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Wagemann O, Liu H, Wang G, Shi X, Bittner T, Scelsi MA, Farlow MR, Clifford DB, Supnet-Bell C, Santacruz AM, Aschenbrenner AJ, Hassenstab JJ, Benzinger TLS, Gordon BA, Coalier KA, Cruchaga C, Ibanez L, Perrin RJ, Xiong C, Li Y, Morris JC, Lah JJ, Berman SB, Roberson ED, van Dyck CH, Galasko D, Gauthier S, Hsiung GYR, Brooks WS, Pariente J, Mummery CJ, Day GS, Ringman JM, Mendez PC, St. George-Hyslop P, Fox NC, Suzuki K, Okhravi HR, Chhatwal J, Levin J, Jucker M, Sims JR, Holdridge KC, Proctor NK, Yaari R, Andersen SW, Mancini M, Llibre-Guerra J, Bateman RJ, McDade E. Downstream Biomarker Effects of Gantenerumab or Solanezumab in Dominantly Inherited Alzheimer Disease: The DIAN-TU-001 Randomized Clinical Trial. JAMA Neurol 2024; 81:582-593. [PMID: 38683602 PMCID: PMC11059071 DOI: 10.1001/jamaneurol.2024.0991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/01/2024] [Indexed: 05/01/2024]
Abstract
Importance Effects of antiamyloid agents, targeting either fibrillar or soluble monomeric amyloid peptides, on downstream biomarkers in cerebrospinal fluid (CSF) and plasma are largely unknown in dominantly inherited Alzheimer disease (DIAD). Objective To investigate longitudinal biomarker changes of synaptic dysfunction, neuroinflammation, and neurodegeneration in individuals with DIAD who are receiving antiamyloid treatment. Design, Setting, and Participants From 2012 to 2019, the Dominantly Inherited Alzheimer Network Trial Unit (DIAN-TU-001) study, a double-blind, placebo-controlled, randomized clinical trial, investigated gantenerumab and solanezumab in DIAD. Carriers of gene variants were assigned 3:1 to either drug or placebo. The present analysis was conducted from April to June 2023. DIAN-TU-001 spans 25 study sites in 7 countries. Biofluids and neuroimaging from carriers of DIAD gene variants in the gantenerumab, solanezumab, and placebo groups were analyzed. Interventions In 2016, initial dosing of gantenerumab, 225 mg (subcutaneously every 4 weeks) was increased every 8 weeks up to 1200 mg. In 2017, initial dosing of solanezumab, 400 mg (intravenously every 4 weeks) was increased up to 1600 mg every 4 weeks. Main Outcomes and Measures Longitudinal changes in CSF levels of neurogranin, soluble triggering receptor expressed on myeloid cells 2 (sTREM2), chitinase 3-like 1 protein (YKL-40), glial fibrillary acidic protein (GFAP), neurofilament light protein (NfL), and plasma levels of GFAP and NfL. Results Of 236 eligible participants screened, 43 were excluded. A total of 142 participants (mean [SD] age, 44 [10] years; 72 female [51%]) were included in the study (gantenerumab, 52 [37%]; solanezumab, 50 [35%]; placebo, 40 [28%]). Relative to placebo, gantenerumab significantly reduced CSF neurogranin level at year 4 (mean [SD] β = -242.43 [48.04] pg/mL; P < .001); reduced plasma GFAP level at year 1 (mean [SD] β = -0.02 [0.01] ng/mL; P = .02), year 2 (mean [SD] β = -0.03 [0.01] ng/mL; P = .002), and year 4 (mean [SD] β = -0.06 [0.02] ng/mL; P < .001); and increased CSF sTREM2 level at year 2 (mean [SD] β = 1.12 [0.43] ng/mL; P = .01) and year 4 (mean [SD] β = 1.06 [0.52] ng/mL; P = .04). Solanezumab significantly increased CSF NfL (log) at year 4 (mean [SD] β = 0.14 [0.06]; P = .02). Correlation analysis for rates of change found stronger correlations between CSF markers and fluid markers with Pittsburgh compound B positron emission tomography for solanezumab and placebo. Conclusions and Relevance This randomized clinical trial supports the importance of fibrillar amyloid reduction in multiple AD-related processes of neuroinflammation and neurodegeneration in CSF and plasma in DIAD. Additional studies of antiaggregated amyloid therapies in sporadic AD and DIAD are needed to determine the utility of nonamyloid biomarkers in determining disease modification. Trial Registration ClinicalTrials.gov Identifier: NCT04623242.
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Affiliation(s)
- Olivia Wagemann
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Haiyan Liu
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Guoqiao Wang
- Department of Biostatistics, Washington University in St Louis, St Louis, Missouri
| | - Xinyu Shi
- Department of Biostatistics, Washington University in St Louis, St Louis, Missouri
| | | | - Marzia A. Scelsi
- F. Hoffmann-La Roche Products Ltd, Welwyn Garden City, United Kingdom
| | - Martin R. Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis
| | - David B. Clifford
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Charlene Supnet-Bell
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Anna M. Santacruz
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | - Jason J. Hassenstab
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | | | - Brian A. Gordon
- Department of Radiology, Washington University in St Louis, St Louis, Missouri
| | | | - Carlos Cruchaga
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Laura Ibanez
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Richard J. Perrin
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, Missouri
| | - Chengjie Xiong
- Department of Biostatistics, Washington University in St Louis, St Louis, Missouri
| | - Yan Li
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - John C. Morris
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - James J. Lah
- Department of Neurology, School of Medicine Emory University, Atlanta, Georgia
| | - Sarah B. Berman
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erik D. Roberson
- Department of Neurology, University of Alabama at Birmingham, Birmingham
| | | | - Douglas Galasko
- Department of Neurology, University of California, San Diego
| | - Serge Gauthier
- Department of Neurology & Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ging-Yuek R. Hsiung
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William S. Brooks
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Jérémie Pariente
- Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Catherine J. Mummery
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Gregory S. Day
- Department of Neurology, Mayo Clinic Florida, Jacksonville
| | - John M. Ringman
- Department of Neurology, University of Southern California, Los Angeles
| | - Patricio Chrem Mendez
- Fundación Para la Lucha Contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | | | - Nick C. Fox
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | | | - Hamid R. Okhravi
- Department of Geriatrics, Eastern Virginia Medical School, Norfolk
| | - Jasmeer Chhatwal
- Department of Neurology, Massachusetts General and Brigham & Women’s Hospitals, Harvard Medical School, Boston
| | - Johannes Levin
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Mathias Jucker
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | | | | | - Roy Yaari
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - Jorge Llibre-Guerra
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Randall J. Bateman
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Eric McDade
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
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McDade E, Cummings JL, Dhadda S, Swanson CJ, Reyderman L, Kanekiyo M, Koyama A, Irizarry M, Kramer LD, Bateman RJ. Lecanemab in patients with early Alzheimer's disease: detailed results on biomarker, cognitive, and clinical effects from the randomized and open-label extension of the phase 2 proof-of-concept study. Alzheimers Res Ther 2022; 14:191. [PMID: 36544184 PMCID: PMC9768996 DOI: 10.1186/s13195-022-01124-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lecanemab, a humanized IgG1 monoclonal antibody that targets soluble aggregated Aβ species (protofibrils), has demonstrated robust brain fibrillar amyloid reduction and slowing of clinical decline in early AD. The objective of this analysis is to report results from study 201 blinded period (core), the open-label extension (OLE), and gap period (between core and OLE) supporting the effectiveness of lecanemab. METHODS The lecanemab study 201 core was a double-blind, randomized, placebo-controlled study of 856 patients randomized to one of five dose regimens or placebo. An OLE of study 201 was initiated to allow patients to receive open-label lecanemab 10mg/kg biweekly for up to 24 months, with an intervening off-treatment period (gap period) ranging from 9 to 59 months (mean 24 months). RESULTS At 12 and 18 months of treatment in the core, lecanemab 10 mg/kg biweekly demonstrated dose-dependent reductions of brain amyloid measured PET and corresponding changes in plasma biomarkers and slowing of cognitive decline. The rates of clinical progression during the gap were similar in lecanemab and placebo subjects, with clinical treatment differences maintained after discontinued dosing over an average of 24 months in the gap period. During the gap, plasma Aβ42/40 ratio and p-tau181 levels began to return towards pre-randomization levels more quickly than amyloid PET. At OLE baseline, treatment differences vs placebo at 18 months in the randomized period were maintained across 3 clinical assessments. In the OLE, lecanemab 10 mg/kg biweekly treatment produced dose-dependent reductions in amyloid PET SUVr, improvements in plasma Aβ42/40 ratio, and reductions in plasma p-tau181. CONCLUSIONS Lecanemab treatment resulted in significant reduction in amyloid plaques and a slowing of clinical decline. Data indicate that rapid and pronounced amyloid reduction correlates with clinical benefit and potential disease-modifying effects, as well as the potential to use plasma biomarkers to monitor for lecanemab treatment effects. TRIAL REGISTRATION ClinicalTrials.gov NCT01767311 .
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Affiliation(s)
- Eric McDade
- grid.4367.60000 0001 2355 7002The DIAN–TU, Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Jeffrey L. Cummings
- grid.272362.00000 0001 0806 6926Chambers-Grundy Center for Transformative Neuroscience, Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV USA
| | - Shobha Dhadda
- grid.418767.b0000 0004 0599 8842Eisai Inc., Nutley, NJ USA
| | | | | | | | - Akihiko Koyama
- grid.418767.b0000 0004 0599 8842Eisai Inc., Nutley, NJ USA
| | | | - Lynn D. Kramer
- grid.418767.b0000 0004 0599 8842Eisai Inc., Nutley, NJ USA
| | - Randall J. Bateman
- grid.4367.60000 0001 2355 7002The DIAN–TU, Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
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3
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Swanson CJ, Zhang Y, Dhadda S, Wang J, Kaplow J, Lai RYK, Lannfelt L, Bradley H, Rabe M, Koyama A, Reyderman L, Berry DA, Berry S, Gordon R, Kramer LD, Cummings JL. A randomized, double-blind, phase 2b proof-of-concept clinical trial in early Alzheimer's disease with lecanemab, an anti-Aβ protofibril antibody. Alzheimers Res Ther 2021; 13:80. [PMID: 33865446 PMCID: PMC8053280 DOI: 10.1186/s13195-021-00813-8] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lecanemab (BAN2401), an IgG1 monoclonal antibody, preferentially targets soluble aggregated amyloid beta (Aβ), with activity across oligomers, protofibrils, and insoluble fibrils. BAN2401-G000-201, a randomized double-blind clinical trial, utilized a Bayesian design with response-adaptive randomization to assess 3 doses across 2 regimens of lecanemab versus placebo in early Alzheimer's disease, mild cognitive impairment due to Alzheimer's disease (AD) and mild AD dementia. METHODS BAN2401-G000-201 aimed to establish the effective dose 90% (ED90), defined as the simplest dose that achieves ≥90% of the maximum treatment effect. The primary endpoint was Bayesian analysis of 12-month clinical change on the Alzheimer's Disease Composite Score (ADCOMS) for the ED90 dose, which required an 80% probability of ≥25% clinical reduction in decline versus placebo. Key secondary endpoints included 18-month Bayesian and frequentist analyses of brain amyloid reduction using positron emission tomography; clinical decline on ADCOMS, Clinical Dementia Rating-Sum-of-Boxes (CDR-SB), and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog14); changes in CSF core biomarkers; and total hippocampal volume (HV) using volumetric magnetic resonance imaging. RESULTS A total of 854 randomized subjects were treated (lecanemab, 609; placebo, 245). At 12 months, the 10-mg/kg biweekly ED90 dose showed a 64% probability to be better than placebo by 25% on ADCOMS, which missed the 80% threshold for the primary outcome. At 18 months, 10-mg/kg biweekly lecanemab reduced brain amyloid (-0.306 SUVr units) while showing a drug-placebo difference in favor of active treatment by 27% and 30% on ADCOMS, 56% and 47% on ADAS-Cog14, and 33% and 26% on CDR-SB versus placebo according to Bayesian and frequentist analyses, respectively. CSF biomarkers were supportive of a treatment effect. Lecanemab was well-tolerated with 9.9% incidence of amyloid-related imaging abnormalities-edema/effusion at 10 mg/kg biweekly. CONCLUSIONS BAN2401-G000-201 did not meet the 12-month primary endpoint. However, prespecified 18-month Bayesian and frequentist analyses demonstrated reduction in brain amyloid accompanied by a consistent reduction of clinical decline across several clinical and biomarker endpoints. A phase 3 study (Clarity AD) in early Alzheimer's disease is underway. TRIAL REGISTRATION Clinical Trials.gov NCT01767311 .
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Affiliation(s)
| | | | | | | | | | | | - Lars Lannfelt
- BioArctic AB, Warfvinges väg 35, SE-112 51, Stockholm, Sweden
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | | | | | | | | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
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Bartl S, Oueslati A, Southwell AL, Siddu A, Parth M, David LS, Maxan A, Salhat N, Burkert M, Mairhofer A, Friedrich T, Pankevych H, Balazs K, Staffler G, Hayden MR, Cicchetti F, Smrzka OW. Inhibiting cellular uptake of mutant huntingtin using a monoclonal antibody: Implications for the treatment of Huntington's disease. Neurobiol Dis 2020; 141:104943. [PMID: 32407769 DOI: 10.1016/j.nbd.2020.104943] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 12/24/2022] Open
Abstract
Huntington's disease (HD) is caused by a highly polymorphic CAG trinucleotide expansion in the gene encoding for the huntingtin protein (HTT). The resulting mutant huntingtin protein (mutHTT) is ubiquitously expressed but also exhibits the ability to propagate from cell-to-cell to disseminate pathology; a property which may serve as a new therapeutic focus. Accordingly, we set out to develop a monoclonal antibody (mAB) targeting a particularly exposed region close to the aa586 caspase-6 cleavage site of the HTT protein. This monoclonal antibody, designated C6-17, effectively binds mutHTT and is able to deplete the protein from cell culture supernatants. Using cell-based assays, we demonstrate that extracellular secretion of mutHTT into cell culture media and its subsequent uptake in recipient HeLa cells can be almost entirely blocked by mAB C6-17. Immunohistochemical stainings of post-mortem HD brain tissue confirmed the specificity of mAB C6-17 to human mutHTT aggregates. These findings demonstrate that mAB C6-17 not only successfully engages with its target, mutHTT, but also inhibits cell uptake suggesting that this antibody could interfere with the pathological processes of mutHTT spreading in vivo.
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Affiliation(s)
| | - Abid Oueslati
- Université Laval/Centre de recherche du CHU, Québec, Canada
| | | | - Alberto Siddu
- Université Laval/Centre de recherche du CHU, Québec, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | - Oskar W Smrzka
- AFFiRiS AG, Vienna, Austria; Ablevia biotech GmbH, Vienna, Austria
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5
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Derry PJ, Hegde ML, Jackson GR, Kayed R, Tour JM, Tsai AL, Kent TA. Revisiting the intersection of amyloid, pathologically modified tau and iron in Alzheimer's disease from a ferroptosis perspective. Prog Neurobiol 2020; 184:101716. [PMID: 31604111 PMCID: PMC7850812 DOI: 10.1016/j.pneurobio.2019.101716] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/12/2019] [Accepted: 09/26/2019] [Indexed: 02/06/2023]
Abstract
The complexity of Alzheimer's disease (AD) complicates the search for effective treatments. While the key roles of pathologically modified proteins has occupied a central role in hypotheses of the pathophysiology, less attention has been paid to the potential role for transition metals overload, subsequent oxidative stress, and tissue injury. The association of transition metals, the major focus heretofore iron and amyloid, the same can now be said for the likely pathogenic microtubular associated tau (MAPT). This review discusses the interplay between iron, pathologically modified tau and oxidative stress, and connects many related discoveries. Basic principles of the transition to pathological MAPT are discussed. Iron, its homeostatic mechanisms, the recently described phenomenon of ferroptosis and purported, although still controversial roles in AD are reviewed as well as considerations to overcome existing hurdles of iron-targeted therapeutic avenues that have been attempted in AD. We summarize the involvement of multiple pathological pathways at different disease stages of disease progression that supports the potential for a combinatorial treatment strategy targeting multiple factors.
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Affiliation(s)
- Paul J Derry
- Center for Genomics and Precision Medicine, Institute of Biosciences and Technology, College of Medicine, Texas A&M Health Science Center, Houston, TX, United States
| | - Muralidhar L Hegde
- Institute for Academic Medicine, Houston Methodist, Weill Cornell Medical College, Houston, TX, United States
| | - George R Jackson
- Department of Neurology Baylor College of Medicine, Houston, TX, United States; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Rakez Kayed
- Mitchell Center for Neurodegenerative Disorders, Department of Neurology, University of Texas Medical Branch, Galveston, TX, United States
| | - James M Tour
- Smalley Institute for Nanoscale Science and Technology, Rice University, Houston, TX, United States
| | - Ah-Lim Tsai
- Department of Biochemistry and Hematology, McGovern School of Medicine, UT Health Science Center, Houston, TX, United States
| | - Thomas A Kent
- Center for Genomics and Precision Medicine, Institute of Biosciences and Technology, College of Medicine, Texas A&M Health Science Center, Houston, TX, United States; Department of Chemistry, Rice University, Houston, TX, United States; Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Houston, TX, United States.
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6
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Affiliation(s)
- Marie Rieux
- Centre de Recherche du CHU de Québec – Université Laval, Axe Neurosciences, 2705 Boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Melanie Alpaugh
- Centre de Recherche du CHU de Québec – Université Laval, Axe Neurosciences, 2705 Boulevard Laurier, Québec, QC G1V 4G2 Canada
| | - Francesca Cicchetti
- Centre de Recherche du CHU de Québec - Université Laval, Axe Neurosciences, 2705 Boulevard Laurier, Québec, QC, G1V 4G2, Canada. .,Département de Psychiatrie & Neurosciences, Université Laval, Québec, QC, G1K 0A6, Canada.
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Logovinsky V, Satlin A, Lai R, Swanson C, Kaplow J, Osswald G, Basun H, Lannfelt L. Safety and tolerability of BAN2401--a clinical study in Alzheimer's disease with a protofibril selective Aβ antibody. ALZHEIMERS RESEARCH & THERAPY 2016; 8:14. [PMID: 27048170 PMCID: PMC4822297 DOI: 10.1186/s13195-016-0181-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/25/2016] [Indexed: 12/14/2022]
Abstract
Background Several monoclonal antibodies for the treatment of Alzheimer’s disease (AD) have been in development over the last decade. BAN2401 is a monoclonal antibody that selectively binds soluble amyloid β (Aβ) protofibrils. Methods Here we describe the first clinical study with BAN2401. Safety and tolerability were investigated in mild to moderate AD. A study design was used with staggered parallel single and multiple ascending doses, from 0.1 mg/kg as a single dose to 10 mg/kg biweekly for four months. The presence of amyloid related imaging abnormalities (ARIA, E for edema, H for hemorrhage) was assessed with magnetic resonance imaging (MRI). Cerebrospinal fluid (CSF) and plasma samples were analyzed to investigate pharmacokinetics (PK) and effects on biomarkers. Results The incidence of ARIA-E/H on MRI was comparable to that of placebo. BAN2401 exposure was approximately dose proportional, with a serum terminal elimination half-life of ~7 days. Only a slight increase of plasma Aβ(1-40) was observed but there were no measurable effects of BAN2401 on CSF biomarkers. On the basis of these findings Phase 2b efficacy study has been initiated in early AD. Conclusions BAN2401 was well-tolerated across all doses. The PK profile has guided us for selecting dose and dose regimens in the ongoing phase 2b study. There was no clear guidance for an effective dose based on biomarkers. Trial registration number NCT01230853 ClinicalTrials.gov Registered October 27, 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13195-016-0181-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Andrew Satlin
- Eisai, Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Robert Lai
- Eisai, Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Chad Swanson
- Eisai, Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - June Kaplow
- Eisai, Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA
| | - Gunilla Osswald
- BioArctic Neuroscience AB, Warfvinges väg 35, 112 51, Stockholm, Sweden
| | - Hans Basun
- BioArctic Neuroscience AB, Warfvinges väg 35, 112 51, Stockholm, Sweden.,Department of Public Health/Geriatrics, Uppsala University, Dag Hammarskiölds väg 14 B, 751 85, Uppsala, Sweden
| | - Lars Lannfelt
- BioArctic Neuroscience AB, Warfvinges väg 35, 112 51, Stockholm, Sweden. .,Department of Public Health/Geriatrics, Uppsala University, Dag Hammarskiölds väg 14 B, 751 85, Uppsala, Sweden.
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8
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β-Sheet interfering molecules acting against β-amyloid aggregation and fibrillogenesis. Bioorg Med Chem 2015; 23:1671-83. [DOI: 10.1016/j.bmc.2015.02.041] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/18/2015] [Indexed: 12/17/2022]
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9
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Ittner A, Bertz J, Suh LS, Stevens CH, Götz J, Ittner LM. Tau-targeting passive immunization modulates aspects of pathology in tau transgenic mice. J Neurochem 2014; 132:135-45. [DOI: 10.1111/jnc.12821] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Arne Ittner
- Dementia Research Unit; School of Medical Sciences; The University of New South Wales; Sydney NSW Australia
- Brain & Mind Research Institute; The University of Sydney; Sydney NSW Australia
| | - Josefine Bertz
- Dementia Research Unit; School of Medical Sciences; The University of New South Wales; Sydney NSW Australia
- Brain & Mind Research Institute; The University of Sydney; Sydney NSW Australia
| | - Lisa S. Suh
- Dementia Research Unit; School of Medical Sciences; The University of New South Wales; Sydney NSW Australia
| | - Claire H. Stevens
- Dementia Research Unit; School of Medical Sciences; The University of New South Wales; Sydney NSW Australia
| | - Jürgen Götz
- Brain & Mind Research Institute; The University of Sydney; Sydney NSW Australia
- Clem Jones Centre for Ageing Dementia Research; Queensland Brain Institute; University of Queensland; Brisbane Qld. Australia
| | - Lars M. Ittner
- Dementia Research Unit; School of Medical Sciences; The University of New South Wales; Sydney NSW Australia
- Brain & Mind Research Institute; The University of Sydney; Sydney NSW Australia
- Neuroscience Research Australia; Sydney NSW Australia
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Panza F, Frisardi V, Imbimbo BP, Logroscino G, Seripa D, Pilotto A, Solfrizzi V. Amyloid-related imaging abnormalities associated with immunotherapy in Alzheimer’s disease patients. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Evaluation of: Sperling R, Salloway S, Brooks DJ et al. Amyloid-related imaging abnormalities in patients with Alzheimer’s disease treated with bapineuzumab: a retrospective analysis. Lancet Neurol. 11(3), 241–249 (2012). Amyloid-related imaging abnormalities (ARIAs) have been reported in patients with Alzheimer’s disease treated with bapineuzumab, a monoclonal antibody targeting β-amyloid (Aβ). The spectrum of ARIA includes signal hyperintensities on fluid attenuation inversion recovery sequences thought to represent ‘vasogenic edema’ and/or sulcal effusion (ARIA-E), as well as signal hypointensities on gradient echo/T2* thought to represent hemosiderin deposits. This study was a retrospective analysis in which two neuroradiologists independently reviewed 2572 fluid attenuation inversion recovery MRI scans from 262 participants in two Phase II studies of bapineuzumab and an open-label extension study. In this analysis, several ARIA-E cases were identified that were initially missed in the reported studies of bapineuzumab (42%). Associated clinical symptoms were observed in only 22% of patients with ARIA-E. Occurrence of ARIA-E increased with bapineuzumab dose and presence of apolipoprotein E (APOE) ε4 alleles. The increased risk of ARIA-E in APOE ε4 carriers and the knowledge that vasogenic edema and microhemorrhages may spontaneously occur in cerebral amyloid angiopathy suggest a potential relationship with vascular Aβ burden. The increased risk of ARIA with a high bapineuzumab dose and the findings from a case with PET amyloid imaging also suggest a possible relationship between ARIA-E with Aβ clearance after passive immunotherapy with monoclonal antibodies.
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Affiliation(s)
- Francesco Panza
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Vincenza Frisardi
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
- Department of Neurological & Psychiatric Sciences, University of Bari, Bari, Italy
| | - Bruno P Imbimbo
- Research & Development Department, Chiesi Farmaceutici, Parma, Italy
| | - Giancarlo Logroscino
- Department of Neurological & Psychiatric Sciences, University of Bari, Bari, Italy
| | - Davide Seripa
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
| | - Alberto Pilotto
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013, San Giovanni Rotondo, Foggia, Italy
- Geriatrics Unit, Azienda ULSS 16 Padova, S Antonio Hospital, Padova, Italy
| | - Vincenzo Solfrizzi
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy
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Panza F, Frisardi V, Solfrizzi V, Imbimbo BP, Logroscino G, Santamato A, Greco A, Seripa D, Pilotto A. Immunotherapy for Alzheimer's disease: from anti-β-amyloid to tau-based immunization strategies. Immunotherapy 2012; 4:213-38. [PMID: 22339463 DOI: 10.2217/imt.11.170] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The exact mechanisms leading to Alzheimer's disease (AD) are largely unknown, limiting the identification of effective disease-modifying therapies. The two principal neuropathological hallmarks of AD are extracellular β-amyloid (Aβ), peptide deposition (senile plaques) and intracellular neurofibrillary tangles containing hyperphosphorylated tau protein. During the last decade, most of the efforts of the pharmaceutical industry were directed against the production and accumulation of Aβ. The most innovative of the pharmacological approaches was the stimulation of Aβ clearance from the brain of AD patients via the administration of Aβ antigens (active vaccination) or anti-Aβ antibodies (passive vaccination). Several active and passive anti-Aβ vaccines are under clinical investigation. Unfortunately, the first active vaccine (AN1792, consisting of preaggregate Aβ and an immune adjuvant, QS-21) was abandoned because it caused meningoencephalitis in approximately 6% of treated patients. Anti-Aβ monoclonal antibodies (bapineuzumab and solanezumab) are now being developed. The clinical results of the initial studies with bapineuzumab were equivocal in terms of cognitive benefit. The occurrence of vasogenic edema after bapineuzumab, and more rarely brain microhemorrhages (especially in Apo E ε4 carriers), has raised concerns on the safety of these antibodies directed against the N-terminus of the Aβ peptide. Solanezumab, a humanized anti-Aβ monoclonal antibody directed against the midregion of the Aβ peptide, was shown to neutralize soluble Aβ species. Phase II studies showed a good safety profile of solanezumab, while studies on cerebrospinal and plasma biomarkers documented good signals of pharmacodynamic activity. Although some studies suggested that active immunization may be effective against tau in animal models of AD, very few studies regarding passive immunization against tau protein are currently available. The results of the large, ongoing Phase III trials with bapineuzumab and solanezumab will tell us if monoclonal anti-Aβ antibodies may slow down the rate of deterioration of AD. Based on the new diagnostic criteria of AD and on recent major failures of anti-Aβ drugs in mild-to-moderate AD patients, one could argue that clinical trials on potential disease-modifying drugs, including immunological approaches, should be performed in the early stages of AD.
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Affiliation(s)
- Francesco Panza
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Foggia, Italy.
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Nabuurs RJA, Rutgers KS, Welling MM, Metaxas A, de Backer ME, Rotman M, Bacskai BJ, van Buchem MA, van der Maarel SM, van der Weerd L. In vivo detection of amyloid-β deposits using heavy chain antibody fragments in a transgenic mouse model for Alzheimer's disease. PLoS One 2012; 7:e38284. [PMID: 22675537 PMCID: PMC3366949 DOI: 10.1371/journal.pone.0038284] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 05/03/2012] [Indexed: 12/18/2022] Open
Abstract
This study investigated the in vivo properties of two heavy chain antibody fragments (VHH), ni3A and pa2H, to differentially detect vascular or parenchymal amyloid-β deposits characteristic for Alzheimer's disease and cerebral amyloid angiopathy. Blood clearance and biodistribution including brain uptake were assessed by bolus injection of radiolabeled VHH in APP/PS1 mice or wildtype littermates. In addition, in vivo specificity for Aβ was examined in more detail with fluorescently labeled VHH by circumventing the blood-brain barrier via direct application or intracarotid co-injection with mannitol. All VHH showed rapid renal clearance (10–20 min). Twenty-four hours post-injection 99mTc-pa2H resulted in a small yet significant higher cerebral uptake in the APP/PS1 animals. No difference in brain uptake were observed for 99mTc-ni3A or DTPA(111In)-pa2H, which lacked additional peptide tags to investigate further clinical applicability. In vivo specificity for Aβ was confirmed for both fluorescently labeled VHH, where pa2H remained readily detectable for 24 hours or more after injection. Furthermore, both VHH showed affinity for parenchymal and vascular deposits, this in contrast to human tissue, where ni3A specifically targeted only vascular Aβ. Despite a brain uptake that is as yet too low for in vivo imaging, this study provides evidence that VHH detect Aβ deposits in vivo, with high selectivity and favorable in vivo characteristics, making them promising tools for further development as diagnostic agents for the distinctive detection of different Aβ deposits.
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Affiliation(s)
- Rob J A Nabuurs
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Omtri RS, Davidson MW, Arumugam B, Poduslo JF, Kandimalla KK. Differences in the cellular uptake and intracellular itineraries of amyloid beta proteins 40 and 42: ramifications for the Alzheimer's drug discovery. Mol Pharm 2012; 9:1887-97. [PMID: 22574751 DOI: 10.1021/mp200530q] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mounting evidence suggests that the pathological hallmarks of Alzheimer's disease (AD), neurofibrillary tangles and parenchymal amyloid plaques, are downstream reflections of neurodegeneration caused by the intraneuronal accumulation of amyloid-β proteins (Aβ), particularly Aβ42 and Aβ40. While the neurotoxicity of more amyloidogenic but less abundant Aβ42 is well documented, the effect of Aβ40 on neurons has been understudied. The Aβ40 expression in the presymptomatic AD brain is ten times greater than that of Aβ42. However, the Aβ40:42 ratio decreases with AD progression and coincides with increased amyloid plaque deposition in the brain. Hence, it is thought that Aβ40 protects neurons from the deleterious effects of Aβ42. The pathophysiological pathways involved in the neuronal uptake of Aβ40 or Aβ42 have not been clearly elucidated. Lack of such critical information obscures therapeutic targets and thwarts rational drug development strategies aimed at preventing neurodegeneration in AD. The current study has shown that fluorescein labeled Aβ42 (F-Aβ42) is internalized by neurons via dynamin dependent endocytosis and is sensitive to membrane cholesterol, whereas the neuronal uptake of F-Aβ40 is energy independent and nonendocytotic. Following their uptake, both F-Aβ40 and F-Aβ42 did not accumulate in early/recycling endosomes; F-Aβ42 but not F-Aβ40 accumulated in late endosomes and in the vesicles harboring caveolin-1. Furthermore, F-Aβ42 demonstrated robust accumulation in the lysosomes and damaged their integrity, whereas F-Aβ40 showed only a sparse lysosomal accumulation. Such regulated trafficking along distinct pathways suggests that Aβ40 and Aβ42 exercise differential effects on neurons. These differences must be carefully considered in the design of a pharmacological agent intended to block the neurodegeneration triggered by Aβ proteins.
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Affiliation(s)
- Rajesh S Omtri
- Division of Basic Pharmaceutical Sciences, Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Tallahassee, Florida, United States
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Imbimbo BP, Ottonello S, Frisardi V, Solfrizzi V, Greco A, Seripa D, Pilotto A, Panza F. Solanezumab for the treatment of mild-to-moderate Alzheimer's disease. Expert Rev Clin Immunol 2012; 8:135-49. [PMID: 22288451 DOI: 10.1586/eci.11.93] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Solanezumab (LY2062430) is a humanized monoclonal antibody that binds to the central region of β-amyloid, a peptide believed to play a key role in the pathogenesis of Alzheimer's disease (AD). Eli Lilly & Co is developing an intravenous formulation of solanezumab for the treatment of mild-to-moderate AD. Acute and subchronic treatment with solanezumab of transgenic mice attenuated or reversed memory deficits with no effects on incidence or severity of cerebral amyloid angiopathy-associated microhemorrhages, a severe side effect associated with bapineuzumab, another monoclonal antibody. Phase II studies in AD patients have shown a good safety profile with encouraging indications on cerebrospinal and plasma biomarkers. The drug is currently being investigated in Phase III trials. While there is a strong hope that solanezumab may represent the first effective passive vaccine for AD treatment, skepticism still exists on the ability of the drug to slow the rate of deterioration in patients with fully established disease.
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Affiliation(s)
- Bruno P Imbimbo
- Research and Development Department, Chiesi Farmaceutici, Parma, Italy.
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Panza F, Frisardi V, Imbimbo BP, Seripa D, Solfrizzi V, Pilotto A. Monoclonal antibodies against β-amyloid (Aβ) for the treatment of Alzheimer's disease: the Aβ target at a crossroads. Expert Opin Biol Ther 2011; 11:679-86. [PMID: 21501112 DOI: 10.1517/14712598.2011.579099] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Several second-generation active β-amyloid (Aβ) vaccines and passive Aβ immunotherapies are under clinical investigation with the aim of boosting Aβ clearance from the brain of the Alzheimer's disease (AD) patients. However, the preliminary cognitive efficacy of bapineuzumab, a humanized anti-Aβ monoclonal antibody, appears uncertain. Moreover, the occurrence of vasogenic edema and, more rarely, brain microhemorrhages, especially in apolipoprotein E ϵ4 carriers, have led to abandoning of the highest dose of the drug. Solanezumab, another humanized anti-Aβ monoclonal antibody, was shown to neutralize soluble Aβ oligomers, which is believed to be the more neurotoxic Aβ species. Phase II studies showed a good safety profile of solanezumab while studies on cerebrospinal and plasma biomarkers documented good signals of pharmacodynamic activity. However, the preliminary equivocal cognitive results obtained with bapineuzumab as well as the detrimental cognitive effects observed with semagacestat, a potent γ-secretase inhibitor, raise the possibility that targeting Aβ may not be clinically efficacious in AD. The results of four ongoing large Phase III trials on bapineuzumab and two Phase III trials on solanezumab will tell us if passive anti-Aβ immunization is able to alter the course of this devastating disease, and if Aβ is still a viable target for anti-AD drugs.
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Krishnamurthy PK, Sigurdsson EM. Therapeutic applications of antibodies in non-infectious neurodegenerative diseases. N Biotechnol 2011; 28:511-7. [PMID: 21473943 DOI: 10.1016/j.nbt.2011.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease, Huntington's disease (HD) or amyotrophic lateral sclerosis (ALS) are all characterised histologically by the presence of deposits of misfolded proteins, tau and amyloid-β, α-synuclein, huntingtin or superoxide dismutase, respectively. Currently, these illnesses do not have any disease modifying treatment options. A novel therapeutic strategy that is being pursued is immunomodulation, which is using the body's immune system to target the self-proteins that are deposited. Most of these promising approaches are still in preclinical development while some have progressed to Phase III clinical trials. As new insights are gained, it is hoped that these immunotherapies will be effective tools at slowing the progression of these debilitating diseases.
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Affiliation(s)
- Pavan K Krishnamurthy
- Department of Physiology and Neuroscience, New York University School of Medicine, 550 First Avenue, New York, NY 10016, United States.
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Complex Pharmacokinetics of a Humanized Antibody Against Human Amyloid Beta Peptide, Anti-Abeta Ab2, in Nonclinical Species. Pharm Res 2011; 28:1696-706. [DOI: 10.1007/s11095-011-0405-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 02/21/2011] [Indexed: 12/26/2022]
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Panza F, Frisardi V, Imbimbo BP, D’Onofrio G, Pietrarossa G, Seripa D, Pilotto A, Solfrizzi V. Bapineuzumab: anti-β-amyloid monoclonal antibodies for the treatment of Alzheimer’s disease. Immunotherapy 2010; 2:767-82. [DOI: 10.2217/imt.10.80] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In the last decade, new therapeutic approaches targeting β-amyloid (Aβ) have been discovered and developed with the hope of modifying the natural history of Alzheimer’s disease (AD). The most revolutionary of these approaches consists in the removal of brain Aβ via anti-Aβ antibodies. After an active vaccine (AN1792) was discontinued in 2002 due to occurrence of meningoencephalitis in approximately 6% of patients, several other second-generation active Aβ vaccines and passive Aβ immunotherapies have been developed and are under clinical investigation with the aim of accelerating Aβ clearance from the brain of AD patients. The most advanced of these immunological approaches is bapineuzumab, which is composed of humanized anti-Aβ monoclonal antibodies that has been tested in two Phase II trials. Bapineuzumab has been shown to reduce Aβ burden in the brain of AD patients. However, its preliminary cognitive efficacy appears uncertain, particularly in ApoE ε4 carriers, and vasogenic edema may limit its clinical use. The results of four ongoing large Phase III trials on bapineuzumab will provide answers regarding whether passive anti-Aβ immunization is able to alter the course of this devastating disease.
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Affiliation(s)
| | - Vincenza Frisardi
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy
| | - Bruno P Imbimbo
- Research & Development Department, Chiesi Farmaceutici, Parma, Italy
| | - Grazia D’Onofrio
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Davide Seripa
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alberto Pilotto
- Geriatric Unit & Gerontology-Geriatric Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Vincenzo Solfrizzi
- Department of Geriatrics, Center for Aging Brain, Memory Unit, University of Bari, Bari, Italy
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[Therapeutic monoclonal antibodies in clinical neurology]. DER NERVENARZT 2010; 81:753-64; quiz 765-6. [PMID: 20232033 DOI: 10.1007/s00115-010-2947-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recombinant monoclonal antibodies break new ground in the treatment of immune-mediated nerve and muscle disorders but also of neurodegenerative diseases, in the field of neuro-oncology and in pain therapy, as they allow molecular targeting of defined cell populations or key pathophysiological molecules. However, safety risks might accompany a high efficacy. Basic understanding of this increasingly important class of agents and a steady update of knowledge, in particular on safety aspects, are therefore key requirements for responsible use based on an individual benefit-risk assessment.
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Abstract
IMPORTANCE OF THE FIELD Alzheimer's disease is the leading cause of dementia in the elderly, and there is no disease-modifying therapy yet available. Immunotherapy directed against the beta-amyloid peptide may be capable of slowing the rate of disease progression. Bapineuzumab, an anti-beta-amyloid monoclonal antibody, will be the first such agent to emerge from Phase III clinical trials. AREAS COVERED IN THIS REVIEW The primary literature on bapineuzumab from 2009 and 2010 is reviewed in its entirety, along with the literature on AN1792, a first-generation anti-beta-amyloid vaccine, from 2003 to 2009. Other Alzheimer's disease immunotherapeutics currently in development, according to www.clinicaltrials.gov , are also discussed. WHAT THE READER WILL GAIN In addition to a critical appraisal of the Phase II trial results for bapineuzumab, this review considers the broader field of immunotherapy for Alzheimer's disease as a whole, including the challenges ahead. TAKE HOME MESSAGE Bapineuzumab appears capable of reducing the cerebral beta-amyloid peptide burden in patients with Alzheimer's disease. However, particularly in APOE 4 carriers, its ability to slow disease progression remains uncertain, and vasogenic edema - a dose-limiting and potentially severe adverse reaction - may limit its clinical applicability.
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Affiliation(s)
- Geoffrey A Kerchner
- Stanford University School of Medicine, Stanford Center for Memory Disorders, 300 Pasteur Drive, Room A343, Stanford, CA 94305-5235, USA
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Kodali R, Williams AD, Chemuru S, Wetzel R. Abeta(1-40) forms five distinct amyloid structures whose beta-sheet contents and fibril stabilities are correlated. J Mol Biol 2010; 401:503-17. [PMID: 20600131 DOI: 10.1016/j.jmb.2010.06.023] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 05/30/2010] [Accepted: 06/11/2010] [Indexed: 10/19/2022]
Abstract
The ability of a single polypeptide sequence to grow into multiple stable amyloid fibrils sets these aggregates apart from most native globular proteins. The existence of multiple amyloid forms is the basis for strain effects in yeast prion biology, and might contribute to variations in Alzheimer's disease pathology. However, the structural basis for amyloid polymorphism is poorly understood. We report here five structurally distinct fibrillar aggregates of the Alzheimer's plaque peptide Abeta(1-40), as well as a non-fibrillar aggregate induced by Zn(2+). Each of these conformational forms exhibits a unique profile of physical properties, and all the fibrillar forms breed true in elongation reactions under a common set of growth conditions. Consistent with their defining cross-beta structure, we find that in this series the amyloid fibrils containing more extensive beta-sheet exhibit greater stability. At the same time, side chain packing outside of the beta-sheet regions contributes to stability, and to differences of stability between polymorphic forms. Stability comparison is facilitated by the unique feature that the free energy of the monomer (equivalent to the unfolded state in a protein folding reaction) does not vary, and hence can be ignored, in the comparison of DeltaG degrees of elongation values for each polymorphic fibril obtained under a single set of conditions.
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Affiliation(s)
- Ravindra Kodali
- Department of Structural Biology and Pittsburgh Institute for Neurodegenerative Diseases, University of Pittsburgh School of Medicine, 3501 Fifth Avenue, Pittsburgh, PA 15260, USA
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Bartolini M, Andrisano V. Strategies for the Inhibition of Protein Aggregation in Human Diseases. Chembiochem 2010; 11:1018-35. [DOI: 10.1002/cbic.200900666] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Boado RJ, Lu JZ, Hui EKW, Pardridge WM. IgG-single chain Fv fusion protein therapeutic for Alzheimer's disease: Expression in CHO cells and pharmacokinetics and brain delivery in the rhesus monkey. Biotechnol Bioeng 2010; 105:627-35. [PMID: 19816967 DOI: 10.1002/bit.22576] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Monoclonal antibodies (MAb) directed against the Abeta amyloid peptide of Alzheimer's disease (AD) are potential new therapies for AD, since these antibodies disaggregate brain amyloid plaque. However, the MAb is not transported across the blood-brain barrier (BBB). To enable BBB transport, a single chain Fv (ScFv) antibody against the Abeta peptide of AD was re-engineered as a fusion protein with the MAb against the human insulin receptor (HIR). The HIRMAb acts as a molecular Trojan horse to ferry the ScFv therapeutic antibody across the BBB. Chinese hamster ovary (CHO) cells were stably transfected with a tandem vector encoding the heavy and light chains of the HIRMAb-ScFv fusion protein. A high secreting line was isolated following methotrexate amplification and dilutional cloning. The HIRMAb-ScFv fusion protein in conditioned serum-free medium was purified by protein A affinity chromatography. The fusion protein was stable as a liquid formulation, and retained high-affinity binding of both the HIR and the Abeta amyloid peptide. The HIRMAb-ScFv fusion protein was radiolabeled with the (125)I-Bolton-Hunter reagent, followed by measurement of the pharmacokinetics of plasma clearance and brain uptake in the adult Rhesus monkey. The HIRMAb-ScFv fusion protein was rapidly cleared from plasma and was transported across the primate BBB in vivo. In conclusion, the HIRMAb-ScFv fusion protein is a new class of antibody-based therapeutic for AD that has been specifically engineered to cross the human BBB.
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Affiliation(s)
- Ruben J Boado
- ArmaGen Technologies, Inc., Santa Monica, California, USA
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25
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The role of the blood-CNS barrier in CNS disorders and their treatment. Neurobiol Dis 2009; 37:3-12. [PMID: 19664711 DOI: 10.1016/j.nbd.2009.07.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 07/30/2009] [Accepted: 07/30/2009] [Indexed: 01/16/2023] Open
Abstract
The physical barrier between blood and the CNS (the blood-brain barrier, the blood-spinal cord barrier and the blood-CSF barrier) protects the CNS from both toxic and pathogenic agents in the blood. It is now clear that disruption of the blood-CNS barrier plays a key role in a number of CNS disorders, particularly those associated with neurodegeneration. Such disruption is inevitably accompanied by inflammatory change, as immune cells and immune mediators gain access to the brain or spinal cord. The blood-CNS barrier also presents a major obstacle for potential CNS medicines. Robust methods to assess CNS permeation are therefore essential for CNS drug discovery, particularly when brain pharmacokinetics are taken into account and especially when such measures are linked to neurochemical, physiological, behavioural or neuroimaging readouts of drug action. Drug candidates can be successfully designed to cross the blood-CNS barrier, but for those that can't there is the possibility of entry with a delivery system that facilitates the movement of drug candidate across the blood-CNS barrier.
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Pitt J, Roth W, Lacor P, Smith AB, Blankenship M, Velasco P, De Felice F, Breslin P, Klein WL. Alzheimer's-associated Abeta oligomers show altered structure, immunoreactivity and synaptotoxicity with low doses of oleocanthal. Toxicol Appl Pharmacol 2009; 240:189-97. [PMID: 19631677 DOI: 10.1016/j.taap.2009.07.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 07/14/2009] [Accepted: 07/14/2009] [Indexed: 12/28/2022]
Abstract
It now appears likely that soluble oligomers of amyloid-beta1-42 peptide, rather than insoluble fibrils, act as the primary neurotoxin in Alzheimer's disease (AD). Consequently, compounds capable of altering the assembly state of these oligomers (referred to as ADDLs) may have potential for AD therapeutics. Phenolic compounds are of particular interest for their ability to disrupt Abeta oligomerization and reduce pathogenicity. This study has focused on oleocanthal (OC), a naturally-occurring phenolic compound found in extra-virgin olive oil. OC increased the immunoreactivity of soluble Abeta species, when assayed with both sequence- and conformation-specific Abeta antibodies, indicating changes in oligomer structure. Analysis of oligomers in the presence of OC showed an upward shift in MW and a ladder-like distribution of SDS-stable ADDL subspecies. In comparison with control ADDLs, oligomers formed in the presence of OC (Abeta-OC) showed equivalent colocalization at synapses but exhibited greater immunofluorescence as a result of increased antibody recognition. The enhanced signal at synapses was not due to increased synaptic binding, as direct detection of fluorescently-labeled ADDLs showed an overall reduction in ADDL signal in the presence of OC. Decreased binding to synapses was accompanied by significantly less synaptic deterioration assayed by drebrin loss. Additionally, treatment with OC improved antibody clearance of ADDLs. These results indicate oleocanthal is capable of altering the oligomerization state of ADDLs while protecting neurons from the synaptopathological effects of ADDLs and suggest OC as a lead compound for development in AD therapeutics.
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Affiliation(s)
- Jason Pitt
- Department of Neurobiology and Physiology, Northwestern University, Evanston, IL 60208, USA.
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