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Lee CA, Schreiber S, Bressler B, Adams JW, Oh DA, Tang YQ, Zhang J, Komori HK, Grundy JS. Safety, Pharmacokinetics, and Pharmacodynamics of Etrasimod: Single and Multiple Ascending Dose Studies in Healthy Adults. Clin Pharmacol Drug Dev 2024; 13:534-548. [PMID: 38345530 DOI: 10.1002/cpdd.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/27/2023] [Indexed: 04/25/2024]
Abstract
Etrasimod is an investigational, once-daily, oral, selective sphingosine 1-phosphate receptor 1,4,5 modulator in development for immune-mediated inflammatory diseases (IMIDs). Here, we report the human safety, pharmacokinetics, and pharmacodynamics of etrasimod obtained from both a single ascending dose (SAD; 0.1-5 mg) study and a multiple ascending dose (MAD; 0.35-3 mg once daily) study. Overall, 99 healthy volunteers (SAD n = 40, MAD n = 59) completed the 2 studies. Evaluated single and multiple doses were well tolerated up to 3 mg without severe adverse events (AEs). Gastrointestinal disorders were the most common etrasimod-related AEs. Over the evaluated single- and multiple-dose ranges, dose-proportional and marginally greater-than-dose-proportional etrasimod plasma exposure were observed, respectively. At steady state, etrasimod oral clearance and half-life mean values ranged from 1.0 to 1.2 L/h and 29.7 to 36.4 hours, respectively. Dose-dependent total peripheral lymphocyte reductions occurred following etrasimod single and multiple dosing. Etrasimod multiple dosing resulted in reductions from baseline in total lymphocyte counts ranging from 41.1% to 68.8% after 21 days. Lymphocyte counts returned to normal range within 7 days following treatment discontinuation. Heart rate lowering from pretreatment baseline on etrasimod dosing was typically mild, with mean reductions seen after the first dose of up to 19.5 bpm (5 mg dose). The favorable safety, pharmacokinetic, and pharmacodynamic properties of etrasimod in humans supported its further development and warranted its investigation for treatment of IMIDs.
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Affiliation(s)
- Caroline A Lee
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
- Excellence Cluster Precision Medicine in Inflammation, Christian-Albrecht University of Kiel, Kiel, Germany
| | - Brian Bressler
- Department of Medicine, Division of Gastroenterology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John W Adams
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Dooman Alexander Oh
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Yong Q Tang
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | - Jinkun Zhang
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
| | | | - John S Grundy
- Arena Pharmaceuticals, A Wholly Owned Subsidiary of Pfizer Inc, San Diego, CA, USA
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2
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Durgun E, Ulusoy Hİ, Narin İ. Sensitive, reliable and simultaneous determination of Fingolimod and Citalopram drug molecules used in multiple sclerosis treatment based on magnetic solid phase extraction and HPLC-PDA. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1237:124071. [PMID: 38484675 DOI: 10.1016/j.jchromb.2024.124071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 04/13/2024]
Abstract
An analytical methodology has been developed for trace amounts of Fingolimod (FIN) and Citalopram (CIT) drug molecules based on magnetic solid phase extraction (MSPE) and high performance liquid chromatographic determination with photodiode array detector (HPLC-DAD). Fingolimod is used in treatment of Multiple sclerosis (MS) disease and sometimes antidepressant drugs such as citalopram accompany to treatment. Both simultaneous analysis of these molecules and application of MSPE with a new adsorbent has been performed for first times. Fe3O4@L-Tyrosine magnetic particles has been synthetized and characterized as a new magnetic adsorbent. Experimental variables of MPSE were examined and optimized step by step such as pH, adsorption and desorption conditions, time effect, etc. Analytical parameters of the proposed method were studied and determined under optimized conditions according to international guidelines. HPLC analysis of FIN and CIT molecules was performed by isocratic elution of a mixture of 50 % Acetonitrile, 40 % pH:3 phosphate buffer and 10 % methanol with flow rate 1.0 mL min-1. The chosen wavelengths in PDA was determined as 238 nm for FIN and 213 nm for CIT. The limits of detection (LOD) for proposed method were 6.32 ng mL-1 for FIN and 6.85 ng mL-1 for CIT molecules. RSD % values were lower than 5.5 % in analysis of model solutions including 250 and 500 ng mL-1 of target molecules. Recovery values by means of synthetic urine and saliva samples were in the range of 95.7-105.4 % for both molecules.
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Affiliation(s)
- Esra Durgun
- Department of Analytical Chemistry, Institute of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Halil İbrahim Ulusoy
- Department of Analytical Chemistry, Faculty of Pharmacy, Sivas Cumhuriyet University, Sivas, Turkey.
| | - İbrahim Narin
- Department of Analytical Chemistry, Faculty of Pharmacy, Erciyes University, Kayseri, Turkey
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3
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Lansberry TR, Stabler CL. Immunoprotection of cellular transplants for autoimmune type 1 diabetes through local drug delivery. Adv Drug Deliv Rev 2024; 206:115179. [PMID: 38286164 PMCID: PMC11140763 DOI: 10.1016/j.addr.2024.115179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/19/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results in the destruction of insulin-secreting β cells of the islets of Langerhans. Allogeneic islet transplantation could be a successful treatment for T1DM; however, it is limited by the need for effective, permanent immunosuppression to prevent graft rejection. Upon transplantation, islets are rejected through non-specific, alloantigen specific, and recurring autoimmune pathways. Immunosuppressive agents used for islet transplantation are generally successful in inhibiting alloantigen rejection, but they are suboptimal in hindering non-specific and autoimmune pathways. In this review, we summarize the challenges with cellular immunological rejection and therapeutics used for islet transplantation. We highlight agents that target these three immune rejection pathways and how to package them for controlled, local delivery via biomaterials. Exploring macro-, micro-, and nano-scale immunomodulatory biomaterial platforms, we summarize their advantages, challenges, and future directions. We hypothesize that understanding their key features will help identify effective platforms to prevent islet graft rejection. Outcomes can further be translated to other cellular therapies beyond T1DM.
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Affiliation(s)
- T R Lansberry
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - C L Stabler
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA; Department of Immunology and Pathology, College of Medicine, University of Florida, Gainesville, FL, USA; University of Florida Diabetes Institute, Gainesville, FL, USA.
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4
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Wang YC, Kung WM, Chung YH, Kumar S. Drugs to Treat Neuroinflammation in Neurodegenerative Disorders. Curr Med Chem 2024; 31:1818-1829. [PMID: 37013428 DOI: 10.2174/0929867330666230403125140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 04/05/2023]
Abstract
Neuroinflammation is associated with disorders of the nervous system, and it is induced in response to many factors, including pathogen infection, brain injury, toxic substances, and autoimmune diseases. Astrocytes and microglia have critical roles in neuroinflammation. Microglia are innate immune cells in the central nervous system (CNS), which are activated in reaction to neuroinflammation-inducing factors. Astrocytes can have pro- or anti-inflammatory responses, which depend on the type of stimuli presented by the inflamed milieu. Microglia respond and propagate peripheral inflammatory signals within the CNS that cause low-grade inflammation in the brain. The resulting alteration in neuronal activities leads to physiological and behavioral impairment. Consequently, activation, synthesis, and discharge of various pro-inflammatory cytokines and growth factors occur. These events lead to many neurodegenerative conditions, such as Alzheimer's disease, Parkinson's disease, and multiple sclerosis discussed in this study. After understanding neuroinflammation mechanisms and the involvement of neurotransmitters, this study covers various drugs used to treat and manage these neurodegenerative illnesses. The study can be helpful in discovering new drug molecules for treating neurodegenerative disorders.
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Affiliation(s)
- Yao-Chin Wang
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Emergency, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Woon-Man Kung
- Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, Taiwan
| | - Yi-Hsiu Chung
- Department of Medical Research and Development, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sunil Kumar
- Graduate Institute of Natural Products, College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan
- School of Law (Patent), Nottingham Trent University, 50 Shakespeare St, Nottingham, NG14FQ, England
- Pomato IP (Ignite Your Idea), Nottingham, England
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5
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Kalkowski L, Walczak P, Mycko MP, Malysz-Cymborska I. Reconsidering the route of drug delivery in refractory multiple sclerosis: Toward a more effective drug accumulation in the central nervous system. Med Res Rev 2023; 43:2237-2259. [PMID: 37203228 DOI: 10.1002/med.21973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/08/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
Multiple sclerosis is a chronic demyelinating disease with different disease phenotypes. The current FDA-approved disease-modifying therapeutics (DMTs) cannot cure the disease, but only alleviate the disease progression. While the majority of patients respond well to treatment, some of them are suffering from rapid progression. Current drug delivery strategies include the oral, intravenous, subdermal, and intramuscular routes, so these drugs are delivered systemically, which is appropriate when the therapeutic targets are peripheral. However, the potential benefits may be diminished when these targets sequester behind the barriers of the central nervous system. Moreover, systemic drug administration is plagued with adverse effects, sometimes severe. In this context, it is prudent to consider other drug delivery strategies improving their accumulation in the brain, thus providing better prospects for patients with rapidly progressing disease course. These targeted drug delivery strategies may also reduce the severity of systemic adverse effects. Here, we discuss the possibilities and indications for reconsideration of drug delivery routes (especially for those "non-responding" patients) and the search for alternative drug delivery strategies. More targeted drug delivery strategies sometimes require quite invasive procedures, but the potential therapeutic benefits and reduction of adverse effects could outweigh the risks. We characterized the major FDA-approved DMTs focusing on their therapeutic mechanism and the potential benefits of improving the accumulation of these drugs in the brain.
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Affiliation(s)
- Lukasz Kalkowski
- Department of Diagnostic Radiology and Nuclear Medicine, Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Piotr Walczak
- Department of Diagnostic Radiology and Nuclear Medicine, Center for Advanced Imaging Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marcin P Mycko
- Medical Division, Department of Neurology, Laboratory of Neuroimmunology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Izabela Malysz-Cymborska
- Department of Neurosurgery, School of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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6
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Wong TS, Li G, Li S, Gao W, Chen G, Gan S, Zhang M, Li H, Wu S, Du Y. G protein-coupled receptors in neurodegenerative diseases and psychiatric disorders. Signal Transduct Target Ther 2023; 8:177. [PMID: 37137892 PMCID: PMC10154768 DOI: 10.1038/s41392-023-01427-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/17/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Neuropsychiatric disorders are multifactorial disorders with diverse aetiological factors. Identifying treatment targets is challenging because the diseases are resulting from heterogeneous biological, genetic, and environmental factors. Nevertheless, the increasing understanding of G protein-coupled receptor (GPCR) opens a new possibility in drug discovery. Harnessing our knowledge of molecular mechanisms and structural information of GPCRs will be advantageous for developing effective drugs. This review provides an overview of the role of GPCRs in various neurodegenerative and psychiatric diseases. Besides, we highlight the emerging opportunities of novel GPCR targets and address recent progress in GPCR drug development.
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Affiliation(s)
- Thian-Sze Wong
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
- School of Medicine, Tsinghua University, 100084, Beijing, China
| | - Guangzhi Li
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, 518000, Shenzhen, Guangdong, China
| | - Shiliang Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Wei Gao
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Geng Chen
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Shiyi Gan
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China
| | - Manzhan Zhang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China
| | - Honglin Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, 200237, Shanghai, China.
- Innovation Center for AI and Drug Discovery, East China Normal University, 200062, Shanghai, China.
| | - Song Wu
- Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen University, 518000, Shenzhen, Guangdong, China.
- Department of Urology, South China Hospital, Health Science Center, Shenzhen University, 518116, Shenzhen, Guangdong, China.
| | - Yang Du
- Kobilka Institute of Innovative Drug Discovery, Shenzhen Key Laboratory of Steroid Drug Discovery and Development, School of Medicine, The Chinese University of Hong Kong, 518172, Shenzhen, Guangdong, China.
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Abstract
The multiple sclerosis (MS) neurotherapeutic landscape is rapidly evolving. New disease-modifying therapies (DMTs) with improved efficacy and safety, in addition to an expanding pipeline of agents with novel mechanisms, provide more options for patients with MS. While treatment of MS neuroinflammation is well tailored in the existing DMT armamentarium, concerted efforts are currently underway for identifying neuropathological targets and drug discovery for progressive MS. There is also ongoing research to develop agents for remyelination and neuroprotection. Further insights are needed to guide DMT initiation and sequencing as well as to determine the role of autologous stem cell transplantation in relapsing and progressive MS. This review provides a summary of these updates.
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Affiliation(s)
- Moein Amin
- Cleveland Clinic, Department of Neurology, Cleveland, OH 44195, USA
| | - Carrie M Hersh
- Cleveland Clinic, Lou Ruvo Center for Brain Health, Las Vegas, NV 89106, USA
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8
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Immunomodulatory drug fingolimod (FTY720) restricts the growth of opportunistic yeast Candida albicans in vitro and in a mouse candidiasis model. PLoS One 2022; 17:e0278488. [PMID: 36477491 PMCID: PMC9728862 DOI: 10.1371/journal.pone.0278488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Fingolimod (FTY720) is a drug derived from the fungicidal compound myriocin. As it was unclear whether FTY720 has antifungal effects as well, we aimed to characterize its effect on Candida albicans in vitro and in a mouse candidiasis model. First, antifungal susceptibility testing was performed in vitro. Then, a randomized, six-arm, parallel, open-label trial was conducted on 48 mice receiving oral FTY720 (0.3 mg/kg/day), intraperitoneal C. albicans inoculation, or placebo with different combinations and chorological patterns. The outcome measures of the trial included serum concentrations of interleukin-10 and interferon-gamma, absolute lymphocyte counts, and fungal burden values in the mice's livers, kidneys, and vaginas. Broth microdilution assay revealed FTY720's minimum inhibitory concentration (MIC99) to be 0.25 mg/mL for C. albicans. The infected mice treated with FTY720 showed lower fungal burden values than the ones not treated with FTY720 (p<0.05). As expected, the mice treated with FTY720 showed a less-inflammatory immune profile compared to the ones not treated with FTY720. We hypothesize that FTY720 synergizes the host's innate immune functions by inducing the production of reactive oxygen species. Further studies are warranted to unveil the mechanistic explanations of our observations and clarify further aspects of repurposing FTY720 for clinical antifungal usage.
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A Validated HPLC-MS/MS Method for Quantification of Fingolimod and Fingolimod-Phosphate in Human Plasma: Application to Patients with Relapsing–Remitting Multiple Sclerosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fingolimod is a sphingosine 1-phosphate-receptor modulator approved for the oral treatment of relapsing–remitting multiple sclerosis (RRMS), a form of MS characterized by a pattern of exacerbation of neurological symptoms followed by recovery. Here, we validated a simple and rapid liquid chromatography–tandem mass spectrometry method for the measurement of the concentrations of Fingolimod and its active metabolite Fingolimod-Phosphate (Fingolimod-P) in human plasma. The lower limits of quantification were set at 0.3 and 1.5 ng/mL for Fingolimod and Fingolimod-P, respectively, and the linearity was in the range 0.3–150 ng Fingolimod/mL and 1.5–150 ng Fingolimod-P/mL. After protein precipitation, the extraction recoveries of both analytes were always above 60% with minimal matrix effect. The method was accurate and precise, satisfying the criteria set in the European Medicine Agency guidelines for bioanalytical method validation. The method was then applied to measure Fingolimod and Fingolimod-P concentrations in the plasma of 15 RRMS patients under chronic treatment with Fingolimod, administered daily at the dose of 0.5 mg for up to 24 months. No significant differences were observed between samples collected at 6, 12 and 24 months for both analytes, indicating that the drug’s bioavailability was unaffected by multiple daily doses up to 24 months. The levels of Fingolimod-P were about two-fold higher than the levels of the parent compound. The availability of this analytical method can allow the monitoring of the impact of plasma levels of the drug and its metabolite on inter-individual variability in clinical responses.
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Zehra Okus F, Busra Azizoglu Z, Canatan H, Eken A. S1P analogues SEW2871, BAF312 and FTY720 affect human Th17 and Treg generation ex vivo. Int Immunopharmacol 2022; 107:108665. [DOI: 10.1016/j.intimp.2022.108665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
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Pournajaf S, Dargahi L, Javan M, Pourgholami MH. Molecular Pharmacology and Novel Potential Therapeutic Applications of Fingolimod. Front Pharmacol 2022; 13:807639. [PMID: 35250559 PMCID: PMC8889014 DOI: 10.3389/fphar.2022.807639] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/31/2022] [Indexed: 12/14/2022] Open
Abstract
Fingolimod is a well-tolerated, highly effective disease-modifying therapy successfully utilized in the management of multiple sclerosis. The active metabolite, fingolimod-phosphate, acts on sphingosine-1-phosphate receptors (S1PRs) to bring about an array of pharmacological effects. While being initially recognized as a novel agent that can profoundly reduce T-cell numbers in circulation and the CNS, thereby suppressing inflammation and MS, there is now rapidly increasing knowledge on its previously unrecognized molecular and potential therapeutic effects in diverse pathological conditions. In addition to exerting inhibitory effects on sphingolipid pathway enzymes, fingolimod also inhibits histone deacetylases, transient receptor potential cation channel subfamily M member 7 (TRMP7), cytosolic phospholipase A2α (cPLA2α), reduces lysophosphatidic acid (LPA) plasma levels, and activates protein phosphatase 2A (PP2A). Furthermore, fingolimod induces apoptosis, autophagy, cell cycle arrest, epigenetic regulations, macrophages M1/M2 shift and enhances BDNF expression. According to recent evidence, fingolimod modulates a range of other molecular pathways deeply rooted in disease initiation or progression. Experimental reports have firmly associated the drug with potentially beneficial therapeutic effects in immunomodulatory diseases, CNS injuries, and diseases including Alzheimer's disease (AD), Parkinson's disease (PD), epilepsy, and even cancer. Attractive pharmacological effects, relative safety, favorable pharmacokinetics, and positive experimental data have collectively led to its testing in clinical trials. Based on the recent reports, fingolimod may soon find its way as an adjunct therapy in various disparate pathological conditions. This review summarizes the up-to-date knowledge about molecular pharmacology and potential therapeutic uses of fingolimod.
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Affiliation(s)
- Safura Pournajaf
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Leila Dargahi
- Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Yang X, Wu C, Su W, Yu J. Mechanochemical C−X/C−H Functionalization: An Alternative Strategy Access to Pharmaceuticals. European J Org Chem 2022. [DOI: 10.1002/ejoc.202101440] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xinjie Yang
- Zhejiang University of Technology Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals Chaowang Road 18# 310014 Hangzhou CHINA
| | - Chongyang Wu
- Zhejiang University of Technology Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals Chaowang Road 18# 310014 Hangzhou CHINA
| | - Weike Su
- Zhejiang University of Technology Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals Chaowang Road 18# 310014 Hangzhou CHINA
| | - Jingbo Yu
- Zhejiang University of Technology Collaborative Innovation Center of Yangtze River Delta Region Green Pharmaceuticals Chaowang Road 18# 310014 Hangzhou CHINA
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Schoedel KA, Kolly C, Gardin A, Neelakantham S, Shakeri-Nejad K. Abuse and dependence potential of sphingosine-1-phosphate (S1P) receptor modulators used in the treatment of multiple sclerosis: a review of literature and public data. Psychopharmacology (Berl) 2022; 239:1-13. [PMID: 34773483 PMCID: PMC8770388 DOI: 10.1007/s00213-021-06011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/18/2021] [Indexed: 12/05/2022]
Abstract
Abuse and misuse of prescription drugs remains an ongoing concern in the USA and worldwide; thus, all centrally active new drugs must be assessed for abuse and dependence potential. Sphingosine-1-phosphate (S1P) receptor modulators are used primarily in the treatment of multiple sclerosis. Among the new S1P receptor modulators, siponimod, ozanimod, and ponesimod have recently been approved in the USA, European Union (EU), and other countries. This review of literature and other public data has been undertaken to assess the potential for abuse of S1P receptor modulators, including ozanimod, siponimod, ponesimod, and fingolimod, as well as several similar compounds in development. The S1P receptor modulators have not shown chemical or pharmacological similarity to known drugs of abuse; have not shown abuse or dependence potential in animal models for subjective effects, reinforcement, or physical dependence; and do not have adverse event profiles demonstrating effects of interest to individuals who abuse drugs (such as sedative, stimulant, mood-elevating, or hallucinogenic effects). In addition, no reports of actual abuse, misuse, or dependence were identified in the scientific literature for fingolimod, which has been on the market since 2010 (USA) and 2011 (EU). Overall, the data suggest that S1P receptor modulators are not associated with significant potential for abuse or dependence, consistent with their unscheduled status in the USA and internationally.
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Affiliation(s)
| | - Carine Kolly
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Anne Gardin
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Srikanth Neelakantham
- grid.464975.d0000 0004 0405 8189Novartis Institutes for Biomedical Research, Novartis Healthcare Pvt Ltd, Hyderabad, India
| | - Kasra Shakeri-Nejad
- grid.419481.10000 0001 1515 9979Novartis Institutes for Biomedical Research, Novartis Pharma AG, Basel, Switzerland
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Motyl JA, Strosznajder JB, Wencel A, Strosznajder RP. Recent Insights into the Interplay of Alpha-Synuclein and Sphingolipid Signaling in Parkinson's Disease. Int J Mol Sci 2021; 22:ijms22126277. [PMID: 34207975 PMCID: PMC8230587 DOI: 10.3390/ijms22126277] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023] Open
Abstract
Molecular studies have provided increasing evidence that Parkinson’s disease (PD) is a protein conformational disease, where the spread of alpha-synuclein (ASN) pathology along the neuraxis correlates with clinical disease outcome. Pathogenic forms of ASN evoke oxidative stress (OS), neuroinflammation, and protein alterations in neighboring cells, thereby intensifying ASN toxicity, neurodegeneration, and neuronal death. A number of evidence suggest that homeostasis between bioactive sphingolipids with opposing function—e.g., sphingosine-1-phosphate (S1P) and ceramide—is essential in pro-survival signaling and cell defense against OS. In contrast, imbalance of the “sphingolipid biostat” favoring pro-oxidative/pro-apoptotic ceramide-mediated changes have been indicated in PD and other neurodegenerative disorders. Therefore, we focused on the role of sphingolipid alterations in ASN burden, as well as in a vast range of its neurotoxic effects. Sphingolipid homeostasis is principally directed by sphingosine kinases (SphKs), which synthesize S1P—a potent lipid mediator regulating cell fate and inflammatory response—making SphK/S1P signaling an essential pharmacological target. A growing number of studies have shown that S1P receptor modulators, and agonists are promising protectants in several neurological diseases. This review demonstrates the relationship between ASN toxicity and alteration of SphK-dependent S1P signaling in OS, neuroinflammation, and neuronal death. Moreover, we discuss the S1P receptor-mediated pathways as a novel promising therapeutic approach in PD.
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Affiliation(s)
- Joanna A. Motyl
- Department of Hybrid Microbiosystems Engineering, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4 St., 02-109 Warsaw, Poland; (J.A.M.); (A.W.)
| | - Joanna B. Strosznajder
- Department of Cellular Signalling, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego St., 02-106 Warsaw, Poland;
| | - Agnieszka Wencel
- Department of Hybrid Microbiosystems Engineering, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4 St., 02-109 Warsaw, Poland; (J.A.M.); (A.W.)
| | - Robert P. Strosznajder
- Laboratory of Preclinical Research and Environmental Agents, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego St., 02-106 Warsaw, Poland
- Correspondence:
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15
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Pérez-Jeldres T, Alvarez-Lobos M, Rivera-Nieves J. Targeting Sphingosine-1-Phosphate Signaling in Immune-Mediated Diseases: Beyond Multiple Sclerosis. Drugs 2021; 81:985-1002. [PMID: 33983615 PMCID: PMC8116828 DOI: 10.1007/s40265-021-01528-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Sphingosine-1-phosphate (S1P) is a bioactive lipid metabolite that exerts its actions by engaging 5 G-protein-coupled receptors (S1PR1-S1PR5). S1P receptors are involved in several cellular and physiological events, including lymphocyte/hematopoietic cell trafficking. An S1P gradient (low in tissues, high in blood), maintained by synthetic and degradative enzymes, regulates lymphocyte trafficking. Because lymphocytes live long (which is critical for adaptive immunity) and recirculate thousands of times, the S1P-S1PR pathway is involved in the pathogenesis of immune-mediated diseases. The S1PR1 modulators lead to receptor internalization, subsequent ubiquitination, and proteasome degradation, which renders lymphocytes incapable of following the S1P gradient and prevents their access to inflammation sites. These drugs might also block lymphocyte egress from lymph nodes by inhibiting transendothelial migration. Targeting S1PRs as a therapeutic strategy was first employed for multiple sclerosis (MS), and four S1P modulators (fingolimod, siponimod, ozanimod, and ponesimod) are currently approved for its treatment. New S1PR modulators are under clinical development for MS, and their uses are being evaluated to treat other immune-mediated diseases, including inflammatory bowel disease (IBD), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis. A clinical trial in patients with COVID-19 treated with ozanimod is ongoing. Ozanimod and etrasimod have shown promising results in IBD; while in phase 2 clinical trials, ponesimod has shown improvement in 77% of the patients with psoriasis. Cenerimod and amiselimod have been tested in SLE patients. Fingolimod, etrasimod, and IMMH001 have shown efficacy in RA preclinical studies. Concerns relating to S1PR modulators are leukopenia, anemia, transaminase elevation, macular edema, teratogenicity, pulmonary disorders, infections, and cardiovascular events. Furthermore, S1PR modulators exhibit different pharmacokinetics; a well-established first-dose event associated with S1PR modulators can be mitigated by gradual up-titration. In conclusion, S1P modulators represent a novel and promising therapeutic strategy for immune-mediated diseases.
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Affiliation(s)
- Tamara Pérez-Jeldres
- Pontificia Universidad Católica de Chile, Santiago, Chile
- Hospital San Borja-Arriarán, Santiago, Chile
| | - Manuel Alvarez-Lobos
- Pontificia Universidad Católica de Chile, Santiago, Chile
- Hospital San Borja-Arriarán, Santiago, Chile
| | - Jesús Rivera-Nieves
- San Diego VA Medical Center (SDVAMC), San Diego, CA, USA.
- Division of Gastroenterology, Department of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive Bldg. BRF-II Rm. 4A32, San Diego, CA, 92093-0063, USA.
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16
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Valenzuela B, Pérez-Ruixo JJ, Leirens Q, Ouwerkerk-Mahadevan S, Poggesi I. Effect of Ponesimod Exposure on Total Lymphocyte Dynamics in Patients with Multiple Sclerosis. Clin Pharmacokinet 2021; 60:1239-1250. [PMID: 33914285 DOI: 10.1007/s40262-021-01019-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the relationship between ponesimod plasma concentrations and the temporal evolution of lymphocyte counts in multiple sclerosis (MS) patients. METHODS Population pharmacokinetic (PK) and PK/pharmacodynamic (PD) models were developed using data from phase I, II, and III trials, and the impact of clinically relevant covariates on PK and PD parameters was assessed. Simulations were conducted to evaluate the maximal lymphocyte count reduction after ponesimod treatment, and the time required for total lymphocyte counts to return to normal values after treatment interruption. RESULTS In MS patients, ponesimod PK were characterized by a low mean apparent plasma clearance (5.52 L/h) and a moderate mean apparent volume of distribution at steady state (239 L). The model developed indicated that none of the evaluated covariates (age, sex, formulation, food, body weight, clinical condition, and renal impairment) had a clinically relevant impact on the PK/PD parameters. In MS patients, total lymphocyte counts were characterized by a maximum reduction of 88.0% and a half maximal inhibitory concentration (IC50) of 54.9 ng/mL. Simulations indicated that in patients with normal hepatic function treated with ponesimod 20 mg daily, total lymphocyte counts were reduced to 41% of baseline at trough. After stopping treatment, lymphocyte counts were restored to normal levels within one week. CONCLUSIONS The population PK/PD model well-characterized the PK of ponesimod and the time course of total lymphocyte counts in MS patients. Additionally, none of the evaluated covariates had a clinically relevant impact. This should be taken into consideration when assessing the risk of infection, administration of live-attenuated vaccines, and concomitant use of immunosuppressants.
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Affiliation(s)
- Belén Valenzuela
- Janssen-Cilag Spain, Part of Janssen Pharmaceutical Companies of Johnson and Johnson, Madrid, Spain.
| | - Juan-José Pérez-Ruixo
- Janssen-Cilag Spain, Part of Janssen Pharmaceutical Companies of Johnson and Johnson, Madrid, Spain
| | - Quentin Leirens
- SGS Exprimo, part of SGS Belgium NV, Mechelen, Belgium.,Pharmetheus AB, Uppsala, Sweden
| | | | - Italo Poggesi
- Janssen-Cilag Italy, part of the Janssen Pharmaceutical Companies of Johnson and Johnson, Cologno Monzese, Italy
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17
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Roy R, Alotaibi AA, Freedman MS. Sphingosine 1-Phosphate Receptor Modulators for Multiple Sclerosis. CNS Drugs 2021; 35:385-402. [PMID: 33797705 DOI: 10.1007/s40263-021-00798-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
Fingolimod (Gilenya) received regulatory approval from the US FDA in 2010 as the first-in-class sphingosine 1-phosphate (S1P) receptor (S1PR) modulator and was the first oral disease-modifying therapy (DMT) used for the treatment of the relapsing forms of multiple sclerosis (MS). Development of this new class of therapeutic compounds has continued to be a pharmacological goal of high interest in clinical trials for treatment of various autoimmune disorders, including MS. S1P is a physiologic signaling molecule that acts as a ligand for a group of cell surface receptors. S1PRs are expressed on various body tissues and regulate diverse physiological and pathological cellular responses involved in innate and adaptive immune, cardiovascular, and neurological functions. Subtype 1 of the S1PR (S1PR1) is expressed on the cell surface of lymphocytes, which are well known for their major role in MS pathogenesis and play an important regulatory role in the egress of lymphocytes from lymphoid organs to the lymphatic circulation. Thus, S1PR1-directed pharmacological interventions aim to modulate its role in immune cell trafficking through sequestration of autoreactive lymphocytes in the lymphoid organs to reduce their recirculation and subsequent infiltration into the central nervous system. Indeed, receptor subtype selectivity for S1PR1 is theoretically favored to minimize safety concerns related to interaction with other S1PR subtypes. Improved understanding of fingolimod's mechanism of action has provided strategies for the development of the more selective second-generation S1PR modulators. This selectivity serves to reduce the most important safety concern regarding cardiac-related side effects, such as bradycardia, which requires prolonged first-dose monitoring. It has led to the generation of smaller molecules with shorter half-lives, improved onset of action with no requirement for phosphorylation for activation, and preserved efficacy. The shorter half-lives of the second-generation agents allow for more rapid reversal of their pharmacological effects following treatment discontinuation. This may be beneficial in addressing further treatment-related complications in case of adverse events, managing serious or opportunistic infections such as progressive multifocal leukoencephalopathy, and eliminating the drug in pregnancies. In March 2019, a breakthrough in MS treatment was achieved with the FDA approval for the second S1PR modulator, siponimod (Mayzent), for both active secondary progressive MS and relapsing-remitting MS. This was the first oral DMT specifically approved for active forms of secondary progressive MS. Furthermore, ozanimod received FDA approval in March 2020 for treatment of relapsing forms of MS, followed by subsequent approvals from Health Canada and the European Commission. Other second-generation selective S1PR modulators that have been tested for MS, with statistically significant data from phase II and phase III clinical studies, include ponesimod (ACT-128800), ceralifimod (ONO-4641), and amiselimod (MT-1303). This review covers the available data about the mechanisms of action, pharmacodynamics and kinetics, efficacy, safety, and tolerability of the various S1PR modulators for patients with relapsing-remitting, secondary progressive, and, for fingolimod, primary progressive MS.
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Affiliation(s)
- Reshmi Roy
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
| | - Alaa A Alotaibi
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Mark S Freedman
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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18
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Alborghetti M, Bellucci G, Gentile A, Calderoni C, Nicoletti F, Capra R, Salvetti M, Centonze D. Drugs used in the treatment of multiple sclerosis during COVID-19 pandemic: a critical viewpoint. Curr Neuropharmacol 2021; 20:107-125. [PMID: 33784961 PMCID: PMC9199540 DOI: 10.2174/1570159x19666210330094017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
Since COVID-19 has emerged as a word public health problem, attention has been focused on how immune-suppressive drugs used for the treatment of autoimmune disorders influence the risk for SARS-CoV-2 infection and the development of acute respiratory distress syndrome (ARDS). Here, we discuss the disease-modifying agents approved for the treatment of multiple sclerosis (MS) within this context. Interferon (IFN)-β1a and -1b, which display antiviral activity, could be protective in the early stage of COVID-19 infection, although SARS-CoV-2 may have developed resistance to IFNs. However, in the hyperinflammation stage, IFNs may become detrimental by facilitating macrophage invasion in the lung and other organs. Glatiramer acetate and its analogues should not interfere with the development of COVID-19 and may be considered safe. Teriflunomide, a first-line oral drug used in the treatment of relapsing-remitting MS (RRMS), may display antiviral activity by depleting cellular nucleotides necessary for viral replication. The other first-line drug, dimethyl fumarate, may afford protection against SARS-CoV-2 by activating the Nrf-2 pathway and reinforcing the cellular defenses against oxidative stress. Concern has been raised regarding the use of second-line treatments for MS during the COVID-19 pandemic. However, this concern is not always justified. For example, fingolimod might be highly beneficial during the hyperinflammatory stage of COVID-19 for a number of mechanisms, including the reinforcement of the endothelial barrier. Caution is suggested for the use of natalizumab, cladribine, alemtuzumab, and ocrelizumab, although MS disease recurrence after discontinuation of these drugs may overcome a potential risk for COVID-19 infection.
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Affiliation(s)
- Marika Alborghetti
- Departments of Neuroscience Mental Health and Sensory Organs (NESMOS), University Sapienza of Rome. Italy
| | - Gianmarco Bellucci
- Departments of Neuroscience Mental Health and Sensory Organs (NESMOS), University Sapienza of Rome. Italy
| | - Antonietta Gentile
- Synaptic Immunopathology Lab, IRCCS San Raffaele Pisana, 00166 Rome. Italy
| | - Chiara Calderoni
- Departments of Physiology and Pharmacology, University Sapienza of Rome. Italy
| | | | - Ruggero Capra
- Multiple Sclerosis Center, ASST Ospedali Civili, Brescia. Italy
| | - Marco Salvetti
- Departments of Neuroscience Mental Health and Sensory Organs (NESMOS),University Sapienza of Rome. Italy
| | - Diego Centonze
- Department of Systems Medicine, Tor Vergata University, 00133 Rome. Italy
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19
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Ma B, Guckian KM, Liu XG, Yang C, Li B, Scannevin R, Mingueneau M, Drouillard A, Walzer T. Novel Potent Selective Orally Active S1P5 Receptor Antagonists. ACS Med Chem Lett 2021; 12:351-355. [PMID: 33738061 DOI: 10.1021/acsmedchemlett.0c00631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022] Open
Abstract
S1P5 is one of the five sphingosine-1-phosphate (S1P) receptors which play important roles in immune and CNS cell homeostasis, growth, and differentiation. Little is known about the effect of modulation of S1P5 due to the lack of S1P5 specific modulators with suitable druglike properties. Here we describe the discovery and optimization of a novel series of potent selective S1P5 antagonists and the identification of an orally active brain-penetrant tool compound 15.
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Affiliation(s)
| | | | | | | | | | | | | | - Annabelle Drouillard
- Université Lyon 1, Lyon 69007, France
- International Center for Infectiology Research, Lyon 69007, France
| | - Thierry Walzer
- Université Lyon 1, Lyon 69007, France
- International Center for Infectiology Research, Lyon 69007, France
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20
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Gilmore JL, Xiao HY, Dhar TGM, Yang M, Xiao Z, Yang X, Taylor TL, McIntyre KW, Warrack BM, Shi H, Levesque PC, Marino AM, Cornelius G, Mathur A, Shen DR, Pang J, Cvijic ME, Lehman-McKeeman LD, Sun H, Xie J, Salter-Cid L, Carter PH, Dyckman AJ. Bicyclic Ligand-Biased Agonists of S1P 1: Exploring Side Chain Modifications to Modulate the PK, PD, and Safety Profiles. J Med Chem 2021; 64:1454-1480. [PMID: 33492963 DOI: 10.1021/acs.jmedchem.0c01109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sphingosine-1-phosphate (S1P) binds to a family of sphingosine-1-phosphate G-protein-coupled receptors (S1P1-5). The interaction of S1P with these S1P receptors has a fundamental role in many physiological processes in the vascular and immune systems. Agonist-induced functional antagonism of S1P1 has been shown to result in lymphopenia. As a result, agonists of this type hold promise as therapeutics for autoimmune disorders. The previously disclosed differentiated S1P1 modulator BMS-986104 (1) exhibited improved preclinical cardiovascular and pulmonary safety profiles as compared to earlier full agonists of S1P1; however, it demonstrated a long pharmacokinetic half-life (T1/2 18 days) in the clinic and limited formation of the desired active phosphate metabolite. Optimization of this series through incorporation of olefins, ethers, thioethers, and glycols into the alkyl side chain afforded an opportunity to reduce the projected human T1/2 and improve the formation of the active phosphate metabolite while maintaining efficacy as well as the improved safety profile. These efforts led to the discovery of 12 and 24, each of which are highly potent, biased agonists of S1P1. These compounds not only exhibited shorter in vivo T1/2 in multiple species but are also projected to have significantly shorter T1/2 values in humans when compared to our first clinical candidate. In models of arthritis, treatment with 12 and 24 demonstrated robust efficacy.
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Affiliation(s)
- John L Gilmore
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Hai-Yun Xiao
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - T G Murali Dhar
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Michael Yang
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Zili Xiao
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Xiaoxia Yang
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Tracy L Taylor
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Kim W McIntyre
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Bethanne M Warrack
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Hong Shi
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Paul C Levesque
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Anthony M Marino
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Georgia Cornelius
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Arvind Mathur
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Ding Ren Shen
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Jian Pang
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Mary Ellen Cvijic
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Lois D Lehman-McKeeman
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Huadong Sun
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Jenny Xie
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Luisa Salter-Cid
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Percy H Carter
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Alaric J Dyckman
- Bristol Myers Squibb Research & Early Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
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21
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Gil A, Martín-Montañez E, Valverde N, Lara E, Boraldi F, Claros S, Romero-Zerbo SY, Fernández O, Pavia J, Garcia-Fernandez M. Neuronal Metabolism and Neuroprotection: Neuroprotective Effect of Fingolimod on Menadione-Induced Mitochondrial Damage. Cells 2020; 10:cells10010034. [PMID: 33383658 PMCID: PMC7824129 DOI: 10.3390/cells10010034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 02/07/2023] Open
Abstract
Imbalance in the oxidative status in neurons, along with mitochondrial damage, are common characteristics in some neurodegenerative diseases. The maintenance in energy production is crucial to face and recover from oxidative damage, and the preservation of different sources of energy production is essential to preserve neuronal function. Fingolimod phosphate is a drug with neuroprotective and antioxidant actions, used in the treatment of multiple sclerosis. This work was performed in a model of oxidative damage on neuronal cell cultures exposed to menadione in the presence or absence of fingolimod phosphate. We studied the mitochondrial function, antioxidant enzymes, protein nitrosylation, and several pathways related with glucose metabolism and glycolytic and pentose phosphate in neuronal cells cultures. Our results showed that menadione produces a decrease in mitochondrial function, an imbalance in antioxidant enzymes, and an increase in nitrosylated proteins with a decrease in glycolysis and glucose-6-phosphate dehydrogenase. All these effects were counteracted when fingolimod phosphate was present in the incubation media. These effects were mediated, at least in part, by the interaction of this drug with its specific S1P receptors. These actions would make this drug a potential tool in the treatment of neurodegenerative processes, either to slow progression or alleviate symptoms.
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Affiliation(s)
- Antonio Gil
- Department of Pharmacology and Pediatrics, Faculty of Medicine, Malaga University, 29010 Malaga, Spain; (A.G.); (E.M.-M.); (O.F.)
| | - Elisa Martín-Montañez
- Department of Pharmacology and Pediatrics, Faculty of Medicine, Malaga University, 29010 Malaga, Spain; (A.G.); (E.M.-M.); (O.F.)
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
| | - Nadia Valverde
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
- Department of Human Physiology, Faculty of Medicine, Malaga University, 29010 Malaga, Spain;
| | - Estrella Lara
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
- Department of Human Physiology, Faculty of Medicine, Malaga University, 29010 Malaga, Spain;
| | - Federica Boraldi
- Department of Life Sciences, University of Modena e Reggio Emilia, 41125 Modena, Italy;
| | - Silvia Claros
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
- Department of Human Physiology, Faculty of Medicine, Malaga University, 29010 Malaga, Spain;
| | | | - Oscar Fernández
- Department of Pharmacology and Pediatrics, Faculty of Medicine, Malaga University, 29010 Malaga, Spain; (A.G.); (E.M.-M.); (O.F.)
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
| | - Jose Pavia
- Department of Pharmacology and Pediatrics, Faculty of Medicine, Malaga University, 29010 Malaga, Spain; (A.G.); (E.M.-M.); (O.F.)
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
- Correspondence: (J.P.); (M.G.-F.)
| | - Maria Garcia-Fernandez
- Neuroscience Unit, Biomedical Research Institute of Malaga (IBIMA), Malaga University Hospital, 29010 Malaga, Spain; (N.V.); (E.L.); (S.C.)
- Department of Human Physiology, Faculty of Medicine, Malaga University, 29010 Malaga, Spain;
- Correspondence: (J.P.); (M.G.-F.)
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22
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Manolis AS, Manolis AA, Manolis TA, Apostolopoulos EJ, Papatheou D, Melita H. COVID-19 infection and cardiac arrhythmias. Trends Cardiovasc Med 2020; 30:451-460. [PMID: 32814095 PMCID: PMC7429078 DOI: 10.1016/j.tcm.2020.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
As the coronavirus 2019 (COVID-19) pandemic marches unrelentingly, more patients with cardiac arrhythmias are emerging due to the effects of the virus on the respiratory and cardiovascular (CV) systems and the systemic inflammation that it incurs, and also as a result of the proarrhythmic effects of COVID-19 pharmacotherapies and other drug interactions and the associated autonomic imbalance that enhance arrhythmogenicity. The most worrisome of all arrhythmogenic mechanisms is the QT prolonging effect of various anti-COVID pharmacotherapies that can lead to polymorphic ventricular tachycardia in the form of torsade des pointes and sudden cardiac death. It is therefore imperative to monitor the QT interval during treatment; however, conventional approaches to such monitoring increase the transmission risk for the staff and strain the health system. Hence, there is dire need for contactless monitoring and telemetry for inpatients, especially those admitted to the intensive care unit, as well as for outpatients needing continued management. In this context, recent technological advances have ushered in a new era in implementing digital health monitoring tools that circumvent these obstacles. All these issues are herein discussed and a large body of recent relevant data are reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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23
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Double Filtration Plasmapheresis Treatment of Refractory Multiple Sclerosis Relapsed on Fingolimod: A Case Report. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Double filtration plasmapheresis (DFPP) is an emerging semi-selective apheretic method for treating immuno-mediated neurological diseases. Here we report the first case of steroid-refractory relapsed multiple sclerosis (MS) on Fingolimod (FTY), treated effectively by this technique, in a 37-year-old woman. This condition is thought to be caused by soluble inflammatory species, but its demyelinating pattern is unknown; moreover, despite megadoses of intravenous 6-methyl prednisolone, it induces severe neurological deterioration, but dramatically responded to DFPP in our patient. The clinical improvement was driven by a strong DFPP-induced anti-inflammatory effect, with significant reduction of C3/C4 components, total gamma globulin concentrations (IgG), and gamma-fibrinogen (FGG), resulting in a brain pseudoatrophy phenomenon. Our findings are: first, the steroid-refractory relapsed MS on FTY, however serious, can be treated with DFPP; second, given the good clinical improvement due to the DFPP-induced neuroinflammatory components removal, this clinical condition can be associated with a Lucchinetti pattern II of demyelination.
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24
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Sphingosine-1-Phosphate Receptor Modulators and Oligodendroglial Cells: Beyond Immunomodulation. Int J Mol Sci 2020; 21:ijms21207537. [PMID: 33066042 PMCID: PMC7588977 DOI: 10.3390/ijms21207537] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/23/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune inflammatory disease characterized by demyelination, axonal loss, and synaptic impairment in the central nervous system (CNS). The available therapies aim to reduce the severity of the pathology during the early inflammatory stages, but they are not effective in the chronic stage of the disease. In this phase, failure in endogenous remyelination is associated with the impairment of oligodendrocytes progenitor cells (OPCs) to migrate and differentiate into mature myelinating oligodendrocytes. Therefore, stimulating differentiation of OPCs into myelinating oligodendrocytes has become one of the main goals of new therapeutic approaches for MS. Different disease-modifying therapies targeting sphingosine-1-phosphate receptors (S1PRs) have been approved or are being developed to treat MS. Besides their immunomodulatory effects, growing evidence suggests that targeting S1PRs modulates mechanisms beyond immunomodulation, such as remyelination. In this context, this review focuses on the current understanding of S1PR modulators and their direct effect on OPCs and oligodendrocytes.
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25
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Litsa EE, Das P, Kavraki LE. Prediction of drug metabolites using neural machine translation. Chem Sci 2020; 11:12777-12788. [PMID: 34094473 PMCID: PMC8162519 DOI: 10.1039/d0sc02639e] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
Metabolic processes in the human body can alter the structure of a drug affecting its efficacy and safety. As a result, the investigation of the metabolic fate of a candidate drug is an essential part of drug design studies. Computational approaches have been developed for the prediction of possible drug metabolites in an effort to assist the traditional and resource-demanding experimental route. Current methodologies are based upon metabolic transformation rules, which are tied to specific enzyme families and therefore lack generalization, and additionally may involve manual work from experts limiting scalability. We present a rule-free, end-to-end learning-based method for predicting possible human metabolites of small molecules including drugs. The metabolite prediction task is approached as a sequence translation problem with chemical compounds represented using the SMILES notation. We perform transfer learning on a deep learning transformer model for sequence translation, originally trained on chemical reaction data, to predict the outcome of human metabolic reactions. We further build an ensemble model to account for multiple and diverse metabolites. Extensive evaluation reveals that the proposed method generalizes well to different enzyme families, as it can correctly predict metabolites through phase I and phase II drug metabolism as well as other enzymes. Compared to existing rule-based approaches, our method has equivalent performance on the major enzyme families while it additionally finds metabolites through less common enzymes. Our results indicate that the proposed approach can provide a comprehensive study of drug metabolism that does not restrict to the major enzyme families and does not require the extraction of transformation rules.
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Affiliation(s)
- Eleni E Litsa
- Department of Computer Science, Rice University Houston TX USA
| | - Payel Das
- IBM Research AI, IBM Thomas J. Watson Research Center Yorktown Heights NY 10598 USA
- Applied Physics and Applied Mathematics, Columbia University New York NY 10027 USA
| | - Lydia E Kavraki
- Department of Computer Science, Rice University Houston TX USA
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Sonne SJ, Smith BT. Incidence of uveitis and macular edema among patients taking fingolimod 0.5 mg for multiple sclerosis. J Ophthalmic Inflamm Infect 2020; 10:24. [PMID: 32954456 PMCID: PMC7502642 DOI: 10.1186/s12348-020-00215-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background Patients with multiple sclerosis (MS) have a higher incidence of uveitis compared with the general population. Fingolimod, a first line disease modifying drug used in multiple sclerosis, may cause macular edema and thus requires ophthalmic examination. However, murine models and anecdotal reports suggest fingolimod may reduce the incidence of uveitis. Purpose To report the incidence of uveitis and macular edema among those on fingolimod 0.5 mg (Gilenya®) therapy for multiple sclerosis (MS). Methods Retrospective review of patients on fingolimod who developed uveitis and/or macular edema. Results No patients had an occurrence or history of uveitis. Four of the 188 (2.13%) patients developed macular edema without ocular inflammation. One of the 188 (0.53%) patients developed Acute Macular Neuroretinopathy. Conclusion Patients taking fingolimod have a lower incidence of uveitis than expected in a population of MS patients.
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Affiliation(s)
| | - Bradley Thomas Smith
- The Retina Institute in St. Louis, 2201 S Brentwood Blvd, St. Louis, MO, 63144, USA. .,Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, USA.
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27
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Roos I, Leray E, Frascoli F, Casey R, Brown JWL, Horakova D, Havrdova EK, Trojano M, Patti F, Izquierdo G, Eichau S, Onofrj M, Lugaresi A, Prat A, Girard M, Grammond P, Sola P, Ferraro D, Ozakbas S, Bergamaschi R, Sá MJ, Cartechini E, Boz C, Granella F, Hupperts R, Terzi M, Lechner-Scott J, Spitaleri D, Van Pesch V, Soysal A, Olascoaga J, Prevost J, Aguera-Morales E, Slee M, Csepany T, Turkoglu R, Sidhom Y, Gouider R, Van Wijmeersch B, McCombe P, Macdonell R, Coles A, Malpas CB, Butzkueven H, Vukusic S, Kalincik T, Duquette P, Grand'Maison F, Iuliano G, Ramo-Tello C, Solaro C, Cabrera-Gomez JA, Rio ME, Bolaños RF, Shaygannejad V, Oreja-Guevara C, Sanchez-Menoyo JL, Petersen T, Altintas A, Barnett M, Flechter S, Fragoso Y, Amato MP, Moore F, Ampapa R, Verheul F, Hodgkinson S, Cristiano E, Yamout B, Laureys G, Dominguez JA, Zwanikken C, Deri N, Dobos E, Vrech C, Butler E, Rozsa C, Petkovska-Boskova T, Karabudak R, Rajda C, Alkhaboori J, Saladino ML, Shaw C, Shuey N, Vucic S, Sempere AP, Campbell J, Piroska I, Taylor B, van der Walt A, Kappos L, Roullet E, Gray O, Simo M, Sirbu CA, Brochet B, Cotton F, De Sèze J, Dion A, Douek P, Guillemin F, Laplaud D, Lebrun-Frenay C, Moreau T, Olaiz J, Pelletier J, Rigaud-Bully C, Stankoff B, Marignier R, Debouverie M, Edan G, Ciron J, Ruet A, Collongues N, Lubetzki C, Vermersch P, Labauge P, Defer G, Cohen M, Fromont A, Wiertlewsky S, Berger E, Clavelou P, Audoin B, Giannesini C, Gout O, Thouvenot E, Heinzlef O, Al-Khedr A, Bourre B, Casez O, Cabre P, Montcuquet A, Créange A, Camdessanché JP, Faure J, Maurousset A, Patry I, Hankiewicz K, Pottier C, Maubeuge N, Labeyrie C, Nifle C. Delay from treatment start to full effect of immunotherapies for multiple sclerosis. Brain 2020; 143:2742-2756. [DOI: 10.1093/brain/awaa231] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/30/2020] [Accepted: 06/01/2020] [Indexed: 01/21/2023] Open
Abstract
Abstract
In multiple sclerosis, treatment start or switch is prompted by evidence of disease activity. Whilst immunomodulatory therapies reduce disease activity, the time required to attain maximal effect is unclear. In this study we aimed to develop a method that allows identification of the time to manifest fully and clinically the effect of multiple sclerosis treatments (‘therapeutic lag’) on clinical disease activity represented by relapses and progression-of-disability events. Data from two multiple sclerosis registries, MSBase (multinational) and OFSEP (French), were used. Patients diagnosed with multiple sclerosis, minimum 1-year exposure to treatment, minimum 3-year pretreatment follow-up and yearly review were included in the analysis. For analysis of disability progression, all events in the subsequent 5-year period were included. Density curves, representing incidence of relapses and 6-month confirmed progression events, were separately constructed for each sufficiently represented therapy. Monte Carlo simulations were performed to identify the first local minimum of the first derivative after treatment start; this point represented the point of stabilization of treatment effect, after the maximum treatment effect was observed. The method was developed in a discovery cohort (MSBase), and externally validated in a separate, non-overlapping cohort (OFSEP). A merged MSBase-OFSEP cohort was used for all subsequent analyses. Annualized relapse rates were compared in the time before treatment start and after the stabilization of treatment effect following commencement of each therapy. We identified 11 180 eligible treatment epochs for analysis of relapses and 4088 treatment epochs for disability progression. External validation was performed in four therapies, with no significant difference in the bootstrapped mean differences in therapeutic lag duration between registries. The duration of therapeutic lag for relapses was calculated for 10 therapies and ranged between 12 and 30 weeks. The duration of therapeutic lag for disability progression was calculated for seven therapies and ranged between 30 and 70 weeks. Significant differences in the pre- versus post-treatment annualized relapse rate were present for all therapies apart from intramuscular interferon beta-1a. In conclusion we have developed, and externally validated, a method to objectively quantify the duration of therapeutic lag on relapses and disability progression in different therapies in patients more than 3 years from multiple sclerosis onset. Objectively defined periods of expected therapeutic lag allows insights into the evaluation of treatment response in randomized clinical trials and may guide clinical decision-making in patients who experience early on-treatment disease activity. This method will subsequently be applied in studies that evaluate the effect of patient and disease characteristics on therapeutic lag.
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Affiliation(s)
- Izanne Roos
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Emmanuelle Leray
- Rennes University, EHESP, REPERES (Pharmaco-epidemiology and Health services research) - EA 7449, Rennes, France
| | - Federico Frascoli
- Faculty of Science, Engineering and Technology, School of Science, Department of Mathematics, Swinburne University of Technology, Melbourne, 3122, Australia
| | - Romain Casey
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
- EUGENE DEVIC EDMUS Foundation against multiple sclerosis, state-approved foundation, F-69677 Bron, France
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Eva K Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, 12808, Czech Republic
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, 70122, Italy
| | - Francesco Patti
- GF Ingrassia Department, University of Catania, Catania, 95123, Italy
- Policlinico G Rodolico, 95123, Catania, Italy
| | | | - Sara Eichau
- Hospital Universitario Virgen Macarena, Sevilla, 41009, Spain
| | - Marco Onofrj
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio, 66100 Chieti, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOSI Riabilitazione Sclerosi Multipla, Bologna, 40139, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alexandre Prat
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | - Marc Girard
- CHUM MS Center and Universite de Montreal, Montreal, H2L 4M1, Canada
| | | | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, 41100, Italy
| | | | | | - Maria José Sá
- Centro Hospitalar Universitário de São João and Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Elisabetta Cartechini
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche - AV3, Macerata, 62100, Italy
| | - Cavit Boz
- KTU Medical Faculty Farabi Hospital, Karadeniz Technical University, Trabzon, 61080, Turkey
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, 43126, Italy
- Department of General Medicine, Parma University Hospital, Parma, 43126, Italy
| | - Raymond Hupperts
- Zuyderland Ziekenhuis, Sittard, Sittard, 6131 BK, The Netherlands
| | - Murat Terzi
- Medical Faculty, 19 Mayis University, Kurupelit, Samsun, 55160, Turkey
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, University Newcastle, 2308, Australia
- Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, 2305, Australia
| | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Contrada Amoretta, Avellino, 83100, Italy
| | | | - Aysun Soysal
- Bakirkoy Education and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, 34142, Turkey
| | - Javier Olascoaga
- Instituto de Investigación Sanitaria Biodonostia, Hospital Universitario Donostia, San San Sebastián, Spain, 20014, Spain
| | | | | | - Mark Slee
- Flinders University, Adelaide, 5042, Australia
| | - Tunde Csepany
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, 4032, Hungary
| | - Recai Turkoglu
- Haydarpasa Numune Training and Research Hospital, Selimiye Mahallesi, Istanbul, 34668, Turkey
| | - Youssef Sidhom
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Riadh Gouider
- Department of Neurology, Razi Hospital, 2010, Tunis, Manouba, Tunisia
| | - Bart Van Wijmeersch
- Rehabilitation and MS-Centre Overpelt and Hasselt University, Hasselt, 3900, Belgium
| | - Pamela McCombe
- University of Queensland, St Lucia, 4072, Australia
- Royal Brisbane and Women's Hospital, Herston, 4029, Australia
| | - Richard Macdonell
- Department of Neurology, Austin Health, Heidlberg, 3084, Australia
- Faculty of Medicine and Dental Health Sciences, University of Melbourne, Melbourne, 3050, Australia
| | - Alasdair Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Charles B Malpas
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, 3004, Australia
- Department of Neurology, The Alfred Hospital, Melbourne, 3004, Australia
- Department of Neurology, Box Hill Hospital, Monash University, Melbourne, 3128, Australia
| | - Sandra Vukusic
- University of Lyon, Claude Bernard University Lyon 1, F-69000 Lyon, France
- Hospices Civils de Lyon, Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, F-69677 Bron, France
- Observatoire Français de la Sclérose en Plaques, Lyon Neuroscience Research Centre, INSERM 1028 et CNRS UMR 5292, F-69003 Lyon, France
| | - Tomas Kalincik
- CORe, Department of Medicine, University of Melbourne, Melbourne, 3050, Australia
- Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital, Melbourne, 3050, Australia
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Branch retinal vein occlusion associated with fingolimod treatment for multiple sclerosis. Can J Ophthalmol 2020; 56:e21-e22. [PMID: 32805204 DOI: 10.1016/j.jcjo.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
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Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 significantly affects multiple systems including the cardiovascular system. Most importantly, in addition to the direct injury from the virus per se, the subsequent cytokine storm, an overproduction of immune cells and their activating compounds, causes devastating damage. To date, emerging anti-SARS-CoV-2 treatments are warranted to control epidemics. Several candidate drugs have been screened and are currently under investigation. These primarily include antiviral regimens and immunomodulatory regimens. However, beyond the anti-SARS-CoV-2 effects, these drugs may also have risks to the cardiovascular system, especially altering cardiac conduction. Herein, we review the cardiovascular risks of potential anti-COVID-19 drugs.
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Hung NA, Costa FG, Hung CT, Rosenberg ME. Bioequivalence Study of 2 Capsule Formulations of Fingolimod 0.5 mg Assessing Both Parent Drug and Active Metabolite in New Zealand Healthy Subjects (Truncated Design). Clin Pharmacol Drug Dev 2020; 9:610-620. [PMID: 32468719 DOI: 10.1002/cpdd.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/10/2020] [Indexed: 11/07/2022]
Abstract
Fingolimod is indicated for the treatment of patients with the relapsing-remitting form of multiple sclerosis. The primary study objective was to evaluate the bioequivalence of a test formulation, 0.5 mg fingolimod HCl capsule (Lebrina, Asofarma Sociedad Anónima Industrial y Comercial, Argentina) relative to a reference formulation, 0.5 mg fingolimod capsule (Gilenya, Novartis Pharmaceutical, Australia). In a single-center, randomized, single-dose, single-blinded, 2-way crossover study, 33 New Zealand healthy subjects of both sexes were enrolled to receive a 0.5-mg dose of 3 capsules of each fingolimod formulation under fasting conditions, with a 42-day washout period between administrations. Additional pharmacokinetic information regarding its main active metabolite, fingolimod phosphate, was also provided. The point estimate and 90% confidence intervals of the ratios of maximum concentration and area under the plasma concentration-time curve from time 0 to 72 hours were 99.07 (95.83-102.41) and 97.64 (95.33-100.00) for fingolimod, and 95.60 (90.95-100.49) and 98.54 (96.19-100.96), for fingolimod phosphate. Primary parameters, maximum concentration and area under the plasma concentration-time curve from time 0 to 72 hours for fingolimod and fingolimod phosphate were found to have no significant difference when test and reference formulations were compared. Fingolimod and fingolimod phosphate of both formulations were within the accepted 90% confidence interval limits of 80.00% and 125.00%. No significant differences between the test and reference drug products were detected in any of the pharmacokinetic parameters estimated. Notwithstanding the primary conclusion of bioequivalence is focused on the measurement of the parent compound, compliance with the same criteria by the active metabolite reinforces the comparability between the pharmacokinetic profiles of both formulations (ClinicalTrials.gov Identifier: NCT03757338).
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Affiliation(s)
| | | | | | - Mónica Esther Rosenberg
- Asofarma S.A.I y C. (Asofarma Sociedad Anónima Industrial y Comercial), Buenos Aires, Argentina
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31
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Dang C, Lu Y, Li Q, Wang C, Ma X. Efficacy of the sphingosine-1-phosphate receptor agonist fingolimod in animal models of stroke: an updated meta-analysis. Int J Neurosci 2020; 131:85-94. [PMID: 32148137 DOI: 10.1080/00207454.2020.1733556] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: Neuroinflammation is a central part of cerebral ischemia/reperfusion injury. The novel immune suppressant, fingolimod, is a promising candidate to ameliorate stroke-induced damage. Fingolimod is efficacious in experimental ischemic models, but a rigorous meta-analysis is lacking that considers how different experiment variables affect outcomes.Methods: We conducted a systematic literature review of fingolimod in stroke models, with the aim of rigorously evaluating fingolimod's effects on reducing infarct volume improving neurological outcomes. Seventeen variables were evaluated as covariates for the source of heterogeneity, and effect sizes were combined by using normalized mean difference meta-analysis to evaluate efficacy. Study quality was evaluated by the CAMARADES ten-item checklist, and publication bias was evaluated by funnel plots and Egger's tests.Results: About 123 unduplicated articles were identified in the literature research. Of these papers, 118 articles were excluded after reading titles and abstracts. Another 17 articles were selected in this study. Study quality was moderate (median = 6; interquartile range = 4), and publication bias was statistically insignificant. fingolimod reduced infarct volume by 30.4% (95% CI 22.4%-38.3%; n = 24; I2 = 90.0%; p < 0.0001) and consistently enhanced neurobehavioral outcome by 34.2% (95% CI 23.1%-45.2%; n = 14; I2 = 76.5%; p < 0.0001). No single factors accounted for heterogeneity.Conclusions: Our rigorous statistical evaluation confirmed the neuroprotective properties of fingolimod. New data can be used in designing future clinical trials.
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Affiliation(s)
- Chun Dang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
| | - Yaoheng Lu
- Department of General Surgery, Chengdu Integrated TCM&Western Medicine Hospital, Chengdu, China
| | - Qian Li
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunyang Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaofeng Ma
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neurotrauma Neuro-Repair and Regeneration in Central N Ministry of Education and Tianjin City, Tianjin, China
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Combinatorial allosteric modulation of agonist response in a self-interacting G-protein coupled receptor. Commun Biol 2020; 3:27. [PMID: 31941999 PMCID: PMC6962373 DOI: 10.1038/s42003-020-0752-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/17/2019] [Indexed: 01/06/2023] Open
Abstract
The structural plasticity of G-protein coupled receptors (GPCRs) enables the long-range transmission of conformational changes induced by specific orthosteric site ligands and other pleiotropic factors. Here, we demonstrate that the ligand binding cavity in the sphingosine 1-phosphate receptor S1PR1, a class A GPCR, is in allosteric communication with both the β-arrestin-binding C-terminal tail, and a receptor surface involved in oligomerization. We show that S1PR1 oligomers are required for full response to different agonists and ligand-specific association with arrestins, dictating the downstream signalling kinetics. We reveal that the active form of the immunomodulatory drug fingolimod, FTY720-P, selectively harnesses both these intramolecular networks to efficiently recruit β-arrestins in a stable interaction with the receptor, promoting deep S1PR1 internalization and simultaneously abrogating ERK1/2 phosphorylation. Our results define a molecular basis for the efficacy of fingolimod for people with multiple sclerosis, and attest that GPCR signalling can be further fine-tuned by the oligomeric state. Patrone et al study the mechanism by which fingolimod, a drug used for multiple sclerosis, and agonist to G-coupled receptor S1PR1, compared to the endogenous ligand S1P. They find that whereas S1P binds a S1PR1 dimer, the action of fingolimod is dependent on receptor oligomerisation, which affects β-arrestin binding, internalisation and signaling.
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Park JW, Kim KA, Park JY. Effects of Ketoconazole, a CYP4F2 Inhibitor, and CYP4F2*3 Genetic Polymorphism on Pharmacokinetics of Vitamin K 1. J Clin Pharmacol 2019; 59:1453-1461. [PMID: 31134657 DOI: 10.1002/jcph.1444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/29/2019] [Indexed: 11/10/2022]
Abstract
The objective of this study was to evaluate whether cytochrome P450 (CYP)4F2 is involved in the exposure of vitamin K1 through a drug interaction study with ketoconazole, a CYP4F2 inhibitor, and a pharmacogenetic study with CYP4F2*3. Twenty-one participants with different CYP4F2*3 polymorphisms were enrolled (8 for *1/*1, 7 for *1/*3, and 6 for *3/*3). All participants were treated twice daily for 5 days with 200 mg of ketoconazole or placebo. Finally, a single dose of 10 mg vitamin K1 was administered, plasma levels of vitamin K1 were measured, and its pharmacokinetics was assessed. Ketoconazole elevated the plasma levels of vitamin K1 and increased the average area under the concentration-time curve (AUCinf ) and peak concentration by 41% and 40%, respectively. CYP4F2*3 polymorphism also affected plasma levels of vitamin K1 and its pharmacokinetics in a gene dose-dependent manner. The average AUCinf value was 659.8 ng·h/mL for CYP4F2*1/*1, 878.1 ng·h/mL for CYP4F2*1/*3, and 1125.2 ng·h/mL for CYP4F2*3/*3 (P = .010). This study revealed that ketoconazole and CYP4F2*3 polymorphism substantially increased the exposure of vitamin K1 in humans. These findings provide a plausible explanation for variations in warfarin dose requirements resulting from interindividual variations in vitamin K1 exposure due to CYP4F2-related drug interactions and genetic polymorphisms.
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Affiliation(s)
- Jin-Woo Park
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyoung-Ah Kim
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ji-Young Park
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Fingolimod reduces neuropathic pain behaviors in a mouse model of multiple sclerosis by a sphingosine-1 phosphate receptor 1-dependent inhibition of central sensitization in the dorsal horn. Pain 2019; 159:224-238. [PMID: 29140922 DOI: 10.1097/j.pain.0000000000001106] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune-inflammatory neurodegenerative disease that is often accompanied by a debilitating neuropathic pain. Disease-modifying agents slow down the progression of multiple sclerosis and prevent relapses, yet it remains unclear if they yield analgesia. We explored the analgesic potential of fingolimod (FTY720), an agonist and/or functional antagonist at the sphingosine-1-phosphate receptor 1 (S1PR1), because it reduces hyperalgesia in models of peripheral inflammatory and neuropathic pain. We used a myelin oligodendrocyte glycoprotein 35 to 55 (MOG35-55) mouse model of experimental autoimmune encephalomyelitis, modified to avoid frank paralysis, and thus, allow for assessment of withdrawal behaviors to somatosensory stimuli. Daily intraperitoneal fingolimod reduced behavioral signs of central neuropathic pain (mechanical and cold hypersensitivity) in a dose-dependent and reversible manner. Both autoimmune encephalomyelitis and fingolimod changed hyperalgesia before modifying motor function, suggesting that pain-related effects and clinical neurological deficits were modulated independently. Fingolimod also reduced cellular markers of central sensitization of neurons in the dorsal horn of the spinal cord: glutamate-evoked Ca signaling and stimulus-evoked phospho-extracellular signal-related kinase ERK (pERK) expression, as well as upregulation of astrocytes (GFAP) and macrophage/microglia (Iba1) immunoreactivity. The antihyperalgesic effects of fingolimod were prevented or reversed by the S1PR1 antagonist W146 (1 mg/kg daily, i.p.) and could be mimicked by either repeated or single injection of the S1PR1-selective agonist SEW2871. Fingolimod did not change spinal membrane S1PR1 content, arguing against a functional antagonist mechanism. We conclude that fingolimod behaves as an S1PR1 agonist to reduce pain in multiple sclerosis by reversing central sensitization of spinal nociceptive neurons.
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Welzel L, Twele F, Schidlitzki A, Töllner K, Klein P, Löscher W. Network pharmacology for antiepileptogenesis: Tolerability and neuroprotective effects of novel multitargeted combination treatments in nonepileptic vs. post-status epilepticus mice. Epilepsy Res 2019; 151:48-66. [PMID: 30831337 DOI: 10.1016/j.eplepsyres.2019.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/23/2019] [Indexed: 01/08/2023]
Abstract
Network-based approaches in drug discovery comprise both development of novel drugs interacting with multiple targets and repositioning of drugs with known targets to form novel drug combinations that interact with cellular or molecular networks whose function is disturbed in a disease. Epilepsy is a complex network phenomenon that, as yet, cannot be prevented or cured. We recently proposed multitargeted, network-based approaches to prevent epileptogenesis by combinations of clinically available drugs chosen to impact diverse epileptogenic processes. In order to test this strategy preclinically, we developed a multiphase sequential study design for evaluating such drug combinations in rodents, derived from human clinical drug development phases. Because pharmacokinetics of such drugs are known, only the tolerability of novel drug combinations needs to be evaluated in Phase I in öhealthy" controls. In Phase IIa, tolerability is assessed following an epileptogenic brain insult, followed by antiepileptogenic efficacy testing in Phase IIb. Here, we report Phase I and Phase IIa evaluation of 7 new drug combinations in mice, using 10 drugs (levetiracetam, topiramate, gabapentin, deferoxamine, fingolimod, ceftriaxone, α-tocopherol, melatonin, celecoxib, atorvastatin) with diverse mechanisms thought to be important in epileptogenesis. Six of the 7 drug combinations were well tolerated in mice during prolonged treatment at the selected doses in both controls and during the latent phase following status epilepticus induced by intrahippocampal kainate. However, none of the combinations prevented hippocampal damage in response to kainate, most likely because treatment started only 16-18 h after kainate. This suggests that antiepileptogenic or disease-modifying treatment may need to start earlier after the brain insult. The present data provide a rich collection of tolerable, network-based combinatorial therapies as a basis for antiepileptogenic or disease-modifying efficacy testing.
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Affiliation(s)
- Lisa Welzel
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany
| | - Friederike Twele
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Alina Schidlitzki
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Kathrin Töllner
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, Bethesda, MD 20817, USA
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, 30559 Hannover, Germany; Center for Systems Neuroscience, 30559 Hannover, Germany.
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Gilmore JL, Xiao HY, Dhar TGM, Yang MG, Xiao Z, Xie J, Lehman-McKeeman LD, Gong L, Sun H, Lecureux L, Chen C, Wu DR, Dabros M, Yang X, Taylor TL, Zhou XD, Heimrich EM, Thomas R, McIntyre KW, Borowski V, Warrack BM, Li Y, Shi H, Levesque PC, Yang Z, Marino AM, Cornelius G, D’Arienzo CJ, Mathur A, Rampulla R, Gupta A, Pragalathan B, Shen DR, Cvijic ME, Salter-Cid LM, Carter PH, Dyckman AJ. Identification and Preclinical Pharmacology of ((1R,3S)-1-Amino-3-((S)-6-(2-methoxyphenethyl)-5,6,7,8-tetrahydronaphthalen-2-yl)cyclopentyl)methanol (BMS-986166): A Differentiated Sphingosine-1-phosphate Receptor 1 (S1P1) Modulator Advanced into Clinical Trials. J Med Chem 2019; 62:2265-2285. [DOI: 10.1021/acs.jmedchem.8b01695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- John L. Gilmore
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Hai-Yun Xiao
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - T. G. Murali Dhar
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Michael G. Yang
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Zili Xiao
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Jenny Xie
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Lois D. Lehman-McKeeman
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Lei Gong
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Huadong Sun
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Lloyd Lecureux
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Cliff Chen
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Dauh-Rurng Wu
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Marta Dabros
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Xiaoxia Yang
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Tracy L. Taylor
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Xia D. Zhou
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Elizabeth M. Heimrich
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Rochelle Thomas
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Kim W. McIntyre
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Virna Borowski
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Bethanne M. Warrack
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Yuwen Li
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Hong Shi
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Paul C. Levesque
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Zheng Yang
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Anthony M. Marino
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Georgia Cornelius
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Celia J. D’Arienzo
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Arvind Mathur
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Richard Rampulla
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Anuradha Gupta
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Bala Pragalathan
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Ding Ren Shen
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Mary Ellen Cvijic
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Luisa M. Salter-Cid
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Percy H. Carter
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
| | - Alaric J. Dyckman
- Bristol-Myers Squibb Research and Development, P.O. Box 4000, Princeton, New Jersey 08543-4000, United States
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Deleu D, Mesraoua B, Canibaño B, Melikyan G, Al Hail H, El-Sheikh L, Ali M, Al Hussein H, Ibrahim F, Hanssens Y. Oral disease-modifying therapies for multiple sclerosis in the Middle Eastern and North African (MENA) region: an overview. Curr Med Res Opin 2019; 35:249-260. [PMID: 29764226 DOI: 10.1080/03007995.2018.1476334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The introduction of new disease-modifying therapies (DMTs) for remitting-relapsing multiple sclerosis (RRMS) has considerably transformed the landscape of therapeutic opportunities for this chronic disabling disease. Unlike injectable drugs, oral DMTs promote patient satisfaction and increase therapeutic adherence. REVIEW This article reviews the salient features about the mode of action, efficacy, safety, and tolerability profile of approved oral DMTs in RRMS, and reviews their place in clinical algorithms in the Middle East and North Africa (MENA) region. A systematic review was conducted using a comprehensive search of MEDLINE, PubMed, Cochrane Database of Systematic Reviews (period January 1, 1995-January 31, 2018). Additional searches of the American Academy of Neurology and European Committee for Treatment and Research in Multiple Sclerosis abstracts from 2012-2017 were performed, in addition to searches of the Food and Drug Administration and European Medicines Agency websites, to obtain relevant safety information on these DMTs. CONCLUSIONS Four oral DMTs: fingolimod, teriflunomide, dimethyl fumarate, and cladribine have been approved by the regulatory agencies. Based on the number needed to treat (NNT), the potential role of these DMTs in the management of active and highly active or rapidly evolving RRMS is assessed. Finally, the place of the oral DMTs in clinical algorithms in the MENA region is reviewed.
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Affiliation(s)
- Dirk Deleu
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Boulenouar Mesraoua
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Beatriz Canibaño
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Gayane Melikyan
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Hassan Al Hail
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Lubna El-Sheikh
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Musab Ali
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Hassan Al Hussein
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Faiza Ibrahim
- a Department of Neurology , Neuroscience Institute, Hamad Medical Corporation , Doha , State of Qatar
| | - Yolande Hanssens
- b Department of Clinical Services Unit , Corporate Pharmacy, Hamad Medical Corporation , Doha , State of Qatar
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Marciniak A, Camp SM, Garcia JGN, Polt R. An update on sphingosine-1-phosphate receptor 1 modulators. Bioorg Med Chem Lett 2018; 28:3585-3591. [PMID: 30409535 DOI: 10.1016/j.bmcl.2018.10.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022]
Abstract
Sphingolipids represent an essential class of lipids found in all eukaryotes, and strongly influence cellular signal transduction. Autoimmune diseases like asthma and multiple sclerosis (MS) are mediated by the sphingosine-1-phosphate receptor 1 (S1P1) to express a variety of symptoms and disease patterns. Inspired by its natural substrate, an array of artificial sphingolipid derivatives has been developed to target this specific G protein-coupled receptor (GPCR) in an attempt to suppress autoimmune disorders. FTY720, also known as fingolimod, is the first oral disease-modifying therapy for MS on the market. In pursuit of improved stability, bioavailability, and efficiency, structural analogues of this initial prodrug have emerged over time. This review covers a brief introduction to the sphingolipid metabolism, the mechanism of action on S1P1, and an updated overview of synthetic sphingosine S1P1 agonists.
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Affiliation(s)
- Alexander Marciniak
- Department of Chemistry & Biochemistry, The University of Arizona, Tucson, AZ 85721, United States.
| | - Sara M Camp
- Department of Medicine, The University of Arizona, Tucson, AZ 85724, United States.
| | - Joe G N Garcia
- Department of Medicine, The University of Arizona, Tucson, AZ 85724, United States.
| | - Robin Polt
- Department of Chemistry & Biochemistry, The University of Arizona, Tucson, AZ 85721, United States.
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Kreitzburg KM, van Waardenburg RCAM, Yoon KJ. Sphingolipid metabolism and drug resistance in ovarian cancer. ACTA ACUST UNITED AC 2018; 1:181-197. [PMID: 31891125 PMCID: PMC6936734 DOI: 10.20517/cdr.2018.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite progress in understanding molecular aberrations that contribute to the development and progression of ovarian cancer, virtually all patients succumb to drug resistant disease at relapse. Emerging data implicate bioactive sphingolipids and regulation of sphingolipid metabolism as components of response to chemotherapy or development of resistance. Increases in cytosolic ceramide induce apoptosis in response to therapy with multiple classes of chemotherapeutic agents. Aberrations in sphingolipid metabolism that accelerate the catabolism of ceramide or that prevent the production and accumulation of ceramide contribute to resistance to standard of care platinum- and taxane-based agents. The aim of this review is to highlight current literature and research investigating the influence of the sphingolipids and enzymes that comprise the sphingosine-1-phosphate pathway on the progression of ovarian cancer. The focus of the review is on the utility of sphingolipid-centric therapeutics as a mechanism to circumvent drug resistance in this tumor type.
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Affiliation(s)
- Kelly M Kreitzburg
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | - Karina J Yoon
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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40
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Factors Predictive of Severe Multiple Sclerosis Disease Reactivation After Fingolimod Cessation. Neurologist 2018; 23:12-16. [PMID: 29266038 DOI: 10.1097/nrl.0000000000000154] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fingolimod withdrawal may trigger the return of pretreatment disease activity. It is difficult to identify patients at risk of disease reactivation. We compared the demographic and clinical features of patients experiencing severe disease reactivation (SDR) after fingolimod cessation with those of patients who did not. METHODS All patients who commenced fingolimod and who continued therapy for at least 6 months were included. The demographic and clinical features of the 2 groups (SDR vs. no SDR) were assessed. RESULTS Forty-four of 303 patients discontinued fingolimod for various reasons. Among these, 31 fulfilled our inclusion criteria and 8 (25.8%) exhibited SDR after drug cessation. The mean time for SDR was 2.6 months (range, 2 to 3 mo). The annualized relapse rate before fingolimod therapy was higher in the SDR than in the non-SDR group (1.59 vs. 0.81) (P=0.018). Although statistical significance was not attained, the mean Expanded Disability Status Scale score at the time of fingolimod cessation was higher in the non-SDR than in the SDR group (2.5 vs. 1.12) (P=0.074). CONCLUSIONS SDR may develop within the first 3 months after cessation of fingolimod. Patients with higher annualized relapse rates and lower Expanded Disability Status Scale scores before commencing fingolimod treatment were more likely to exhibit SDR.
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41
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Li GF, Yu G, Li Y, Zheng Y, Zheng QS, Derendorf H. Quantitative Estimation of Plasma Free Drug Fraction in Patients With Varying Degrees of Hepatic Impairment: A Methodological Evaluation. J Pharm Sci 2018. [DOI: 10.1016/j.xphs.2018.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Evangelopoulos ME, Miclea A, Schrewe L, Briner M, Salmen A, Engelhardt B, Huwiler A, Chan A, Hoepner R. Frequency and clinical characteristics of Multiple Sclerosis rebounds after withdrawal of Fingolimod. CNS Neurosci Ther 2018; 24:984-986. [PMID: 29898493 DOI: 10.1111/cns.12992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Maria Eleftheria Evangelopoulos
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Andrei Miclea
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Lisa Schrewe
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Myriam Briner
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | | | - Andrea Huwiler
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Andrew Chan
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Bern University Hospital and University of Bern, Switzerland
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David OJ, Behrje R, Pal P, Hara H, Lates CD, Schmouder R. Pharmacokinetic Interaction Between Fingolimod and Carbamazepine in Healthy Subjects. Clin Pharmacol Drug Dev 2018; 7:575-586. [PMID: 29694732 PMCID: PMC6099239 DOI: 10.1002/cpdd.459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/13/2018] [Indexed: 01/26/2023]
Abstract
This open‐label, single‐sequence study in healthy subjects investigated the effects of steady‐state carbamazepine on the pharmacokinetic (PK) profile of a single 2‐mg dose of fingolimod. In period 1, a single oral dose of fingolimod 2 mg (day 1) was followed by PK and safety assessments up to 36 days. In period 2, carbamazepine was administered in flexible, up‐titrated doses (600 mg twice daily maximum) for 49 days. Fingolimod was administered on day 35, followed by a study completion evaluation (day 71). The PK analysis included 23 of 26 of the enrolled subjects (88.5%). Coadministration of fingolimod at steady‐state carbamazepine concentrations resulted in increased fingolimod CL/F by 67% through the induction of CYP3A4, a cytochrome with negligible involvement in fingolimod clearance in an uninduced state. Fingolimod Cmax was reduced by 18% and AUCinf by 40%, as was T1/2 (106 vs 163 hours). A similar trend was observed for fingolimod‐P. Models linking fingolimod‐P blood concentrations to lymphocyte count or annual relapse rate suggest that such a decrease would have a low impact on the treatment effect. However, in the absence of efficacy data of fingolimod at doses lower than the therapeutic dose, their coadministration should be used with caution.
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Affiliation(s)
| | - Rhett Behrje
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Parasar Pal
- Novartis Healthcare Private Limited, Hyderabad, India
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Longbrake EE, Kantor D, Pawate S, Bradshaw MJ, von Geldern G, Chahin S, Cross AH, Parks BJ, Rice M, Khoury SJ, Yamout B, Zeineddine M, Russell-Giller S, Caminero-Rodriguez A, Edwards K, Lathi E, VanderKodde D, Meador W, Berkovich R, Ge L, Bacon TE, Kister I. Effectiveness of alternative dose fingolimod for multiple sclerosis. Neurol Clin Pract 2018; 8:102-107. [PMID: 29708225 DOI: 10.1212/cpj.0000000000000434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/04/2017] [Indexed: 11/15/2022]
Abstract
Background Fingolimod is a daily oral medication used to treat relapsing multiple sclerosis (MS). Clinicians often adopt less frequent dosing for patients with profound drug-induced lymphopenia or other adverse events. Data on the effectiveness of alternate dose fingolimod are limited. Methods We conducted a multicenter, retrospective, observational study at 14 sites and identified 170 patients with MS taking alternate doses of fingolimod for ≥1 month. Clinical and radiologic outcomes were collected and compared during daily and alternate fingolimod dosing. Results Profound lymphopenia (77%), liver function abnormalities (9%), and infections (7%) were the most common reasons for patients to switch to alternate fingolimod dosing. The median follow-up was 12 months on daily dose and 14 months on alternate dose. Most patients (64%) took fingolimod every other day during alternate dosing. Disease activity was similar on alternate dose compared to daily dose: annualized relapse rate was 0.1 on daily dose vs 0.2 on alternate dose (p = 0.25); proportion of patients with contrast-enhancing MRI lesions was 7.6% on daily vs 9.4% on alternate (p = 0.55); proportion of patients with cumulative MS activity (clinical and radiologic disease) was 13.5% on daily vs 18.2% on alternate (p = 0.337). Patients who developed contrast-enhancing lesions while on daily dose were at higher risk for breakthrough disease while on alternate dose fingolimod (odds ratio 11.4, p < 0.001). Conclusions These data support the clinical strategy of alternate dosing of fingolimod in patients with good disease control but profound lymphopenia or other adverse events while on daily dose. Classification of Evidence This study provides Class IV evidence that for patients with MS on daily dose fingolimod with adverse events, alternate dose fingolimod is associated with disease activity similar to daily dose fingolimod.
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Affiliation(s)
- Erin E Longbrake
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Daniel Kantor
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Siddharama Pawate
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Michael J Bradshaw
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Gloria von Geldern
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Salim Chahin
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Anne H Cross
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Becky J Parks
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Marc Rice
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Samia J Khoury
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Bassem Yamout
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Maya Zeineddine
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Shira Russell-Giller
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Ana Caminero-Rodriguez
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Keith Edwards
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Ellen Lathi
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Danita VanderKodde
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - William Meador
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Regina Berkovich
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Lily Ge
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Tamar E Bacon
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
| | - Ilya Kister
- Yale University (EEL), New Haven, CT; Medical Partnership 4 MS (MP4MS) (DK), Coconut Creek, FL; Vanderbilt University (SP, MJB), Nashville, TN; University of Washington (GvG), Seattle; Washington University (SC, AHC, BJP), St. Louis, MO; MS Center of Tidewater (MR), Norfolk, VA; Nehme & Therese Tohme MS Center (SJK, BY, MZ), Beirut, Lebanon; RWJ Barnabas Health (SR-G, IK), West Orange, NJ; C/Fuentes Claras 1 (AC-R), Avila, Spain; MS Center of Northeastern NY (KE), Latham; Elliot Lewis Center for MS Care (EL), Wellesley, MA; Spectrum Health Medical Group (DV), Grand Rapids, MI; University of Alabama (WM), Birmingham; University of Southern California (RB), Los Angeles; and NYU Langone Health (LG, TEB, IK), New York, NY
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Tanguay M, Fröhlich T, Drouin M, Beuerle G. A randomized, open-label study assessing the bioequivalence of two formulations of Fingolimod 0.5 mg in healthy subjects. AAPS OPEN 2018. [DOI: 10.1186/s41120-018-0023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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David OJ, Berwick A, Pezous N, Lang M, Tiel-Wilck K, Ziemssen T, Li P, Hara H, Schmouder R. Determination of Seminal Concentration of Fingolimod and Fingolimod-Phosphate in Multiple Sclerosis Patients Receiving Chronic Treatment With Fingolimod. Clin Pharmacol Drug Dev 2017; 7:217-221. [PMID: 29266794 PMCID: PMC5814852 DOI: 10.1002/cpdd.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 11/02/2017] [Indexed: 11/10/2022]
Abstract
The safety profile of fingolimod 0.5 mg, approved therapy for relapsing multiple sclerosis, is well established in clinical and real‐world studies. As fingolimod is teratogenic in rats, it was considered important to assess the concentrations of fingolimod and its active metabolite, fingolimod‐phosphate, in the semen of male patients on treatment and the risk of harming a fetus in a pregnant partner. In this multicenter open‐label study, 13 male patients receiving fingolimod for at least 6 months provided 1 semen and 1 blood sample for analyte concentration measurements. The steady‐state seminal concentrations of fingolimod and fingolimod‐phosphate were close to those simultaneously observed in blood. The amount of fingolimod‐related material in 10 mL of ejaculate was estimated to be 47.5 ng. The estimated fingolimod and fingolimod‐phosphate blood Cmax values in a woman having regular sexual intercourse with a male patient treated with fingolimod 0.5 mg were approximately 400 and 2400 times smaller than the estimated values in the embryo‐fetal development study in rats at the no‐observed‐adverse‐event level. Consequently, the risk of harming a fetus in a pregnant woman is considered extremely unlikely.
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Affiliation(s)
| | - Amy Berwick
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Michael Lang
- NeuroPoint, Ulm and NTD Study Group, Ulm, Germany
| | - Klaus Tiel-Wilck
- Neurologisches Facharztzentrum, NTD Study Group, Berlin, Germany
| | | | - Peng Li
- WuXi AppTec Co, Shanghai, China
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Pharmacokinetics, Pharmacodynamics, Tolerability, and Food Effect of Cenerimod, a Selective S1P₁ Receptor Modulator in Healthy Subjects. Int J Mol Sci 2017; 18:ijms18122636. [PMID: 29211013 PMCID: PMC5751239 DOI: 10.3390/ijms18122636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022] Open
Abstract
The pharmacokinetics, pharmacodynamics, tolerability, and food effect of cenerimod, a potent sphingosine-1-phosphate subtype 1 receptor modulator, were investigated in three sub-studies. Two double-blind, placebo-controlled, randomised studies in healthy male subjects were performed. Cenerimod was administered either as single dose (1, 3, 10 or 25 mg; Study 1) or once daily for 35 days (0.5, 1, 2 or 4 mg; Study 2). A two-period cross-over, open-label study was performed to assess the food effect (1 mg, Study 3). The pharmacokinetic profile of cenerimod was characterised by a tmax of 5.0–6.2 h. Terminal half-life after single and multiple doses ranged from 170 to 199 h and 283 to 539 h, respectively. Food had no relevant effect on the pharmacokinetics of cenerimod. A dose-dependent decrease in lymphocyte count was observed after initiation of cenerimod and reached a plateau (maximum change from baseline: −64%) after 20–23 days of treatment. Lymphocyte counts returned to baseline values at end-of-study examination. One serious adverse event of circulatory collapse (25 mg dose group, maximum tolerated dose: 10 mg) and adverse events of mild-to-moderate intensity were reported. Treatment initiation was associated with transient decreases in heart rate and blood pressure at doses >1 and ≥10 mg, respectively.
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Gu C, Wen S, Doig P, Gangl E, Zheng X, Wang Y, Johannes JW. Mouse Red Blood Cell-Mediated Rare Xenobiotic Phosphorylation of a Drug Molecule Not Intended to Be a Kinase Substrate. Drug Metab Dispos 2017; 45:1345-1353. [PMID: 28986473 DOI: 10.1124/dmd.117.076869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/04/2017] [Indexed: 11/22/2022] Open
Abstract
Phosphorylation of xenobiotics is rare, probably owing to a strong evolutionary pressure against it. This rarity may have attracted more attention recently as a result of intentionally designed kinase-substrate analogs that depend on kinase-catalyzed activation to form phosphorylated active drugs. We report a rare phosphorylated metabolite observed unexpectedly in mouse plasma samples after an oral dose of a Tankyrase inhibitor that was not intended to be a kinase substrate, i.e., (S)-2-(4-(6-(3,4-dimethylpiperazin-1-yl)-4-methylpyridin-3-yl)phenyl)-8-(hydroxymethyl)quinazolin-4(3H)-one (AZ2381). The phosphorylated metabolite was not generated in mouse hepatocytes. In vitro experiments showed that the phosphorylation of AZ2381 occurred in mouse whole blood with heparin as anticoagulant but not in mouse plasma. The phosphorylated metabolite was also produced in rat, dog, and human blood, albeit at lower yields than in mouse. Divalent metal ions are required for the phosphorylation since the reaction is inhibited by the metal chelator EDTA. Further investigations with different cellular fractions of mouse blood revealed that the phosphorylation of AZ2381 was mediated by erythrocytes but did not occur with leukocytes. The levels of 18O incorporation into the phosphorylated metabolite when inorganic 18O4-phosphate and γ-18O4-ATP were added to the mouse blood incubations separately suggested that the phosphoryl transfer was from inorganic phosphate rather than ATP. It remains unclear which enzyme present in red blood cells is responsible for this rare phosphorylation.
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Affiliation(s)
- Chungang Gu
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Shenghua Wen
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Peter Doig
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Eric Gangl
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Xiaolan Zheng
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Yanjun Wang
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
| | - Jeffrey W Johannes
- Oncology DMPK (C.G., E.G.), Oncology Biosciences (S.W., Y.W.), Discovery Sciences (P.D.), and Oncology Medicinal Chemistry (X.Z., J.W.J.), Innovative Medicines and Early Development, AstraZeneca, Waltham, Massachusetts
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Fingolimod induces neuronal-specific gene expression with potential neuroprotective outcomes in maturing neuronal progenitor cells exposed to HIV. J Neurovirol 2017; 23:808-824. [PMID: 28913617 PMCID: PMC5725524 DOI: 10.1007/s13365-017-0571-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 12/13/2022]
Abstract
Fingolimod (FTY720), a structural analogue of sphingosine, targets sphingosine-1-phosphate receptor signaling and is currently an immunomodulatory therapy for multiple sclerosis. Fingolimod accesses the central nervous system (CNS) where its active metabolite, fingolimod phosphate (FTY720-P), has pleotropic neuroprotective effects in an inflammatory microenvironment. To investigate potential neuronal-specific mechanisms of fingolimod neuroprotection, we cultured the human neuronal progenitor cell line, hNP1, in differentiation medium supplemented with HIV- or Mock-infected supernatants, with or without FTY720-P. Gene expression was investigated using microarray and functional genomics. FTY720-P treatment increased differentially expressed (DE) neuronal genes by 33% in HIV-exposed and 40% in Mock-exposed cultures. FTY720-P treatment broadened the functional profile of DE genes in HIV-exposed versus Mock-exposed neurons, including not only immune responses but also transcriptional regulation and cell differentiation, among others. FTY720-P treatment downregulated the gene for follistatin, the antagonist of activin signaling, in all culture conditions. FTY720-P treatment differentially affected both glycolysis-related and immune response genes in Mock- or HIV-exposed cultures, significantly upregulating 11 glycolysis-related genes in HIV-exposed neurons. FTY720-P treatment also differentially upregulated genes related to innate immune responses and antigen presentation in Mock-exposed and more so in HIV-exposed neurons. However, in HIV-exposed neurons, FTY720-P depressed the magnitude of differential expression in almost half the genes, suggesting an anti-inflammatory potential. Moreover, in HIV-exposed neurons, FTY720-P reduced expression of the amyloid precursor protein (APP) gene, resulting in reduced expression of the APP protein. This study provides new evidence that fingolimod alters neuronal gene expression in inflammatory, viral-infected microenvironments, with the potential for neuroprotective effects.
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Thomas K, Proschmann U, Ziemssen T. Fingolimod hydrochloride for the treatment of relapsing remitting multiple sclerosis. Expert Opin Pharmacother 2017; 18:1649-1660. [PMID: 28844164 DOI: 10.1080/14656566.2017.1373093] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Fingolimod was the first oral and the first in class disease modifying treatment in multiple sclerosis that acts as sphingosine-1-phospathe receptor agonist. Since approval in 2010 there is a growing experience with fingolimod use in clinical practice, but also next-generation sphingosin-1-receptor agonists in ongoing clinical trials. Growing evidence demonstrates additional effects beyond impact on lymphocyte circulation, highlighting further promising targets in multiple sclerosis therapy. Areas covered: Here we present a systematic review using PubMed database searching and expert opinion on fingolimod use in clinical practice. Long-term data of initial clinical trials and post-marketing evaluations including long-term efficacy, safety, tolerability and management especially within growing disease modifying treatment options and pre-treatment constellation in multiple sclerosis patients are critically discussed. Furthermore novel findings in mechanism of actions and prospective on additional use in progressive forms in multiple sclerosis are presented. Expert opinion: There is an extensive long-term experience on fingolimod use in clinical practice demonstrating the favorable benefit-risk of this drug. Using a defined risk management approach experienced MS clinicians should apply fingolimod after critical choice of patients and review of clinical aspects. Further studies are essential to discuss additional benefit in progressive forms in multiple sclerosis.
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Affiliation(s)
- Katja Thomas
- a Center of Clinical Neuroscience , University Hospital, Dresden , Dresden , Germany
| | - Undine Proschmann
- a Center of Clinical Neuroscience , University Hospital, Dresden , Dresden , Germany
| | - Tjalf Ziemssen
- a Center of Clinical Neuroscience , University Hospital, Dresden , Dresden , Germany
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