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Winicki NM, Nanavati AP, Morrell CH, Moen JM, Axsom JE, Krawczyk M, Petrashevskaya NN, Beyman MG, Ramirez C, Alfaras I, Mitchell SJ, Juhaszova M, Riordon DR, Wang M, Zhang J, Cerami A, Brines M, Sollott SJ, de Cabo R, Lakatta EG. A small erythropoietin derived non-hematopoietic peptide reduces cardiac inflammation, attenuates age associated declines in heart function and prolongs healthspan. Front Cardiovasc Med 2023; 9:1096887. [PMID: 36741836 PMCID: PMC9889362 DOI: 10.3389/fcvm.2022.1096887] [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] [Received: 11/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Background Aging is associated with increased levels of reactive oxygen species and inflammation that disrupt proteostasis and mitochondrial function and leads to organism-wide frailty later in life. ARA290 (cibinetide), an 11-aa non-hematopoietic peptide sequence within the cardioprotective domain of erythropoietin, mediates tissue protection by reducing inflammation and fibrosis. Age-associated cardiac inflammation is linked to structural and functional changes in the heart, including mitochondrial dysfunction, impaired proteostasis, hypertrophic cardiac remodeling, and contractile dysfunction. Can ARA290 ameliorate these age-associated cardiac changes and the severity of frailty in advanced age? Methods We conducted an integrated longitudinal (n = 48) and cross-sectional (n = 144) 15 months randomized controlled trial in which 18-month-old Fischer 344 x Brown Norway rats were randomly assigned to either receive chronic ARA290 treatment or saline. Serial echocardiography, tail blood pressure and body weight were evaluated repeatedly at 4-month intervals. A frailty index was calculated at the final timepoint (33 months of age). Tissues were harvested at 4-month intervals to define inflammatory markers and left ventricular tissue remodeling. Mitochondrial and myocardial cell health was assessed in isolated left ventricular myocytes. Kaplan-Meier survival curves were established. Mixed ANOVA tests and linear mixed regression analysis were employed to determine the effects of age, treatment, and age-treatment interactions. Results Chronic ARA290 treatment mitigated age-related increases in the cardiac non-myocyte to myocyte ratio, infiltrating leukocytes and monocytes, pro-inflammatory cytokines, total NF-κB, and p-NF-κB. Additionally, ARA290 treatment enhanced cardiomyocyte autophagy flux and reduced cellular accumulation of lipofuscin. The cardiomyocyte mitochondrial permeability transition pore response to oxidant stress was desensitized following chronic ARA290 treatment. Concurrently, ARA290 significantly blunted the age-associated elevation in blood pressure and preserved the LV ejection fraction. Finally, ARA290 preserved body weight and significantly reduced other markers of organism-wide frailty at the end of life. Conclusion Administration of ARA290 reduces cell and tissue inflammation, mitigates structural and functional changes within the cardiovascular system leading to amelioration of frailty and preserved healthspan.
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Affiliation(s)
- Nolan M. Winicki
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Alay P. Nanavati
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Christopher H. Morrell
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Jack M. Moen
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Jessie E. Axsom
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Melissa Krawczyk
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Natalia N. Petrashevskaya
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Max G. Beyman
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Christopher Ramirez
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Irene Alfaras
- Laboratory of Experimental Gerontology, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Sarah J. Mitchell
- Laboratory of Experimental Gerontology, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Magdalena Juhaszova
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Daniel R. Riordon
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Mingyi Wang
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Jing Zhang
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Anthony Cerami
- Araim Pharmaceuticals, Inc., Tarrytown, NY, United States
| | - Michael Brines
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Steven J. Sollott
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Rafael de Cabo
- Laboratory of Cardiovascular Science, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States
| | - Edward G. Lakatta
- Laboratory of Experimental Gerontology, Intramural Research Program, National Institute on Aging, Baltimore, MD, United States,*Correspondence: Edward G. Lakatta,
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Silva I, Alípio C, Pinto R, Mateus V. Potential anti-inflammatory effect of erythropoietin in non-clinical studies in vivo: A systematic review. Biomed Pharmacother 2021; 139:111558. [PMID: 33894624 DOI: 10.1016/j.biopha.2021.111558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/19/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Erythropoietin (EPO) is a hypoxia-induced hormone produced in adult kidneys with erythropoietic and non-erythropoietic effects. In vivo studies represent an important role to comprehend the efficacy and safety in the early phase of repurposing drugs. The aim is to evaluate the potential anti-inflammatory effect of EPO observed in animal models of disease. Following PRISMA statements, electronic database Medline via PubMed platform was used to search articles with the research expression ((erythropoietin [MeSH Terms]) AND (inflammation [MeSH Terms]) AND (disease models, animal [MeSH Terms])). The inclusion criteria were original articles, studies where EPO was administered, studies where inflammation was studied and/or evaluated, non-clinical studies in vivo with rodents, and articles published in English. Thirty-six articles met the criteria for qualitative analysis. Exogenous EPO was used in models of sepsis, traumatic brain injury, and autoimmune neuritis, with an average of 3000 IU/Kg for single and multiple doses, using mice and rats. Biomarkers such as immune-related effectors, cytokines, reactive oxygen species, prostaglandins, and other biomarkers were assessed. EPO has been recognized as a multifunctional cytokine with anti-inflammatory properties, showing its significant effect both in acute and chronic models of inflammation. Further non-clinical studies are suggested for the enlightenment of anti-inflammatory mechanisms of EPO in lower doses, allowing us to understand the translational data for humans.
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Affiliation(s)
- Inês Silva
- H&TRC-Health and Technology Research Center, ESTeSL-Lisbon School of Health Technology, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; iMed.ULisboa, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - Carolina Alípio
- H&TRC-Health and Technology Research Center, ESTeSL-Lisbon School of Health Technology, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
| | - Rui Pinto
- iMed.ULisboa, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal; JCS, Dr. Joaquim Chaves, Laboratório de Análises Clínicas, Miraflores, 1495-069 Algés, Portugal
| | - Vanessa Mateus
- H&TRC-Health and Technology Research Center, ESTeSL-Lisbon School of Health Technology, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal; iMed.ULisboa, Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal.
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Lois N, Gardner E, McFarland M, Armstrong D, McNally C, Lavery NJ, Campbell C, Kirk RI, Bajorunas D, Dunne A, Cerami A, Brines M. A Phase 2 Clinical Trial on the Use of Cibinetide for the Treatment of Diabetic Macular Edema. J Clin Med 2020; 9:jcm9072225. [PMID: 32674280 PMCID: PMC7408632 DOI: 10.3390/jcm9072225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Evaluating the effects of cibinetide in diabetic macular edema (DME). METHODS Phase 2 trial. Naïve patients with >400 µm central retinal thickness (CRT) DME in one/both eyes were recruited (May 2016-April 2017) at the Belfast Health and Social Care Trust. The study eye was that with best vision and lowest CRT. Patients self-administered cibinetide 4 mg/day subcutaneously for 12 weeks. Primary and secondary outcomes: mean change from baseline to week 12 in best corrected visual acuity (BCVA), CRT, central retinal sensitivity, tear production, patient-reported outcomes, adverse events and antibodies to cibinetide. Descriptive statistics were used; exploratory analyses focused on non-study eyes, diabetic control, serum cytokines and albuminuria. RESULTS Nine patients were recruited; eight completed the study. There was no improvement in mean change baseline-week 12 in BCVA (-2.9 + 5.0), CRT (10 + 94.6 microns), central retinal sensitivity (-0.53 + 1.9 dB) or tear production (-0.13 + 7.7 mm), but there was an improvement in National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite scores (2.7 + 3.1). Some participants experienced improvements in CRT, tear production, diabetic control and albuminuria. No serious adverse events/reactions or anti-cibinetide antibodies were seen. CONCLUSIONS The cibinetide 12-week course was safe. Improvements in NEI VFQ-25 scores, CRT, tear production, diabetic control and albuminuria, observed in some participants, warrant further investigation. TRIAL REGISTRATION EudraCT number: 2015-001940-12. ISRCTN16962255-registration date 25.06.15.
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Affiliation(s)
- Noemi Lois
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (D.A.); (N.J.L.)
- Correspondence:
| | - Evie Gardner
- The Northern Ireland Clinical Trials Unit (NICTU), 1st Floor, Elliott Dynes Centre, Royal Hospitals, Belfast BT12 6BA, UK; (E.G.); (C.M.); (C.C.)
| | | | - David Armstrong
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (D.A.); (N.J.L.)
| | - Christine McNally
- The Northern Ireland Clinical Trials Unit (NICTU), 1st Floor, Elliott Dynes Centre, Royal Hospitals, Belfast BT12 6BA, UK; (E.G.); (C.M.); (C.C.)
| | - Nuala Jane Lavery
- The Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK; (D.A.); (N.J.L.)
| | - Christina Campbell
- The Northern Ireland Clinical Trials Unit (NICTU), 1st Floor, Elliott Dynes Centre, Royal Hospitals, Belfast BT12 6BA, UK; (E.G.); (C.M.); (C.C.)
| | - Rita I Kirk
- Araim Pharmaceuticals, 580 White Plains Road, Suite 210, Tarrytown, NY 10591, USA; (R.I.K.); (D.B.); (A.D.); (A.C.); (M.B.)
| | - Daiva Bajorunas
- Araim Pharmaceuticals, 580 White Plains Road, Suite 210, Tarrytown, NY 10591, USA; (R.I.K.); (D.B.); (A.D.); (A.C.); (M.B.)
| | - Ann Dunne
- Araim Pharmaceuticals, 580 White Plains Road, Suite 210, Tarrytown, NY 10591, USA; (R.I.K.); (D.B.); (A.D.); (A.C.); (M.B.)
| | - Anthony Cerami
- Araim Pharmaceuticals, 580 White Plains Road, Suite 210, Tarrytown, NY 10591, USA; (R.I.K.); (D.B.); (A.D.); (A.C.); (M.B.)
| | - Michael Brines
- Araim Pharmaceuticals, 580 White Plains Road, Suite 210, Tarrytown, NY 10591, USA; (R.I.K.); (D.B.); (A.D.); (A.C.); (M.B.)
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Targeting the innate repair receptor to treat neuropathy. Pain Rep 2016; 1:e566. [PMID: 29392190 PMCID: PMC5741312 DOI: 10.1097/pr9.0000000000000566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 11/26/2022] Open
Abstract
The innate repair receptor (IRR) is a heteromer of the erythropoietin receptor and the β-common (CD131) receptor, which simultaneously activates anti-inflammatory and tissue repair pathways. Experimental data suggest that after peripheral nerve injury, the IRR is upregulated in the spinal cord and modulates the neurogenic inflammatory response. The recently introduced selective IRR agonist ARA290 is an 11-amino acid peptide initially tested in animal models of neuropathy. After sciatic nerve injury, ARA290 produced a rapid and long-term relief of mechanical and cold allodynia in normal mice, but not in animals with a β-common receptor knockout phenotype. In humans, ARA290 has been evaluated in patients with small fiber neuropathy associated with sarcoidosis or type 2 diabetes (T2D) mellitus. In patients with sarcoidosis, ARA290 significantly improved neuropathic and autonomic symptoms, as well as quality of life as assessed by the small fiber neuropathy screening list questionnaire. In addition, ARA290 treatment for 28 days initiated a regrowth of small nerve fibers in the cornea, but not in the epidermis. In patients with T2D, the results were similar to those observed in patients with sarcoidosis along with an improved metabolic profile. In both populations, ARA290 lacked significant adverse effects. These experimental and clinical studies show that ARA290 effectively reprograms a proinflammatory, tissue-damaging milieu into one of healing and tissue repair. Further clinical trials with long-term treatment and follow-up are needed to assess the full potential of IRR activation by ARA290 as a disease-modifying therapy in neuropathy of various etiologies.
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van Velzen M, Heij L, Niesters M, Cerami A, Dunne A, Dahan A, Brines M. ARA 290 for treatment of small fiber neuropathy in sarcoidosis. Expert Opin Investig Drugs 2014; 23:541-50. [PMID: 24555851 DOI: 10.1517/13543784.2014.892072] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Painful peripheral neuropathy is a common, difficult-to-treat complication associated with a variety of diseases, including diabetes mellitus and sarcoidosis. It is caused by damage of small and autonomic nerve fibers, resulting in potentially debilitating symptoms of neuropathic pain and autonomic dysfunction. The limited efficacy of current treatment options dictates a rationalized design of novel compounds. AREAS COVERED The authors present the recent data from two Phase II clinical trials on ARA290, an erythropoietin derivative with tissue protective and healing properties that does not stimulate erythropoiesis. ARA 290 treatment was consistently associated with a significant improvement of neuropathic pain symptoms in sarcoidosis patients, evidenced by a decrease in pain scores on validated questionnaires. Moreover, ARA 290 treatment resulted in significant increases in corneal nerve fibers, improved sensory pain thresholds, improved quality of life and physical functioning. EXPERT OPINION Current treatment modalities of neuropathy are based on a trial-and-error approach, have limited efficacy and come with significant side effects. Given the excellent safety profile while reducing neuropathy symptoms, the prospects of ARA 290 treatment in sarcoid neuropathy seem promising. The long-lasting beneficial effects of ARA 290 on both pain-related and non-pain-related symptoms in sarcoidosis patients prompt additional studies on potential disease-modifying properties of ARA 290.
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Affiliation(s)
- Monique van Velzen
- Leiden University Medical Center, Department of Anesthesiology , Leiden , The Netherlands +31 71 526 2301 ; +31 71 526 6230 ;
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