259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND Neutralizing antibodies toward FVIII replacement therapy (inhibitors) are the most serious treatment-related complication in hemophilia A (HA). A rat model of severe HA (F8(-/-) ) has recently been developed, but an immunological characterization is needed to determine the value of using the model for research into inhibitor development. OBJECTIVES Characterize the antibody response towards recombinant human coagulation factor VIII (rhFVIII) in the HA rat, following a human prophylactic dosing regimen. METHODS Two identical studies were performed, which included a total of 17 homozygous HA rats (F8(-/-) , 0% FVIII activity), 12 heterozygous rats (F8(+/-) ), and 12 wild-type (F8(+/+) ) rats. All rats received intravenous injections of rhFVIII at 50 IU kg(-1) twice weekly for 4 weeks. Predosing blood samples were analyzed for binding and neutralizing anti-rhFVIII antibodies at weeks 1-7. RESULTS In both studies, antibodies developed after 4-6 administrations of rhFVIII, and neutralizing antibodies reached levels similar to human patients (range 1-111 BU, median 6.0 BU) at the end of the study. There was no significant difference between the two studies or between genotypes in time to response or levels reached for binding and neutralizing antibodies. Interestingly, early spontaneous bleeds were associated with a faster antibody response. CONCLUSIONS Following intravenous administration of human FVIII, according to a clinical prophylaxis regimen, a robust and reproducible antibody response is seen in this HA rat model, suggesting that the model is useful for intervention studies with the aim of suppressing, delaying, or preventing the inhibitor response. Also, bleeds seem to have an adjuvant effect on the immune response.
Collapse
Affiliation(s)
- K M Lövgren
- Translational Hemophilia Pharmacology, Global Research, Novo Nordisk A/S, Maaloev, Denmark
- Department of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark
| | - H Søndergaard
- Diabetes Complications Pharmacology, Global Research, Novo Nordisk A/S, Maaloev, Denmark
| | - S Skov
- Department of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark
| | - K N Weldingh
- Immunogenicity Assessment, Global Research, Novo Nordisk A/S, Maaloev, Denmark
| | - M Tranholm
- Hemophilia Pharmacology, Global Research, Novo Nordisk A/S, Maaloev, Denmark
| | - B Wiinberg
- Translational Hemophilia Pharmacology, Global Research, Novo Nordisk A/S, Maaloev, Denmark
| |
Collapse
|
9
|
Engert A, Balduini C, Brand A, Coiffier B, Cordonnier C, Döhner H, de Wit TD, Eichinger S, Fibbe W, Green T, de Haas F, Iolascon A, Jaffredo T, Rodeghiero F, Salles G, Schuringa JJ. The European Hematology Association Roadmap for European Hematology Research: a consensus document. Haematologica 2016; 101:115-208. [PMID: 26819058 PMCID: PMC4938336 DOI: 10.3324/haematol.2015.136739] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/27/2016] [Indexed: 01/28/2023] Open
Abstract
The European Hematology Association (EHA) Roadmap for European Hematology Research highlights major achievements in diagnosis and treatment of blood disorders and identifies the greatest unmet clinical and scientific needs in those areas to enable better funded, more focused European hematology research. Initiated by the EHA, around 300 experts contributed to the consensus document, which will help European policy makers, research funders, research organizations, researchers, and patient groups make better informed decisions on hematology research. It also aims to raise public awareness of the burden of blood disorders on European society, which purely in economic terms is estimated at €23 billion per year, a level of cost that is not matched in current European hematology research funding. In recent decades, hematology research has improved our fundamental understanding of the biology of blood disorders, and has improved diagnostics and treatments, sometimes in revolutionary ways. This progress highlights the potential of focused basic research programs such as this EHA Roadmap.The EHA Roadmap identifies nine 'sections' in hematology: normal hematopoiesis, malignant lymphoid and myeloid diseases, anemias and related diseases, platelet disorders, blood coagulation and hemostatic disorders, transfusion medicine, infections in hematology, and hematopoietic stem cell transplantation. These sections span 60 smaller groups of diseases or disorders.The EHA Roadmap identifies priorities and needs across the field of hematology, including those to develop targeted therapies based on genomic profiling and chemical biology, to eradicate minimal residual malignant disease, and to develop cellular immunotherapies, combination treatments, gene therapies, hematopoietic stem cell treatments, and treatments that are better tolerated by elderly patients.
Collapse
Affiliation(s)
| | | | - Anneke Brand
- Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | | | | | | | | | | | - Willem Fibbe
- Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Tony Green
- Cambridge Institute for Medical Research, United Kingdom
| | - Fleur de Haas
- European Hematology Association, The Hague, the Netherlands
| | | | | | | | - Gilles Salles
- Hospices Civils de Lyon/Université de Lyon, Pierre-Bénite, France
| | | |
Collapse
|
10
|
Auerswald G, Kurnik K, Aledort LM, Chehadeh H, Loew-Baselli A, Steinitz K, Reininger AJ. The EPIC study: a lesson to learn. Haemophilia 2015; 21:622-8. [DOI: 10.1111/hae.12666] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 12/01/2022]
Affiliation(s)
- G. Auerswald
- Prof. Hess Children's Hospital; Klinikum Bremen-Mitte; Bremen Germany
| | - K. Kurnik
- Klinikum der Universitaet Muenchen; Dr von Haunersches Children's Hospital; Munich Germany
| | | | | | | | | | | | | |
Collapse
|