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Taubel J, Hauke W, Rump S, Viereck J, Batkai S, Poetzsch J, Rode L, Weigt H, Genschel C, Lorch U, Theek C, Levin A, Bauersachs J, Solomon S, Thum T. Novel antisense therapy targeting microRNA-132 in patients with heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac microRNA-132-3p (miR-132) levels are increased in patients with heart failure (HF) and mechanistically drive cardiac remodelling processes. CDR132L, a specific antisense oligonucleotide, is a first-in-class miR-132 inhibitor that attenuates and even reverses HF in preclinical models.
Purpose
The aim of the current clinical Phase 1b study was to assess safety, pharmacokinetics, target engagement, and exploratory pharmacodynamic effects of CDR132L in patients on standard-of-care therapy for chronic ischaemic HF in a randomized, placebo-controlled, double-blind, dose-escalation study.
Methods
Patients had left ventricular ejection fraction between ≥30% and <50% or amino terminal fragment of pro-brain natriuretic peptide (NT-proBNP) >125 ng/L at screening. Twenty-eight patients were randomized to receive CDR132L (0.32, 1, 3, and 10 mg/kg body weight) or placebo (0.9% saline) in two intravenous infusions, 4 weeks apart in four cohorts of seven (five verum and two placebo) patients each.
Results
CDR132L was safe and well tolerated, without apparent dose-limiting toxicity. A pharmacokinetic/pharmacodynamic dose modelling approach suggested an effective dose level at ≥1 mg/kg CDR132L. CDR132L treatment resulted in a dose-dependent, sustained miR-132 reduction in plasma. Patients given CDR132L ≥1 mg/kg displayed median 23.3% NT-proBNP reduction, vs. 0.9% median increase in the control group. CDR132L treatment induced significant QRS narrowing and positive trends for cardiac fibrosis biomarkers.
Conclusions
This study is the first clinical trial of an antisense drug in HF patients. CDR132L was safe and well tolerated, confirmed linear plasma pharmacokinetics with no signs of accumulation, and suggests cardiac functional improvements. The indicative efficacy of this drug is very encouraging justifying additional clinical studies to confirm the beneficial CDR132L pharmacodynamic effects for the treatment of HF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Cardior Pharmaceuticals GmbH
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Affiliation(s)
- J Taubel
- Richmond Pharmacology, London, United Kingdom
| | - W Hauke
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - S Rump
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - J Viereck
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - S Batkai
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - J Poetzsch
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - L Rode
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - H Weigt
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - C Genschel
- Cardior Pharmaceuticals GmbH, Hannover, Germany
| | - U Lorch
- Richmond Pharmacology, London, United Kingdom
| | - C Theek
- University of Witten/Herdecke, Witten, Germany
| | - A.A Levin
- Avidity Biosciences, La Jolla, United States of America
| | - J Bauersachs
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - S.D Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Boston, United States of America
| | - T Thum
- Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover, Germany
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Gryzik S, Hoang Y, Lischke T, Mohr E, Venzke M, Kadner I, Poetzsch J, Groth D, Radbruch A, Hutloff A, Baumgrass R. Identification of a super-functional Tfh-like subpopulation in murine lupus by pattern perception. eLife 2020; 9:53226. [PMID: 32441253 PMCID: PMC7274784 DOI: 10.7554/elife.53226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 05/20/2020] [Indexed: 01/20/2023] Open
Abstract
Dysregulated cytokine expression by T cells plays a pivotal role in the pathogenesis of autoimmune diseases. However, the identification of the corresponding pathogenic subpopulations is a challenge, since a distinction between physiological variation and a new quality in the expression of protein markers requires combinatorial evaluation. Here, we were able to identify a super-functional follicular helper T cell (Tfh)-like subpopulation in lupus-prone NZBxW mice with our binning approach "pattern recognition of immune cells (PRI)". PRI uncovered a subpopulation of IL-21+ IFN-γhigh PD-1low CD40Lhigh CXCR5- Bcl-6- T cells specifically expanded in diseased mice. In addition, these cells express high levels of TNF-α and IL-2, and provide B cell help for IgG production in an IL-21 and CD40L dependent manner. This super-functional T cell subset might be a superior driver of autoimmune processes due to a polyfunctional and high cytokine expression combined with Tfh-like properties.
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Affiliation(s)
- Stefanie Gryzik
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Yen Hoang
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany.,University of Potsdam, Potsdam, Germany
| | - Timo Lischke
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Elodie Mohr
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Melanie Venzke
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Isabelle Kadner
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany.,University of Potsdam, Potsdam, Germany
| | - Josephine Poetzsch
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany.,University of Potsdam, Potsdam, Germany
| | | | - Andreas Radbruch
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany.,Charité, Campus Mitte, Berlin, Germany
| | - Andreas Hutloff
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany
| | - Ria Baumgrass
- German Rheumatism Research Center (DRFZ), A Leibniz Institute, Berlin, Germany.,University of Potsdam, Potsdam, Germany
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Abstract
Regulatory actions taken to reduce the risk of harmful effects of exposure to chemicals often are not commensurate with the toxicological risk assessment. A number of factors relating to psychology, sociology, economics and politics rather than science and medicine affect the final decision. Werner Lutz and colleagues illustrate the situation using the leukemia-inducing chemical benzene as an example.
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Affiliation(s)
- W K Lutz
- Institute of Toxicology, Swiss Federal Institute of Technology
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