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Svistushkin VM, Nikiforova GN, Eremeeva KV, Dekhanov AS, Kochetkov PA. [Potential of azoximere bromide for treatment of patients with acute inflammatory and infectious upper respiratory diseases]. TERAPEVT ARKH 2023; 95:951-957. [PMID: 38158951 DOI: 10.26442/00403660.2023.11.202488] [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: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
AIM To evaluate the efficacy and safety of Polyoxidonium® in patients with inflammatory and infectious upper respiratory diseases in real clinical practice. MATERIALS AND METHODS This retrospective multicenter study included data from adults and children over 6 months old with inflammatory and infectious upper respiratory diseases (n=16 365). The exploratory endpoints included: the proportion of patients with complete relief of symptoms, demographic characteristics of patients, the frequency of prescriptions of Polyoxidonium® by disease groups, determination of the groups of concomitant drugs, most commonly prescribed treatment regimen, frequency of prescribing different Polyoxidonium® dosage forms, duration of the most common specific symptoms of acute respiratory infections during therapy, the incidence of treatment-related adverse events. RESULTS After treatment completion, the proportion of patients with complete relief of symptoms was 40%, with positive dynamics - 99.77%. Polyoxidonium® in combination therapy was also effective in the treatment of COVID-19 and Post-COVID-19 syndrome. The median patient age was 28 years. Polyoxidonium® was most frequently prescribed for the treatment of inflammatory and infectious upper respiratory diseases in combination with antibiotics or symptomatic drugs in dosage form solution. The primary routes of administration were intranasal and sublingual. The resolution of infection symptoms occurred predominantly within the first 5 days after the initiation of therapy. The therapy appeared to be equally effective across all age groups. No Polyoxidonium®-related adverse events occurred. CONCLUSION Treatment with Polyoxidonium® contributes to achieving favorable outcomes in patients with inflammatory and infectious upper respiratory diseases. The study drug has a high safety profile.
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Affiliation(s)
- V M Svistushkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - G N Nikiforova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - K V Eremeeva
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A S Dekhanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - P A Kochetkov
- Sechenov First Moscow State Medical University (Sechenov University)
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Kostinova AM, Latysheva EA, Akhmatova NK, Vlasenko AE, Skhodova SA, Khromova EA, Linok AV, Poddubikov AA, Latysheva TV, Kostinov MP. Expression of Toll-like Receptors on the Immune Cells in Patients with Common Variable Immune Deficiency after Different Schemes of Influenza Vaccination. Viruses 2023; 15:2091. [PMID: 37896869 PMCID: PMC10611272 DOI: 10.3390/v15102091] [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: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND for the first time, the effect of one and two doses of adjuvanted influenza vaccines on toll-like receptors (TLRs) in patients with common variable immunodeficiency (CVID) was studied and compared (primary vaccination with one vs. two doses, primary vs. repeated vaccination). MATERIALS AND METHODS Six patients received one dose of quadrivalent adjuvanted influenza vaccine during the 2018-2019 and 2019-2020 influenza seasons, and nine patients with CVID received two doses of trivalent inactivated influenza vaccine during 2019-2020. Expression of TLRs was measured by flow cytometry. RESULTS The expression of toll-like receptors in patients with CVID was noted both with repeated (annual) administration of the influenza vaccine and in most cases was accompanied by an increase in the proportion of granulocytes (TLR3 and TLR9), lymphocytes (TLR3 and TLR8), and monocytes (TLR3 and TLR9). When carried out for the first time as a simultaneous vaccination with two doses it was accompanied by an increase in the proportion of granulocytes, lymphocytes expressing TLR9, and on monocytes-TLR3 and TLR9. CONCLUSION in CVID patients, the use of adjuvanted vaccines is promising, and research on the influence of the innate immunity and more effective regimens should be continued.
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Affiliation(s)
- Aristitsa Mikhailovna Kostinova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Str. 8/2, 119991 Moscow, Russia (A.A.P.); (M.P.K.)
- National Research Center—Institute of Immunology Federal Medical-Biological Agency of Russia, Kashirskoe Shosse, 24, 115478 Moscow, Russia (T.V.L.)
| | - Elena Alexandrovna Latysheva
- National Research Center—Institute of Immunology Federal Medical-Biological Agency of Russia, Kashirskoe Shosse, 24, 115478 Moscow, Russia (T.V.L.)
- Pirogov Russian National Research Medical University, Ostrovitianov Str. 1, 117997 Moscow, Russia
| | - Nelly Kimovna Akhmatova
- Russian Federal State Budgetary Scientific Institution «I.I. Mechnikov Research Institute of Vaccines and Sera», Malyi Kazenniy Pereulok, 5a, 105064 Moscow, Russia (E.A.K.)
| | - Anna Egorovna Vlasenko
- Federal State Budgetary Educational Institution of Higher Education “Samara State Medical University” of the Ministry of Healthcare of the Russian Federation, Chapaevskaya Street, 89, 443099 Samara, Russia
| | - Svetlana Anatolyevna Skhodova
- Russian Federal State Budgetary Scientific Institution «I.I. Mechnikov Research Institute of Vaccines and Sera», Malyi Kazenniy Pereulok, 5a, 105064 Moscow, Russia (E.A.K.)
| | - Ekaterina Alexandrovna Khromova
- Russian Federal State Budgetary Scientific Institution «I.I. Mechnikov Research Institute of Vaccines and Sera», Malyi Kazenniy Pereulok, 5a, 105064 Moscow, Russia (E.A.K.)
| | - Andrey Viktorovich Linok
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Str. 8/2, 119991 Moscow, Russia (A.A.P.); (M.P.K.)
| | - Arseniy Alexandrovich Poddubikov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Str. 8/2, 119991 Moscow, Russia (A.A.P.); (M.P.K.)
| | - Tatyana Vasilievna Latysheva
- National Research Center—Institute of Immunology Federal Medical-Biological Agency of Russia, Kashirskoe Shosse, 24, 115478 Moscow, Russia (T.V.L.)
| | - Mikhail Petrovich Kostinov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya Str. 8/2, 119991 Moscow, Russia (A.A.P.); (M.P.K.)
- Russian Federal State Budgetary Scientific Institution «I.I. Mechnikov Research Institute of Vaccines and Sera», Malyi Kazenniy Pereulok, 5a, 105064 Moscow, Russia (E.A.K.)
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Nanodispersions of Polyelectrolytes Based on Humic Substances: Isolation, Physico-Chemical Characterization and Evaluation of Biological Activity. Pharmaceutics 2021; 13:pharmaceutics13111954. [PMID: 34834368 PMCID: PMC8623726 DOI: 10.3390/pharmaceutics13111954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022] Open
Abstract
Natural polyelectrolytes, including in the form of complexes with colloidal particles, are increasingly used in pharmacy due to the possibility of regulated attachment of medicinal substances and their targeted delivery to the target organ. However, the formation, stability, and molecular-mass characteristics of polyelectrolyte nanodispersions (ND) vary depending on the nature and composition of the medium of their origin. This is due to the lack of standardized approaches to quality control and regulatory documentation for most natural ND. In this paper, we first introduced the isolation, followed by investigations into their physico-chemical properties and bioactivity. Using the dried droplet method, we were able to detect the “coffee ring effect”. Fractographic studies of the surface structure of EHA and FA dried samples using SEM showed its heterogeneity and the presence of submicron particles encapsulated in the internal molecular cavities of polyelectrolyte. FTIR spectroscopy revealed the ND chemical structure of benzo-α-pyron and benzo-γ-pyron, consisting of nanoparticles and a branched frame part. The main elements detected by X-ray fluorescence in humic substance extract and fulvic acid include Si, P, S, K, Ca, Mn, Fe, Cu, Zn, whereas Fe is in high concentrations. The UV-spectra and fluorescent radiation demonstrated the possibility of studying the effect of the fulvate chromone structure on its optical properties. It is shown that dilution of the initial solutions of polyelectrolytes 1:10 contributes to the detection of smaller nanoparticles and an increase in the absolute value of the negative ζ-potential as a factor of ND stability. A study of the EHS effect on the SARS-CoV-2 virus infectious titer in the Vero E6 cell showed the effective against virus both in the virucidal scheme (the SI is 11.90–22.43) and treatment/prevention scheme (the SI is 34.85–57.33). We assume that polyelectrolyte ND prevent the binding of the coronavirus spike glycoprotein to the receptor. Taking into account the results obtained, we expect that the developed approach can become unified for the standardization of the ND natural polyelectrolytes complex, which has great prospects for use in pharmacy and medicine as a drug with antiviral activity.
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Grivtsova LY, Falaleeva NA, Tupitsyn NN. Azoximer Bromide: Mystery, Serendipity, and Promise. Front Oncol 2021; 11:699546. [PMID: 34568029 PMCID: PMC8461167 DOI: 10.3389/fonc.2021.699546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/23/2021] [Indexed: 12/20/2022] Open
Abstract
Azoximer bromide (AZB) was identified as an immunomodulator, and was initially developed and currently successfully indicated as one of several natural polyelectrolytes, a vaccine adjuvant, and an effective agent for the treatment of infectious and inflammatory diseases of viral, bacterial, and fungal origin. AZB has the potential to increase an individual's resistance to local and general infection and is indicated for the treatment of viral infections, and has also demonstrated clinical efficacy in the treatment of a variety of secondary immunodeficiencies. However, AZB may offer long-term promise beyond use against infection. Multiple clinical trials and research studies in cancer patients have reported favourable outcomes with AZB as well as an optimal safety and tolerability profile. The findings raise the possibility of direct antitumor properties. This literature review analyses the novel mechanisms that mediate the AZB direct anticancer effects. Overall, the evidence suggests that AZB has the hallmark of an agent that could be used to support existing cancer treatments at different stages of disease.
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Affiliation(s)
- Lyudmila Yuryevna Grivtsova
- A. Tsyb Medical Radiological Research Centre, National Medical Research Radiological Centre of Ministry of Health of the Russian Federation, Moscow, Russia
| | - Natalia Alexandrovna Falaleeva
- A. Tsyb Medical Radiological Research Centre, National Medical Research Radiological Centre of Ministry of Health of the Russian Federation, Moscow, Russia
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Efimov SV, Matsiyeuskaya NV, Boytsova OV, Akhieva LY, Kvasova EI, Harrison F, Karpova YS, Tikhonov A, Khomyakova NF, Hardman T, Rossi JF. The effect of azoximer bromide (Polyoxidonium®) in patients hospitalized with coronavirus disease (COVID-19): an open-label, multicentre, interventional clinical study. Drugs Context 2021; 10:dic-2020-11-1. [PMID: 33828607 PMCID: PMC8007208 DOI: 10.7573/dic.2020-11-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/10/2020] [Indexed: 01/08/2023] Open
Abstract
A clinical need for aetiotropic coronavirus disease (COVID-19) treatments is required. The immune modulator azoximer bromide (AZB; Polyoxidonium®) is indicated in Russia for use against acute viral infections and during remission. In this study, adults hospitalized with COVID-19 (n=32) received AZB and standard of care in an open-label, multicentre, interventional study. All patients were symptomatic; 22 had severe disease (National Early Warning Score ≥5) and required mechanical ventilation or oxygen saturation (SpO2) and 19 patients had co-morbidities. Patients received AZB 12 mg intravenously once daily for 3 days, then intramuscularly every other day (approximately ten injections) until discharge. The primary endpoint was the patient's clinical status (7-point Ordinal Scale; OS) on day 15 versus that at baseline. The mean duration of hospitalization was 20 days. All patients were alive and discharged with normal SpO2 with no secondary infections or delayed mortality reported by the end-of-study visit (on day 28-72). A decrease in the mean OS and National Early Warning Score values was observed following treatment with AZB. A decrease in OS score was marked in patients identified as severe. Both sets of patients achieved similar scores, which can be classified as an improvement by day 9-10; SpO2 levels trended to normalization over time. By day 11-12, all patients had a normal body temperature. Serum C-reactive protein levels decreased in patients with severe and mild disease. Most patients had signs of pneumonia at baseline (n=27), with the majority recovering by days 10-12. No major toxicities were observed. AZB was safe and well tolerated when administered in addition to standard of care treatment for COVID-19. Further randomized, placebo-controlled studies are needed to elucidate any potential therapeutic effect in COVID-19.
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Affiliation(s)
- Sergey V Efimov
- State-Funded Healthcare Institution 'Emergency Hospital' of Ministry of Health of Chuvash Republic, Chuvash Republic, Cheboksary, Russia
| | | | - Olga V Boytsova
- State-Funded Healthcare Institution 'Infectious Disease Hospital No.3' of Ministry of Health of Krasnodar Krai, Krasnodar Krai, Novorossiysk, Russia
| | - Lyudmila Yu Akhieva
- State-Funded Institution of Mari El Republic 'Ioshkar-Ola City Hospital', Mari El Republic, Ioshkar Ola, Russia
| | - Elena I Kvasova
- State-Funded Healthcare Institution of Voronezh Region 'Novaya Usman District Hospital', Voronezh Region, Novaya Usman, Russia
| | | | | | | | | | | | - Jean-François Rossi
- Institut Sainte Catherine, Avignon, France.,Université de Montpellier, UFR Médecine, Montpellier, France
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Talayev V, Zaichenko I, Svetlova M, Matveichev A, Babaykina O, Voronina E, Mironov A. Low-dose influenza vaccine Grippol Quadrivalent with adjuvant Polyoxidonium induces a T helper-2 mediated humoral immune response and increases NK cell activity. Vaccine 2020; 38:6645-6655. [PMID: 32873403 DOI: 10.1016/j.vaccine.2020.07.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 12/20/2022]
Abstract
The influenza vaccine Grippol® Quadrivalent (GQ) is a new vaccine, containing the adjuvant Polyoxidonium® and recombinant hemagglutinins from 4 strains of the influenza virus in amount of 5-6 μg of each hemagglutinin per human dose. These doses of antigens are about 3 times less than the standard dose recommended by WHO. We sought to characterize the immune response to the GQ vaccine and to determine the contribution of the adjuvant in this response. BALB/c mice were vaccinated with GQ or with adjuvant-free antigen mixtures (AGs). Then, the antibody response, the number of memory T cells in the spleen, and the functional properties of splenocytes were determined. The vaccine GQ has been shown to induce antibodies to all 4 influenza hemagglutinins. The vaccination with GQ caused a strong increase in the AG-induced proliferation and production of Th2 cytokines ex vivo. These effects were equal to effect achieved by standard dose of antigens. Vaccination also caused the accumulation of CD4+ large lymphocytes with the phenotype of central and effector memory T cells in the spleen. The GQ vaccine enhanced the cytolytic activity of natural killer (NK) cells, whereas the adjuvant-free mixture of AGs in lowered and standard doses did not affect NK activity. We did not find a noticeable response of Th1 and CD8+ T cells to vaccination. In vitro, the GQ vaccine stimulated the maturation of human monocyte-derived dendritic cells (DCs) enhancing the expression of HLA-DR, CD80, CD83, CD86 and ICOSL molecules. Polyoxidonium without AGs also induced expression of ICOSL, which plays an important role in T-dependent humoral immune response. In summary, the low-dose influenza vaccine GQ with Polyoxidonium adjuvant is immunogenic, induces a Th2-polarized T-cell response and CD4+ memory T cells maturation, activates the production of antibodies to influenza hemagglutinins, and increases the activity of NK cells.
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Affiliation(s)
- Vladimir Talayev
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology of Rospotrebnadzor (Russian Federal Consumer Rights Protection and Human Health Control Service), 603950, 71 M. Yamskay str., Nizhny Novgorod, Russia.
| | - Irina Zaichenko
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology of Rospotrebnadzor (Russian Federal Consumer Rights Protection and Human Health Control Service), 603950, 71 M. Yamskay str., Nizhny Novgorod, Russia
| | - Maria Svetlova
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology of Rospotrebnadzor (Russian Federal Consumer Rights Protection and Human Health Control Service), 603950, 71 M. Yamskay str., Nizhny Novgorod, Russia
| | - Alexei Matveichev
- NPO Petrovax Pharm LLC, 142143, 1 Sosnovaya St., Pokrov Village, Podolsk, Moscow Region, Russia
| | - Olga Babaykina
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology of Rospotrebnadzor (Russian Federal Consumer Rights Protection and Human Health Control Service), 603950, 71 M. Yamskay str., Nizhny Novgorod, Russia
| | - Elena Voronina
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology of Rospotrebnadzor (Russian Federal Consumer Rights Protection and Human Health Control Service), 603950, 71 M. Yamskay str., Nizhny Novgorod, Russia
| | - Andrei Mironov
- Lobachevsky State University of Nizhny Novgorod, 603950, 23 Prospekt Gagarina (Gagarin Avenue), Nizhny Novgorod, Russia
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Alexia C, Cren M, Louis-Plence P, Vo DN, El Ahmadi Y, Dufourcq-Lopez E, Lu ZY, Hernandez J, Shamilov F, Chernysheva O, Vasilieva M, Vorotnikov I, Vishnevskay Y, Tupitsyn N, Rossi JF, Villalba M. Polyoxidonium ® Activates Cytotoxic Lymphocyte Responses Through Dendritic Cell Maturation: Clinical Effects in Breast Cancer. Front Immunol 2019; 10:2693. [PMID: 31849934 PMCID: PMC6892947 DOI: 10.3389/fimmu.2019.02693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/01/2019] [Indexed: 12/29/2022] Open
Abstract
Immunotherapy, which is seen as a major tool for cancer treatment, requires, in some cases, the presence of several agents to maximize its effects. Adjuvants can enhance the effect of other agents. However, despite their long-time use, only a few adjuvants are licensed today, and their use in cancer treatment is rare. Azoximer bromide, marketed under the trade name Polyoxidonium® (PO), is a copolymer of N-oxidized 1,4-ethylenepiperazine and (N-carboxyethyl)-1,4-ethylene piperazinium bromide. It has been described as an immune adjuvant and immunomodulator that is clinically used with excellent tolerance. PO is used in the treatment and prophylaxis of diseases connected with damage to the immune system, and there is interest in testing it in antitumor therapy. We show here that PO treatment for 1 week induced positive pathological changes in 6 out of 20 patients with breast cancer, including complete response in a triple-negative patient. This correlated with an increased tumor CD4+ T-lymphocyte infiltration. The immune effects of PO are associated with myeloid cell activation, and little is known about the action of PO on lymphocyte lineages, such as natural killer (NK) and T cells. We reveal that PO increases T-cell proliferation in vitro without negative effects on any activation marker. PO does not affect dendritic cell (DC) viability and increases the expansion of immature DC (iDC) and mature DC (mDC) at 100 μg/ml, and it stimulates expression of several DC co-stimulatory molecules, inducing the proliferation of allogeneic T cells. In contrast, PO decreases DC viability when added at day 5 post-expansion. PO is not toxic for NK cells at doses up to 100 μM and does not affect their activation, maturation, and cytotoxicity but tends to increase degranulation. This could be beneficial against target cells that show low sensitivity to NK cells, e.g., solid tumor cells. Finally, we have found great variability in PO response between donors. In summary, our in vitro results show that PO increases the number of costimulatory molecules on DC that prime T cells, favoring the production of effector T cells. This may support the future clinical development of PO in cancer treatment.
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Affiliation(s)
| | - Mailys Cren
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | | | - Dang-Nghiem Vo
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | | | | | - Zhao-Yang Lu
- IRMB, University of Montpellier, INSERM, Montpellier, France
| | | | - Farkhad Shamilov
- Federal State Budgetary Institute "N.N. Blokhin National Oncology Research Center" of the Ministry of Health of Russian Federation, Moscow, Russia
| | - Olga Chernysheva
- Federal State Budgetary Institute "N.N. Blokhin National Oncology Research Center" of the Ministry of Health of Russian Federation, Moscow, Russia
| | - M Vasilieva
- Voronezh Oncology Dispansery, Vronezh, Russia
| | - I Vorotnikov
- Federal State Budgetary Institute "N.N. Blokhin National Oncology Research Center" of the Ministry of Health of Russian Federation, Moscow, Russia
| | - Yana Vishnevskay
- Federal State Budgetary Institute "N.N. Blokhin National Oncology Research Center" of the Ministry of Health of Russian Federation, Moscow, Russia
| | - Nikolay Tupitsyn
- Federal State Budgetary Institute "N.N. Blokhin National Oncology Research Center" of the Ministry of Health of Russian Federation, Moscow, Russia
| | - Jean-François Rossi
- Institut Sainte Catherine, Avignon, France.,Université de Montpellier I, UFR Médecine, Montpellier, France
| | - Martin Villalba
- IRMB, University of Montpellier, INSERM, Montpellier, France.,CHU Montpellier, Montpellier, France.,IRMB, University of Montpellier, INSERM, CNRS, CHU Montpellier, Montpellier, France
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