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Lesage A, Gibson C, Marceau F, Ambrosi HD, Saupe J, Katzer W, Loenders B, Charest-Morin X, Knolle J. In Vitro Pharmacological Profile of a New Small Molecule Bradykinin B 2 Receptor Antagonist. Front Pharmacol 2020; 11:916. [PMID: 32636746 PMCID: PMC7316994 DOI: 10.3389/fphar.2020.00916] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
We here report the discovery and early characterization of Compound 3, a representative of a novel class of small molecule bradykinin (BK) B2 receptor antagonists, and its superior profile to the prior art B2 receptor antagonists Compound 1 and Compound 2. Compound 3, Compound 2, and Compound 1 are highly potent antagonists of the human recombinant B2 receptor (Kb values 0.24, 0.95, and 1.24 nM, respectively, calcium mobilization assay). Compound 3 is more potent than the prior art compounds and icatibant in this assay (Kb icatibant 2.81 nM). The compounds also potently inhibit BK-induced contraction of endogenous B2 receptors in a human isolated umbilical vein bioassay. The potencies of Compound 3, Compound 2, Compound 1, and icatibant are (pA2 values) 9.67, 9.02, 8.58, and 8.06 (i.e. 0.21, 0.95, 2.63, and 8.71 nM), respectively. Compound 3 and Compound 2 were further characterized. They inhibit BK-induced c-Fos signaling and internalization of recombinant human B2 receptors in HEK293 cells, and do not antagonize the venous effects mediated by other G protein-coupled receptors in the umbilical vein model, including the bradykinin B1 receptor. Antagonist potency of Compound 3 at cloned cynomolgus monkey, dog, rat, and mouse B2 receptors revealed species selectivity, with a high antagonist potency for human and monkey B2 receptors, but several hundred-fold lower potency for the other B2 receptors. The in vitro off-target profile of Compound 3 demonstrates a high degree of selectivity over a wide range of molecular targets, including the bradykinin B1 receptor. Compound 3 showed a lower intrinsic clearance in the microsomal stability assay than the prior art compounds. With an efflux ratio of 1.0 in the Caco-2 permeability assay Compound 3 is predicted to be not a substrate of efflux pumps. In conclusion, we discovered a novel chemical class of highly selective and very potent B2 receptor antagonists, as exemplified by Compound 3. The compound showed excellent absorption in the Caco-2 assay, predictive of good oral bioavailability, and favourable metabolic stability in liver microsomes. Compound 3 has provided a significant stepping stone towards the discovery of the orally bioavailable B2 antagonist PHA-022121, currently in phase 1 clinical development.
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Affiliation(s)
- Anne Lesage
- Pharvaris Netherlands B.V., Leiden, Netherlands
| | | | - François Marceau
- Axe Microbiologie-Infectiologie et Immunologie, Research Center, CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Jörn Saupe
- AnalytiCon Discovery GmbH, Potsdam, Germany
| | | | | | - Xavier Charest-Morin
- Axe Microbiologie-Infectiologie et Immunologie, Research Center, CHU de Québec-Université Laval, Québec, QC, Canada
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Rosa A, Miranda M, Franco R, Guarino MG, Barlattani A, Bollero P. Experimental protocol of dental procedures In patients with hereditary angioedema: the role of anxiety and the use of nitrogen oxide. ORAL & IMPLANTOLOGY 2017; 9:49-53. [PMID: 28042430 DOI: 10.11138/orl/2016.9.2.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hereditary angioedema (HAE) is a rare disease, little known to the medical and dental community, but with a growing rate of hospitalization over the years. HAE is due to a deficit/dysfunction of C1 esterase inhibitor which leads to an increase in vascular permeability and the appearance of edemas widespread in all body areas. The airways are the most affected and laryngeal swelling, which can occur, it is dangerous for the patient's life, is also a sensitive spot in our daily practice, therefore, it is also important to be aware of all the signs of this disease. Episodes of HAE have no obvious cause, but it can be triggered by anxiety, invasive procedures and trauma. So this disease is a major problem in oral and maxillofacial surgery, ENT, endoscopy, emergency medicine and anesthesia because even simple procedures can cause laryngeal edema. The recommendations on the management of HAE include long- and short-term prophylaxis and treatment for acute attacks, however, the importance of anxiety control during the operating phases is undervalued. The present work suggests an experimental protocol for the surgery management of HAE patients with the help of nitrous oxide, with a brief review of the literature on this topic.
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Affiliation(s)
- A Rosa
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - M Miranda
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - R Franco
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - M G Guarino
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
| | - A Barlattani
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - P Bollero
- Department of Systems Medicine, Medical School, University of Rome "Tor Vergata", Rome, Italy
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3
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Ocampo J, Floccard B, Bouillet L, Rimmele T. [Controversy to use icatibant for prophylaxis in angioedema]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:543. [PMID: 26070696 DOI: 10.1016/j.redar.2015.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/30/2015] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Affiliation(s)
- J Ocampo
- Servicio de Anestesiología y Reanimación, Centro de Referencia del angioedema mediado por bradiquinina, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, Francia
| | - B Floccard
- Servicio de Anestesiología y Reanimación, Centro de Referencia del angioedema mediado por bradiquinina, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, Francia.
| | - L Bouillet
- Clínica de Medicina Interna, Centro Nacional de Referencia del angioedema mediado por bradiquinina, Hospital Michallon, Grenoble, Francia
| | - T Rimmele
- Servicio de Anestesiología y Reanimación, Centro de Referencia del angioedema mediado por bradiquinina, Hospices Civils de Lyon, Hospital Edouard Herriot, Lyon, Francia
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Bonner N, Abetz-Webb L, Renault L, Caballero T, Longhurst H, Maurer M, Christiansen S, Zuraw B. Development and content validity testing of a patient-reported outcomes questionnaire for the assessment of hereditary angioedema in observational studies. Health Qual Life Outcomes 2015; 13:92. [PMID: 26129930 PMCID: PMC4487558 DOI: 10.1186/s12955-015-0292-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/22/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hereditary Angioedema (HAE), a rare genetic disease, manifests as intermittent, painful attacks of angioedema. Attacks vary in frequency and severity and include skin, abdominal and life-threatening laryngeal swellings. This study aimed to develop a patient reported outcome (PRO) tool for the assessment of HAE attacks, including their management and impact on patients' lives, for use in clinical studies, or by physicians in general practice. METHODS The results of open-ended face to face concept elicitation interviews with HAE patients in Argentina (n = 10) and the US (n = 33) were used to develop the first draft questionnaire of the HAE patient reported outcomes questionnaire (HAE PRO). Subsequently, in-depth cognitive debriefing interviews were performed with HAE patients in the UK (n = 10), Brazil (n = 10), Germany (n = 11) and France (n = 12). Following input from eight multinational clinical experts further cognitive interviews were conducted in the US (n = 12) and Germany (n = 12). Patients who experienced abdominal, cutaneous or laryngeal attacks of varying severity levels were included in all rounds of interviews. Across the rounds of interviews patients discussed their HAE attack symptoms, impacts and treatments. Cognitive debriefing interviews explored patient understanding and relevance of questionnaire items. All interviews were conducted face to face following a pre-defined semi-structured interview guide in the patient's native language. RESULTS Patients reported a variety of HAE symptoms, attack triggers, warning signs, attack impacts and treatment options which were used to develop the HAE PRO. The HAE PRO was revised and refined following input from patients and clinical experts. The final 18-item HAE PRO provides an assessment of the HAE attack experience including symptoms, impacts, treatment requirements, healthcare resource use and loss of productivity caused by HAE attacks. CONCLUSIONS Patient and expert input has contributed to the development of a content valid questionnaire that assesses concepts important to HAE patients globally. HAE patients across cultures consider the HAE PRO a relevant and appropriate assessment of HAE attacks and treatment.
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Affiliation(s)
- Nicola Bonner
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, UK.
| | | | | | - Teresa Caballero
- University Hospital, La Paz, Hospital La Paz Institute for Health Research (IdiPaz), Biomedical Research Network on Rare Diseases-U754 (CIBERER), Madrid, Spain.
| | | | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Sandra Christiansen
- Medicine Division Allergy/ Immunology and US HAEA Angioedema Center, University of California, San Diego, CA, USA.
| | - Bruce Zuraw
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, UC San Diego School of Medicine, San Diego, CA, USA.
- San Diego Veterans Hospital, San Diego, CA, USA.
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Ferrante G, Scavone V, Muscia MC, Adrignola E, Corsello G, Passalacqua G, La Grutta S. The care pathway for children with urticaria, angioedema, mastocytosis. World Allergy Organ J 2015; 8:5. [PMID: 25674297 PMCID: PMC4313464 DOI: 10.1186/s40413-014-0052-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 12/11/2014] [Indexed: 12/31/2022] Open
Abstract
Cutaneous involvement characterized by urticarial lesions with or without angioedema and itch is commonly observed in routine medical practice. The clinical approach may still remain complex in real life, because several diseases may display similar cutaneous manifestations. Urticaria is a common disease, characterized by the sudden appearance of wheals, with/without angioedema. The term Chronic Urticaria (CU) encompasses a group of conditions with different underlying causes and different mechanisms, but sharing the clinical picture of recurring wheals and/or angioedema for at least 6 weeks. Hereditary Angioedema (HAE) is a rare disorder characterized by recurrent episodes of non-pruritic, non-pitting, subcutaneous or submucosal edema affecting the extremities, face, throat, trunk, genitalia, or bowel, that are referred as “attacks”. HAE is an autosomal dominant disease caused by a deficiency of functional C1 inhibitor, due to a mutation in C1-INH gene (serping 1 gene) characterized by the clonal proliferation of mast cells, leading to their accumulation, and possibly mediator release, in one or more organs. In childhood there are two main forms of mastocytosis, the Systemic and the Cutaneous. The clinical features of skin lesions in urticaria, angioedema and mastocytosis may differ depending on the aetiologic factors, and the underlying pathophysiological mechanisms. The diagnostic process, as stepwise approach in routine clinical practice, is here reviewed for CU, HAE and mastocytosis, resulting in an integrated method for improved management of these cutaneous diseases. Taking into account that usually these conditions have also a relevant impact on the quality of life of children, affecting social activities and behavior, the availability of care pathways could be helpful in disentangle the diagnostic issue achieving the most cost-effective ratio.
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Affiliation(s)
- Giuliana Ferrante
- Department of Science for Health Promotion and Mother and Child Care, Università di Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Valeria Scavone
- Department of Science for Health Promotion and Mother and Child Care, Università di Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Maria Concetta Muscia
- Department of Science for Health Promotion and Mother and Child Care, Università di Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Emilia Adrignola
- Department of Science for Health Promotion and Mother and Child Care, Università di Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Giovanni Corsello
- Department of Science for Health Promotion and Mother and Child Care, Università di Palermo, Via del Vespro, 133, 90127 Palermo, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS San Martino, University of Genoa, Genoa, Italy
| | - Stefania La Grutta
- Institute of Biomedicine and Molecular Immunology IBIM, National Research Council, Palermo, Italy
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Banerji A. The burden of illness in patients with hereditary angioedema. Ann Allergy Asthma Immunol 2013; 111:329-36. [DOI: 10.1016/j.anai.2013.08.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/02/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
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Abstract
Hereditary angioedema (HAE) is an autosomal dominant, potentially life-threatening condition, manifesting as recurrent and self-limiting episodes of facial, laryngeal, genital, or peripheral swelling with abdominal pain secondary to intra-abdominal edema. The estimated prevalence of HAE in the general population is one individual per 50,000, with reported ranges from 1:10,000 to 1:150,000, without major sex or ethnic differences. Various treatment options for acute attacks and prophylaxis of HAE are authorized and available in the market, including plasma-derived (Berinert®, Cinryze®, and Cetor®) and recombinant (Rhucin® and Ruconest™) C1 inhibitors, kallikrein inhibitor-ecallantide (Kalbitor®), and bradykinin B2 receptor antagonist-icatibant (Firazyr®). Some of these drugs are used only to treat HAE attacks, whereas others are only approved for prophylactic therapies and all of them have improved disease outcomes due to their different mechanisms of action. Bradykinin and its binding to B2 receptor have been demonstrated to be responsible for most of the symptoms of HAE. Thus icatibant (Firazyr®), a bradykinin B2 receptor antagonist, has proven to be an effective and more targeted treatment option and has been approved for the treatment of acute attacks of HAE. Rapid and stable relief from symptoms of cutaneous, abdominal, or laryngeal HAE attacks has been demonstrated by 30 mg of icatibant in Phase III clinical trials. Self-resolving mild to moderate local site reactions after subcutaneous injection of icatibant were observed. Icatibant is a new, safe, and effective treatment for acute attacks of HAE. HAE has been reported to result in enormous humanistic burden to patients, affecting both physical and mental health, with a negative impact on education, career, and work productivity, and with substantial economic burdens. The timely and proper use of disease-specific treatments could improve patients’ quality of life, reduce the disease-specific morbidity and mortality, and, last but not least, reduce costs associated with hospitalizations and emergency room visits. Therefore, the paradigm of HAE treatment has the potential to evolve significantly, thereby exponentially improving a patient’s quality of life.
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Affiliation(s)
- Aasia Ghazi
- University of Texas Medical Branch, Division of Allergy and Clinical Immunology, Galveston, TX, USA
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Zhang Y, Cardell LO, Edvinsson L, Xu CB. MAPK/NF-κB-dependent upregulation of kinin receptors mediates airway hyperreactivity: a new perspective for the treatment. Pharmacol Res 2013; 71:9-18. [PMID: 23428345 DOI: 10.1016/j.phrs.2013.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/02/2013] [Accepted: 02/11/2013] [Indexed: 12/30/2022]
Abstract
Airway hyperreactivity (AHR) is a major feature of asthmatic and inflammatory airways. Cigarette smoke exposure, and bacterial and viral infections are well-known environmental risk factors for AHR, but knowledge about the underlying molecular mechanisms on how these risk factors lead to the development of AHR is limited. Activation of intracellular mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B (NF-κB) and their related signal pathways including protein kinase C (PKC), phosphoinositide 3-kinase (PI3K) and protein kinase A (PKA) signaling pathways may result in airway kinin receptor upregulation, which is suggested to play an important role in the development of AHR. Environmental risk factors trigger the production of pro-inflammatory mediators such as tumor necrosis factor-α (TNF-α) and interleukins (ILs) that activate intracellular MAPK- and NF-κB-dependent inflammatory pathways, which subsequently lead to AHR via kinin receptor upregulation. Blockage of intracellular MAPK/NF-κB signaling prevents kinin B₁ and B₂ receptor expression in the airways, resulting in a decrease in the response to bradykinin (kinin B₂ receptor agonist) and des-Arg⁹-bradykinin (kinin B₁ receptor agonist). This suggests that MAPK- and NF-κB-dependent kinin receptor upregulation can provide a novel option for treatment of AHR in asthmatic as well as in other inflammatory airway diseases.
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Affiliation(s)
- Yaping Zhang
- Institute of Basic and Translational Medicine, Xi'an Medical University, Xi'an, Shaanxi 710021, People's Republic of China
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Blasco AJ, Lázaro P, Caballero T, Guilarte M. Social costs of icatibant self-administration vs. health professional-administration in the treatment of hereditary angioedema in Spain. HEALTH ECONOMICS REVIEW 2013; 3:2. [PMID: 23398817 PMCID: PMC3584739 DOI: 10.1186/2191-1991-3-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
BACKGROUND Icatibant is the only subcutaneous treatment for acute Type I and Type II hereditary angioedema with C1-esterase inhibitor deficiency (HAE-C1-INH) licensed for self-administration in Europe. AIM To compare the economic impact of two icatibant administration strategies: health professional-administration only (strategy 1) versus including the patient self-administration option (strategy 2). METHODS Economic evaluation model based on the building of a decision tree. Both strategies are assumed to have equivalent effectiveness. The payer (Spanish National Health System) and the social perspectives were considered. All relevant cost-generating factors were taken into account. The time horizon was one year. Sources of information included scientific evidence, official data and experts' opinion. A deterministic sensitivity analysis was carried out to quantify the underlying uncertainty in the model. RESULTS From the social perspective, which considers both direct (health care costs) and indirect costs (productivity losses), strategy 2 would result into average savings of €121.30 per acute attack compared to strategy 1. For Spain, this would achieve in an annual savings of €551,371. The reduction in direct costs accounts for 74% of the savings and lower indirect costs account for the remaining 26%. Savings per acute attack may range from €79.50 to €169.80; accordingly, the annual savings in Spain may vary between €90,319 and €2,315,360. CONCLUSION Costs related to the management of acute HAE attacks with C1 inhibitor deficiency may be substantially reduced through interventions targeting home treatment by training patients to self-administer icatibant.
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Affiliation(s)
- Antonio J Blasco
- Advanced Techniques in Health Services Research (TAISS), Madrid, Spain
| | - Pablo Lázaro
- Advanced Techniques in Health Services Research (TAISS), Madrid, Spain
| | - Teresa Caballero
- Allergy Service, Hospital La Paz Health Research Center (IdiPaz), Biomedical Research Network on Rare Diseases-U754 (CIBERER), Madrid, Spain
| | - Mar Guilarte
- Allergy Section, Department of Internal Medicine, Hospital Universitario Vall d´Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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