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Al Musaimi O. FDA's stamp of approval: Unveiling peptide breakthroughs in cardiovascular diseases, ACE, HIV, CNS, and beyond. J Pept Sci 2024:e3627. [PMID: 38885943 DOI: 10.1002/psc.3627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024]
Abstract
Peptides exhibit significant specificity and effective interaction with therapeutic targets, positioning themselves as key players in the global pharmaceutical market. They offer potential treatments for a wide range of diseases, including those that pose significant challenges. Notably, the peptide trofinetide (Daybue) marked a groundbreaking achievement by providing the first-ever cure for Rett syndrome, and several peptides have secured FDA approval as first-in-class medications. Furthermore, peptides are expanding their presence in areas traditionally dominated by either small or large molecules. A noteworthy example is the FDA approval of motixafortide (Aphexda) as the first peptide-based chemokine antagonist. Here, the focus will be on the analysis of FDA-approved peptides, particularly those targeting cardiovascular diseases, human immunodeficiency, central nervous system diseases, and various other intriguing classes addressing conditions such as osteoporosis, thrombocytopenia, Cushing's disease, and hypoglycemia, among others. The review will explore the chemical structures of the peptides, their indications and modes of action, the developmental trajectory, and potential adverse effects.
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Affiliation(s)
- Othman Al Musaimi
- School of Pharmacy, Newcastle upon Tyne, UK
- Department of Chemical Engineering, Imperial College London, London, UK
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He MM, Zhu SX, Cannon JR, Christensen JK, Duggal R, Gunduz M, Hilgendorf C, Hughes A, Kekessie I, Kullmann M, Leung D, Terjung C, Wang K, Wesche F. Metabolism and Excretion of Therapeutic Peptides: Current Industry Practices, Perspectives, and Recommendations. Drug Metab Dispos 2023; 51:1436-1450. [PMID: 37591731 DOI: 10.1124/dmd.123.001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/19/2023] Open
Abstract
Therapeutic peptides (TPeps) have expanded from the initial endogenous peptides to complex modified peptides through medicinal chemistry efforts for almost a century. Different from small molecules and large proteins, the diverse submodalities of TPeps have distinct structures and carry different absorption, distribution, metabolism, and excretion (ADME) properties. There is no distinct regulatory guidance for the industry on conducting ADME studies (what, how, and when) for TPeps. Therefore, the Peptide ADME Working Group sponsored by the Translational and ADME Sciences Leadership Group of the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ) was formed with the goal to develop a white paper focusing on metabolism and excretion studies to support discovery and development of TPeps. In this paper, the key learnings from an IQ industry survey and U.S. Food and Drug Administration/European Medicines Agency submission documents of TPeps approved between 2011 and 2022 are outlined in detail. In addition, a comprehensive assessment of in vitro and in vivo metabolism and excretion studies, mitigation strategies for TPep metabolism, analytical tools to conduct studies, regulatory status, and Metabolites in Safety Testing considerations are provided. Finally, an industry recommendation on conducting metabolism and excretion studies is proposed for regulatory filing of TPeps. SIGNIFICANCE STATEMENT: This white paper presents current industry practices for metabolism and excretion studies of therapeutic peptides based on an industry survey, regulatory submission documents, and expert opinions from the participants in the Peptide Absorption, Distribution, Metabolism, and Excretion Working Group of the International Consortium for Innovation and Quality in Pharmaceutical Development. The group also provides recommendations on the Metabolites in Safety Testing considerations and metabolism and excretion studies for regulatory filing of therapeutic peptides.
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Affiliation(s)
- Minxia Michelle He
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Sean Xiaochun Zhu
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Joe R Cannon
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Jesper Kammersgaard Christensen
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Ruchia Duggal
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Mithat Gunduz
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Constanze Hilgendorf
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Adam Hughes
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Ivy Kekessie
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Maximilian Kullmann
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Dennis Leung
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Carsten Terjung
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Kai Wang
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
| | - Frank Wesche
- Drug Disposition, Eli Lilly and Company, Indianapolis, Indiana (M.M.H.); Drug Metabolism and Pharmacokinetics, Takeda Development Center Americas, Inc., Cambridge, Massachusetts (S.X.Z.); Drug Metabolism and Pharmacokinetics, Bristol Myers Squibb, Princeton, New Jersey (J.R.C.); Development ADME, Novo Nordisk A/S, Måløv, Denmark (J.K.C.); Preclinical Development ADME, Merck & Co., Boston, Massachusetts (R.D.); PK Sciences/Global Biotransformation, Novartis Institutes for BioMedical Research, Cambridge, Massachusetts (M.G.); DMPK, Research and Early Development Cardiovascular Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca Gothenburg, Sweden (C.H.); Discovery Drug Metabolism and Pharmacokinetics, GlaxoSmithKline, Stevenage, United Kingdom (A.H.); Early Discovery Biochemistry, Genentech, Inc., South San Francisco, California (I.K.); Drug Metabolism and Pharmacokinetics, Bayer AG, Wuppertal, Germany (M.K., C.T.); Small Molecule Pharmaceutical Sciences, Genentech, Inc., South San Francisco, California (D.L.); Translational PK/PD and Investigative Toxicology, Janssen Research & Development, San Diego, California (K.W.); and Department of Drug Discovery Sciences, Discovery Science Technology Group, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach a.d. Riss, Germany (F.W.)
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Hu K, Wu W, Xie L, Geng H, Zhang Y, Hanyu M, Zhang L, Liu Y, Nagatsu K, Suzuki H, Guo J, Wu Y, Li Z, Wang F, Zhang M. Whole-body PET tracking of a d-dodecapeptide and its radiotheranostic potential for PD-L1 overexpressing tumors. Acta Pharm Sin B 2022; 12:1363-1376. [PMID: 35530129 PMCID: PMC9069398 DOI: 10.1016/j.apsb.2021.09.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/02/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
Peptides that are composed of dextrorotary (d)-amino acids have gained increasing attention as a potential therapeutic class. However, our understanding of the in vivo fate of d-peptides is limited. This highlights the need for whole-body, quantitative tracking of d-peptides to better understand how they interact with the living body. Here, we used mouse models to track the movement of a programmed death-ligand 1 (PD-L1)-targeting d-dodecapeptide antagonist (DPA) using positron emission tomography (PET). More specifically, we profiled the metabolic routes of [64Cu]DPA and investigated the tumor engagement of [64Cu/68Ga]DPA in mouse models. Our results revealed that intact [64Cu/68Ga]DPA was primarily eliminated by the kidneys and had a notable accumulation in tumors. Moreover, a single dose of [64Cu]DPA effectively delayed tumor growth and improved the survival of mice. Collectively, these results not only deepen our knowledge of the in vivo fate of d-peptides, but also underscore the utility of d-peptides as radiopharmaceuticals.
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Affiliation(s)
- Kuan Hu
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Lin Xie
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Hao Geng
- State Key Laboratory of Chemical Oncogenomics, the School of Chemical Biology and Biotechnology, Peking University, Shenzhen Graduate School, Shenzhen 518055, China
| | - Yiding Zhang
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Masayuki Hanyu
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Lulu Zhang
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Yinghuan Liu
- State Key Laboratory of Chemical Oncogenomics, the School of Chemical Biology and Biotechnology, Peking University, Shenzhen Graduate School, Shenzhen 518055, China
| | - Kotaro Nagatsu
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Hisashi Suzuki
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Jialin Guo
- Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Yundong Wu
- State Key Laboratory of Chemical Oncogenomics, the School of Chemical Biology and Biotechnology, Peking University, Shenzhen Graduate School, Shenzhen 518055, China
- Institute of Chemical Biology, Shenzhen Bay Laboratory, Shenzhen 518038, China
- Corresponding authors. Tel./fax: +81 43 3823709 (Mingrong Zhang), +86 25 52271455 (Feng Wang), +86 755 26033616 (Zigang Li), +86 755 26611113 (Yundong Wu).
| | - Zigang Li
- State Key Laboratory of Chemical Oncogenomics, the School of Chemical Biology and Biotechnology, Peking University, Shenzhen Graduate School, Shenzhen 518055, China
- Pingshan Translational Medicine Center, Shenzhen Bay Laboratory, Shenzhen 518118, China
- Corresponding authors. Tel./fax: +81 43 3823709 (Mingrong Zhang), +86 25 52271455 (Feng Wang), +86 755 26033616 (Zigang Li), +86 755 26611113 (Yundong Wu).
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
- Corresponding authors. Tel./fax: +81 43 3823709 (Mingrong Zhang), +86 25 52271455 (Feng Wang), +86 755 26033616 (Zigang Li), +86 755 26611113 (Yundong Wu).
| | - Mingrong Zhang
- Department of Advanced Nuclear Medicine Sciences, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
- Corresponding authors. Tel./fax: +81 43 3823709 (Mingrong Zhang), +86 25 52271455 (Feng Wang), +86 755 26033616 (Zigang Li), +86 755 26611113 (Yundong Wu).
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Nakamura H, Tokumoto M, Anayama M, Kurihara S, Makino Y, Tamura K, Nagasawa M. A case of a hemodialysis patient with secondary hyperparathyroidism who was resistant to etelcalcetide treatment but not to cinacalcet hydrochloride. CEN Case Rep 2021; 11:254-258. [PMID: 34787825 PMCID: PMC9061916 DOI: 10.1007/s13730-021-00664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Although both cinacalcet and etelcalcetide are calcimimetics that directly inhibit parathyroid hormone (PTH) secretion by activating the calcium (Ca)-sensing receptor (CaSR), their binding sites are different. We report a first case of a hemodialysis (HD) patient with secondary hyperparathyroidism (SHPT), in whom cinacalcet, but not etelcalcetide, could reduce serum intact PTH (i-PTH) levels. A HD patient received total parathyroidectomy (PTx) with auto-transplantation 16 years earlier. Due to SHPT relapse, cinacalcet was started at 7 years after PTx. His i-PTH levels had been controlled with both 75–100 mg of cinacalcet and 4.5 μg/week of calcitriol for a year before switching from cinacalcet to etelcalcetide. At 1 month following the switch, his serum i-PTH level increased to 716 pg/mL. The dose of etelcalcetide was gradually increased and finally reached the maximal dose of 45 mg/week. Because even the maximal dose of etelcalcetide for > 4 months did not reduce his serum i-PTH levels to < 700 pg/mL, etelcalcetide was switched to 50 mg/day of cinacalcet, which reduced the levels to 208 pg/mL at 2 months after the switch. Genomic sequencing test using whole blood revealed no mutation in the portion including Cys 482 of CaSR gene. The patient was resistant to etelcalcetide treatment but not to cinacalcet, suggesting the possibility that the enlarged parathyroid gland has some change in the portion including Cys 482 in the CaSR gene. Therefore, considering the possibility of etelcalcetide resistance during SHPT treatment should be kept in mind.
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Affiliation(s)
- Hironori Nakamura
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan.
| | - Masanori Tokumoto
- Department of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Mariko Anayama
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan
| | - Shigekazu Kurihara
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan
| | - Yasushi Makino
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan
| | - Katsuhiko Tamura
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan
| | - Masaki Nagasawa
- Department of Nephrology, Shinonoi General Hospital, 666-1 Ai Shinonoi, Nagano, 388-8004, Japan
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5
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Dachy G, Pochet JM, Labriola L, Buemi A, Gillion V, Jadoul M, Kanaan N, Devresse A. Severe hypercalcaemia early after kidney transplantation in two patients with severe secondary hyperparathyroidism previously treated with etelcalcetide. Clin Kidney J 2021; 14:1977-1979. [PMID: 34345422 PMCID: PMC8323146 DOI: 10.1093/ckj/sfab063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Cinacalcet and, more recently, etelcalcetide revolutionized the treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney transplant (KT) usually improves CKD-MBD. However, a significant proportion of KT recipients have high serum calcium levels, not requiring any treatment. We report two patients previously treated with etelcalcetide who developed severe (>3.3 mmol/L) hypercalcaemia in the early post-KT course, requiring parathyroidectomy. Pathological studies showed parathyroid adenomas and hyperplasia. One patient had a graft biopsy showing numerous intratubular calcium phosphate crystals. These observations should prompt pharmacovigilance studies and careful follow-up of KT recipients previously treated with etelcalcetide.
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Affiliation(s)
- Guillaume Dachy
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Michel Pochet
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laura Labriola
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Antoine Buemi
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Valentine Gillion
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Michel Jadoul
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Nada Kanaan
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Arnaud Devresse
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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6
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Díaz-Eufracio BI, Palomino-Hernández O, Arredondo-Sánchez A, Medina-Franco JL. D-Peptide Builder: A Web Service to Enumerate, Analyze, and Visualize the Chemical Space of Combinatorial Peptide Libraries. Mol Inform 2020; 39:e2000035. [PMID: 32558380 DOI: 10.1002/minf.202000035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/18/2020] [Indexed: 11/07/2022]
Abstract
Peptide-based drug discovery is re-gaining attention in drug discovery. Similarly, combinatorial chemistry continues to be a useful technique for the rapid exploration of chemical space. A current challenge, however, is the enumeration of combinatorial peptide libraries using freely accessible tools. To facilitate the swift enumeration of combinatorial peptide libraries, we introduce herein D-Peptide Builder. In the current version, the user can build up to pentapeptides, linear or cyclic, using the natural pool of 20 amino acids. The user can use non- and/or N-methylated amino acids. The server also enables the rapid visualization of the chemical space of the newly enumerated peptides in comparison with other libraries relevant to drug discovery and preloaded in the server. D-Peptide Builder is freely accessible at http://dpeptidebuilder. quimica.unam.mx:4000/. It is also accessible through the open D-Tools platform (DIFACQUIM Tools for Chemoinformatics https://www.difacquim.com/d-tools/).
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Affiliation(s)
- Bárbara I Díaz-Eufracio
- DIFACQUIM research group, Department of Pharmacy, School of Chemistry, Universidad Nacional Autónoma de México, Avenida Universidad 3000, 04510, Mexico City, Mexico
| | - Oscar Palomino-Hernández
- Computational Biomedicine, Institute of Advanced Simulation (IAS-5), and Institute of Neuroscience and Medicine (INM-9), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Aarón Arredondo-Sánchez
- DIFACQUIM research group, Department of Pharmacy, School of Chemistry, Universidad Nacional Autónoma de México, Avenida Universidad 3000, 04510, Mexico City, Mexico
| | - José L Medina-Franco
- DIFACQUIM research group, Department of Pharmacy, School of Chemistry, Universidad Nacional Autónoma de México, Avenida Universidad 3000, 04510, Mexico City, Mexico
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7
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Guo D, He H, Hou T. Purification and characterization of positive allosteric regulatory peptides of calcium sensing receptor (CaSR) from desalted duck egg white. Food Chem 2020; 325:126919. [PMID: 32387992 DOI: 10.1016/j.foodchem.2020.126919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023]
Abstract
HPLC-ESI-MS/MS, molecular docking simulation and in situ single-pass intestinal perfusion (SPIP) study were used to identify, select, and confirm the binding affinities between peptides identified from desalted duck egg white peptides (DPs) and calcium sensing receptor (CaSR), respectively. F3 fraction from DPs possessed superior calcium binding activity (P < 0.05), and 16 peptides enriched aromatic amino acids and other 33 peptides were identified. FAE, FNE, INSW, FDPE and NFE presented well binding affinities with CaSR in molecular docking. Additionally, SPIP results showed that NFE and INSW significantly reduced the increased PTH levels by 45.8% and 48.8%, respectively (P < 0.05), and increased calcium percent absorption, calcium absorption rate constant (Ka) and calcium effective permeability (Peff) (P < 0.05), as well as up-regulated mRNA levels of CaSR (P < 0.05). Moreover, NFE and INSW could interact with the VFT domain of CaSR, which exhibited the potential activities in regulation of CaSR.
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Affiliation(s)
- Danjun Guo
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Hui He
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan 430070, China.
| | - Tao Hou
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan 430070, China.
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8
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Bellasi A, Cozzolino M, Malberti F, Cancarini G, Esposito C, Guastoni CM, Ondei P, Pontoriero G, Teatini U, Vezzoli G, Pasquali M, Messa P, Locatelli F. New scenarios in secondary hyperparathyroidism: etelcalcetide. Position paper of working group on CKD-MBD of the Italian Society of Nephrology. J Nephrol 2019; 33:211-221. [PMID: 31853791 PMCID: PMC7118036 DOI: 10.1007/s40620-019-00677-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.
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Affiliation(s)
- Antonio Bellasi
- UOC Ricerca, Innovazione, Brand Reputation, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Mario Cozzolino
- UOC Nefrologia e Dialisi ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Fabio Malberti
- Struttura Complessa di Nefrologia e Dialisi, Istituti Ospedalieri di Cremona, Cremona, Italy
| | - Giovanni Cancarini
- U.O.C. Nefrologia e Dipartimento della Cronicità, ASST, Spedali Civili e, Università di Brescia, Brescia, Italy
| | - Ciro Esposito
- Struttura Complessa di Nefrologia e Dialisi, ICS Maugeri SpA SB, Università di Pavia, Pavia, Italy
| | | | - Patrizia Ondei
- USS Emodialisi, Azienda Ospedaliera Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Ugo Teatini
- UOC Nefrologia e Dialisi. ASST Rhodense, Garbagnate M.se, Italy
| | - Giuseppe Vezzoli
- Unità di Nefrologia e Dialisi, IRCCS Istituto Scientifico San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Marzia Pasquali
- UOC di Nefrologia-Azienda Ospedaliero-Universitaria Policlinico Umberto I Roma, Rome, Italy
| | - Piergiorgio Messa
- Unità Operativa Complessa di Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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9
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Russo D, Tripepi R, Malberti F, Di Iorio B, Scognamiglio B, Di Lullo L, Paduano IG, Tripepi GL, Panuccio VA. Etelcalcetide in Patients on Hemodialysis with Severe Secondary Hyperparathyroidism. Multicenter Study in "Real Life". J Clin Med 2019; 8:E1066. [PMID: 31330805 PMCID: PMC6678718 DOI: 10.3390/jcm8071066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 12/29/2022] Open
Abstract
Etelcalcetide is a new calcimimetic indicated for the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients. Etelcalcetide efficacy in SHPT has been ascertained only in randomized controlled trials. This multicenter study was carried out in "real world" setting that is different from randomized controlled trials (RCTs) to (1) evaluate the effectiveness of etelcalcetide in SHPT, (2) to assess calcium, phosphorus, alkaline phosphatase changes, (3) to register gastrointestinal side effects. Data were collected from twenty-three dialysis units with n = 1190 patients on the charge. From this cohort, n = 168 (14%) patients were on treatment with etelcalcetide, and they were evaluated for statistics. A median weekly dose of etelcalcetide was 15 mg (7.5-45 mg). Patients were either naïve (33%) or switched from cinacalcet to obtain better control of SHPT with reduced side effects or pills burden. Serum parathyroid hormone (PTH) declined over time from a median value of 636 pg/mL to 357 pg/mL. The median time for responders (intact PTH (iPTH) range: two to nine times the upper normal limit) was 53 days; the percentage of responders increased (from baseline 27% to 63%) being similar in switched-patients and naïve-patients. Few patients had symptomatic hypocalcemia requiring etelcalcetide withdrawal (four cases (3%) at 30-day control, two cases (2%) at 60-day, one case (1%) at 90-day control). Side effects with etelcalcetide were lower (3-4%) than that registered during cinacalcet treatment (53%). Etelcalcetide is a new therapeutic option for SHPT with low side effects and pills burden. Etelcalcetide may improve adherence to therapy, avoiding unremitting SHP. It remains to be assessed whether etelcalcetide may reduce parathyroidectomy, vascular calcification, or mortality. Being etelcalcetide very potent in suppressing PTH levels, even in severe SHPT, future studies should evaluate the potential risk of more adynamic bone disease during long-term therapy.
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Affiliation(s)
- Domenico Russo
- Department of Public Health, University of Naples FEDERICO II, 80131 Naples, Italy.
| | - Rocco Tripepi
- Institute of Clinical Physiology (IFC-CNR) Research Unit of Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Fabio Malberti
- Department of Nephrology Cremona Hospital, 26100 Cremona, Italy
| | - Biagio Di Iorio
- Department of Nephrology AORN Cardarelli, 80131 Naples, Italy
| | | | - Luca Di Lullo
- Department of Nephrology Ospedale "Parodi Delfino" di Colleferro (Roma), 00034 Colleferro, Roma, Italy
| | | | - Giovanni Luigi Tripepi
- Institute of Clinical Physiology (IFC-CNR) Research Unit of Reggio Calabria, 89124 Reggio Calabria, Italy
| | - Vincenzo Antonio Panuccio
- Nephrology, Dialysis and transplantation Unit G.O.M. "Bianchi Melacrino Morelli", 89121 Reggio Calabria, Italy
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10
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Block GA, Chertow GM, Sullivan JT, Deng H, Mather O, Tomlin H, Serenko M. An integrated analysis of safety and tolerability of etelcalcetide in patients receiving hemodialysis with secondary hyperparathyroidism. PLoS One 2019; 14:e0213774. [PMID: 30875390 PMCID: PMC6420005 DOI: 10.1371/journal.pone.0213774] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 02/11/2019] [Indexed: 01/13/2023] Open
Abstract
Background Calcimimetics have been shown to be effective and safe therapies for the treatment of secondary hyperparathyroidism (sHPT), a serious complication of disordered mineral metabolism associated with dialysis-dependent chronic kidney disease. Etelcalcetide, a recently approved intravenous calcimimetic, reduces serum parathyroid hormone (PTH), calcium, phosphorus, and fibroblast growth factor-23 concentrations. Here we report the first integrated safety profile of etelcalcetide using pooled data from five pivotal clinical trials. Methods This analysis included data from patients receiving hemodialysis with moderate to severe sHPT enrolled in two randomized, placebo-controlled trials; a randomized active-controlled (with cinacalcet) trial; and two single-arm, open-label extension trials. Patients initially received etelcalcetide intravenously 5 mg three times weekly (TIW) after hemodialysis; with potential dose increases of 2.5 or 5 mg at 4-week intervals to a maximum dose of 15 mg TIW, depending on serum PTH and calcium levels. The nature, frequency, and severity of treatment-emergent adverse events (AEs) and changes in laboratory parameters were assessed. Results Overall, we evaluated 1023 patients from the placebo-controlled trials, 683 from the active-controlled trial, and 1299 from open-label extensions. The frequency and nature of common treatment-emergent AEs reported for the etelcalcetide arm were consistent among the placebo-controlled and active-controlled trials. The most common AEs were those related to mineral metabolism (decreased blood calcium, hypophosphatemia, muscle spasms) or gastrointestinal abnormalities (diarrhea, nausea, vomiting). Hypocalcemia leading to discontinuation of either calcimimetic was experienced in ≤ 1% of patients. Conclusions This integrated safety assessment of etelcalcetide across placebo- and active-controlled trials showed an overall favorable risk/benefit profile, with safety similar to that of cinacalcet. Consistent with its mechanism of action, the most important risks associated with etelcalcetide were serum calcium reductions and hypocalcemia-related AEs; no new safety findings were identified in the pooled long-term extension trials.
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Affiliation(s)
| | - Glenn M. Chertow
- Stanford University, Stanford, California, United States of America
| | | | - Hongjie Deng
- Amgen Inc., Thousand Oaks, California, United States of America
| | - Omar Mather
- Amgen Inc., Thousand Oaks, California, United States of America
- * E-mail:
| | - Holly Tomlin
- Amgen Inc., Thousand Oaks, California, United States of America
| | - Michael Serenko
- Amgen Inc., Thousand Oaks, California, United States of America
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11
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Ikegami T. Hydrophilic interaction chromatography for the analysis of biopharmaceutical drugs and therapeutic peptides: A review based on the separation characteristics of the hydrophilic interaction chromatography phases. J Sep Sci 2019; 42:130-213. [DOI: 10.1002/jssc.201801074] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/17/2018] [Accepted: 11/18/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Tohru Ikegami
- Faculty of Molecular Chemistry and Engineering; Kyoto Institute of Technology; Kyoto Japan
- Institute of Pharmaceutical Sciences; Pharmaceutical (Bio-) Analysis; Eberhard-Karls Universität Tübingen; Tübingen Germany
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12
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Al Musaimi O, Al Shaer D, de la Torre BG, Albericio F. 2017 FDA Peptide Harvest. Pharmaceuticals (Basel) 2018; 11:ph11020042. [PMID: 29735913 PMCID: PMC6027222 DOI: 10.3390/ph11020042] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/30/2018] [Accepted: 05/03/2018] [Indexed: 12/11/2022] Open
Abstract
2017 was an excellent year in terms of new drugs (chemical entities and biologics) approved by the FDA, with a total of 46. In turn, one of the highlights was the number of peptides (six) included in this list. Here, the six peptides are analyzed in terms of chemical structure, synthetic strategy used for their production, source, therapeutic use, and mode of action.
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Affiliation(s)
- Othman Al Musaimi
- College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
- School of Chemistry, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Danah Al Shaer
- College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa.
- School of Chemistry, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Beatriz G de la Torre
- KRISP, College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
| | - Fernando Albericio
- School of Chemistry, University of KwaZulu-Natal, Durban 4001, South Africa.
- CIBER-BBN, Networking Centre on Bioengineering, Biomaterials and Nanomedicine, University of Barcelona, 08028 Barcelona, Spain.
- Department of Organic Chemistry, University of Barcelona, 08028 Barcelona, Spain.
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13
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Ye J, Deng G, Gao F. Theoretical overview of clinical and pharmacological aspects of the use of etelcalcetide in diabetic patients undergoing hemodialysis. Drug Des Devel Ther 2018; 12:901-909. [PMID: 29719376 PMCID: PMC5914547 DOI: 10.2147/dddt.s160223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Etelcalcetide is the first intravenous calcimimetic agent authorized for the treatment of secondary hyperparathyroidism (sHPT) in patients undergoing hemodialysis in Europe, the US, and Japan. The relationship between sHPT and diabetes resides on complex, bidirectional effects and largely unknown homeostatic mechanisms. Although 30% or more patients with end-stage renal disease are diabetics and about the same percentage of those patients suffer from sHPT associated with hemodialysis, no data on the specificities of the use of etelcalcetide in such patients are available yet. Regarding pharmacokinetic interactions, etelcalcetide may compete with oral hypoglycemics recommended for use in patients undergoing hemodialysis and insulins detemir and degludec, causing unexpected hypocalcemia or hypoglycemia. More importantly, hypocalcemia, a common side effect of etelcalcetide, may cause decompensation of preexisting cardiac insufficiency in diabetic patients or worsen dialysis-related hypotension and lead to hypotension-related cardiac events, such as myocardial ischemia. In diabetic patients, hypocalcemia may lead to dangerous ventricular arrhythmias, as both insulin-related hypoglycemia and hemodialysis prolong QT interval. Patients with diabetes, therefore, should be strictly monitored for hypocalcemia and associated effects. Due to an altered parathormone activity in this patient group, plasma calcium should be the preferred indicator of etelcalcetide effects. Until more clinical experience with etelcalcetide is available, the clinicians should be cautious when using this calcimimetic in patients with diabetes.
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Affiliation(s)
- Jianzhen Ye
- Department of Endocrinology, Huangzhou District People’s Hospital, Huanggang, People’s Republic of China
| | - Guangrui Deng
- Department of Endocrinology, Huangzhou District People’s Hospital, Huanggang, People’s Republic of China
| | - Feng Gao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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14
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Nemeth EF, Van Wagenen BC, Balandrin MF. Discovery and Development of Calcimimetic and Calcilytic Compounds. PROGRESS IN MEDICINAL CHEMISTRY 2018; 57:1-86. [PMID: 29680147 DOI: 10.1016/bs.pmch.2017.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The extracellular calcium receptor (CaR) is a G protein-coupled receptor (GPCR) and the pivotal molecule regulating systemic Ca2+ homeostasis. The CaR was a challenging target for drug discovery because its physiological ligand is an inorganic ion (Ca2+) rather than a molecule so there was no structural template to guide medicinal chemistry. Nonetheless, small molecules targeting this receptor were discovered. Calcimimetics are agonists or positive allosteric modulators of the CaR, while calcilytics are antagonists and all to date are negative allosteric modulators. The calcimimetic cinacalcet was the first allosteric modulator of a GPCR to achieve regulatory approval and is a first-in-class treatment for secondary hyperparathyroidism in patients on dialysis, and for hypercalcemia in some forms of primary hyperparathyroidism. It is also useful in treating some rare genetic diseases that cause hypercalcemia. Two other calcimimetics are now on the market (etelcalcetide) or under regulatory review (evocalcet). Calcilytics stimulate the secretion of parathyroid hormone and were initially developed as treatments for osteoporosis. Three different calcilytics of two different chemotypes failed in clinical trials due to lack of efficacy. Calcilytics are now being repurposed and might be useful in treating hypoparathyroidism and several rare genetic diseases causing hypocalcemia. The challenges ahead for medicinal chemists are to design compounds that select conformations of the CaR that preferentially target a particular signalling pathway and/or that affect the CaR in a tissue-selective manner.
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15
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Wu B, Melhem M, Subramanian R, Chen P, Jaramilla Sloey B, Fouqueray B, Hock MB, Skiles GL, Chow AT, Lee E. Clinical Pharmacokinetics and Pharmacodynamics of Etelcalcetide, a Novel Calcimimetic for Treatment of Secondary Hyperparathyroidism in Patients With Chronic Kidney Disease on Hemodialysis. J Clin Pharmacol 2018. [PMID: 29534286 DOI: 10.1002/jcph.1090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Etelcalcetide, a d-amino acid peptide, is an intravenous calcimimetic approved for the treatment of secondary hyperparathyroidism. Etelcalcetide binds the calcium-sensing receptor and increases its sensitivity to extracellular calcium, thereby decreasing secretion of parathyroid hormone (PTH) by chief cells. Etelcalcetide and its low-molecular-weight transformation products are rapidly cleared by renal excretion in healthy subjects, but clearance is substantially reduced and dependent on hemodialysis in end-stage renal disease. The effective half-life is 3-5 days in patients undergoing hemodialysis 3 times a week. A clinical study using a single microtracer intravenous dose of [14 C]etelcalcetide indicated that 60% of the administered dose was eliminated in dialysate. Etelcalcetide undergoes reversible disulfide exchange with serum albumin to form a serum albumin peptide conjugate that is too large (67 kDa) to be dialyzed, until a subsequent exchange forms etelcalcetide or a low-molecular-weight transformation product. This exchange from albumin is apparent after hemodialysis, when it partially restores etelcalcetide concentrations in plasma. Etelcalcetide has no known risks for drug-drug interactions. In phase 3 studies, 74%-75% of hemodialysis patients with secondary hyperparathyroidism who received etelcalcetide achieved a >30% PTH reduction from baseline versus 8%-10% of patients who received placebo. The pharmacokinetics and pharmacodynamics of etelcalcetide in hemodialysis patients supports a 5-mg starting dose administered after hemodialysis and uptitration in 2.5- or 5-mg increments every 4 weeks to a maximum dose of 15 mg 3 times a week.
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16
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Eidman KE, Wetmore JB. Managing hyperparathyroidism in hemodialysis: role of etelcalcetide. Int J Nephrol Renovasc Dis 2018; 11:69-80. [PMID: 29440923 PMCID: PMC5804266 DOI: 10.2147/ijnrd.s128252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is common in patients receiving maintenance hemodialysis and is associated with adverse outcomes. Currently, SHPT is managed by reducing circulating levels of phosphate with oral binders and parathyroid hormone (PTH) with vitamin D analogs and/or the calcimimetic cinacalcet. Etelcalcetide, a novel calcimimetic administered intravenously (IV) at the end of a hemodialysis treatment session, effectively reduces PTH in clinical trials when given thrice weekly. Additional clinical effects include reductions in circulating levels of phosphate and FGF-23 and an improved profile of markers of bone turnover. However, despite being administered IV, etelcalcetide appears to be associated with rates of nausea and vomiting comparable to those of cinacalcet. Additionally, etelcalcetide, relative to placebo, causes hypocalcemia and prolonged electrocardiographic QT intervals, effects that must be considered when contemplating its use. Etelcalcetide likely has a role in treating hemodialysis patients with uncontrolled SHPT or with hypercalcemia or hyperphosphatemia receiving activated vitamin D compounds. However, its use should be at least partially constrained by consideration of the risk of hypocalcemia and resultant prolonged QT intervals in vulnerable patients. Because of its effectiveness as a PTH-reducing agent administered in the dialysis unit, etelcalcetide represents a potentially promising new therapeutic approach to the often vexing problem of SHPT in hemodialysis patients. However, whether its use is associated with changes in surrogate clinical end points, such as effects on rates of parathyroidectomy, fracture, vascular calcification, or mortality or on quality of life, remains to be studied.
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Affiliation(s)
- Keith E Eidman
- Division of Nephrology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
| | - James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN
- Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
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Pereira L, Meng C, Marques D, Frazão JM. Old and new calcimimetics for treatment of secondary hyperparathyroidism: impact on biochemical and relevant clinical outcomes. Clin Kidney J 2017; 11:80-88. [PMID: 29423207 PMCID: PMC5798074 DOI: 10.1093/ckj/sfx125] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/18/2017] [Indexed: 12/22/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT) is associated with increased bone turnover, risk of fractures, vascular calcifications, and cardiovascular and all-cause mortality. The classical treatment for SHPT includes active vitamin D compounds and phosphate binders. However, achieving the optimal laboratory targets is often difficult because vitamin D sterols suppress parathyroid hormone (PTH) secretion, while also promoting calcium and phosphate intestinal absorption. Calcimimetics increase the sensitivity of the calcium-sensing receptor, so that even with lower levels of extracellular calcium a signal can still exist, leading to a decrease of the set-point for systemic calcium homeostasis. This enables a decrease in plasma PTH levels and, consequently, of calcium levels. Cinacalcet was the first calcimimetic to be approved for clinical use. More than 10 years since its approval, cinacalcet has been demonstrated to effectively reduce PTH and improve biochemical control of mineral and bone disorders in chronic kidney patients. Three randomized controlled trials have analysed the effects of treatment with cinacalcet on hard clinical outcomes such as vascular calcification, bone histology and cardiovascular mortality and morbidity. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Etelcalcetide is a new second-generation calcimimetic with a pharmacokinetic profile that allows thrice-weekly dosing at the time of haemodialysis. It was recently approved in Europe, and is regarded as a second opportunity to improve outcomes by optimizing treatment for SHPT. In this review, we summarize the impact of cinacalcet with regard to biochemical and clinical outcomes. We also discuss the possible implications of the new calcimimetic etelcalcetide in the quest to improve outcomes.
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Affiliation(s)
- Luciano Pereira
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal.,Nephrology and Infeciology group, INEB-National Institute of Biomedical Engineer, University of Porto, Porto, Portugal.,Department of Nephrology, São João Hospital Center, Porto, Portugal.,DaVita Kidney Care, Porto, Portugal
| | - Catarina Meng
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal.,Nephrology and Infeciology group, INEB-National Institute of Biomedical Engineer, University of Porto, Porto, Portugal.,Department of Nephrology, São João Hospital Center, Porto, Portugal
| | | | - João M Frazão
- Institute of Investigation and Innovation in Health, University of Porto, Porto, Portugal.,Nephrology and Infeciology group, INEB-National Institute of Biomedical Engineer, University of Porto, Porto, Portugal.,Department of Nephrology, São João Hospital Center, Porto, Portugal.,DaVita Kidney Care, Porto, Portugal
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Pharmacokinetics, Biotransformation, and Excretion of [ 14C]Etelcalcetide (AMG 416) Following a Single Microtracer Intravenous Dose in Patients with Chronic Kidney Disease on Hemodialysis. Clin Pharmacokinet 2017; 56:179-192. [PMID: 27517676 PMCID: PMC5247555 DOI: 10.1007/s40262-016-0433-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Etelcalcetide (AMG 416) is a novel synthetic peptide calcium-sensing receptor activator in clinical development as an intravenous calcimimetic for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on hemodialysis. Etelcalcetide is composed of seven d-aminoacids with an l-cysteine linked to a d-cysteine by a disulfide bond. A single intravenous dose of [14C]etelcalcetide (10 mg; 26.3 kBq; 710 nCi) was administered to patients with CKD on hemodialysis to elucidate the pharmacokinetics, biotransformation, and excretion of etelcalcetide in this setting. Blood, dialysate, urine, and feces were collected to characterize the pharmacokinetics, biotransformation product profiles, mass balance, and formation of anti-etelcalcetide antibodies. Accelerator mass spectrometry was necessary to measure the microtracer quantities of C-14 excreted in the large volumes of dialysate and other biomatrices. An estimated 67 % of the [14C]etelcalcetide dose was recovered in dialysate, urine, and feces 176 days after dose administration. Etelcalcetide was primarily cleared by hemodialysis, with approximately 60 % of the administered dose eliminated in dialysate. Minor excretion was observed in urine and feces. Biotransformation resulted from disulfide exchange with endogenous thiols, and preserved the etelcalcetide d-amino acid backbone. Drug-related radioactivity circulated primarily as serum albumin peptide conjugate (SAPC). Following removal of plasma etelcalcetide by hemodialysis, re-equilibration occurred between SAPC and l-cysteine present in blood to partially restore the etelcalcetide plasma concentrations between dialysis sessions. No unanticipated safety signals or anti-etelcalcetide or anti-SAPC antibodies were detected.
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433. The November 2017 monograph topics are Ertugliflozin, Glecaprevir / pibrentasvir, Neratinib, Sofosbuvir, velpatasvir, voxilaprevir and SQ C1 esterase inhibitor. The MUE is on glecaprevir, pibrentasvir.
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Clinical immunogenicity of the d -amino acid peptide therapeutic etelcalcetide: Method development challenges and anti-drug antibody clinical impact assessments. J Immunol Methods 2017; 445:37-44. [DOI: 10.1016/j.jim.2017.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/17/2017] [Accepted: 03/03/2017] [Indexed: 11/21/2022]
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Cozzolino M, Galassi A, Conte F, Mangano M, Di Lullo L, Bellasi A. Treatment of secondary hyperparathyroidism: the clinical utility of etelcalcetide. Ther Clin Risk Manag 2017; 13:679-689. [PMID: 28615947 PMCID: PMC5461056 DOI: 10.2147/tcrm.s108490] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary hyperparathyroidism (SHPT), a very frequent, severe, and worsening complication of chronic kidney disease, is characterized by high serum parathyroid hormone (PTH), parathyroid gland hyperplasia, and disturbances in mineral metabolism. Clinically, SHPT shows renal osteodystrophy, vascular calcification, cardiovascular damage, and fatal outcome. Calcium-sensing receptor (CaSR) is the main physiological regulator of PTH secretion; its activation by calcium rapidly inhibits PTH. Another important player in regulating mineral metabolism is vitamin D receptor (VDR), which is under the influence of vitamin D and influences the intestinal absorption of calcium and phosphate, PTH gene expression, and bone calcium mobilization. Serum phosphate levels influence fibroblast growth factor 23 (FGF-23) production, a phosphatonin that modulates serum phosphate reabsorption, PTH synthesis, and vitamin D production. Current therapeutic approaches consist of 1) phosphate intake control by diet or phosphate binders, 2) vitamin D by VDR activation, and 3) calcimimetic agents that activate CaSR. Recently, a new long-acting peptide (etelcalcetide) belonging to the calcimimetics class was approved for intravenous use in hemodialysis patients with SHPT. Etelcalcetide binds directly to CaSR, by a sulfide bond, inhibiting the production and secretion of PTH by parathyroid glands. After intravenous administration in rats, etelcalcetide is quickly distributed to the tissues and eliminated by kidneys, while in uremic animals the nonrenal excretion is only 1.2%. In hemodialysis patients, the treatment itself is the main route of elimination. Etelcalcetide in hemodialysis patients with SHPT was more effective than placebo and cinacalcet, with a PTH reduction of >30% in 76% of patients with etelcalcetide versus 10% with placebo. Particular attention was paid to the safety of the drug; the most common adverse event was asymptomatic blood calcium reduction, similar to cinacalcet, while gastrointestinal symptoms were less frequent. This promising new drug available for better control of SHPT will, together with drugs already in use, optimize the treatment to normalize the biochemical parameters.
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Affiliation(s)
- Mario Cozzolino
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Andrea Galassi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Ferruccio Conte
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Michela Mangano
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
| | - Luca Di Lullo
- U.O.C. Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro, Roma
| | - Antonio Bellasi
- Department of Health Sciences, Renal Division, University of Milan, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan
- Sant’Anna Hospital, ASST-Lariana, Como, Italy
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Hamano N, Komaba H, Fukagawa M. Etelcalcetide for the treatment of secondary hyperparathyroidism. Expert Opin Pharmacother 2017; 18:529-534. [DOI: 10.1080/14656566.2017.1303482] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Wu L, Melhem M, Subramanian R, Wu B. Drug disposition model of radiolabeled etelcalcetide in patients with chronic kidney disease and secondary hyperparathyroidism on hemodialysis. J Pharmacokinet Pharmacodyn 2017; 44:43-53. [PMID: 28063122 DOI: 10.1007/s10928-016-9503-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/23/2016] [Indexed: 11/27/2022]
Abstract
Etelcalcetide (AMG 416) is an allosteric activator of the calcium-sensing receptor for treatment of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on hemodialysis. To characterize the time course of etelcalcetide in different matrices (plasma, dialysate, urine, and feces), a drug disposition model was developed. Nonlinear mixed-effect modeling was used to describe data from six adults with CKD on hemodialysis who received a single intravenous dose of [14C]etelcalcetide (10 mg; 710 nCi) after hemodialysis (study NCT02054572). A three-compartment model with the following attributes adequately described the observed concentration-time profiles of etelcalcetide in the different matrices: biotransformation in the central compartment; elimination in dialysate, urine, and feces; and a nonspecific elimination process. The terminal half-life of total C-14 in plasma was approximately 56 days. The ratio of conjugation-deconjugation rate constants between etelcalcetide and biotransformed products was 11.3. Simulations showed that three hemodialysis sessions per week for 52 weeks would contribute to 60.1% of the total clearance of etelcalcetide following single-dose intravenous etelcalcetide administration. Minimal amounts were eliminated in urine (2.5%) and feces (5.7%), whereas nonspecific elimination accounted for 31.2% of total elimination. In addition to removal of etelcalcetide, ~10% of small-molecular weight biotransformed products was estimated to have been removed through hemodialysis and in urine. This model provided a quantitative approach to describe biotransformation, distribution, and elimination of etelcalcetide, a unique synthetic D-amino acid peptide, in the relevant patient population.
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Affiliation(s)
- Liviawati Wu
- Clinical Pharmacology Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | - Murad Melhem
- Clinical Pharmacology Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA.
| | - Raju Subramanian
- Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, CA, USA
| | - Benjamin Wu
- Clinical Pharmacology Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
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Edson KZ, Wu BM, Iyer A, Goodman W, Skiles GL, Subramanian R. Determination of Etelcalcetide Biotransformation and Hemodialysis Kinetics to Guide the Timing of Its Dosing. Kidney Int Rep 2016; 1:24-33. [PMID: 29318205 PMCID: PMC5720529 DOI: 10.1016/j.ekir.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction Etelcalcetide, a novel calcimimetic agonist of the calcium-sensing receptor for treatment of secondary hyperparathyroidism in chronic kidney disease patients on hemodialysis, is a d-amino acid linear heptapeptide with a d-cysteine that is linked to an l-cysteine by a disulfide bond. In addition to binding to the calcium-sensing receptor, etelcalcetide is biotransformed by disulfide exchange in whole blood to predominantly form a covalent serum albumin peptide conjugate (SAPC). Key factors anticipated to affect the pharmacokinetics and disposition of etelcalcetide in chronic kidney disease patients on hemodialysis are the drug’s intrinsic dialytic properties and biotransformation kinetics. Methods These factors were investigated using in vitro methods, and the findings were modeled to derive corresponding kinetic rate constants. Results Biotransformation was reversible after incubation of etelcalcetide or SAPC in human whole blood. The rate of SAPC formation from etelcalcetide was 18-fold faster than the reverse process. Clearance of etelcalcetide by hemodialysis was rapid in the absence of blood and when hemodialysis was initiated immediately after addition of etelcalcetide to blood. Preincubation of etelcalcetide in blood for 3 hours before hemodialysis resulted in formation of SAPC and decreased its clearance due to the slow rate of etelcalcetide formation from SAPC. Etelcalcetide hemodialysis clearance was >16-fold faster than its biotransformation. Discussion These results indicate that etelcalcetide should be administered after hemodialysis to avoid elimination of a significant fraction of the dose.
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Affiliation(s)
- Katheryne Z Edson
- Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, California, USA
| | - Benjamin M Wu
- Clinical Pharmacology Modeling and Simulations, Amgen Inc., Thousand Oaks, California, USA
| | - Abhinaya Iyer
- Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, California, USA
| | - William Goodman
- Global Development, Amgen Inc., Thousand Oaks, California, USA
| | - Gary L Skiles
- Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, California, USA
| | - Raju Subramanian
- Pharmacokinetics and Drug Metabolism, Amgen Inc., Thousand Oaks, California, USA
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Fielden MR, Dean C, Black K, Sawant SG, Subramanian R, Tomlinson JE, Walter S, Zimmermann C, Griggs MW, McKeon ME, Lewis EM, Beevers C, Pyrah I. Nonclinical Safety Profile of Etelcalcetide, a Novel Peptide Calcimimetic for the Treatment of Secondary Hyperparathyroidism. Int J Toxicol 2016; 35:294-308. [DOI: 10.1177/1091581816633407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Etelcalcetide is a novel d-amino acid peptide that functions as an allosteric activator of the calcium-sensing receptor and is being developed as an intravenous calcimimetic for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on hemodialysis. To support clinical development and marketing authorization, a comprehensive nonclinical safety package was generated. Primary adverse effects included hypocalcemia, tremoring, and convulsions. Other adverse effects were considered sequelae of stress associated with hypocalcemia. Cardiovascular safety evaluations in the dog revealed an anticipated prolongation of the corrected QT interval that was related to reductions in serum calcium. Etelcalcetide did not affect the human ether-a-go-go gene ion channel current. Etelcalcetide was mutagenic in some strains of Salmonella, however, based on the negative results in 2 in vitro and 2 in vivo mammalian genotoxicity assays, including a 28-day Muta mouse study, etelcalcetide is considered nongenotoxic. Further support for a lack of genotoxicity was provided due to the fact that etelcalcetide was not carcinogenic in a 6-month transgenic rasH2 mouse model or a 2-year study in rats. There were no effects on fertility, embryo–fetal development, and prenatal and postnatal development. All of the adverse effects observed in both rat and dog were considered directly or secondarily related to the pharmacologic activity of etelcalcetide and the expected sequelae associated with dose-related reductions in serum calcium due to suppression of parathyroid hormone secretion. These nonclinical data indicate no safety signal of concern for human risk beyond that associated with hypocalcemia and associated QT prolongation.
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Affiliation(s)
- Mark R. Fielden
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
| | - Charles Dean
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
| | - Kurt Black
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
| | - Satin G. Sawant
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
| | - Raju Subramanian
- Pharmacokinetics and Drug Metabolism, Amgen Inc, Thousand Oaks, CA, USA
| | | | - Sarah Walter
- Cardiometabolic Disorders, Amgen Inc, Thousand Oaks, CA, USA
| | - Cameron Zimmermann
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
| | | | | | | | | | - Ian Pyrah
- Comparative Biology and Safety Sciences, Amgen Inc, Thousand Oaks, CA, USA
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