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Babu S, Nicholson KA, Rothstein JD, Swenson A, Sampognaro PJ, Pant P, Macklin EA, Spruill S, Paganoni S, Gendron TF, Prudencio M, Petrucelli L, Nix D, Landrette S, Nkrumah E, Fandrick K, Edwards J, Young PR. Apilimod dimesylate in C9orf72 amyotrophic lateral sclerosis: a randomized phase 2a clinical trial. Brain 2024:awae109. [PMID: 38606777 DOI: 10.1093/brain/awae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/18/2024] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
Apilimod dimesylate is a first-in-class phosphoinositide kinase, FYVE-type zinc finger containing (PIKfyve) inhibitor with favourable clinical safety profile and has demonstrated activity in preclinical C9orf72 and TDP-43 amyotrophic lateral sclerosis models. In this amyotrophic lateral sclerosis clinical trial, the safety, tolerability, CNS penetrance, and modulation of pharmacodynamic target engagement biomarkers were evaluated. This Phase 2a, randomized, double-blind, placebo-controlled, biomarker-endpoint clinical trial was conducted in four USA centres (ClinicalTrials.gov NCT05163886). Participants with C9orf72 repeat expansion were randomly assigned (2:1) to receive twice-daily oral treatment of 125 mg apilimod dimesylate capsules or matching placebo for 12 weeks, followed by a 12-week open-label extension. Safety was measured as the occurrence of treatment-emergent adverse or serious adverse events attributable to study drug, and tolerability as trial completion on treatment over 12 weeks. Changes from baseline in plasma and CSF and concentrations of apilimod and its active metabolites and of pharmacodynamic biomarkers of PIKfyve inhibition (soluble glycoprotein nonmetastatic melanoma protein B [sGPNMB] upregulation) and disease-specific CNS target engagement (poly[GP]). Between Dec 16, 2021, and Jul 7, 2022, 15 eligible participants were enrolled. There were no drug-related serious adverse events reported in the trial. Fourteen (93%) participants completed the double-blind period with 99% dose compliance (N=9 [90%] apilimod dimesylate; N=5 [100%] placebo). At Week 12, apilimod dimesylate was measurable in CSF at 1.63 ng/mL (SD: 0.937). At Week 12, apilimod dimesylate increased plasma sGPNMB by > 2.5-fold (p < 0.001) indicating PIKfyve inhibition and lowered CSF poly(GP) protein levels by 73% (p < 0.001) indicating CNS tissue-level proof of mechanism. Apilimod dimesylate met prespecified key safety and biomarker endpoints in this Phase 2a trial and demonstrated CNS penetrance and pharmacodynamic target engagement. Apilimod dimesylate was observed to have the greatest reduction in CSF poly(GP) levels observed to date in C9orf72 clinical trials.
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Affiliation(s)
- Suma Babu
- Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Katharine A Nicholson
- Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Sanofi, Cambridge, MA 02139, USA
| | | | - Andrea Swenson
- Department of Neurology, University of Iowa, Iowa city, IA 52242, USA
| | - Paul J Sampognaro
- Neuromuscular Division, Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Pravin Pant
- Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Eric A Macklin
- Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Susan Spruill
- Applied Statistics and Consulting, Spruce Pine, NC 28777, USA
| | - Sabrina Paganoni
- Sean M Healey & AMG Center for ALS, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Haverkos B, Alpdogan O, Baiocchi R, Brammer JE, Feldman TA, Capra M, Brem EA, Nair S, Scheinberg P, Pereira J, Shune L, Joffe E, Young P, Spruill S, Katkov A, McRae R, Royston I, Faller DV, Rojkjaer L, Porcu P. Targeted therapy with nanatinostat and valganciclovir in recurrent EBV-positive lymphoid malignancies: a phase 1b/2 study. Blood Adv 2023; 7:6339-6350. [PMID: 37530631 PMCID: PMC10587711 DOI: 10.1182/bloodadvances.2023010330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/30/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
Lymphomas are not infrequently associated with the Epstein-Barr virus (EBV), and EBV positivity is linked to worse outcomes in several subtypes. Nanatinostat is a class-I selective oral histone deacetylase inhibitor that induces the expression of lytic EBV BGLF4 protein kinase in EBV+ tumor cells, activating ganciclovir via phosphorylation, resulting in tumor cell apoptosis. This phase 1b/2 study investigated the combination of nanatinostat with valganciclovir in patients aged ≥18 years with EBV+ lymphomas relapsed/refractory to ≥1 prior systemic therapy with no viable curative treatment options. In the phase 1b part, 25 patients were enrolled into 5 dose escalation cohorts to determine the recommended phase 2 dose (RP2D) for phase 2 expansion. Phase 2 patients (n = 30) received RP2D (nanatinostat 20 mg daily, 4 days per week with valganciclovir 900 mg orally daily) for 28-day cycles. The primary end points were safety, RP2D determination (phase 1b), and overall response rate (ORR; phase 2). Overall, 55 patients were enrolled (B-non-Hodgkin lymphoma [B-NHL], [n = 10]; angioimmunoblastic T-cell lymphoma-NHL, [n = 21]; classical Hodgkin lymphoma, [n = 11]; and immunodeficiency-associated lymphoproliferative disorders, [n = 13]). The ORR was 40% in 43 evaluable patients (complete response rate [CRR], 19% [n = 8]) with a median duration of response of 10.4 months. For angioimmunoblastic T-cell lymphoma-NHL (n = 15; all refractory to the last prior therapy), the ORR/CRR ratio was 60%/27%. The most common adverse events were nausea (38% any grade) and cytopenia (grade 3/4 neutropenia [29%], thrombocytopenia [20%], and anemia [20%]). This novel oral regimen provided encouraging efficacy across several EBV+ lymphoma subtypes and warrants further evaluation; a confirmatory phase 2 study (NCT05011058) is underway. This phase 1b/2 study is registered at www.clinicaltrials.gov as #NCT03397706.
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Affiliation(s)
| | - Onder Alpdogan
- Division of Hematologic Malignancies and Hematopoetic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Robert Baiocchi
- The Ohio State University James Comprehensive Cancer Center, Columbus, OH
| | | | - Tatyana A. Feldman
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ
| | - Marcelo Capra
- Centro Integrado de Hematologia e Oncologia - Hospital Mãe de Deus, Porto Alegre, Brazil
| | - Elizabeth A. Brem
- Division of Hematology/Oncology, Deptartment of Medicine, University of California, Irvine, Orange, CA
| | - Santosh Nair
- Mid Florida Hematology and Oncology Center, Orange City, FL
| | - Phillip Scheinberg
- Division of Hematology, Hospital A Beneficência Portuguesa, São Paulo, Brazil
| | - Juliana Pereira
- Division of Hematology, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Leyla Shune
- University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, KS
| | - Erel Joffe
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoetic Stem Cell Transplantation, Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
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Kim WJ, Roberts CC, Song JY, Yoon JG, Seong H, Hyun HJ, Lee H, Gil A, Oh Y, Park JE, Lee JE, Jeon B, Kane D, Spruill S, Kudchodkar SB, Muthumani K, Park YK, Kwon I, Maslow JN. Immune response enhancement with GLS-5310 DNA primary vaccine against SARS-CoV-2 followed by administration of an mRNA vaccine heterologous boost. Vaccine 2023:S0264-410X(23)00683-7. [PMID: 37296017 DOI: 10.1016/j.vaccine.2023.06.013] [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] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
Heterologous boost regimens are being increasingly considered against SARS-CoV-2. We report results for the 32 of 45 participants in the Phase 1 CoV2-001 clinical trial (Kim et al., Int J Iinfect Dis 2023, 128:112-120) who elected to receive an EUA-approved SARS-CoV-2 mRNA vaccine 6 to 8 months following a two-dose primary vaccination with the GLS-5310 bi-cistronic DNA vaccine given intradermally and followed by application of suction using the GeneDerm device. Receipt of EUA-approved mRNA vaccines after GLS-5310 vaccination was well-tolerated, with no reported adverse events. Immune responses were enhanced such that binding antibody titers, neutralizing antibody titers, and T-cell responses increased 1,187-fold, 110-fold, and 2.9-fold, respectively. This paper is the first description of the immune responses following heterologous vaccination with a DNA primary series and mRNA boost.
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Affiliation(s)
- Woo Joo Kim
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | | | - Joon Young Song
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hak-Jun Hyun
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hyojin Lee
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Areum Gil
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Yeeun Oh
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ji-Eun Park
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ji-Eun Lee
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Bohyun Jeon
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Deborah Kane
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Susan Spruill
- Applied Statistics and Consulting, Spruce Pine, NC, USA
| | | | - Kar Muthumani
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Young K Park
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ijoo Kwon
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Joel N Maslow
- GeneOne Life Science, Inc., Seoul, Republic of Korea; Department of Medicine, Morristown Medical Center, Morristown, NJ, USA.
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Kim WJ, Roberts CC, Song JY, Yoon JG, Seong H, Hyun HJ, Lee H, Gil A, Oh Y, Park JE, Jeon B, Lee JE, Choi SK, Yoon SK, Lee S, Kim B, Kane D, Spruill S, Kudchodkar SB, Muthumani K, Park YK, Kwon I, Jeong M, Maslow JN. Safety and immunogenicity of the bi-cistronic GLS-5310 COVID-19 DNA vaccine delivered with the GeneDerm suction device. Int J Infect Dis 2023; 128:112-120. [PMID: 36592685 PMCID: PMC9803371 DOI: 10.1016/j.ijid.2022.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/12/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The CoV2-001 phase I randomized trial evaluated the safety and immunogenicity of the GLS-5310 bi-cistronic DNA vaccine through 48 weeks of follow-up. DESIGN A total of 45 vaccine-naïve participants were recruited between December 31, 2020, and March 30, 2021. GLS-5310, encoding for the SARS-CoV-2 spike and open reading frame 3a (ORF3a) proteins, was administered intradermally at 0.6 mg or 1.2 mg per dose, followed by application of the GeneDerm suction device as part of a two-dose regimen spaced either 8 or 12 weeks between vaccinations. RESULTS GLS-5310 was well tolerated with no serious adverse events reported. Antibody and T cell responses were dose-independent. Anti-spike antibodies were induced in 95.5% of participants with an average geometric mean titer of ∼480 four weeks after vaccination and declined minimally through 48 weeks. Neutralizing antibodies were induced in 55.5% of participants with post-vaccination geometric mean titer of 28.4. T cell responses were induced in 97.8% of participants, averaging 716 site forming units/106 cells four weeks after vaccination, increasing to 1248 at week 24, and remaining greater than 1000 through 48 weeks. CONCLUSION GLS-5310 administered with the GeneDerm suction device was well tolerated and induced high levels of binding antibodies and T-cell responses. Antibody responses were similar to other DNA vaccines, whereas T cell responses were many-fold greater than DNA and non-DNA vaccines.
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Affiliation(s)
- Woo Joo Kim
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | | | - Joon Young Song
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Jin Gu Yoon
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hye Seong
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hak-Jun Hyun
- Division of Infectious Diseases, Guro Hospital, Vaccine Innovation Center, Korea University, College of Medicine, Seoul, Republic of Korea
| | - Hyojin Lee
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Areum Gil
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Yeeun Oh
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ji-Eun Park
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Bohyun Jeon
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ji-Eun Lee
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Sang Kyu Choi
- Division of Vaccine clinical Research, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health Korea Disease Korean Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Sun Kyung Yoon
- Division of Vaccine clinical Research, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health Korea Disease Korean Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Sunhee Lee
- Division of Vaccine clinical Research, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health Korea Disease Korean Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Byoungguk Kim
- Division of Vaccine clinical Research, Center for Vaccine Research, National Institute of Infectious Diseases, National Institute of Health Korea Disease Korean Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Deborah Kane
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | | | | | - Kar Muthumani
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Young K Park
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Ijoo Kwon
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Moonsup Jeong
- GeneOne Life Science, Inc., Seoul, Republic of Korea
| | - Joel N Maslow
- GeneOne Life Science, Inc., Seoul, Republic of Korea; Department of Medicine, Morristown Medical Center, Morristown, USA.
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Maslow JN, Kwon JJ, Mikota SK, Spruill S, Cho Y, Jeong M. Severe fever and thrombocytopenia syndrome virus infection: Considerations for vaccine evaluation of a rare disease. Hum Vaccin Immunother 2019; 15:2249-2257. [PMID: 31215838 PMCID: PMC6816409 DOI: 10.1080/21645515.2019.1633875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/29/2019] [Accepted: 06/15/2019] [Indexed: 11/03/2022] Open
Abstract
Infection caused by the severe fever and thrombocytopenia syndrome virus (SFTSV) causes a hemorrhagic illness with a mortality between 20% and 40%. Initially recognized in 2009 in China, cases have additionally been documented in Japan and Korea although retrospective studies have documented seroprevalence since 1996. Although case rates have increased due to increased awareness and more widely available diagnostics, SFTSV infection remains rare with the highest rates documented in Korea for Jeju Province (3.5 cases per 100,000 population) and the Inje-gun region (66.2 cases per 100,000). Because of the very low incidence of infection, a placebo-controlled study with 1:1 randomization to evaluate an SFTSV vaccine would require a sample size that is 25% greater than the region of study. We discuss alternatives to licensure. Vaccine effectiveness may be assessed through a registry, comparing rates of infection over time between vaccine recipients versus regional populations. Modeled data can be updated based on actual case rates and population changes over the years of follow-up. Using one model, statistically significant differences are seen after 10 years in Inje-gun and 15 years of follow-up in Jeju. This approach may be applicable to other uncommon infectious diseases for which a standard study design is difficult.
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Affiliation(s)
- Joel N. Maslow
- GeneOne Life Science, Inc., Seoul, Korea
- Department of Medicine, Morristown Medical Center, Morristown, USA
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Wolever T, Jenkins A, Campbell J, Spruill S, Richard B, Harkness L, Klinken J. Differential Serving Sizes of High β Glucan Oatmeal Elicit Lower Glycemic Response than Rice Cereal. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Susan Spruill
- Applied Statistics and ConsultingSprice PineNCUnited States
| | - Black Richard
- Research and Development Center PepsiCo Barrington ILUnited States
| | - Laura Harkness
- Research and Development Center PepsiCo Barrington ILUnited States
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Petros WP, Hopkins PJ, Spruill S, Broadwater G, Vredenburgh JJ, Colvin OM, Peters WP, Jones RB, Hall J, Marks JR. Associations Between Drug Metabolism Genotype, Chemotherapy Pharmacokinetics, and Overall Survival in Patients With Breast Cancer. J Clin Oncol 2005; 23:6117-25. [PMID: 16087946 DOI: 10.1200/jco.2005.06.075] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate associations between patient survival, pharmacokinetics, and drug metabolism–related genetic polymorphisms in patients receiving a combination chemotherapy regimen for breast cancer. Patients and Methods A genotype association study was conducted on 85 chemotherapy-naïve patients with metastatic or inflammatory breast cancer that were evaluated for an extended period after receiving standard-dose chemotherapy followed by high-dose cyclophosphamide, cisplatin, and carmustine. Blood pharmacokinetics were evaluated, and DNA was genotyped for 29 polymorphisms in 17 drug metabolism genes. Results Patients with cyclophosphamide plasma exposures above the median (implying slower metabolic activation) had a shorter survival than those below the median (1.8 v 3.8 years, respectively; P = .042). Patients having a variant genotype of cytochrome P450 3A4 displayed higher blood concentrations of parent (inactive) cyclophosphamide with the second and third doses (P = .024 and .028, respectively) in addition to slower cyclophosphamide activation over the three doses (P = .031). Median survival for these patients was 1.3 years compared with 2.7 years for those without the variant (P = .043). Similar results were observed for patients carrying a genetic variant of P450 3A5. Median survival for patients with deletions of glutathione-S-transferase M1 gene was 3.5 v 1.5 years for patients with one or both copies (P = .041). Patients with a polymorphism in a gene regulating metallothionein had lower platinum concentrations and shorter survival (P = .033). Conclusion These data suggest that pretreatment evaluation of drug metabolism genes may explain some interindividual differences in both anticancer drug pharmacokinetics and response. The correlations found here may have implications for other commonly used anticancer drugs.
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Affiliation(s)
- William P Petros
- West Virginia University Health Sciences Center, PO Box 9300, Morgantown, WV 26506, USA.
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