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Nooh MH, Alshehri MS, Alzahrani ZS, Alsolami HM, Almutairi AO, AlOtaibi AS, Aljohani AN. The Efficacy and Safety of Intra-articular Low Molecular Weight Fraction of Human Serum Albumin for the Management of Moderate to Moderately Severe Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41240. [PMID: 37529519 PMCID: PMC10387823 DOI: 10.7759/cureus.41240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Osteoarthritis is a chronic degenerative joint disease that affects weight-bearing joints. Low molecular weight fraction of 5% (LMWF-5A) human serum albumin is an intra-articular injection that emerged for the treatment of knee osteoarthritis. The aim of this review is to assess the efficacy and safety of LMWF-5A versus placebo through a systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EBSCO, and ClinicalTrials.gov registry databases were utilized to search for studies. Only randomized controlled trials (RCTs) that evaluated the efficacy of LMWF-5A versus placebo were included. Efficacy endpoints were represented by Western Ontario and McMaster Universities Arthritis Index (WOMAC) A and C scores for pain and function, respectively. Serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality rates were used to evaluate the safety of the drug. The revised Cochrane risk of bias tool was used for the risk of bias assessment. Seven RCTs (n=2939) that met the inclusion criteria were included. The meta-analysis did not find significant improvement in pain (WOMAC A) (standardized mean difference (SMD)= -0.01, 95% confidence interval (CI) -0.10 - 0.09, P=0.87, I²=30%). Additionally, no significant change in function was noted (WOMAC C) (SMD=0.01, 95% CI -0.08 - 0.10, P=0.87, I²=22%). The pooled analysis did not find a significant difference between LMWF-5A and placebo regarding the incidence of joint swelling (P=0.84), joint stiffness (P=0.53), arthralgia (P=0.53), extremity pain (P=0.45), NSAEs (P=0.21), SAEs (P=0.92), or mortality (P=1.00). However, the subgroup analysis showed a significant reduction of 42% in NSAEs upon administration of 10 mL of LMWF-5A (risk ratio (RR)=0.58, 95% CI 0.35-0.97, P=0.04). In summary, our meta-analysis did not find significant differences between LMWF-5A and placebo regarding the incidence of NSAEs, SAEs, or mortality. On the other hand, LMWF-5A did not demonstrate superiority over saline in terms of efficacy. Therefore, it is not an effective drug for managing knee osteoarthritis.
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Affiliation(s)
- Mohammad H Nooh
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed S Alshehri
- Orthopaedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
- Orthopaedic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ziyad S Alzahrani
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatem M Alsolami
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Amal O Almutairi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | | | - Abdulaziz N Aljohani
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
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Assi R, Quintiens J, Monteagudo S, Lories RJ. Innovation in Targeted Intra-articular Therapies for Osteoarthritis. Drugs 2023; 83:649-663. [PMID: 37067759 DOI: 10.1007/s40265-023-01863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/18/2023]
Abstract
Osteoarthritis is the most common chronic joint disease characterized by progressive damage to the joints, leading to pain and loss of function. There is currently no cure or disease-modifying therapy for osteoarthritis. Hence, the increasing disease prevalence linked with ageing and obesity represents a substantial socio-economic burden. Intra-articular therapy by injection of drugs into affected joints can optimize local drug bioavailability, while reducing risks of systemic toxicity, a concern in an ageing patient population. In this review, we investigate the current landscape of intra-articular drug therapies for osteoarthritis, including established approaches and those in clinical development. We performed a literature review using PubMed, complemented with a search for clinical trials using the ClinicalTrials.gov repository. Additionally, conference abstracts and presentations were identified and systematic snowballing was applied. Identified drugs were divided into several groups by main mechanism of action, and include drugs that reduce inflammation (anti-inflammatory), drugs aiming to prevent or reverse structural damage (structure modifying), drugs that aim to reduce the pain, and other drugs with a specific target. Most studies have been performed for osteoarthritis of the knee, a joint that is easily accessible for intra-articular treatments. Optimal therapy would provide symptomatic relief, while preventing further damage to the joint. The field of intra-articular drug therapies for osteoarthritis is rapidly evolving with clear challenges identified: definition of relevant outcome measures, optimization of clinical trial set-ups, and dealing with placebo responses. While many uncertainties persist, it appears that the innovation in drug development and improved clinical trial set-up may finally deliver successful therapies for this important disease.
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Affiliation(s)
- Reem Assi
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium
| | - Jolien Quintiens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium
- Division of Rheumatology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Silvia Monteagudo
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium
| | - Rik J Lories
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Laboratory of Tissue Homeostasis and Disease, KU Leuven, Leuven, Belgium.
- Division of Rheumatology, University Hospitals Leuven, 3000, Leuven, Belgium.
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Kuten Pella O, Hornyák I, Horváthy D, Fodor E, Nehrer S, Lacza Z. Albumin as a Biomaterial and Therapeutic Agent in Regenerative Medicine. Int J Mol Sci 2022; 23:10557. [PMID: 36142472 PMCID: PMC9502107 DOI: 10.3390/ijms231810557] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
Albumin is a constitutional plasma protein, with well-known biological functions, e.g., a nutrient for stem cells in culture. However, albumin is underutilized as a biomaterial in regenerative medicine. This review summarizes the advanced therapeutic uses of albumin, focusing on novel compositions that take advantage of the excellent regenerative potential of this protein. Albumin coating can be used for enhancing the biocompatibility of various types of implants, such as bone grafts or sutures. Albumin is mainly known as an anti-attachment protein; however, using it on implantable surfaces is just the opposite: it enhances stem cell adhesion and proliferation. The anticoagulant, antimicrobial and anti-inflammatory properties of albumin allow fine-tuning of the biological reaction to implantable tissue-engineering constructs. Another potential use is combining albumin with natural or synthetic materials that results in novel composites suitable for cardiac, neural, hard and soft tissue engineering. Recent advances in materials have made it possible to electrospin the globular albumin protein, opening up new possibilities for albumin-based scaffolds for cell therapy. Several described technologies have already entered the clinical phase, making good use of the excellent biological, but also regulatory, manufacturing and clinical features of serum albumin.
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Affiliation(s)
| | - István Hornyák
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary
| | - Dénes Horváthy
- Department of Interventional Radiology, Semmelweis University, 1122 Budapest, Hungary
| | - Eszter Fodor
- Institute for Sports and Health Sciences, Hungarian University of Sports Science, 1123 Budapest, Hungary
| | - Stefan Nehrer
- Center for Regenerative Medicine, Danube University Krems, 3500 Krems an der Donau, Austria
| | - Zsombor Lacza
- Orthosera GmbH, 3500 Krems an der Donau, Austria
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary
- Institute for Sports and Health Sciences, Hungarian University of Sports Science, 1123 Budapest, Hungary
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Zhang Z, Schon L. The Current Status of Clinical Trials on Biologics for Cartilage Repair and Osteoarthritis Treatment: An Analysis of ClinicalTrials.gov Data. Cartilage 2022; 13:19476035221093065. [PMID: 35546280 PMCID: PMC9152205 DOI: 10.1177/19476035221093065] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Biologics are increasingly used for cartilage repair and osteoarthritis (OA) treatment. This study aimed to provide an overview of the clinical trials conducted on this subject. DESIGN Two-word combinations of two sets of key words "cartilage"; "joint"; "osteoarthritis" and "biologics"; "stem cells"; "cell implantation" were used to search the database of ClinicalTrials.gov and supplemented with searches of PubMed and EMbase. The registered trials were analyzed for clinical conditions, completion status, phases, and investigated biologics. Recently completed trials with posted/published results were summarized. RESULTS From 2000 to 2022, a total of 365 clinical trials were registered at ClinicalTrials.gov to use biologics for cartilage repair and OA treatment. Since 2006, the number of registered trials accelerated at an annual rate of 16.4%. Of the 265 trials designated with a phase, 72% were early Phase 1, Phase 1, and Phase 2. Chondrocytes and platelet-rich plasma (PRP) were studied in nearly equal number of early- and late-stage trials. Mesenchymal stem/stromal cells (MSCs) were the most commonly investigated biologics (38%) and mostly derived from bone marrow and adipose tissue (70%). In last 5 years, 32 of the 72 completed trials posted/published results, among which seven Phase 3 trials investigated chondrocytes, PRP, bone marrow aspirate concentrate, hyaluronic acid, collagen membrane, and albumin. CONCLUSIONS There was a rapid increase in the number of registered clinical trials in recent years, using a variety of biologics for cartilage repair and OA treatment. Majority of the biologics still require late-stage trials to validate their clinical effectiveness.
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Affiliation(s)
- Zijun Zhang
- Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD, USA,Zijun Zhang, Center for Orthopaedic Innovation, Mercy Medical Center, 301 Saint Paul Place, Baltimore, MD 21202, USA.
| | - Lew Schon
- Center for Orthopaedic Innovation, Mercy Medical Center, Baltimore, MD, USA,Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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Thomas G, Hirter K, Frederick E, Hausburg M, Bar-Or R, Mulugeta Y, Roshon M, Mains C, Bar-Or D. AMP5A modulates Toll-like receptors 7 and 8 single-stranded RNA immune responses in PMA-differentiated THP-1 and PBMC. TRANSLATIONAL MEDICINE COMMUNICATIONS 2022; 7:3. [PMID: 35261923 PMCID: PMC8891742 DOI: 10.1186/s41231-022-00110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dysregulation of antiviral immunity has been implicated in the progression of acute respiratory syndrome coronavirus 2 infection into severe cases of coronavirus disease of 2019 (COVID-19). Imbalances in the inflammatory response drive the overabundant production of pro-inflammatory cytokines and chemokines. The low molecular weight fraction of 5% human serum albumin commercial preparation (AMP5A) is a novel biologic drug currently under clinical investigation for the treatment of osteoarthritis and the hyperinflammatory response associated with COVID-19. This study aims to elucidate AMP5A effects following the activation of immune cells with agonists of Toll-like receptor (TLR) 7 and/or 8, which detect ssRNA viral sequences. METHODS CXCL10 ELISAs were used to evaluate the dynamics of myeloid cells activated with CL075 and CL307, agonists of TLR7/8 and TLR7, respectively. In addition, enrichment analysis of gene sets generated by ELISA arrays was utilized to gain insight into the biologic processes underlying the identified differentially expressed cytokine profiles. Finally, relative potency (REP) was employed to confirm the involvement of mechanisms of action paramount to AMP5A activity. RESULTS AMP5A inhibits the release of CXCL10 from both CL075- and CL307-activated PMA-differentiated THP-1 and peripheral blood mononuclear cells. Furthermore, AMP5A suppresses a distinct set of pro-inflammatory cytokines (including IL-1β, IL-6, IL-12, and CXCL10) associated with COVID-19 and pro-inflammatory NF-κB activation. REP experiments using antagonists specific for the immunomodulatory transcription factors, peroxisome proliferator-activated receptor γ, and aryl hydrocarbon receptor, also indicate that these pathways are involved in the ability of AMP5A to inhibit CXCL10 release. CONCLUSION Due to the biphasic course of COVID-19, therapeutic approaches that augment antiviral immunity may be more beneficial early in infection, whereas later interventions should focus on inflammation suppression. In this study, we show that AMP5A inhibits TLR 7/8 signaling in myeloid cells, resulting in a decrease in inflammatory mediators associated with hyperinflammation and autoimmunity. Furthermore, data demonstrating that AMP5A activates immunomodulatory transcription factors found to be protective in lung disease is provided. These findings suggest that the modes and mechanisms of action of AMP5A are well suited to treat conditions involving dysregulated TLR 7/8 activation.
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Affiliation(s)
- Gregory Thomas
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO 80122 USA
| | - Kristen Hirter
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO 80122 USA
| | - Elizabeth Frederick
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO 80122 USA
| | - Melissa Hausburg
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden, Englewood, CO 80113 USA
- Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO 80228 USA
- Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907 USA
- Department of Molecular Biology, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134 USA
- Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO 80112 USA
| | - Raphael Bar-Or
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO 80122 USA
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden, Englewood, CO 80113 USA
- Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO 80228 USA
- Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907 USA
- Department of Molecular Biology, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134 USA
- Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO 80112 USA
| | - Yetti Mulugeta
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO 80122 USA
| | - Michael Roshon
- Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907 USA
| | - Charles Mains
- Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO 80112 USA
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden, Englewood, CO 80113 USA
- Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO 80228 USA
- Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO 80907 USA
- Department of Molecular Biology, Rocky Vista University, 8401 S Chambers Rd, Parker, CO 80134 USA
- Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO 80112 USA
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Previtali D, Merli G, Di Laura Frattura G, Candrian C, Zaffagnini S, Filardo G. The Long-Lasting Effects of "Placebo Injections" in Knee Osteoarthritis: A Meta-Analysis. Cartilage 2021; 13:185S-196S. [PMID: 32186401 PMCID: PMC8808779 DOI: 10.1177/1947603520906597] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. DESIGN Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. RESULTS Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain -13.4 mean difference (MD) (95% confidence interval [CI]: -21.7/-5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain -3.3 MD (95% CI: -3.9/-2.7; P < 0.001). Other significant improvements were WOMAC-stiffness -1.1 MD (95% CI: -1.6/-0.6; P < 0.001), WOMAC-function -10.1 MD (95% CI: -12.2/-8.0; P < 0.001), and Evaluator Global Assessment -21.4 MD (95% CI: -29.2/-13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the "minimal clinically important difference" for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. CONCLUSIONS The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.
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Affiliation(s)
- Davide Previtali
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland
| | - Giulia Merli
- Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Giulia Merli, Applied and Translational
Research Center, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10,
Bologna 40136, Italy.
| | | | - Christian Candrian
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland
| | | | - Giuseppe Filardo
- Orthopaedic and Traumatology Unit,
Ospedale Regionale di Lugano, EOC, Lugano, Ticino, Switzerland,Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Siddiq MAB, Clegg D, Jansen TL, Rasker JJ. Emerging and New Treatment Options for Knee Osteoarthritis. Curr Rheumatol Rev 2021; 18:20-32. [PMID: 34784876 DOI: 10.2174/1573397117666211116111738] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/15/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, resulting in pain and often chronic disability and a significant burden on healthcare systems globally. Non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, intra-articular corticosteroid injections are of little value in the long term, and opioids may have ominous consequences. Radiotherapy of knee OA has no added value. Physical therapy, exercises, weight loss, and lifestyle modifications may give pain relief, improve physical functioning and quality of life. However, no single treatment has regenerating potential for damaged articular cartilage. Due to a better understanding of osteoarthritis, innovative new treatment options have been developed. In this narrative review, we focus on emerging OA knee treatments, relieving symptoms, and regenerating damaged articular cartilage that includes intra-articular human serum albumin, conventional disease-modifying anti-rheumatic drugs (DMARDs), lipid-lowering agents (statin), nerve growth factors antagonists, bone morphogenetic protein, fibroblast growth factors, Platelet-Rich Plasma (PRP), Mesenchymal Stem Cells (MSC), exosomes, interleukin-1 blockers, gene-based therapy, and bisphosphonate.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Department of Physical Medicine and Rheumatology, Brahmanbaria Medical College, Brahmanbaria. Bangladesh
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London. United Kingdom
| | - Tim L Jansen
- Department of Rheumatology, Viecuri MC, Venlo. Netherlands
| | - Johannes J Rasker
- Faculty of Behavioral, Management and Social sciences, Department Psychology, Health and Technology, University of Twente, Enschede . Netherlands
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A Randomized Controlled Trial to Evaluate the Safety and Efficacy of a Novel Inhaled Biologic Therapeutic in Adults with Respiratory Distress Secondary to COVID-19 Infection. Infect Dis Ther 2021; 11:595-605. [PMID: 34775578 PMCID: PMC8590808 DOI: 10.1007/s40121-021-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Inhaled therapeutics may act to directly target and attenuate lung inflammation due to COVID-19. An inhalation form of a novel biologic drug, AMP5A, is being developed as an immunomodulatory agent to treat dysregulated immune responses and is being studied in hospitalized patients to treat respiratory complications due to COVID-19. METHODS A randomized, controlled, phase I trial was conducted to evaluate hospitalized adults with respiratory distress secondary to COVID-19. Patients received the standard care (SOC) for COVID-19, including respiratory therapy, corticosteroids, and antiviral therapies such as remdesivir. Patients were randomized 1:1 to inhalation treatment with AMP5A as an adjunct to SOC or to SOC alone (control). AMP5A was administered via inhalation daily for 5 days via hand-held nebulizer, non-invasive ventilator, or mechanical ventilation. Safety and clinical efficacy endpoints were evaluated. RESULTS Forty subjects were enrolled and randomized (n = 19 AMP5A, n = 21 control). Remdesivir was used in fewer AMP5A subjects (26%) than control (52%), and dexamethasone was administered for most subjects (84% AMP5A, 71% control). The study met its primary endpoint with no AMP5A treatment-related adverse events (AEs), and the incidence and severity of AEs were comparable between groups: 18 AEs for control (8 mild, 1 moderate, 9 severe) and 19 AEs for AMP5A (7 mild, 7 moderate, 5 severe). Notably, subjects treated with AMP5A had fewer deaths (5% vs. 24%), shorter hospital stay (8 days vs. 12 days), fewer ICU admissions (21% vs. 33%), and a greater proportion with improved clinical outcomes than control. CONCLUSION The phase I clinical results indicate inhaled AMP5A is safe, is well tolerated, and could lead to fewer patients experiencing deterioration or death. Based on the treatment effect (i.e., reduced mortality), a phase II trial has been initiated. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04606784.
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Thomas G, Frederick E, Thompson L, Bar-Or R, Mulugeta Y, Hausburg M, Roshon M, Mains C, Bar-Or D. LMWF5A suppresses cytokine release by modulating select inflammatory transcription factor activity in stimulated PBMC. J Transl Med 2020; 18:452. [PMID: 33256749 PMCID: PMC7702209 DOI: 10.1186/s12967-020-02626-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background Dysregulation of transcription and cytokine expression has been implicated in the pathogenesis of a variety inflammatory diseases. The resulting imbalance between inflammatory and resolving transcriptional programs can cause an overabundance of pro-inflammatory, classically activated macrophage type 1 (M1) and/or helper T cell type 1 (Th1) products, such as IFNγ, TNFα, IL1-β, and IL12, that prevent immune switching to resolution and healing. The low molecular weight fraction of human serum albumin (LMWF5A) is a novel biologic drug that is currently under clinical investigation for the treatment of osteoarthritis and the hyper-inflammatory response associated with COVID-19. This study aims to elucidate transcriptional mechanisms of action involved with the ability of LMWF5A to reduce pro-inflammatory cytokine release. Methods ELISA arrays were used to identify cytokines and chemokines influenced by LMWF5A treatment of LPS-stimulated peripheral blood mononuclear cells (PBMC). The resulting profiles were analyzed by gene enrichment to gain mechanistic insight into the biologic processes and transcription factors (TFs) underlying the identified differentially expressed cytokines. DNA-binding ELISAs, luciferase reporter assays, and TNFα or IL-1β relative potency were then employed to confirm the involvement of enriched pathways and TFs. Results LMWF5A was found to significantly inhibit a distinct set of pro-inflammatory cytokines (TNFα, IL-1β, IL-12, CXCL9, CXCL10, and CXCL11) associated with pro-inflammatory M1/Th1 immune profiles. Gene enrichment analysis also suggests these cytokines are, in part, regulated by NF-κB and STAT transcription factors. Data from DNA-binding and reporter assays support this with LMWF5A inhibition of STAT1α DNA-binding activity as well as a reduction in overall NF-κB-driven luciferase expression. Experiments using antagonists specific for the immunomodulatory and NF-κB/STAT-repressing transcription factors, peroxisome proliferator-activated receptor (PPAR)γ and aryl hydrocarbon receptor (AhR), indicate these pathways are involved in the LMWF5A mechanisms of action by reducing LMWF5A drug potency as measured by TNFα and IL-1β release. Conclusion In this report, we provide evidence that LMWF5A reduces pro-inflammatory cytokine release by activating the immunoregulatory transcription factors PPARγ and AhR. In addition, our data indicate that LMWF5A suppresses NF-κB and STAT1α pro-inflammatory pathways. This suggests that LMWF5A acts through these mechanisms to decrease pro-inflammatory transcription factor activity and subsequent inflammatory cytokine production.
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Affiliation(s)
- Gregory Thomas
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO, 80122, USA
| | - Elizabeth Frederick
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO, 80122, USA
| | - Lisa Thompson
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO, 80122, USA
| | - Raphael Bar-Or
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO, 80122, USA.,Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave. Rm 4-454, Englewood, CO, 80113, USA.,Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO, 80228, USA.,Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA.,Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO, 80112, USA
| | - Yetti Mulugeta
- Ampio Pharmaceuticals Inc, 373 Inverness Parkway Suite 200, Englewood, CO, 80122, USA
| | - Melissa Hausburg
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave. Rm 4-454, Englewood, CO, 80113, USA.,Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO, 80228, USA.,Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA.,Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO, 80112, USA
| | - Michael Roshon
- Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA
| | - Charles Mains
- Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO, 80112, USA
| | - David Bar-Or
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Ave. Rm 4-454, Englewood, CO, 80113, USA. .,Trauma Research Department, St. Anthony Hospital, 11600 W 2nd Pl, Lakewood, CO, 80228, USA. .,Trauma Research Department, Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA. .,Centura Health Systems, 9100 E. Mineral Cir, Centennial, CO, 80112, USA. .,Department of Molecular Biology, Rocky Vista University, 8401 S Chambers Rd, Parker, CO, 80134, USA.
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Bar-Or D, Thomas G, Rael LT, Frederick E, Hausburg M, Bar-Or R, Brody E. On the Mechanisms of Action of the Low Molecular Weight Fraction of Commercial Human Serum Albumin in Osteoarthritis. Curr Rheumatol Rev 2020; 15:189-200. [PMID: 30451114 PMCID: PMC6791032 DOI: 10.2174/1573397114666181119121519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 01/05/2023]
Abstract
The low molecular weight fraction of commercial human serum albumin (LMWF5A) has been shown to successfully relieve pain and inflammation in severe osteoarthritis of the knee (OAK). LMWF5A contains at least three active components that could account for these antiinflammatory and analgesic effects. We summarize in vitro experiments in bone marrow-derived mesenchymal stem cells, monocytic cell lines, chondrocytes, peripheral blood mononuclear cells, fibroblast-like synoviocytes, and endothelial cells on the biochemistry of anti-inflammatory changes induced by LMWF5A. We then look at four of the major pathways that cut across cell-type considerations to examine which biochemical reactions are affected by mTOR, COX-2, CD36, and AhR pathways. All three components show anti-inflammatory activities in at least some of the cell types. The in vitro experiments show that the effects of LMWF5A in chondrocytes and bone marrow- derived stem cells in particular, coupled with recent data from previous clinical trials of single and multiple injections of LMWF5A into OAK patients demonstrated improvements in pain, function, and Patient Global Assessment (PGA), as well as high responder rates that could be attributed to the multiple mechanism of action (MOA) pathways are summarized here. In vitro and in vivo data are highly suggestive of LMWF5A being a disease-modifying drug for OAK.
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Affiliation(s)
- David Bar-Or
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States.,Ampio Pharmaceuticals, Inc., 373 Inverness Parkway, #200, Englewood, CO 80112, United States
| | - Gregory Thomas
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States.,Ampio Pharmaceuticals, Inc., 373 Inverness Parkway, #200, Englewood, CO 80112, United States
| | - Leonard T Rael
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States
| | - Elizabeth Frederick
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States.,Ampio Pharmaceuticals, Inc., 373 Inverness Parkway, #200, Englewood, CO 80112, United States
| | - Melissa Hausburg
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States
| | - Raphael Bar-Or
- Trauma Research Department, Swedish Medical Center, 501 E. Hampden Avenue, Englewood, CO 80113, United States.,Trauma Research Department, St. Anthony Hospital, 1600 W. 2nd Place, Lakewood, CO 80228, United States.,Trauma Research Department, Medical City Plano, 3901 W. 15th Street, Plano, TX 75075, United States.,Trauma Research Department, Penrose Hospital, 2222 N. Nevada Avenue, Colorado Springs, CO 80907, United States.,Trauma Research Department, Research Medical Center, 2315 E. Meyer Boulevard, Kansas City, MO 64132, United States.,Trauma Research Department, Wesley Medical Center, 550 N. Hillside Street, Witchita, KS 67214, United States.,Ampio Pharmaceuticals, Inc., 373 Inverness Parkway, #200, Englewood, CO 80112, United States
| | - Edward Brody
- SomaLogic, Inc., 2945 Wilderness Place, Boulder, CO 80301, United States
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