NZ735659B2 - Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack - Google Patents
Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack Download PDFInfo
- Publication number
- NZ735659B2 NZ735659B2 NZ735659A NZ73565916A NZ735659B2 NZ 735659 B2 NZ735659 B2 NZ 735659B2 NZ 735659 A NZ735659 A NZ 735659A NZ 73565916 A NZ73565916 A NZ 73565916A NZ 735659 B2 NZ735659 B2 NZ 735659B2
- Authority
- NZ
- New Zealand
- Prior art keywords
- antibody
- hae
- attack
- amino acid
- binding
- Prior art date
Links
- 206010019860 Hereditary angioedema Diseases 0.000 title abstract description 182
- 108090000113 Plasma Kallikrein Proteins 0.000 title abstract description 81
- 102000003827 Plasma Kallikrein Human genes 0.000 title abstract description 75
- 229940127379 Kallikrein Inhibitors Drugs 0.000 title description 4
- 230000027455 binding Effects 0.000 claims abstract description 87
- 239000003814 drug Substances 0.000 claims abstract description 59
- 238000004519 manufacturing process Methods 0.000 claims abstract description 17
- 239000003937 drug carrier Substances 0.000 claims abstract description 11
- 150000001413 amino acids Chemical class 0.000 claims description 42
- 125000003275 alpha amino acid group Chemical group 0.000 claims description 27
- KRKNYBCHXYNGOX-UHFFFAOYSA-N citric acid Chemical compound OC(=O)CC(O)(C(O)=O)CC(O)=O KRKNYBCHXYNGOX-UHFFFAOYSA-N 0.000 claims description 24
- 239000012634 fragment Substances 0.000 claims description 23
- 239000000427 antigen Substances 0.000 claims description 20
- 108091007433 antigens Proteins 0.000 claims description 20
- 102000036639 antigens Human genes 0.000 claims description 20
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 claims description 18
- 108010047041 Complementarity Determining Regions Proteins 0.000 claims description 17
- HNDVDQJCIGZPNO-YFKPBYRVSA-N L-histidine Chemical compound OC(=O)[C@@H](N)CC1=CN=CN1 HNDVDQJCIGZPNO-YFKPBYRVSA-N 0.000 claims description 10
- HNDVDQJCIGZPNO-UHFFFAOYSA-N histidine Natural products OC(=O)C(N)CC1=CN=CN1 HNDVDQJCIGZPNO-UHFFFAOYSA-N 0.000 claims description 10
- 239000011780 sodium chloride Substances 0.000 claims description 9
- 235000010482 polyoxyethylene sorbitan monooleate Nutrition 0.000 claims description 8
- 229920000053 polysorbate 80 Polymers 0.000 claims description 8
- 239000001488 sodium phosphate Substances 0.000 claims description 8
- 229910000162 sodium phosphate Inorganic materials 0.000 claims description 8
- RYFMWSXOAZQYPI-UHFFFAOYSA-K trisodium phosphate Chemical compound [Na+].[Na+].[Na+].[O-]P([O-])([O-])=O RYFMWSXOAZQYPI-UHFFFAOYSA-K 0.000 claims description 8
- QZIQJVCYUQZDIR-UHFFFAOYSA-N mechlorethamine hydrochloride Chemical compound Cl.ClCCN(C)CCCl QZIQJVCYUQZDIR-UHFFFAOYSA-N 0.000 claims description 4
- 239000000244 polyoxyethylene sorbitan monooleate Substances 0.000 claims description 2
- 229940068968 polysorbate 80 Drugs 0.000 claims description 2
- 238000000034 method Methods 0.000 abstract description 54
- 241000282414 Homo sapiens Species 0.000 description 76
- 229940079593 drug Drugs 0.000 description 50
- 210000002381 plasma Anatomy 0.000 description 50
- 238000011282 treatment Methods 0.000 description 48
- 108090000623 proteins and genes Proteins 0.000 description 47
- 235000001014 amino acid Nutrition 0.000 description 44
- 229940024606 amino acid Drugs 0.000 description 40
- 210000004027 cell Anatomy 0.000 description 35
- 239000003112 inhibitor Substances 0.000 description 35
- 108060003951 Immunoglobulin Proteins 0.000 description 34
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 34
- 102000018358 immunoglobulin Human genes 0.000 description 34
- 230000000694 effects Effects 0.000 description 30
- 239000000203 mixture Substances 0.000 description 30
- 239000000902 placebo Substances 0.000 description 28
- 229940068196 placebo Drugs 0.000 description 28
- 201000010099 disease Diseases 0.000 description 23
- 235000018102 proteins Nutrition 0.000 description 21
- 102000004169 proteins and genes Human genes 0.000 description 21
- 101710117290 Aldo-keto reductase family 1 member C4 Proteins 0.000 description 20
- 238000004458 analytical method Methods 0.000 description 19
- 102000023732 binding proteins Human genes 0.000 description 19
- 108091008324 binding proteins Proteins 0.000 description 19
- 230000035772 mutation Effects 0.000 description 18
- 239000003795 chemical substances by application Substances 0.000 description 17
- 150000001875 compounds Chemical class 0.000 description 16
- 101001091365 Homo sapiens Plasma kallikrein Proteins 0.000 description 15
- 239000000463 material Substances 0.000 description 15
- 238000012423 maintenance Methods 0.000 description 14
- 230000003285 pharmacodynamic effect Effects 0.000 description 13
- 101800004538 Bradykinin Proteins 0.000 description 12
- QXZGBUJJYSLZLT-UHFFFAOYSA-N H-Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg-OH Natural products NC(N)=NCCCC(N)C(=O)N1CCCC1C(=O)N1C(C(=O)NCC(=O)NC(CC=2C=CC=CC=2)C(=O)NC(CO)C(=O)N2C(CCC2)C(=O)NC(CC=2C=CC=CC=2)C(=O)NC(CCCN=C(N)N)C(O)=O)CCC1 QXZGBUJJYSLZLT-UHFFFAOYSA-N 0.000 description 12
- 102000002261 High-Molecular-Weight Kininogen Human genes 0.000 description 12
- 108010000487 High-Molecular-Weight Kininogen Proteins 0.000 description 12
- 102100035792 Kininogen-1 Human genes 0.000 description 12
- 238000003556 assay Methods 0.000 description 12
- QXZGBUJJYSLZLT-FDISYFBBSA-N bradykinin Chemical compound NC(=N)NCCC[C@H](N)C(=O)N1CCC[C@H]1C(=O)N1[C@H](C(=O)NCC(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@@H](CO)C(=O)N2[C@@H](CCC2)C(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@@H](CCCNC(N)=N)C(O)=O)CCC1 QXZGBUJJYSLZLT-FDISYFBBSA-N 0.000 description 12
- 150000007523 nucleic acids Chemical class 0.000 description 12
- 241000288906 Primates Species 0.000 description 11
- 208000035475 disorder Diseases 0.000 description 11
- 238000011068 loading method Methods 0.000 description 11
- 239000008194 pharmaceutical composition Substances 0.000 description 11
- 230000009467 reduction Effects 0.000 description 11
- 238000007920 subcutaneous administration Methods 0.000 description 11
- -1 yl group Chemical group 0.000 description 11
- 208000028185 Angioedema Diseases 0.000 description 10
- 108010071241 Factor XIIa Proteins 0.000 description 10
- 230000001154 acute effect Effects 0.000 description 10
- 210000002966 serum Anatomy 0.000 description 10
- 238000006467 substitution reaction Methods 0.000 description 10
- 208000024891 symptom Diseases 0.000 description 10
- 101150038444 Ment gene Proteins 0.000 description 9
- 125000000539 amino acid group Chemical group 0.000 description 9
- 230000005764 inhibitory process Effects 0.000 description 9
- 108020004707 nucleic acids Proteins 0.000 description 9
- 102000039446 nucleic acids Human genes 0.000 description 9
- 238000011321 prophylaxis Methods 0.000 description 9
- 230000002829 reductive effect Effects 0.000 description 9
- 230000001225 therapeutic effect Effects 0.000 description 9
- 238000002560 therapeutic procedure Methods 0.000 description 9
- 239000002253 acid Substances 0.000 description 8
- 230000000295 complement effect Effects 0.000 description 8
- 230000001965 increasing effect Effects 0.000 description 8
- 108090000765 processed proteins & peptides Proteins 0.000 description 8
- 150000003839 salts Chemical class 0.000 description 8
- 239000000243 solution Substances 0.000 description 8
- 239000013598 vector Substances 0.000 description 8
- 108010067060 Immunoglobulin Variable Region Proteins 0.000 description 7
- 208000026935 allergic disease Diseases 0.000 description 7
- 230000000875 corresponding effect Effects 0.000 description 7
- 230000002265 prevention Effects 0.000 description 7
- 239000000758 substrate Substances 0.000 description 7
- 238000001262 western blot Methods 0.000 description 7
- 108700040183 Complement C1 Inhibitor Proteins 0.000 description 6
- 102000055157 Complement C1 Inhibitor Human genes 0.000 description 6
- 108010080865 Factor XII Proteins 0.000 description 6
- 102000000429 Factor XII Human genes 0.000 description 6
- 102000006395 Globulins Human genes 0.000 description 6
- 108010044091 Globulins Proteins 0.000 description 6
- 102000017727 Immunoglobulin Variable Region Human genes 0.000 description 6
- 241001529936 Murinae Species 0.000 description 6
- 206010042674 Swelling Diseases 0.000 description 6
- 230000004913 activation Effects 0.000 description 6
- 230000002411 adverse Effects 0.000 description 6
- 210000004602 germ cell Anatomy 0.000 description 6
- 150000002500 ions Chemical class 0.000 description 6
- 208000004296 neuralgia Diseases 0.000 description 6
- 208000021722 neuropathic pain Diseases 0.000 description 6
- 230000036470 plasma concentration Effects 0.000 description 6
- 229920001184 polypeptide Polymers 0.000 description 6
- 102000004196 processed proteins & peptides Human genes 0.000 description 6
- 230000008961 swelling Effects 0.000 description 6
- 102000004420 Creatine Kinase Human genes 0.000 description 5
- 108010042126 Creatine kinase Proteins 0.000 description 5
- 102000004190 Enzymes Human genes 0.000 description 5
- 108090000790 Enzymes Proteins 0.000 description 5
- 206010020751 Hypersensitivity Diseases 0.000 description 5
- 102000001399 Kallikrein Human genes 0.000 description 5
- 108060005987 Kallikrein Proteins 0.000 description 5
- 240000004808 Saccharomyces cerevisiae Species 0.000 description 5
- 230000003187 abdominal effect Effects 0.000 description 5
- 239000000090 biomarker Substances 0.000 description 5
- 210000004369 blood Anatomy 0.000 description 5
- 239000008280 blood Substances 0.000 description 5
- 230000007423 decrease Effects 0.000 description 5
- 238000011161 development Methods 0.000 description 5
- 230000018109 developmental process Effects 0.000 description 5
- 239000012636 effector Substances 0.000 description 5
- 229940088598 enzyme Drugs 0.000 description 5
- 239000013604 expression vector Substances 0.000 description 5
- 230000006870 function Effects 0.000 description 5
- 238000001802 infusion Methods 0.000 description 5
- 238000002347 injection Methods 0.000 description 5
- 239000007924 injection Substances 0.000 description 5
- 238000001990 intravenous administration Methods 0.000 description 5
- 239000003550 marker Substances 0.000 description 5
- 238000005259 measurement Methods 0.000 description 5
- 239000002773 nucleotide Substances 0.000 description 5
- 125000003729 nucleotide group Chemical group 0.000 description 5
- 230000004044 response Effects 0.000 description 5
- 201000000596 systemic lupus erythematosus Diseases 0.000 description 5
- 230000009261 transgenic effect Effects 0.000 description 5
- 241000282412 Homo Species 0.000 description 4
- 102100038297 Kallikrein-1 Human genes 0.000 description 4
- 101710176219 Kallikrein-1 Proteins 0.000 description 4
- 241001465754 Metazoa Species 0.000 description 4
- 206010030113 Oedema Diseases 0.000 description 4
- 208000002193 Pain Diseases 0.000 description 4
- 230000007815 allergy Effects 0.000 description 4
- 238000000540 analysis of variance Methods 0.000 description 4
- 150000001768 cations Chemical class 0.000 description 4
- 210000004978 chinese hamster ovary cell Anatomy 0.000 description 4
- 230000001419 dependent effect Effects 0.000 description 4
- 239000006185 dispersion Substances 0.000 description 4
- 239000002552 dosage form Substances 0.000 description 4
- 238000005516 engineering process Methods 0.000 description 4
- 238000009472 formulation Methods 0.000 description 4
- 230000004927 fusion Effects 0.000 description 4
- QURWXBZNHXJZBE-SKXRKSCCSA-N icatibant Chemical compound NC(N)=NCCC[C@@H](N)C(=O)N[C@@H](CCCN=C(N)N)C(=O)N1CCC[C@H]1C(=O)N1[C@H](C(=O)NCC(=O)N[C@@H](CC=2SC=CC=2)C(=O)N[C@@H](CO)C(=O)N2[C@H](CC3=CC=CC=C3C2)C(=O)N2[C@@H](C[C@@H]3CCCC[C@@H]32)C(=O)N[C@@H](CCCN=C(N)N)C(O)=O)C[C@@H](O)C1 QURWXBZNHXJZBE-SKXRKSCCSA-N 0.000 description 4
- 239000002502 liposome Substances 0.000 description 4
- 238000003259 recombinant expression Methods 0.000 description 4
- 239000000523 sample Substances 0.000 description 4
- 241000894007 species Species 0.000 description 4
- DCXYFEDJOCDNAF-UHFFFAOYSA-N Asparagine Natural products OC(=O)C(N)CC(N)=O DCXYFEDJOCDNAF-UHFFFAOYSA-N 0.000 description 3
- 108091026890 Coding region Proteins 0.000 description 3
- 101150074155 DHFR gene Proteins 0.000 description 3
- 108020004414 DNA Proteins 0.000 description 3
- 101150072419 F12 gene Proteins 0.000 description 3
- 208000005139 Hereditary Angioedema Types I and II Diseases 0.000 description 3
- 108010054477 Immunoglobulin Fab Fragments Proteins 0.000 description 3
- 102000001706 Immunoglobulin Fab Fragments Human genes 0.000 description 3
- 102000012745 Immunoglobulin Subunits Human genes 0.000 description 3
- 108010079585 Immunoglobulin Subunits Proteins 0.000 description 3
- 102000010631 Kininogens Human genes 0.000 description 3
- 108010077861 Kininogens Proteins 0.000 description 3
- 241000124008 Mammalia Species 0.000 description 3
- 201000008736 Systemic mastocytosis Diseases 0.000 description 3
- 238000010521 absorption reaction Methods 0.000 description 3
- 238000009825 accumulation Methods 0.000 description 3
- 150000007513 acids Chemical class 0.000 description 3
- 235000009582 asparagine Nutrition 0.000 description 3
- 229960001230 asparagine Drugs 0.000 description 3
- 230000008901 benefit Effects 0.000 description 3
- 230000004071 biological effect Effects 0.000 description 3
- 230000015572 biosynthetic process Effects 0.000 description 3
- 230000008499 blood brain barrier function Effects 0.000 description 3
- 210000001218 blood-brain barrier Anatomy 0.000 description 3
- 238000006243 chemical reaction Methods 0.000 description 3
- 230000003247 decreasing effect Effects 0.000 description 3
- 230000007812 deficiency Effects 0.000 description 3
- 230000002950 deficient Effects 0.000 description 3
- 238000003745 diagnosis Methods 0.000 description 3
- 238000009826 distribution Methods 0.000 description 3
- 108010011867 ecallantide Proteins 0.000 description 3
- 239000003623 enhancer Substances 0.000 description 3
- 230000016784 immunoglobulin production Effects 0.000 description 3
- 238000000338 in vitro Methods 0.000 description 3
- 238000001727 in vivo Methods 0.000 description 3
- 239000004615 ingredient Substances 0.000 description 3
- 230000002401 inhibitory effect Effects 0.000 description 3
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 238000007918 intramuscular administration Methods 0.000 description 3
- VBGWSQKGUZHFPS-VGMMZINCSA-N kalbitor Chemical compound C([C@H]1C(=O)N[C@@H](CC(N)=O)C(=O)N[C@H](C(N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@H](C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CCC(N)=O)C(=O)N[C@@H]2C(=O)N[C@@H](CCC(O)=O)C(=O)N[C@@H](CCC(O)=O)C(=O)N[C@@H](CC=3C=CC=CC=3)C(=O)N[C@H](C(=O)N[C@@H](CC=3C=CC(O)=CC=3)C(=O)NCC(=O)NCC(=O)N[C@H]3CSSC[C@H](NC(=O)[C@@H]4CCCN4C(=O)CNC(=O)[C@H](CC(O)=O)NC(=O)[C@H](CC(O)=O)NC(=O)[C@H](C)NC(=O)[C@H](CCCCN)NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](C)NC(=O)[C@@H](NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](CO)NC(=O)[C@H](CC=4NC=NC=4)NC(=O)[C@H](CCSC)NC(=O)[C@H](C)NC(=O)[C@@H](N)CCC(O)=O)CSSC[C@H](NC(=O)[C@H](CCSC)NC(=O)[C@H](CCCCN)NC(=O)[C@H](CCCCN)NC(=O)[C@@H](NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](CC(C)C)NC(=O)[C@H](CO)NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CCC(N)=O)NC(=O)[C@H](CC(N)=O)NC(=O)CNC(=O)[C@H](CCC(O)=O)NC3=O)CSSC2)C(=O)N[C@@H]([C@H](C)O)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CC(O)=O)C(O)=O)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](C)C(=O)N[C@@H](C)C(=O)N[C@@H](CC=2NC=NC=2)C(=O)N2CCC[C@H]2C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CC=2C3=CC=CC=C3NC=2)C(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N1)[C@@H](C)CC)[C@H](C)O)=O)[C@@H](C)CC)C1=CC=CC=C1 VBGWSQKGUZHFPS-VGMMZINCSA-N 0.000 description 3
- 230000000670 limiting effect Effects 0.000 description 3
- 208000008585 mastocytosis Diseases 0.000 description 3
- 230000001404 mediated effect Effects 0.000 description 3
- 230000004048 modification Effects 0.000 description 3
- 238000012986 modification Methods 0.000 description 3
- 231100000252 nontoxic Toxicity 0.000 description 3
- 230000003000 nontoxic effect Effects 0.000 description 3
- 239000000843 powder Substances 0.000 description 3
- 238000002360 preparation method Methods 0.000 description 3
- 230000000069 prophylactic effect Effects 0.000 description 3
- 230000001105 regulatory effect Effects 0.000 description 3
- 239000002904 solvent Substances 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- 238000011269 treatment regimen Methods 0.000 description 3
- NFGXHKASABOEEW-UHFFFAOYSA-N 1-methylethyl 11-methoxy-3,7,11-trimethyl-2,4-dodecadienoate Chemical compound COC(C)(C)CCCC(C)CC=CC(C)=CC(=O)OC(C)C NFGXHKASABOEEW-UHFFFAOYSA-N 0.000 description 2
- 206010002198 Anaphylactic reaction Diseases 0.000 description 2
- 108010039627 Aprotinin Proteins 0.000 description 2
- 101710085045 B2 bradykinin receptor Proteins 0.000 description 2
- 206010008190 Cerebrovascular accident Diseases 0.000 description 2
- 108020004705 Codon Proteins 0.000 description 2
- 241000699802 Cricetulus griseus Species 0.000 description 2
- 102100024746 Dihydrofolate reductase Human genes 0.000 description 2
- 238000002965 ELISA Methods 0.000 description 2
- 241000588724 Escherichia coli Species 0.000 description 2
- 229940122601 Esterase inhibitor Drugs 0.000 description 2
- DHMQDGOQFOQNFH-UHFFFAOYSA-N Glycine Chemical compound NCC(O)=O DHMQDGOQFOQNFH-UHFFFAOYSA-N 0.000 description 2
- 241000282575 Gorilla Species 0.000 description 2
- 206010019233 Headaches Diseases 0.000 description 2
- 208000000998 Hereditary Angioedema Type III Diseases 0.000 description 2
- 102000008394 Immunoglobulin Fragments Human genes 0.000 description 2
- 108010021625 Immunoglobulin Fragments Proteins 0.000 description 2
- 108700005091 Immunoglobulin Genes Proteins 0.000 description 2
- DCXYFEDJOCDNAF-REOHCLBHSA-N L-asparagine Chemical compound OC(=O)[C@@H](N)CC(N)=O DCXYFEDJOCDNAF-REOHCLBHSA-N 0.000 description 2
- AGPKZVBTJJNPAG-WHFBIAKZSA-N L-isoleucine Chemical compound CC[C@H](C)[C@H](N)C(O)=O AGPKZVBTJJNPAG-WHFBIAKZSA-N 0.000 description 2
- COLNVLDHVKWLRT-QMMMGPOBSA-N L-phenylalanine Chemical compound OC(=O)[C@@H](N)CC1=CC=CC=C1 COLNVLDHVKWLRT-QMMMGPOBSA-N 0.000 description 2
- AYFVYJQAPQTCCC-GBXIJSLDSA-N L-threonine Chemical compound C[C@@H](O)[C@H](N)C(O)=O AYFVYJQAPQTCCC-GBXIJSLDSA-N 0.000 description 2
- QIVBCDIJIAJPQS-VIFPVBQESA-N L-tryptophane Chemical compound C1=CC=C2C(C[C@H](N)C(O)=O)=CNC2=C1 QIVBCDIJIAJPQS-VIFPVBQESA-N 0.000 description 2
- OUYCCCASQSFEME-QMMMGPOBSA-N L-tyrosine Chemical compound OC(=O)[C@@H](N)CC1=CC=C(O)C=C1 OUYCCCASQSFEME-QMMMGPOBSA-N 0.000 description 2
- KZSNJWFQEVHDMF-BYPYZUCNSA-N L-valine Chemical compound CC(C)[C@H](N)C(O)=O KZSNJWFQEVHDMF-BYPYZUCNSA-N 0.000 description 2
- 241000699670 Mus sp. Species 0.000 description 2
- 108091028043 Nucleic acid sequence Proteins 0.000 description 2
- 241000283973 Oryctolagus cuniculus Species 0.000 description 2
- 241000282576 Pan paniscus Species 0.000 description 2
- 206010035226 Plasma cell myeloma Diseases 0.000 description 2
- 108010076504 Protein Sorting Signals Proteins 0.000 description 2
- 208000017442 Retinal disease Diseases 0.000 description 2
- 206010038923 Retinopathy Diseases 0.000 description 2
- 101150054830 S100A6 gene Proteins 0.000 description 2
- AYFVYJQAPQTCCC-UHFFFAOYSA-N Threonine Natural products CC(O)C(N)C(O)=O AYFVYJQAPQTCCC-UHFFFAOYSA-N 0.000 description 2
- 239000004473 Threonine Substances 0.000 description 2
- QIVBCDIJIAJPQS-UHFFFAOYSA-N Tryptophan Natural products C1=CC=C2C(CC(N)C(O)=O)=CNC2=C1 QIVBCDIJIAJPQS-UHFFFAOYSA-N 0.000 description 2
- KZSNJWFQEVHDMF-UHFFFAOYSA-N Valine Natural products CC(C)C(N)C(O)=O KZSNJWFQEVHDMF-UHFFFAOYSA-N 0.000 description 2
- 230000002159 abnormal effect Effects 0.000 description 2
- 230000005856 abnormality Effects 0.000 description 2
- 230000036783 anaphylactic response Effects 0.000 description 2
- 208000003455 anaphylaxis Diseases 0.000 description 2
- 208000007474 aortic aneurysm Diseases 0.000 description 2
- 239000007864 aqueous solution Substances 0.000 description 2
- 230000001580 bacterial effect Effects 0.000 description 2
- 210000004204 blood vessel Anatomy 0.000 description 2
- 239000000872 buffer Substances 0.000 description 2
- 230000000747 cardiac effect Effects 0.000 description 2
- 208000026106 cerebrovascular disease Diseases 0.000 description 2
- 230000008859 change Effects 0.000 description 2
- 238000003776 cleavage reaction Methods 0.000 description 2
- 230000007012 clinical effect Effects 0.000 description 2
- 238000000576 coating method Methods 0.000 description 2
- 230000002860 competitive effect Effects 0.000 description 2
- 230000004540 complement-dependent cytotoxicity Effects 0.000 description 2
- 239000012141 concentrate Substances 0.000 description 2
- 238000013270 controlled release Methods 0.000 description 2
- 230000002596 correlated effect Effects 0.000 description 2
- CVSVTCORWBXHQV-UHFFFAOYSA-N creatine Chemical compound NC(=[NH2+])N(C)CC([O-])=O CVSVTCORWBXHQV-UHFFFAOYSA-N 0.000 description 2
- 230000003013 cytotoxicity Effects 0.000 description 2
- 231100000135 cytotoxicity Toxicity 0.000 description 2
- 230000034994 death Effects 0.000 description 2
- 231100000517 death Toxicity 0.000 description 2
- 238000012217 deletion Methods 0.000 description 2
- 230000037430 deletion Effects 0.000 description 2
- 108020001096 dihydrofolate reductase Proteins 0.000 description 2
- 239000002612 dispersion medium Substances 0.000 description 2
- 231100000673 dose–response relationship Toxicity 0.000 description 2
- 238000012377 drug delivery Methods 0.000 description 2
- 229960001174 ecallantide Drugs 0.000 description 2
- 230000002255 enzymatic effect Effects 0.000 description 2
- 239000002329 esterase inhibitor Substances 0.000 description 2
- 229940050762 firazyr Drugs 0.000 description 2
- 239000004023 fresh frozen plasma Substances 0.000 description 2
- 125000003147 glycosyl group Chemical group 0.000 description 2
- 239000001963 growth medium Substances 0.000 description 2
- 231100000869 headache Toxicity 0.000 description 2
- 230000036541 health Effects 0.000 description 2
- 210000003958 hematopoietic stem cell Anatomy 0.000 description 2
- 238000009396 hybridization Methods 0.000 description 2
- 108700023918 icatibant Proteins 0.000 description 2
- 229960001062 icatibant Drugs 0.000 description 2
- 208000013601 idiopathic anaphylaxis Diseases 0.000 description 2
- 230000028993 immune response Effects 0.000 description 2
- 230000002163 immunogen Effects 0.000 description 2
- 230000009851 immunogenic response Effects 0.000 description 2
- 229940072221 immunoglobulins Drugs 0.000 description 2
- 239000007943 implant Substances 0.000 description 2
- 208000015181 infectious disease Diseases 0.000 description 2
- 230000003993 interaction Effects 0.000 description 2
- 238000007912 intraperitoneal administration Methods 0.000 description 2
- AGPKZVBTJJNPAG-UHFFFAOYSA-N isoleucine Natural products CCC(C)C(N)C(O)=O AGPKZVBTJJNPAG-UHFFFAOYSA-N 0.000 description 2
- 229960000310 isoleucine Drugs 0.000 description 2
- 230000002045 lasting effect Effects 0.000 description 2
- 239000007788 liquid Substances 0.000 description 2
- 239000006193 liquid solution Substances 0.000 description 2
- 206010025135 lupus erythematosus Diseases 0.000 description 2
- 239000011159 matrix material Substances 0.000 description 2
- 238000002483 medication Methods 0.000 description 2
- 229960000485 methotrexate Drugs 0.000 description 2
- 235000013336 milk Nutrition 0.000 description 2
- 239000008267 milk Substances 0.000 description 2
- 210000004080 milk Anatomy 0.000 description 2
- 230000003278 mimic effect Effects 0.000 description 2
- 238000000302 molecular modelling Methods 0.000 description 2
- 201000000050 myeloid neoplasm Diseases 0.000 description 2
- 239000013642 negative control Substances 0.000 description 2
- 210000001672 ovary Anatomy 0.000 description 2
- 230000037361 pathway Effects 0.000 description 2
- 230000002093 peripheral effect Effects 0.000 description 2
- 238000002823 phage display Methods 0.000 description 2
- COLNVLDHVKWLRT-UHFFFAOYSA-N phenylalanine Natural products OC(=O)C(N)CC1=CC=CC=C1 COLNVLDHVKWLRT-UHFFFAOYSA-N 0.000 description 2
- 125000002467 phosphate group Chemical group [H]OP(=O)(O[H])O[*] 0.000 description 2
- 229940126155 plasma kallikrein inhibitor Drugs 0.000 description 2
- 108091033319 polynucleotide Proteins 0.000 description 2
- 102000040430 polynucleotide Human genes 0.000 description 2
- 239000002157 polynucleotide Substances 0.000 description 2
- 230000003389 potentiating effect Effects 0.000 description 2
- 230000002035 prolonged effect Effects 0.000 description 2
- 230000010076 replication Effects 0.000 description 2
- 206010039073 rheumatoid arthritis Diseases 0.000 description 2
- 230000007017 scission Effects 0.000 description 2
- 230000000087 stabilizing effect Effects 0.000 description 2
- 238000010254 subcutaneous injection Methods 0.000 description 2
- 239000007929 subcutaneous injection Substances 0.000 description 2
- QAOWNCQODCNURD-UHFFFAOYSA-L sulfate group Chemical group S(=O)(=O)([O-])[O-] QAOWNCQODCNURD-UHFFFAOYSA-L 0.000 description 2
- 238000003786 synthesis reaction Methods 0.000 description 2
- 230000009885 systemic effect Effects 0.000 description 2
- 238000012360 testing method Methods 0.000 description 2
- 230000004797 therapeutic response Effects 0.000 description 2
- OUYCCCASQSFEME-UHFFFAOYSA-N tyrosine Natural products OC(=O)C(N)CC1=CC=C(O)C=C1 OUYCCCASQSFEME-UHFFFAOYSA-N 0.000 description 2
- 239000004474 valine Substances 0.000 description 2
- UCTWMZQNUQWSLP-VIFPVBQESA-N (R)-adrenaline Chemical compound CNC[C@H](O)C1=CC=C(O)C(O)=C1 UCTWMZQNUQWSLP-VIFPVBQESA-N 0.000 description 1
- 229930182837 (R)-adrenaline Natural products 0.000 description 1
- IIZPXYDJLKNOIY-JXPKJXOSSA-N 1-palmitoyl-2-arachidonoyl-sn-glycero-3-phosphocholine Chemical compound CCCCCCCCCCCCCCCC(=O)OC[C@H](COP([O-])(=O)OCC[N+](C)(C)C)OC(=O)CCC\C=C/C\C=C/C\C=C/C\C=C/CCCCC IIZPXYDJLKNOIY-JXPKJXOSSA-N 0.000 description 1
- JKMHFZQWWAIEOD-UHFFFAOYSA-N 2-[4-(2-hydroxyethyl)piperazin-1-yl]ethanesulfonic acid Chemical compound OCC[NH+]1CCN(CCS([O-])(=O)=O)CC1 JKMHFZQWWAIEOD-UHFFFAOYSA-N 0.000 description 1
- FWMNVWWHGCHHJJ-SKKKGAJSSA-N 4-amino-1-[(2r)-6-amino-2-[[(2r)-2-[[(2r)-2-[[(2r)-2-amino-3-phenylpropanoyl]amino]-3-phenylpropanoyl]amino]-4-methylpentanoyl]amino]hexanoyl]piperidine-4-carboxylic acid Chemical compound C([C@H](C(=O)N[C@H](CC(C)C)C(=O)N[C@H](CCCCN)C(=O)N1CCC(N)(CC1)C(O)=O)NC(=O)[C@H](N)CC=1C=CC=CC=1)C1=CC=CC=C1 FWMNVWWHGCHHJJ-SKKKGAJSSA-N 0.000 description 1
- 208000004998 Abdominal Pain Diseases 0.000 description 1
- NLZUEZXRPGMBCV-UHFFFAOYSA-N Butylhydroxytoluene Chemical compound CC1=CC(C(C)(C)C)=C(O)C(C(C)(C)C)=C1 NLZUEZXRPGMBCV-UHFFFAOYSA-N 0.000 description 1
- 240000001546 Byrsonima crassifolia Species 0.000 description 1
- 235000003197 Byrsonima crassifolia Nutrition 0.000 description 1
- 125000001433 C-terminal amino-acid group Chemical group 0.000 description 1
- 201000007120 C1 inhibitor deficiency Diseases 0.000 description 1
- OYPRJOBELJOOCE-UHFFFAOYSA-N Calcium Chemical compound [Ca] OYPRJOBELJOOCE-UHFFFAOYSA-N 0.000 description 1
- 241000282693 Cercopithecidae Species 0.000 description 1
- 206010009900 Colitis ulcerative Diseases 0.000 description 1
- 102000008186 Collagen Human genes 0.000 description 1
- 108010035532 Collagen Proteins 0.000 description 1
- 208000035473 Communicable disease Diseases 0.000 description 1
- 108010069112 Complement System Proteins Proteins 0.000 description 1
- 102000000989 Complement System Proteins Human genes 0.000 description 1
- 208000011231 Crohn disease Diseases 0.000 description 1
- 101710112752 Cytotoxin Proteins 0.000 description 1
- 241001429719 Daubentonia madagascariensis Species 0.000 description 1
- 241001416561 Daubentoniidae Species 0.000 description 1
- 208000005156 Dehydration Diseases 0.000 description 1
- 206010012688 Diabetic retinal oedema Diseases 0.000 description 1
- 206010012735 Diarrhoea Diseases 0.000 description 1
- HJEINPVZRDJRBY-UHFFFAOYSA-N Disul Chemical group OS(=O)(=O)OCCOC1=CC=C(Cl)C=C1Cl HJEINPVZRDJRBY-UHFFFAOYSA-N 0.000 description 1
- 241000196324 Embryophyta Species 0.000 description 1
- 108010062466 Enzyme Precursors Proteins 0.000 description 1
- 102000010911 Enzyme Precursors Human genes 0.000 description 1
- YQYJSBFKSSDGFO-UHFFFAOYSA-N Epihygromycin Natural products OC1C(O)C(C(=O)C)OC1OC(C(=C1)O)=CC=C1C=C(C)C(=O)NC1C(O)C(O)C2OCOC2C1O YQYJSBFKSSDGFO-UHFFFAOYSA-N 0.000 description 1
- 206010015216 Erythema marginatum Diseases 0.000 description 1
- 108010008177 Fd immunoglobulins Proteins 0.000 description 1
- 238000012413 Fluorescence activated cell sorting analysis Methods 0.000 description 1
- 108010010803 Gelatin Proteins 0.000 description 1
- 208000034826 Genetic Predisposition to Disease Diseases 0.000 description 1
- WHUUTDBJXJRKMK-UHFFFAOYSA-N Glutamic acid Natural products OC(=O)C(N)CCC(O)=O WHUUTDBJXJRKMK-UHFFFAOYSA-N 0.000 description 1
- 239000004471 Glycine Substances 0.000 description 1
- 239000007995 HEPES buffer Substances 0.000 description 1
- 241000590002 Helicobacter pylori Species 0.000 description 1
- 101000690301 Homo sapiens Aldo-keto reductase family 1 member C4 Proteins 0.000 description 1
- 101001081555 Homo sapiens Plasma protease C1 inhibitor Proteins 0.000 description 1
- 101001116548 Homo sapiens Protein CBFA2T1 Proteins 0.000 description 1
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 description 1
- 102000006496 Immunoglobulin Heavy Chains Human genes 0.000 description 1
- 108010019476 Immunoglobulin Heavy Chains Proteins 0.000 description 1
- 102000013463 Immunoglobulin Light Chains Human genes 0.000 description 1
- 108010065825 Immunoglobulin Light Chains Proteins 0.000 description 1
- 206010022086 Injection site pain Diseases 0.000 description 1
- 102000002397 Kinins Human genes 0.000 description 1
- 108010093008 Kinins Proteins 0.000 description 1
- XUJNEKJLAYXESH-REOHCLBHSA-N L-Cysteine Chemical compound SC[C@H](N)C(O)=O XUJNEKJLAYXESH-REOHCLBHSA-N 0.000 description 1
- ONIBWKKTOPOVIA-BYPYZUCNSA-N L-Proline Chemical compound OC(=O)[C@@H]1CCCN1 ONIBWKKTOPOVIA-BYPYZUCNSA-N 0.000 description 1
- QNAYBMKLOCPYGJ-REOHCLBHSA-N L-alanine Chemical compound C[C@H](N)C(O)=O QNAYBMKLOCPYGJ-REOHCLBHSA-N 0.000 description 1
- CKLJMWTZIZZHCS-REOHCLBHSA-N L-aspartic acid Chemical compound OC(=O)[C@@H](N)CC(O)=O CKLJMWTZIZZHCS-REOHCLBHSA-N 0.000 description 1
- WHUUTDBJXJRKMK-VKHMYHEASA-N L-glutamic acid Chemical compound OC(=O)[C@@H](N)CCC(O)=O WHUUTDBJXJRKMK-VKHMYHEASA-N 0.000 description 1
- ZDXPYRJPNDTMRX-VKHMYHEASA-N L-glutamine Chemical compound OC(=O)[C@@H](N)CCC(N)=O ZDXPYRJPNDTMRX-VKHMYHEASA-N 0.000 description 1
- ROHFNLRQFUQHCH-YFKPBYRVSA-N L-leucine Chemical compound CC(C)C[C@H](N)C(O)=O ROHFNLRQFUQHCH-YFKPBYRVSA-N 0.000 description 1
- FFEARJCKVFRZRR-BYPYZUCNSA-N L-methionine Chemical compound CSCC[C@H](N)C(O)=O FFEARJCKVFRZRR-BYPYZUCNSA-N 0.000 description 1
- FBOZXECLQNJBKD-ZDUSSCGKSA-N L-methotrexate Chemical compound C=1N=C2N=C(N)N=C(N)C2=NC=1CN(C)C1=CC=C(C(=O)N[C@@H](CCC(O)=O)C(O)=O)C=C1 FBOZXECLQNJBKD-ZDUSSCGKSA-N 0.000 description 1
- 241000288903 Lemuridae Species 0.000 description 1
- ROHFNLRQFUQHCH-UHFFFAOYSA-N Leucine Natural products CC(C)CC(N)C(O)=O ROHFNLRQFUQHCH-UHFFFAOYSA-N 0.000 description 1
- KDXKERNSBIXSRK-UHFFFAOYSA-N Lysine Natural products NCCCCC(N)C(O)=O KDXKERNSBIXSRK-UHFFFAOYSA-N 0.000 description 1
- 239000004472 Lysine Substances 0.000 description 1
- 102100033320 Lysosomal Pro-X carboxypeptidase Human genes 0.000 description 1
- FYYHWMGAXLPEAU-UHFFFAOYSA-N Magnesium Chemical compound [Mg] FYYHWMGAXLPEAU-UHFFFAOYSA-N 0.000 description 1
- MBBZMMPHUWSWHV-BDVNFPICSA-N N-methylglucamine Chemical compound CNC[C@H](O)[C@@H](O)[C@H](O)[C@H](O)CO MBBZMMPHUWSWHV-BDVNFPICSA-N 0.000 description 1
- 241001045988 Neogene Species 0.000 description 1
- 241000282579 Pan Species 0.000 description 1
- 241000282577 Pan troglodytes Species 0.000 description 1
- 102000057297 Pepsin A Human genes 0.000 description 1
- 108090000284 Pepsin A Proteins 0.000 description 1
- 206010057249 Phagocytosis Diseases 0.000 description 1
- 206010034829 Pharyngeal oedema Diseases 0.000 description 1
- 241000235648 Pichia Species 0.000 description 1
- 102100034869 Plasma kallikrein Human genes 0.000 description 1
- 229920002732 Polyanhydride Polymers 0.000 description 1
- 229920000954 Polyglycolide Polymers 0.000 description 1
- 229920001710 Polyorthoester Polymers 0.000 description 1
- ZLMJMSJWJFRBEC-UHFFFAOYSA-N Potassium Chemical compound [K] ZLMJMSJWJFRBEC-UHFFFAOYSA-N 0.000 description 1
- ONIBWKKTOPOVIA-UHFFFAOYSA-N Proline Natural products OC(=O)C1CCCN1 ONIBWKKTOPOVIA-UHFFFAOYSA-N 0.000 description 1
- 108010026552 Proteome Proteins 0.000 description 1
- 201000004681 Psoriasis Diseases 0.000 description 1
- 201000001263 Psoriatic Arthritis Diseases 0.000 description 1
- 208000036824 Psoriatic arthropathy Diseases 0.000 description 1
- 206010037884 Rash pruritic Diseases 0.000 description 1
- 241000235070 Saccharomyces Species 0.000 description 1
- 206010040047 Sepsis Diseases 0.000 description 1
- 102000012479 Serine Proteases Human genes 0.000 description 1
- 108010022999 Serine Proteases Proteins 0.000 description 1
- 208000006011 Stroke Diseases 0.000 description 1
- 238000000692 Student's t-test Methods 0.000 description 1
- 208000004732 Systemic Vasculitis Diseases 0.000 description 1
- 241000288942 Tarsiidae Species 0.000 description 1
- 101710120037 Toxin CcdB Proteins 0.000 description 1
- 108700019146 Transgenes Proteins 0.000 description 1
- 108090000631 Trypsin Proteins 0.000 description 1
- 102000004142 Trypsin Human genes 0.000 description 1
- 201000006704 Ulcerative Colitis Diseases 0.000 description 1
- 206010047115 Vasculitis Diseases 0.000 description 1
- 206010047700 Vomiting Diseases 0.000 description 1
- 240000008042 Zea mays Species 0.000 description 1
- 235000005824 Zea mays ssp. parviglumis Nutrition 0.000 description 1
- 235000002017 Zea mays subsp mays Nutrition 0.000 description 1
- 208000002223 abdominal aortic aneurysm Diseases 0.000 description 1
- 208000020560 abdominal swelling Diseases 0.000 description 1
- 230000001594 aberrant effect Effects 0.000 description 1
- 230000002378 acidificating effect Effects 0.000 description 1
- 230000009471 action Effects 0.000 description 1
- 239000004480 active ingredient Substances 0.000 description 1
- 239000013543 active substance Substances 0.000 description 1
- 238000001042 affinity chromatography Methods 0.000 description 1
- 230000009824 affinity maturation Effects 0.000 description 1
- 235000004279 alanine Nutrition 0.000 description 1
- 125000001931 aliphatic group Chemical group 0.000 description 1
- 229910052784 alkaline earth metal Inorganic materials 0.000 description 1
- 150000001342 alkaline earth metals Chemical class 0.000 description 1
- 150000001412 amines Chemical class 0.000 description 1
- 230000003321 amplification Effects 0.000 description 1
- 239000003708 ampul Substances 0.000 description 1
- 239000003098 androgen Substances 0.000 description 1
- 238000010171 animal model Methods 0.000 description 1
- 239000003242 anti bacterial agent Substances 0.000 description 1
- 230000000844 anti-bacterial effect Effects 0.000 description 1
- 239000003146 anticoagulant agent Substances 0.000 description 1
- 229940127219 anticoagulant drug Drugs 0.000 description 1
- 229940121375 antifungal agent Drugs 0.000 description 1
- 239000003429 antifungal agent Substances 0.000 description 1
- 229940125715 antihistaminic agent Drugs 0.000 description 1
- 239000000739 antihistaminic agent Substances 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- ZPNFWUPYTFPOJU-MPSLMFKFSA-N aprotinin Chemical compound CC[C@H](C)[C@@H]1NC(=O)[C@@H](CCCNC(N)=N)NC(=O)[C@@H](C)NC(=O)[C@H](CCCCN)NC(=O)[C@@H]2CSSC[C@H]3NC(=O)CNC(=O)CNC(=O)[C@H](Cc4ccc(O)cc4)NC(=O)[C@H](NC(=O)[C@H](Cc4ccccc4)NC(=O)[C@@H](NC(=O)[C@H](CCC(N)=O)NC(=O)[C@@H](CSSC[C@@H](NC(=O)[C@H](CC(O)=O)NC(=O)[C@@H](CCC(O)=O)NC(=O)[C@H](C)NC(=O)[C@@H](CO)NC(=O)[C@H](CCCCN)NC(=O)[C@@H](Cc4ccccc4)NC(=O)[C@H](CC(N)=O)NC(=O)[C@@H](CC(N)=O)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@@H](CCCCN)NC(=O)[C@H](C)NC(=O)[C@H](CCCNC(N)=N)NC3=O)C(=O)N[C@H](CCSC)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@H](CSSC[C@@H](NC(=O)[C@H](Cc3ccccc3)NC(=O)[C@@H](CC(O)=O)NC(=O)[C@H]3CCCN3C(=O)[C@H](N)CCCNC(N)=N)C(=O)N[C@H](CC(C)C)C(=O)N[C@@H](CCC(O)=O)C(=O)N3CCC[C@@H]3C(=O)N3CCC[C@H]3C(=O)N[C@H](Cc3ccc(O)cc3)C(=O)N[C@H]([C@H](C)O)C(=O)NCC(=O)N3CCC[C@H]3C(=O)N2)C(=O)NCC(=O)NCC(=O)N[C@H](C)C(O)=O)NC(=O)[C@@H](CC(C)C)NC(=O)CNC(=O)[C@@H](C)NC(=O)[C@H](CCCCN)NC(=O)[C@@H](C)NC(=O)[C@H](CC(N)=O)NC(=O)[C@@H](Cc2ccc(O)cc2)NC(=O)[C@H](Cc2ccccc2)NC(=O)[C@@H](Cc2ccc(O)cc2)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@H](NC1=O)[C@H](C)CC)[C@@H](C)O)C(C)C ZPNFWUPYTFPOJU-MPSLMFKFSA-N 0.000 description 1
- 229960004405 aprotinin Drugs 0.000 description 1
- 159000000032 aromatic acids Chemical class 0.000 description 1
- 125000003118 aryl group Chemical group 0.000 description 1
- 230000001174 ascending effect Effects 0.000 description 1
- 150000001508 asparagines Chemical class 0.000 description 1
- 235000003704 aspartic acid Nutrition 0.000 description 1
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 1
- 230000002238 attenuated effect Effects 0.000 description 1
- JUHORIMYRDESRB-UHFFFAOYSA-N benzathine Chemical compound C=1C=CC=CC=1CNCCNCC1=CC=CC=C1 JUHORIMYRDESRB-UHFFFAOYSA-N 0.000 description 1
- 229940075791 berinert Drugs 0.000 description 1
- OQFSQFPPLPISGP-UHFFFAOYSA-N beta-carboxyaspartic acid Natural products OC(=O)C(N)C(C(O)=O)C(O)=O OQFSQFPPLPISGP-UHFFFAOYSA-N 0.000 description 1
- 229920000249 biocompatible polymer Polymers 0.000 description 1
- 230000023555 blood coagulation Effects 0.000 description 1
- 238000009534 blood test Methods 0.000 description 1
- DQXBYHZEEUGOBF-UHFFFAOYSA-N but-3-enoic acid;ethene Chemical compound C=C.OC(=O)CC=C DQXBYHZEEUGOBF-UHFFFAOYSA-N 0.000 description 1
- 210000004899 c-terminal region Anatomy 0.000 description 1
- 229910052791 calcium Inorganic materials 0.000 description 1
- 239000011575 calcium Substances 0.000 description 1
- 239000001506 calcium phosphate Substances 0.000 description 1
- 229910000389 calcium phosphate Inorganic materials 0.000 description 1
- 235000011010 calcium phosphates Nutrition 0.000 description 1
- 238000004364 calculation method Methods 0.000 description 1
- 125000001314 canonical amino-acid group Chemical group 0.000 description 1
- 230000003197 catalytic effect Effects 0.000 description 1
- 239000013592 cell lysate Substances 0.000 description 1
- 230000001413 cellular effect Effects 0.000 description 1
- VDANGULDQQJODZ-UHFFFAOYSA-N chloroprocaine Chemical compound CCN(CC)CCOC(=O)C1=CC=C(N)C=C1Cl VDANGULDQQJODZ-UHFFFAOYSA-N 0.000 description 1
- 229960002023 chloroprocaine Drugs 0.000 description 1
- OEYIOHPDSNJKLS-UHFFFAOYSA-N choline Chemical compound C[N+](C)(C)CCO OEYIOHPDSNJKLS-UHFFFAOYSA-N 0.000 description 1
- 229960001231 choline Drugs 0.000 description 1
- 229940088949 cinryze Drugs 0.000 description 1
- GKTWGGQPFAXNFI-HNNXBMFYSA-N clopidogrel Chemical compound C1([C@H](N2CC=3C=CSC=3CC2)C(=O)OC)=CC=CC=C1Cl GKTWGGQPFAXNFI-HNNXBMFYSA-N 0.000 description 1
- 230000015271 coagulation Effects 0.000 description 1
- 238000005345 coagulation Methods 0.000 description 1
- 239000011248 coating agent Substances 0.000 description 1
- 229920001436 collagen Polymers 0.000 description 1
- 238000002648 combination therapy Methods 0.000 description 1
- 230000004154 complement system Effects 0.000 description 1
- 238000013329 compounding Methods 0.000 description 1
- 108700005721 conestat alfa Proteins 0.000 description 1
- 238000010276 construction Methods 0.000 description 1
- 230000001276 controlling effect Effects 0.000 description 1
- 238000007796 conventional method Methods 0.000 description 1
- 235000005822 corn Nutrition 0.000 description 1
- 229960003624 creatine Drugs 0.000 description 1
- 239000006046 creatine Substances 0.000 description 1
- 238000011461 current therapy Methods 0.000 description 1
- 235000018417 cysteine Nutrition 0.000 description 1
- XUJNEKJLAYXESH-UHFFFAOYSA-N cysteine Natural products SCC(N)C(O)=O XUJNEKJLAYXESH-UHFFFAOYSA-N 0.000 description 1
- 229940127089 cytotoxic agent Drugs 0.000 description 1
- 239000002254 cytotoxic agent Substances 0.000 description 1
- 231100000599 cytotoxic agent Toxicity 0.000 description 1
- 239000002619 cytotoxin Substances 0.000 description 1
- POZRVZJJTULAOH-LHZXLZLDSA-N danazol Chemical compound C1[C@]2(C)[C@H]3CC[C@](C)([C@](CC4)(O)C#C)[C@@H]4[C@@H]3CCC2=CC2=C1C=NO2 POZRVZJJTULAOH-LHZXLZLDSA-N 0.000 description 1
- 229960000766 danazol Drugs 0.000 description 1
- 230000018044 dehydration Effects 0.000 description 1
- 238000006297 dehydration reaction Methods 0.000 description 1
- 230000001934 delay Effects 0.000 description 1
- 230000006866 deterioration Effects 0.000 description 1
- 201000011190 diabetic macular edema Diseases 0.000 description 1
- 238000000502 dialysis Methods 0.000 description 1
- 150000001991 dicarboxylic acids Chemical class 0.000 description 1
- ZBCBWPMODOFKDW-UHFFFAOYSA-N diethanolamine Chemical compound OCCNCCO ZBCBWPMODOFKDW-UHFFFAOYSA-N 0.000 description 1
- 229940043237 diethanolamine Drugs 0.000 description 1
- 230000029087 digestion Effects 0.000 description 1
- OZRNSSUDZOLUSN-LBPRGKRZSA-N dihydrofolic acid Chemical compound N=1C=2C(=O)NC(N)=NC=2NCC=1CNC1=CC=C(C(=O)N[C@@H](CCC(O)=O)C(O)=O)C=C1 OZRNSSUDZOLUSN-LBPRGKRZSA-N 0.000 description 1
- 229940042399 direct acting antivirals protease inhibitors Drugs 0.000 description 1
- 238000010494 dissociation reaction Methods 0.000 description 1
- 230000005593 dissociations Effects 0.000 description 1
- 238000001647 drug administration Methods 0.000 description 1
- 239000003596 drug target Substances 0.000 description 1
- 230000002526 effect on cardiovascular system Effects 0.000 description 1
- 230000001516 effect on protein Effects 0.000 description 1
- 210000002889 endothelial cell Anatomy 0.000 description 1
- 229960005139 epinephrine Drugs 0.000 description 1
- 210000002919 epithelial cell Anatomy 0.000 description 1
- 239000003797 essential amino acid Substances 0.000 description 1
- 235000020776 essential amino acid Nutrition 0.000 description 1
- 239000005038 ethylene vinyl acetate Substances 0.000 description 1
- 210000003527 eukaryotic cell Anatomy 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 238000001704 evaporation Methods 0.000 description 1
- 230000008020 evaporation Effects 0.000 description 1
- 238000000855 fermentation Methods 0.000 description 1
- 230000004151 fermentation Effects 0.000 description 1
- 239000011888 foil Substances 0.000 description 1
- 230000037433 frameshift Effects 0.000 description 1
- 238000002825 functional assay Methods 0.000 description 1
- 210000001035 gastrointestinal tract Anatomy 0.000 description 1
- 239000000499 gel Substances 0.000 description 1
- 229920000159 gelatin Polymers 0.000 description 1
- 239000008273 gelatin Substances 0.000 description 1
- 235000019322 gelatine Nutrition 0.000 description 1
- 235000011852 gelatine desserts Nutrition 0.000 description 1
- 230000014509 gene expression Effects 0.000 description 1
- 230000002068 genetic effect Effects 0.000 description 1
- 238000010353 genetic engineering Methods 0.000 description 1
- 210000004392 genitalia Anatomy 0.000 description 1
- 210000004907 gland Anatomy 0.000 description 1
- 235000013922 glutamic acid Nutrition 0.000 description 1
- 239000004220 glutamic acid Substances 0.000 description 1
- ZDXPYRJPNDTMRX-UHFFFAOYSA-N glutamine Natural products OC(=O)C(N)CCC(N)=O ZDXPYRJPNDTMRX-UHFFFAOYSA-N 0.000 description 1
- 230000013595 glycosylation Effects 0.000 description 1
- 238000006206 glycosylation reaction Methods 0.000 description 1
- 229940037467 helicobacter pylori Drugs 0.000 description 1
- 102000054751 human RUNX1T1 Human genes 0.000 description 1
- 102000044507 human SERPING1 Human genes 0.000 description 1
- BHEPBYXIRTUNPN-UHFFFAOYSA-N hydridophosphorus(.) (triplet) Chemical compound [PH] BHEPBYXIRTUNPN-UHFFFAOYSA-N 0.000 description 1
- 150000002433 hydrophilic molecules Chemical class 0.000 description 1
- 125000002887 hydroxy group Chemical group [H]O* 0.000 description 1
- 230000009610 hypersensitivity Effects 0.000 description 1
- 230000001900 immune effect Effects 0.000 description 1
- 210000000987 immune system Anatomy 0.000 description 1
- 238000003018 immunoassay Methods 0.000 description 1
- 230000005847 immunogenicity Effects 0.000 description 1
- 238000000099 in vitro assay Methods 0.000 description 1
- 238000010874 in vitro model Methods 0.000 description 1
- 238000005462 in vivo assay Methods 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 230000002458 infectious effect Effects 0.000 description 1
- ZPNFWUPYTFPOJU-LPYSRVMUSA-N iniprol Chemical compound C([C@H]1C(=O)NCC(=O)NCC(=O)N[C@H]2CSSC[C@H]3C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@H](C(N[C@H](C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC=4C=CC=CC=4)C(=O)N[C@@H](CC=4C=CC(O)=CC=4)C(=O)N[C@@H](CC(N)=O)C(=O)N[C@@H](C)C(=O)N[C@@H](CCCCN)C(=O)N[C@@H](C)C(=O)NCC(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC(O)=O)NC(=O)[C@H](CCC(O)=O)NC(=O)[C@H](C)NC(=O)[C@H](CO)NC(=O)[C@H](CCCCN)NC(=O)[C@H](CC=4C=CC=CC=4)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CC(N)=O)NC(=O)[C@H](CCCNC(N)=N)NC(=O)[C@H](CCCCN)NC(=O)[C@H](C)NC(=O)[C@H](CCCNC(N)=N)NC2=O)C(=O)N[C@@H](CCSC)C(=O)N[C@@H](CCCNC(N)=N)C(=O)N[C@@H]([C@@H](C)O)C(=O)N[C@@H](CSSC[C@H](NC(=O)[C@H](CC=2C=CC=CC=2)NC(=O)[C@H](CC(O)=O)NC(=O)[C@H]2N(CCC2)C(=O)[C@@H](N)CCCNC(N)=N)C(=O)N[C@@H](CC(C)C)C(=O)N[C@@H](CCC(O)=O)C(=O)N2[C@@H](CCC2)C(=O)N2[C@@H](CCC2)C(=O)N[C@@H](CC=2C=CC(O)=CC=2)C(=O)N[C@@H]([C@@H](C)O)C(=O)NCC(=O)N2[C@@H](CCC2)C(=O)N3)C(=O)NCC(=O)NCC(=O)N[C@@H](C)C(O)=O)C(=O)N[C@@H](CCC(N)=O)C(=O)N[C@H](C(=O)N[C@@H](CC=2C=CC=CC=2)C(=O)N[C@H](C(=O)N1)C(C)C)[C@@H](C)O)[C@@H](C)CC)=O)[C@@H](C)CC)C1=CC=C(O)C=C1 ZPNFWUPYTFPOJU-LPYSRVMUSA-N 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 210000000936 intestine Anatomy 0.000 description 1
- 238000001361 intraarterial administration Methods 0.000 description 1
- 238000010255 intramuscular injection Methods 0.000 description 1
- 239000007927 intramuscular injection Substances 0.000 description 1
- 238000007913 intrathecal administration Methods 0.000 description 1
- 238000010253 intravenous injection Methods 0.000 description 1
- 238000011835 investigation Methods 0.000 description 1
- 238000005304 joining Methods 0.000 description 1
- 229940018902 kalbitor Drugs 0.000 description 1
- 229940039088 kininogenase Drugs 0.000 description 1
- 239000000787 lecithin Substances 0.000 description 1
- 229940067606 lecithin Drugs 0.000 description 1
- 235000010445 lecithin Nutrition 0.000 description 1
- 239000003446 ligand Substances 0.000 description 1
- 238000012417 linear regression Methods 0.000 description 1
- 239000008297 liquid dosage form Substances 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 230000000527 lymphocytic effect Effects 0.000 description 1
- 108010057284 lysosomal Pro-X carboxypeptidase Proteins 0.000 description 1
- 229910052749 magnesium Inorganic materials 0.000 description 1
- 239000011777 magnesium Substances 0.000 description 1
- 238000011418 maintenance treatment Methods 0.000 description 1
- 206010025482 malaise Diseases 0.000 description 1
- 210000004962 mammalian cell Anatomy 0.000 description 1
- 230000005541 medical transmission Effects 0.000 description 1
- 230000005906 menstruation Effects 0.000 description 1
- 229930182817 methionine Natural products 0.000 description 1
- 239000004530 micro-emulsion Substances 0.000 description 1
- 101150091879 neo gene Proteins 0.000 description 1
- 230000003472 neutralizing effect Effects 0.000 description 1
- 206010029410 night sweats Diseases 0.000 description 1
- 230000036565 night sweats Effects 0.000 description 1
- 238000003199 nucleic acid amplification method Methods 0.000 description 1
- 229920001542 oligosaccharide Polymers 0.000 description 1
- 150000002482 oligosaccharides Chemical class 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 150000007524 organic acids Chemical class 0.000 description 1
- 235000005985 organic acids Nutrition 0.000 description 1
- 230000002018 overexpression Effects 0.000 description 1
- 229910052760 oxygen Inorganic materials 0.000 description 1
- 239000001301 oxygen Substances 0.000 description 1
- 239000002245 particle Substances 0.000 description 1
- 244000052769 pathogen Species 0.000 description 1
- 230000008506 pathogenesis Effects 0.000 description 1
- 230000001575 pathological effect Effects 0.000 description 1
- 239000013610 patient sample Substances 0.000 description 1
- 229940111202 pepsin Drugs 0.000 description 1
- 239000000137 peptide hydrolase inhibitor Substances 0.000 description 1
- 210000001322 periplasm Anatomy 0.000 description 1
- 230000008782 phagocytosis Effects 0.000 description 1
- 239000006187 pill Substances 0.000 description 1
- 229920001200 poly(ethylene-vinyl acetate) Polymers 0.000 description 1
- 239000004633 polyglycolic acid Substances 0.000 description 1
- 238000013105 post hoc analysis Methods 0.000 description 1
- 230000001323 posttranslational effect Effects 0.000 description 1
- 239000011591 potassium Substances 0.000 description 1
- 229910052700 potassium Inorganic materials 0.000 description 1
- 239000000955 prescription drug Substances 0.000 description 1
- 230000003449 preventive effect Effects 0.000 description 1
- 125000002924 primary amino group Chemical group [H]N([H])* 0.000 description 1
- 229940025656 proin Drugs 0.000 description 1
- 108020003175 receptors Proteins 0.000 description 1
- 102000005962 receptors Human genes 0.000 description 1
- 238000010188 recombinant method Methods 0.000 description 1
- 230000000306 recurrent effect Effects 0.000 description 1
- 230000000717 retained effect Effects 0.000 description 1
- 238000012216 screening Methods 0.000 description 1
- 239000008299 semisolid dosage form Substances 0.000 description 1
- 230000035945 sensitivity Effects 0.000 description 1
- 230000035939 shock Effects 0.000 description 1
- 150000003384 small molecules Chemical class 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
- 229910052708 sodium Inorganic materials 0.000 description 1
- 239000007909 solid dosage form Substances 0.000 description 1
- 210000001082 somatic cell Anatomy 0.000 description 1
- 238000004611 spectroscopical analysis Methods 0.000 description 1
- 230000002269 spontaneous effect Effects 0.000 description 1
- 238000000528 statistical test Methods 0.000 description 1
- 239000008223 sterile water Substances 0.000 description 1
- 230000001954 sterilising effect Effects 0.000 description 1
- 238000004659 sterilization and disinfection Methods 0.000 description 1
- 150000003431 steroids Chemical class 0.000 description 1
- 230000004936 stimulating effect Effects 0.000 description 1
- 230000000153 supplemental effect Effects 0.000 description 1
- 239000000829 suppository Substances 0.000 description 1
- 238000002198 surface plasmon resonance spectroscopy Methods 0.000 description 1
- 239000004094 surface-active agent Substances 0.000 description 1
- 239000000725 suspension Substances 0.000 description 1
- 230000002459 sustained effect Effects 0.000 description 1
- 238000013268 sustained release Methods 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 239000003826 tablet Substances 0.000 description 1
- 229940124597 therapeutic agent Drugs 0.000 description 1
- 230000001732 thrombotic effect Effects 0.000 description 1
- 230000036962 time dependent Effects 0.000 description 1
- 230000002110 toxicologic effect Effects 0.000 description 1
- 231100000759 toxicological effect Toxicity 0.000 description 1
- 238000001890 transfection Methods 0.000 description 1
- 229940108519 trasylol Drugs 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- QORWJWZARLRLPR-UHFFFAOYSA-H tricalcium bis(phosphate) Chemical compound [Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O QORWJWZARLRLPR-UHFFFAOYSA-H 0.000 description 1
- 239000012588 trypsin Substances 0.000 description 1
- 241000701161 unidentified adenovirus Species 0.000 description 1
- 238000001291 vacuum drying Methods 0.000 description 1
- 238000009777 vacuum freeze-drying Methods 0.000 description 1
- 210000005166 vasculature Anatomy 0.000 description 1
- 239000003981 vehicle Substances 0.000 description 1
- 230000003612 virological effect Effects 0.000 description 1
- 230000000007 visual effect Effects 0.000 description 1
- 230000008673 vomiting Effects 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Chemical compound O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 1
- 210000005253 yeast cell Anatomy 0.000 description 1
- NWONKYPBYAMBJT-UHFFFAOYSA-L zinc sulfate Chemical compound [Zn+2].[O-]S([O-])(=O)=O NWONKYPBYAMBJT-UHFFFAOYSA-L 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K39/00—Medicinal preparations containing antigens or antibodies
- A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P7/00—Drugs for disorders of the blood or the extracellular fluid
- A61P7/10—Antioedematous agents; Diuretics
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
- C07K16/40—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against enzymes
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
- C07K2317/21—Immunoglobulins specific features characterized by taxonomic origin from primates, e.g. man
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
- C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
- C07K2317/565—Complementarity determining region [CDR]
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
- C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
-
- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K2317/00—Immunoglobulins specific features
- C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
- C07K2317/94—Stability, e.g. half-life, pH, temperature or enzyme-resistance
Abstract
Provided herein are plasma kallikrein antibodies binding to active plasma kallikrein and methods of using such antibodies in preventing hereditary angioedema attack or reducing the rate of hereditary angioedema attack. A specific embodiment includes the use of the antibody DX-2930 in the manufacture of a medicament for preventing hereditary angioedema (HAE) attack or reducing the rate of HAE attack in a subject, wherein the antibody comprises a heavy chain CDRs 1-3 defined by SEQ ID Nos 5-7 and light chain CDRs defined by SEQ ID Nos 8-10 wherein the antibody is formulated in a pharmaceutically acceptable carrier wherein the medicament is to be administered at about 300 mg of the antibody every two to four weeks at least two times, and wherein the subject is a patient experiencing at least two HAE attacks per year prior to the administration.
Description
Provided herein are plasma rein antibodies binding to active plasma kallikrein and methods
of using such antibodies in preventing hereditary angioedema attack or reducing the rate of
hereditary angioedema attack. A specific embodiment includes the use of the dy DX-2930
in the manufacture of a ment for preventing hereditary angioedema (HAE) attack or
reducing the rate of HAE attack in a subject, wherein the antibody comprises a heavy chain CDRs
1-3 defined by SEQ ID Nos 5-7 and light chain CDRs defined by SEQ ID Nos 8-10 wherein the
antibody is formulated in a pharmaceutically acceptable carrier n the medicament is to
be administered at about 300 mg of the antibody every two to four weeks at least two times,
and wherein the subject is a patient experiencing at least two HAE attacks per year prior to the
administration.
NZ 735659
PLASMA KALLIKREIN TORS AND USES THEREOF FOR
PREVENTING HEREDITARYANGIOEDEMAATTACK
RELATED APPLICATIONS
This application claims the benefit under 35 U.S.C. § 119(e) of US. provisional
application number 62/140,277, filed March 30, 2015, US. provisional application
number 62/214,293, filed September 24, 2015 and US. ional application
number ,289, filed March 30, 2015, the content of each of which is herein
incorporated by nce in its entirety.
BACKGROUND
Plasma kallikrein is a serine protease component of the contact system and a
potential drug target for different in?ammatory, cardiovascular, infectious (sepsis)
and oncology es (Sainz I.M. et al., Thromb Haemost 98, 77—83, 2007). The
contact system is activated by either factor XIIa upon exposure to foreign or
negatively charged surfaces or on endothelial cell surfaces by
prolylcarboxypeptidases (Sainz I.M. et al., Thromb Haemost 98, 77—83, 2007).
Activation of the plasma kallikrein amplifies intrinsic coagulation via its feedback
activation of factor X11 and enhances in?ammation via the production of the
proin?ammatory nonapeptide bradykinin. As the primary kininogenase in the
circulation, plasma kallikrein is largely responsible for the generation of bradykinin in
the vasculature. A genetic deficiency in the C l—inhibitor protein (C l—INH), the major
natural inhibitor of plasma kallikrein, leads to hereditary angioedema (HAE). Patients
with HAE suffer from acute s of painful edema often precipitated by unknown
triggers (Zuraw B.L. et al., N Engl J Med 359, 1027—1036, 2008).
SUMMARY
The present disclosure is, in part, based on the results derived from clinical
studies showing that doses of 0, an dy binding to the active form of
human plasma kallikrein, (e.g., 30 mg, 100 mg, 300 mg or 400 mg stered every
two weeks) showed unexpected effectiveness in preventing HAE attack or reducing
the rate of HAE attack in human ts. Further, DX—2930 treatment did not show
evidence of dose—limiting ty when administered to humans. Overall, the results
obtained from the instant study were unexpected since DX-2930 is the first
completely ic plasma kallikrein inhibitor that has shown high efficacy in HAE
treatment. This demonstrates that plasma rein is central to disease pathogenesis.
Accordingly, in a first aspect, the present invention es the use of an antibody in
the manufacture of a medicament for preventing hereditary dema (HAE) attack or
reducing the rate of HAE attack in a subject, n the antibody comprises a heavy chain
(HC) complementarity determining region (CDR) 1 having the amino acid sequence HYIMM
(SEQ ID NO: 5), a HC CDR2 having the amino acid sequence GIYSSGGITVYADSVKG
(SEQ ID NO: 6), a HC CDR3 having the amino acid sequence RRIGVPRRDEFDI (SEQ ID
NO: 7), a light chain (LC) CDR1 having the amino acid sequence RASQSISSWLA (SEQ ID
NO: 8), a LC CDR2 having the amino acid sequence KASTLES (SEQ ID NO: 9), and a LC
CDR3 having the amino acid sequence QQYNTYWT (SEQ ID NO: 10), wherein the
antibody is formulated in a pharmaceutically acceptable carrier comprising sodium phosphate
at a concentration of 30 mM, citric acid, histidine at a concentration of 50 mM, sodium
chloride at a concentration of 90 mM, and polysorbate 80 at 0.01%, pH 6.0, wherein the
medicament is to be administered of the dy every two to four weeks at least two times,
and wherein the subject is a patient experiencing at least two HAE s per year prior to
the administration.
One aspect of the present disclosure features a method of preventing HAE attack or
reducing the rate of HAE attack (e.g., type I, II, or III HAE), the method comprising
administering to a subject in need thereof an antibody binding to the active form of human
plasma kallikrein (e.g., DX-2930) in an effective amount (e.g., about 30 mg -400 mg, about
100 mg – 400 mg, about 100 mg - 300 mg, or about 300 mg - 400 mg). In some
ments, the antibody is administered every two to four weeks for at least two times. In
some embodiments, the dy is administered at 300 mg or 400 mg every 2 weeks to four
weeks (e.g., every two weeks or every four weeks).
In any one of the methods described herein, the antibody can be administered by
subcutaneous administration. In some embodiments, the subject is a human t
experiencing at least two HAE attack per year (e.g., at least one HAE attack within 6 month
prior to the first administration, at least 2 HAE attacks within 3 months prior to the first
administration, or at least 9 HAE attacks within 3 months prior to the first administration).
The HAE can be type I HAE or type II HAE. For example, the method described herein is
for prophylactic treatment of HAE.
The antibody used in any of the methods described herein may be an antibody (e.g., a
ength antibody or an antigen-binding fragment) that binds the same epitope as DX-2930
or competes against DX-2930 for binding to active human plasma kallikrein. In some
ments, the antibody comprises the same heavy chain and light chain CDRs. In one
example, the antibody is DX-2930. Any of the antibody as described herein (e.g., DX-2930)
may be formulated in a pharmaceutical ition, which comprises a pharmaceutically
acceptable r. In some examples, the pharmaceutical composition comprises sodium
phosphate, citric acid, histidine, sodium chloride, and Tween 80. In one example, the
antibody (e.g., DX-2930) is formulated in 30 mM sodium phosphate, 8.6 mM citric acid, 50
mM histidine, 90 mM sodium chloride, and 0.01% Tween 80, pH 6.0.
In yet other aspects, the t disclosure features a method of treating HAE (e.g.,
type I, II, or III), the method comprising administering to a subject in need thereof an
antibody binding to the active form of human plasma kallikrein (e.g., DX-
2930) in an effective amount (e. g., 100—400 mg, 100—300 mg, 150 mg or 300 mg),
wherein the DX—2930 antibody is administered in a dosage regimen having a loading
period (e.g., first administered every week such as for at least one week), a
maintenance period (e. g., subsequently administered every two to four weeks), and
ally a —on period.
In some embodiments, the antibody is administered to the subject at 100 to
300 mg (e.g., 150 mg or 300 mg) during the loading period. The loading period may
be two weeks. The antibody may be administered at day 0, day 7, and day 14 at, e.g.,
150 mg or 300 mg.
Alternatively or in addition, the dy is administered to the subject at 100
to 300 mg (e.g., 150 mg or 300 mg) during the maintenance period. The maintenance
period may last for 10 weeks. The antibody can be administered at day 28, day 42,
day 56, day 70 and day 84.
In any of the methods described herein, the method may further comprise
administering to the subject the antibody after the maintenance period once every two
to four weeks (e.g., every two weeks or every four weeks). In some examples, the
antibody is administered at 100 to 400 mg (e.g., 100 mg to 300 mg, for example, 150
mg or 300 mg).
In some ments of any one of the methods described herein, the
dy can be administered by subcutaneous administration. In some embodiments,
the subject is a human patient suffering from, suspected of having, or at risk for HAE
attack. For example, the method described herein is for prophylactic treatment of
HAE. The subject may be a human patient who experienced at least 2 attacks per
year (e.g., at least one attack per 4 weeks) prior to the treatment. In some
embodiments, the antibody is administered for preventing HAE attack or for reducing
the rate of HAE attack.
In some ments, the antibody (e.g., DX-2930) is first administered every
week for one, two or three weeks and subsequently administered every two, three or
four weeks. In some embodiments, the antibody (e.g., DX—2930) is subsequently
administered every two weeks for ten weeks. In some ments, the subject has
at least one attack every four weeks prior to the first administration.
The antibody to be used in any of the s described herein may be an
antibody that binds the same epitope as 0 or competes against DX—293O for
binding to active human plasma kallikrein. In some embodiments, the antibody
comprises the same heavy chain and light chain CDRs. In one example, the antibody
is 0.
Also within the scope of the present disclosure are (a) pharmaceutical
compositions for use in treating HAE (e.g., preventing HAE attack or reducing the
rate of HAE attack), the pharmaceutical composition comprising any of the anti—
rein antibodies described herein and a pharmaceutically acceptable carrier,
wherein the pharmaceutical composition is administered to a subject ing any of
the treatment regimens described herein; and (b) use of the ceutical
composition for cturing a medicament for the treatment of HAE. Use of the
antibodies for the ed purposes could be performed under the treating regimens
as described .
The details of one or more embodiments of the invention are set forth in the
description below. Other features or advantages of the present invention will be
apparent from the following drawings and detailed ption of several
embodiments, and also from the appended claims.
BRIEF DESCRIPTION OF DRAWINGS
FIGURE 1 shows DX—2930 plasma drug levels following subcutaneous
dosing in HAE patients in the phase lb study.
FIGURE 2 shows ?uorogenic activity assay of HAE patient samples from the
phase lb study.
FIGURE 3 is a Western blot analysis of SCAT169 plasma from HAE patients
from the phase lb study.
FIGURE 4 is a Western blot analysis of citrated plasma from HAE patients
from the phase 1b study.
FIGURE 5 is a Western blot analysis of citrated plasma activated ex vivo
with FXIIa from HAE patients from the phase 1b study.
FIGURE 6 shows the primary efficacy assessment period for ts in
different dosing cohorts. A.: 300 mg cohort. B.: 400 mg cohort. Red bars show the
interval assessed for efficacy.
FIGURE 7 shows the reduction in HAE attack rate in patients treated with
300 mg, 400 mg, combined (300 and 400 mg) or placebo. Baseline was defined as
historical HAE attacks over last 3 months prior to dosing. The data includes patients
with a baseline rate of Z 2 attacks in the last 3 months. Day 8 to 50 attack rates were
unadjusted for baseline rates. t reduction in HAE attack rate over placebo and
p—value were calculated based upon Mixed Model Repeated Measurements with
Analysis of ce (baseline attack rate as covariate) and assuming n
distribution.
FIGURE 8 shows the nce of HAE attacks in placebo—treated subjects.
The X-axis shows the study day number.
FIGURE 9 shows the mean DX-2930 concentration and HAE attack
nce following 30 mg dosage.
FIGURE 10 shows the mean DX—2930 tration and HAE attack
incidence following 100 mg dosage.
FIGURE 11 shows the mean DX—2930 concentration and HAE attack
incidence following 300 mg dosage.
FIGURE 12 shows the mean DX—2930 concentration and HAE attack
incidence following 400 mg dosage. Excludes one patient who received only one
dose (in order to derive the mean pharmacokinetic .
FIGURE 13 shows DX—2930 concentration and HAE attacks in patients with
historical attack rate 2 9 attacks/3months. A.: a placebo patient. B.: a patient treated
with 300 mg. and C.-F.: patients treated with 400 mg.
FIGURE 14 shows an exemplary dosing regimen comprising a loading period
and a maintenance period, which may be followed by an extended ent period or
a t period.
DETAILED DESCRIPTION
Definitions
For convenience, before further description of the present invention, certain
terms employed in the specification, examples and appended claims are defined here.
Other terms are defined as they appear in the speci?cation.
The singular forms “a”, “an”, and “the” include plural references unless the
context clearly dictates otherwise.
The term “antibody” refers to a protein that includes at least one
immunoglobulin variable domain ble region) or immunoglobulin variable
domain (variable ) sequence. For example, an antibody can include a heavy
(H) chain variable region (abbreviated herein as VH or HV), and a light (L) chain
le region (abbreviated herein as VL or LV). In another example, an antibody
includes two heavy (H) chain variable regions and two light (L) chain variable
regions. The term “antibody” encompasses antigen—binding fragments of antibodies
(e. g., single chain antibodies, Fab and sFab fragments, F(ab')2, Fd fragments, Fv
fragments, scFv, and domain antibodies (dAb) fragments (de Wildt et al., Eur J
Immunol. 1996; 26(3):629-39)) as well as complete dies. An antibody can have
the structural features of IgA, IgG, IgE, IgD, IgM (as well as subtypes thereof).
Antibodies may be from any , but primate (human and non-human primate) and
primatized are preferred.
The VH and VL regions can be further subdivided into regions of
ariability, termed ementarity determining regions” (“CDRs”),
persed with regions that are more conserved, termed “framework regions”
(“FRs”). The extent of the framework region and CDRs have been defined (see,
Kabat, EA, et al. (1991) Sequences of Proteins of Immunological Interest, Fifth
Edition, US. ment of Health and Human Services, NIH Publication No. 91—
3242, and Chothia, C. et al. (1987) J. Mol. Biol. 196:901—917). Kabat definitions are
used herein. Each VH and VL is typically ed of three CDRs and four FRs,
arranged from amino—terminus to carboxy—terminus in the following order: FRl,
CDRl, FR2, CDR2, FR3, CDR3, FR4.
As used herein, an “immunoglobulin variable domain sequence” refers to an
amino acid sequence which can form the structure of an immunoglobulin variable
domain such that one or more CDR regions are positioned in a conformation suitable
for an antigen binding site. For e, the sequence may include all or part of the
amino acid sequence of a naturally—occurring variable domain. For example, the
sequence may omit one, two or more N- or C-terminal amino acids, internal amino
acids, may include one or more insertions or additional terminal amino acids, or may
include other tions. In one embodiment, a polypeptide that includes
immunoglobulin variable domain sequence can associate with another
immunoglobulin variable domain sequence to form an antigen binding site, e.g., a
structure that preferentially cts with plasma kallikrein.
The VH or VL chain of the dy can further include all or part of a heavy or
light chain constant region, to thereby form a heavy or light globulin chain,
respectively. In one embodiment, the antibody is a tetramer of two heavy
immunoglobulin chains and two light immunoglobulin chains, wherein the heavy and
light immunoglobulin chains are inter—connected by, e.g., ide bonds. In IgGs,
the heavy chain constant region includes three immunoglobulin domains, CH1, CH2
and CH3. The light chain constant region includes a CL domain. The variable region
of the heavy and light chains contains a binding domain that interacts with an antigen.
The constant regions of the antibodies typically mediate the binding of the antibody to
host tissues or factors, including various cells of the immune system (e.g., effector
cells) and the first component (Clq) of the classical complement system. The light
chains of the immunoglobulin may be of types kappa or lambda. In one embodiment,
the antibody is glycosylated. An antibody can be functional for antibody—dependent
cytotoxicity and/or ment—mediated cytotoxicity.
One or more regions of an antibody can be human or effectively human. For
example, one or more of the variable regions can be human or effectively human. For
example, one or more of the CDRs can be human, e.g., HC CDRl, HC CDR2, HC
CDR3, LC CDRl, LC CDR2, and/or LC CDR3. Each of the light chain (LC) and/or
heavy chain (HC) CDRs can be human. HC CDR3 can be human. One or more of
the framework regions can be human, e.g., FRl, FR2, FR3, and/or FR4 of the HC
and/or LC. For example, the Fc region can be human. In one embodiment, all the
framework regions are human, e.g., derived from a human somatic cell, e.g., a
hematopoietic cell that produces immunoglobulins or a non—hematopoietic cell. In
one embodiment, the human sequences are germline sequences, e.g., encoded by a
ne nucleic acid. In one embodiment, the framework (FR) residues of a selected
Fab can be converted to the acid type of the corresponding residue in the most
similar primate germline gene, ally the human germline gene. One or more of
the constant regions can be human or effectively human. For example, at least 70, 75,
80, 85, 90, 92, 95, 98, or 100% of an globulin variable domain, the constant
region, the constant domains (CH1, CH2, CH3, and/or CLl), or the entire dy
can be human or effectively human.
All or part of an antibody can be encoded by an immunoglobulin gene or a
segment thereof. Exemplary human immunoglobulin genes include the kappa,
lambda, alpha (IgAl and IgA2), gamma (IgGl, IgG2, IgG3, IgG4), delta, n and
mu constant region genes, as well as the many immunoglobulin variable region genes.
Full—length immunoglobulin “light chains” (about 25 KDa or about 214 amino acids)
are encoded by a variable region gene at the NH2—terminus (about 110 amino acids)
and a kappa or lambda constant region gene at the COOH—terminus. Full—length
immunoglobulin “heavy chains” (about 50 KDa or about 446 amino acids), are
similarly encoded by a variable region gene (about 116 amino acids) and one of the
other aforementioned constant region genes, e.g., gamma (encoding about 330 amino
acids). The length of human HC varies considerably because HC CDR3 varies from
about 3 amino—acid residues to over 35 amino—acid residues.
The term en—binding fragment” of a full length antibody refers to one or
more fragments of a full—length antibody that retain the ability to specifically bind to a
target of interest. Examples of binding fragments assed within the term
“antigen—binding fragment” of a full length antibody and that retain functionality
include (i) a Fab fragment, a monovalent nt consisting of the VL, VH, CL and
CH1 domains; (ii) a F(ab')2 fragment, a bivalent nt including two Fab
fragments linked by a disul?de bridge at the hinge region; (iii) a Fd fragment
consisting of the VH and CH1 domains; (iv) a Fv fragment consisting of the VL and
VH s of a single arm of an dy, (v) a dAb fragment (Ward et al., (1989)
Nature 341:544—546), which consists of a VH domain; and (vi) an isolated
complementarity ining region (CDR). Furthermore, although the two domains
of the Fv fragment, VL and VH, are coded for by separate genes, they can be joined,
using recombinant methods, by a tic linker that enables them to be made as a
single protein chain in which the VL and VH regions pair to form monovalent
molecules known as single chain Fv (scFv). See, e.g., US. Pat. Nos. 5,260,203,
778, and 4,881,175; Bird et a1. (1988) Science 242:423—426; and Huston et a1.
(1988) Proc. Natl. Acad. Sci. USA 9-5883.
Antibody fragments can be obtained using any appropriate technique
including conventional techniques known to those with skill in the art. The term
“monospecific antibody” refers to an antibody that displays a single binding
specificity and affinity for a particular target, e.g., epitope. This term includes a
“monoclonal antibody” or “monoclonal dy composition,” which as used herein
refers to a preparation of antibodies or fragments thereof of single molecular
composition, irrespective of how the antibody was generated.
Antibodies are “germlined” by reverting one or more non—germline amino
acids in framework regions to ponding germline amino acids of the antibody, so
long as g properties are substantially retained.
The inhibition constant (Ki) provides a measure of tor potency; it is the
concentration of inhibitor required to reduce enzyme activity by half and is not
dependent on enzyme or substrate concentrations. The apparent Ki (Ki,app) is
obtained at different substrate concentrations by measuring the inhibitory effect of
different concentrations of inhibitor (e.g., inhibitory binding protein) on the extent of
the reaction (e.g., enzyme activity); ?tting the change in pseudo-first order rate
constant as a function of inhibitor tration to the Morrison equation (Equation 1)
yields an estimate of the apparent Ki value. The Ki is obtained from the rcept
extracted from a linear regression analysis of a plot of Ki,app versus substrate
concentration.
(KW, + I + E)— (KW, + I + E) —42 - I - E
v 2 v0 — v0
Equation 1
Where v = measured velocity; v0 = velocity in the absence of inhibitor; Ki,app
= apparent inhibition constant; I = total inhibitor concentration; and E = total enzyme
concentration.
As used herein, “binding affinity” refers to the apparent association nt
or KA. The KA is the reciprocal of the dissociation constant (KD). A binding
antibody may, for example, have a binding af?nity of at least 105, 106, 107, 108, 109,
1010 and 1011 M-l for a ular target molecule, e.g., plasma kallikrein. Higher
affinity binding of a binding antibody to a first target ve to a second target can be
ted by a higher KA (or a smaller numerical value KD) for binding the first target
than the KA (or numerical value KD) for binding the second target. In such cases, the
binding antibody has specificity for the first target (e.g., a n in a first
conformation or mimic thereof) relative to the second target (e.g., the same protein in
a second conformation or mimic thereof; or a second protein). Differences in binding
affinity (e.g., for specificity or other comparisons) can be at least 1.5, 2, 3, 4, 5, 10,
, 20, 37.5, 50, 70, 80, 91, 100, 500, 1000, 10,000 or 105 fold.
Binding affinity can be determined by a variety of methods including
equilibrium dialysis, equilibrium binding, gel tion, ELISA, surface plasmon
resonance, or spectroscopy (e.g., using a ?uorescence assay). Exemplary conditions
for evaluating binding affinity are in HBS—P buffer (10 mM HEPES pH7.4, 150 mM
NaCl, 0.005% (v/v) Surfactant P20). These ques can be used to measure the
concentration of bound and free binding protein as a function of binding protein (or
target) tration. The concentration of bound binding protein ([Bound]) is related
to the tration of free g n ([Free]) and the concentration of binding
sites for the binding protein on the target where (N) is the number of binding sites per
target molecule by the following equation:
[Bound] = N - [Free]/((1/KA) + [Free]).
It is not always necessary to make an exact determination of KA, though,
since sometimes it is sufficient to obtain a quantitative measurement of ty, e.g.,
determined using a method such as ELISA or FACS analysis, is proportional to KA,
and thus can be used for comparisons, such as determining whether a higher affinity
is, e. g., 2 fold higher, to obtain a ative measurement of affinity, or to obtain an
inference of affinity, e.g., by activity in a functional assay, e.g., an in vitro or in vivo
assay.
The term “binding antibody” (or “binding protein” used interchangeably
herein) refers to an antibody that can interact with a target molecule. This term is
used interchangeably with “ligand.” A “plasma kallikrein binding antibody” refers to
an antibody that can interact with (e.g., bind) plasma kallikrein, and includes, in
particular, dies that preferentially or specifically ct with and/or inhibit
plasma kallikrein. An antibody inhibits plasma kallikrein if it causes a decrease in the
activity of plasma kallikrein as compared to the activity of plasma kallikrein in the
absence of the antibody and under the same ions.
A “conservative amino acid substitution” is one in which the amino acid
residue is replaced with an amino acid residue having a similar side chain. Families
of amino acid residues having similar side chains have been defined in the art. These
families include amino acids with basic side chains (e.g., lysine, ne, histidine),
acidic side chains (e. g., aspartic acid, glutamic acid), uncharged polar side chains
(e.g., glycine, asparagine, glutamine, , threonine, tyrosine, cysteine), nonpolar
side chains (e.g., alanine, valine, leucine, isoleucine, proline, phenylalanine,
methionine, tryptophan), beta—branched side chains (e.g., threonine, valine,
isoleucine) and aromatic side chains (e.g., tyrosine, phenylalanine, tryptophan,
histidine).
It is possible for one or more framework and/or CDR amino acid es of a
binding protein to include one or more mutations (e.g., substitutions (e.g.,
conservative substitutions or substitutions of non-essential amino , insertions, or
deletions) relative to a binding protein described herein. A plasma kallikrein binding
protein may have ons (e.g., substitutions (e.g., vative substitutions or
substitutions of non—essential amino acids), insertions, or deletions) (e.g., at least one,
two, three, or four, and/or less than 15, 12, 10, 9, 8, 7, 6, 5, 4, 3, or 2 mutations)
relative to a binding protein described herein, e.g., mutations which do not have a
substantial effect on protein on. The ons can be present in framework
regions, CDRs, and/or constant s. In some embodiments, the mutations are
present in a framework region. In some embodiments, the mutations are present in a
CDR. In some ments, the mutations are present in a constant region. Whether
or not a particular substitution will be tolerated, i.e., will not adversely affect
biological properties, such as binding activity, can be predicted, e.g., by evaluating
whether the mutation is conservative or by the method of Bowie, et al. (1990) Science
247:1306—1310.
An “effectively human” immunoglobulin variable region is an
globulin le region that includes a sufficient number of human
framework amino acid positions such that the immunoglobulin variable region does
not elicit an immunogenic response in a normal human. An “effectively human”
antibody is an antibody that includes a suf?cient number of human amino acid
positions such that the antibody does not elicit an immunogenic response in a normal
human.
An “epitope” refers to the site on a target compound that is bound by a binding
protein (e. g., an antibody such as a Fab or full length antibody). In the case where the
target compound is a protein, the site can be ly composed of amino acid
components, entirely composed of al modi?cations of amino acids of the
protein (e. g., glycosyl moieties), or composed of combinations thereof. Overlapping
epitopes include at least one common amino acid residue, yl group, phosphate
group, sulfate group, or other molecular feature.
A first binding antibody “binds to the same epitope” as a second binding
antibody if the first g antibody binds to the same site on a target compound that
the second binding antibody binds, or binds to a site that overlaps (e.g., 50%, 60%,
70%, 80%, 90%, or 100% overlap, e.g., in terms of amino acid sequence or other
molecular feature (e.g., glycosyl group, phosphate group, or sulfate group)) with the
site that the second binding antibody binds.
A first binding dy “competes for binding” with a second binding
antibody if the binding of the first binding antibody to its epitope decreases (e.g., by
%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, or more) the amount of the
second binding antibody that binds to its epitope. The competition can be direct (e.g.,
the first binding antibody binds to an epitope that is the same as, or overlaps with, the
epitope bound by the second binding antibody), or indirect (e.g., the binding of the
first binding antibody to its epitope causes a steric change in the target compound that
decreases the y of the second binding antibody to bind to its epitope).
Calculations of “homology” or “sequence identity” between two sequences
(the terms are used interchangeably herein) are med as follows. The sequences
are aligned for optimal comparison purposes (e.g., gaps can be introduced in one or
both of a first and a second amino acid or c acid ce for optimal alignment
and mologous sequences can be disregarded for comparison purposes). The
optimal alignment is determined as the best score using the GAP program in the GCG
software package with a Blossum 62 scoring matrix with a gap penalty of 12, a gap
extend penalty of 4, and a frameshift gap penalty of 5. The amino acid residues or
nucleotides at corresponding amino acid ons or nucleotide positions are then
compared. When a position in the first sequence is occupied by the same amino acid
residue or tide as the corresponding position in the second ce, then the
molecules are identical at that position (as used herein amino acid or nucleic acid
“identity” is equivalent to amino acid or nucleic acid “homology”). The percent
identity between the two sequences is a function of the number of identical positions
shared by the sequences.
In a preferred embodiment, the length of a reference sequence aligned for
comparison purposes is at least 30%, ably at least 40%, more preferably at least
50%, even more preferably at least 60%, and even more preferably at least 70%, 80%,
90%, 92%, 95%, 97%, 98%, or 100% of the length of the nce sequence. For
example, the reference sequence may be the length of the immunoglobulin variable
domain sequence.
A “humanized” globulin variable region is an immunoglobulin
le region that is ed to include a suf?cient number of human framework
amino acid positions such that the immunoglobulin variable region does not elicit an
genic response in a normal human. Descriptions of “humanized”
immunoglobulins include, for example, US. 6,407,213 and US. 5,693,762.
An “isolated” antibody refers to an antibody that is removed from at least 90%
of at least one component of a natural sample from which the isolated antibody can be
obtained. Antibodies can be “of at least” a certain degree of purity if the s or
population of species of interest is at least 5, 10, 25, 50, 75, 80, 90, 92, 95, 98, or 99%
pure on a weight—weight basis.
A “patient,99 63subject” or “host” (these terms are used interchangeably) to be
d by the subject method may mean either a human or non—human animal.
The terms “prekallikrein” and “preplasma kallikrein” are used interchangeably
herein and refer to the zymogen form of active plasma kallikrein, which is also known
as likrein.
As used herein, the term “substantially identical” (or “substantially
homologous”) is used herein to refer to a first amino acid or nucleic acid sequence
that contains a sufficient number of identical or lent (e.g., with a similar side
chain, e. g., conserved amino acid substitutions) amino acid residues or nucleotides to
a second amino acid or nucleic acid sequence such that the first and second amino
acid or nucleic acid sequences have (or encode proteins having) similar activities, e.g.,
a binding activity, a binding preference, or a biological activity. In the case of
antibodies, the second dy has the same specificity and has at least 50%, at least
%, or at least 10% of the affinity relative to the same antigen.
Sequences similar or homologous (e.g., at least about 85% sequence identity)
to the ces disclosed herein are also part of this application. In some
embodiments, the sequence identity can be about 85%, 90%, 91%, 92%, 93%, 94%,
95%, 96%, 97%, 98%, 99% or higher. In some embodiments, a plasma kallikrein
binding antibody can have about 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%,
98%, 99% or higher sequence identity to an antibody described herein. In some
embodiments, a plasma kallikrein binding antibody can have about 85%, 90%, 91%,
92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or higher sequence identity in the HC
and/or LC framework regions (e.g., HC and/or LC FR 1, 2, 3, and/or 4) to an antibody
described herein (e.g., DX-2930). In some embodiments, a plasma kallikrein binding
antibody can have about 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%,
99% or higher sequence ty in the HC and/or LC CDRs (e.g., HC and/or LC
CDRl, 2, and/or 3) to an dy described herein (e.g., DX-2930). In some
embodiments, a plasma kallikrein binding antibody can have about 85%, 90%, 91%,
92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or higher sequence identity in the
nt region (e.g., CH1, CH2, CH3, and/or CLl) to an antibody described herein
(e.g., DX—2930).
In addition, substantial identity exists when the nucleic acid segments
hybridize under selective hybridization conditions (e.g., highly stringent hybridization
conditions), to the complement of the strand. The nucleic acids may be present in
whole cells, in a cell lysate, or in a partially purified or substantially pure form.
Statistical significance can be determined by any art known method.
Exemplary statistical tests include: the Students T—test, Mann y U non—
parametric test, and Wilcoxon non—parametric tical test. Some statistically
icant relationships have a P value of less than 0.05 or 0.02. Particular binding
proteins may show a difference, e.g., in speci?city or binding that are statistically
significant (e.g., P value < 0.05 or 0.02). The terms “induce”, “inhibit39 4‘
, potentiate”,
“elevate”, “increase”, ase” or the like, e.g., which denote distinguishable
qualitative or quantitative differences between two states, may refer to a ence,
e.g., a tically significant difference, between the two states.
A “therapeutically ive dosage” ably modulates a measurable
parameter, e.g., plasma kallikrein activity, by a statistically significant degree or at
least about 20%, more preferably by at least about 40%, even more preferably by at
least about 60%, and still more preferably by at least about 80% relative to untreated
subjects. The ability of a compound to modulate a measurable parameter, e.g., a
disease—associated parameter, can be evaluated in an animal model system predictive
of efficacy in human disorders and conditions. Alternatively, this property of a
composition can be evaluated by examining the ability of the compound to modulate a
parameter in vitro.
The term “treating” as used herein refers to the application or administration
of a ition including one or more active agents to a subject, who has an allergic
disease, a symptom of the allergic disease, or a predisposition toward the allergic
disease, with the purpose to cure, heal, alleviate, e, alter, remedy, ameliorate,
improve, or affect the disease, the symptoms of the e, or the predisposition
toward the disease. “Prophylactic treatment,” also known as “preventive treatment,”
refers to a treatment that aims at protecting a person from, or ng the risk for a
disease to which he or she has been, or may be, exposed.
The term “preventing” a e in a subject refers to subjecting the subject
to a pharmaceutical treatment, e.g., the stration of a drug, such that at least one
symptom of the disease is prevented, that is, administered prior to clinical
manifestation of the unwanted condition (e.g., disease or other unwanted state of the
host animal) so that it protects the host against developing the unwanted
condition. “Preventing” a e may also be ed to as “prophylaxis” or
“prophylactic treatment.”
A ylactically effective amount” refers to an amount effective, at
dosages and for periods of time necessary, to e the desired prophylactic
result. Typically, because a prophylactic dose is used in subjects prior to or at an
earlier stage of disease, the prophylactically effective amount will be less than the
therapeutically effective amount.
Plasma kallikrein binding antibodies for use in the methods described herein
can be full—length (e.g., an IgG (e.g., an IgGl, IgG2, IgG3, IgG4), IgM, IgA (e.g.,
IgAl, IgAZ), IgD, and IgE) or can include only an antigen-binding fragment (e.g., a
Fab, F(ab’)2 or scFv fragment. The binding antibody can include two heavy chain
immunoglobulins and two light chain immunoglobulins, or can be a single chain
antibody. Plasma kallikrein binding antibodies can be recombinant ns such as
humanized, CDR grafted, chimeric, nized, or in vitro generated antibodies,
and may optionally include constant regions derived from human germline
immunoglobulin sequences. In one embodiment, the plasma kallikrein binding
antibody is a monoclonal antibody.
In one aspect, the disclosure features an antibody (e.g., an isolated antibody)
that binds to plasma kallikrein (e.g., human plasma kallikrein and/or murine
kallikrein) and es at least one immunoglobulin variable . For example,
the antibody includes a heavy chain (HC) globulin variable domain sequence
and/or a light chain (LC) globulin variable domain sequence. In one
embodiment, the antibody binds to and inhibits plasma kallikrein, e.g., human plasma
kallikrein and/or murine kallikrein.
The antibody can include one or more of the following characteristics: (a) a
human CDR or human framework region; (b) the HC immunoglobulin le
domain ce comprises one or more (6.3., 1, 2, or 3) CDRs that are at least 85 ,
88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a CDR of a HC
le domain described herein; (c) the LC immunoglobulin variable domain
ce comprises one or more (e.g., 1, 2, or 3) CDRs that are at least 85 , 88, 89, 90,
91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a CDR of a LC variable
domain described ; ((1) the LC immunoglobulin variable domain sequence is at
least 85, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, or 100% identical to a LC
variable domain described herein (e.g., overall or in framework regions or CDRs); (e)
the HC immunoglobulin variable domain sequence is at least 85, 88, 89, 90, 91, 92,
93, 94, 95, 96, 97, 98, 99, or 100% identical to a HC variable domain described herein
(e.g., overall or in ork regions or CDRs); (f) the antibody binds an epitope
bound by an antibody described herein, or competes for binding with an antibody
described herein; (g) a primate CDR or primate framework region; (h) the HC
immunoglobulin variable domain sequence comprises a CDRl that differs by at least
one amino acid but by no more than 2 or 3 amino acids from the CDRl of a HC
variable domain described ; (i) the HC immunoglobulin variable domain
sequence comprises a CDR2 that differs by at least one amino acid but by no more
than 2, 3, 4, 5, 6, 7, or 8 amino acids from the CDR2 of a HC variable domain
described herein; 0) the HC immunoglobulin variable domain sequence comprises a
CDR3 that differs by at least one amino acid but by no more than 2, 3, 4, 5, or 6
amino acids from the CDR3 of a HC variable domain described herein; (k) the LC
immunoglobulin variable domain sequence comprises a CDRl that differs by at least
one amino acid but by no more than 2, 3, 4, or 5 amino acids from the CDRl of a LC
variable domain described herein; (1) the LC immunoglobulin variable domain
sequence comprises a CDR2 that differs by at least one amino acid but by no more
than 2, 3, or 4 amino acids from the CDR2 of a LC variable domain described herein;
(m) the LC immunoglobulin variable domain sequence comprises a CDR3 that differs
by at least one amino acid but by no more than 2, 3, 4, or 5 amino acids from the
CDR3 of a LC le domain described herein ; (n) the LC immunoglobulin
variable domain sequence differs by at least one amino acid but by no more than 2, 3,
4, 5, 6, 7, 8, 9, or 10 amino acids from a LC variable domain described herein (e.g.,
overall or in ork regions or CDR3); and (o) the HC immunoglobulin variable
domain sequence differs by at least one amino acid but by no more than 2, 3, 4, 5, 6,
7, 8, 9, or 10 amino acids from a HC variable domain described herein (e.g., overall or
in framework regions or CDRs).
The plasma rein binding protein may be an isolated antibody (e.g., at
least 70, 80, 90, 95, or 99% free of other proteins). In some embodiments, the plasma
rein binding antibody, or composition thereof, is ed from antibody
cleavage fragments (e.g., DX—2930) that are inactive or partially active (e.g., bind
plasma kallikrein with a Ki, app of 5000 nM or greater) ed to the plasma
kallikrein binding antibody. For example, the plasma kallikrein binding antibody is at
least 70% free of such antibody ge fragments; in other embodiments the
binding antibody is at least 80%, at least 90%, at least 95%, at least 99% or even
100% free from antibody cleavage fragments that are inactive or partially active.
The plasma rein binding antibody may additionally inhibit plasma
kallikrein, e.g., human plasma kallikrein.
In some embodiments, the plasma kallikrein binding antibody does not bind
prekallikrein (e.g., human prekallikrein and/or murine prekallikrein), but binds to the
active form of plasma rein (e.g., human plasma kallikrein and/or murine
kallikrein).
In certain embodiments, the antibody binds at or near the active site of the
catalytic domain of plasma rein, or a fragment thereof, or binds an epitope that
overlaps with the active site of plasma rein.
In some aspects, the antibody binds the same epitope or competes for binding
with an antibody described herein.
The antibody can bind to plasma kallikrein, e.g., human plasma kallikrein,
with a binding affinity of at least 105, 106, 107, 108, 109, 1010 and 1011 M1. In one
embodiment, the antibody binds to human plasma kallikrein with a Koff slower than
1 X 103, 5 X 10¢l S4, or 1 X 10'4 s‘l. In one embodiment, the dy binds to human
plasma kallikrein with a Kon faster than 1 X 102, l X 103, or 5 X 103 M'ls'l. In one
embodiment, the antibody binds to plasma kallikrein, but does not bind to tissue
kallikrein and/or plasma likrein (e.g., the antibody binds to tissue kallikrein
and/or plasma prekallikrein less effectively (e.g., 5-, 10-, 50-, 100-, or 1000-fold less
or not at all, e. g., as compared to a negative control) than it binds to plasma kallikrein,
In one embodiment, the antibody inhibits human plasma kallikrein activity,
e.g., with a Ki of less than 105, 106, 10”, 10*, 109, and 10‘10 M. The antibody can
have, for example, an IC50 of less than 100 nM, 10 nM, l, 0.5, or 0.2 nM. For
example, the antibody may modulate plasma kallikrein activity, as well as the
production of Factor XIIa (e.g. , from Factor XII) andlor bradykinin (e.g., from high—
molecular—weight kininogen (HMWK)). The antibody may inhibit plasma kallikrein
activity, and/or the production of Factor XIIa (e.g., from Factor XII) and/or
bradykinin (e.g., from high—molecular—weight gen (HMWK)). The affinity of
the antibody for human plasma kallikrein can be characterized by a KD of less than
100 nm, less than 10 nM, less than 5 nM, less than 1 nM, less than 0.5 nM. In one
embodiment, the antibody inhibits plasma kallikrein, but does not inhibit tissue
kallikrein (e. g., the dy inhibits tissue kallikrein less effectively (e. g., 5—, 10—, 50—
or 1000—fold less or not at all, e.g., as compared to a negative control) than it
, 100—,
inhibits plasma kallikrein.
In some embodiments, the antibody has an apparent inhibition nt (KLapp)
of less than 1000, 500, 100, 5, l, 0.5 or 0.2 nM.
Plasma rein binding antibodies may have their HC and LC variable
domain sequences included in a single polypeptide (e.g., scFv), or on different
polypeptides (e. g., IgG or Fab).
In one embodiment, the HC and LC variable domain sequences are
components of the same polypeptide chain. In another, the HC and LC variable
domain sequences are components of ent polypeptide chains. For example, the
antibody is an IgG, e. g., IgGl, IgG2, IgG3, or IgG4. The antibody can be a soluble
Fab. In other implementations the dy es a Fab2', scFv, minibody,
scszch fusion, FabzzHSA fusion, HSA::Fab fusion, FabzzHSAzzFab fusion, or other
molecule that comprises the antigen ing site of one of the binding proteins
herein. The VH and VL regions of these Fabs can be provided as IgG, Fab, Fab2,
Fab2', scFv, PEGylated Fab, PEGylated scFv, PEGylated Fab2, VH::CH1::HSA+LC,
HSA::VH::CH1+LC, LszHSA + l, HSA::LC + VH::CHl, or other
appropriate construction.
In one embodiment, the antibody is a human or humanized antibody or is non—
immunogenic in a human. For example, the antibody includes one or more human
dy framework regions, e. g., all human framework regions, or framework
regions at least 85, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% identical to human
framework regions. In one embodiment, the antibody es a human Fc ,
or an Fc domain that is at least 95, 96, 97, 98, or 99% identical to a human Fc .
In one embodiment, the antibody is a primate or primatized antibody or is non—
immunogenic in a human. For example, the antibody includes one or more primate
antibody framework regions, e.g., all primate framework regions, or framework
regions at least 85, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99% identical to primate
framework regions. In one ment, the antibody includes a primate Fc domain,
or an Fc domain that is at least 95 or 99% identical to a e Fc
, 96, 97, 98,
domain. “Primate” includes humans (Homo sapiens), chimpanzees (Pan troglodytes
and Pan paniscus (bonobos)), gorillas (Gorilla a), gibons, monkeys, lemurs,
aye—ayes (Daubentonia madagascariensis), and tarsiers.
In some ments, the affinity of the primate antibody for human plasma
kallikrein is characterized by a KD of less than 1000, 500, 100, 10, 5, l, 0.5 nM, e.g.,
less than 10 nM, less than 1 nM, or less than 0.5 nM.
In certain embodiments, the antibody includes no sequences from mice or
rabbits (e. g., is not a murine or rabbit antibody).
In some embodiments, the antibody used in the methods described herein may
be DX-2930 as bed herein or a functional variant thereof, or an antibody that
binds the same epitope as DX—2930 or competes against DX—2930 for binding to
active plasma kallikrein.
In one example, a functional variant of DX—2930 comprises the same
complementary ining regions (CDRs) as 0, as determined by the same
. In another example, the functional variants of DX—2930 may contain one or
more mutations (e.g., conservative substitutions) in the FRs of either the VH or the VL
as compared to those in the VH and VL of DX—2930. Preferably, such mutations do
not occur at residues which are predicted to interact with one or more of the CDRs,
which can be determined by routine logy. In other embodiments, the functional
variants described herein n one or more mutations (e.g., l, 2, or 3) within one or
more of the CDR regions of DX—2930. Preferably, such onal variants retain the
same regions/residues responsible for antigen—binding as the parent. In yet other
embodiments, a functional variant of DX-2930 may comprise a VH chain that
comprises an amino acid sequence at least 85% (e.g., 90%, 92%, 94%, 95%, 96%,
97%, 98%, or 99%) identical to that of the VH of DX—2930 and/or a VL chain that has
an amino acid sequence at least 85% (e.g., 90%, 92%, 94%, 95%, 96%, 97%, 98%, or
99%) identical to that of the VL of 0. These variants are capable of binding to
the active form of plasma kallikrein and preferably do not bind to prekallikrein.
The nt identity” of two amino acid sequences is determined using the
algorithm of Karlin and Altschul Proc. Natl. Acad. Sci. USA 87:2264—68, 1990,
modified as in Karlin and Altschul Proc. Natl. Acad. Sci. USA 90:5873—77, 1993.
Such an algorithm is incorporated into the NBLAST and XBLAST programs (version
2.0) of Altschul, er al. J. Mol. Biol. 215:403—10, 1990. BLAST protein searches can
be performed with the XBLAST program, score=50, wordlength=3 to obtain amino
acid sequences homologous to the protein les of interest. Where gaps exist
n two sequences, Gapped BLAST can be utilized as described in Altschul er
al., Nucleic Acids Res. 25(17):3389—3402, 1997. When utilizing BLAST and Gapped
BLAST programs, the default parameters of the respective programs (e.g., XBLAST
and ) can be used.
In some embodiments, the antibody used in the methods and compositions
described herein may be the DX—2930 antibody. The heavy and light chain full and
variable sequences for DX-2930 are ed below, with signal sequences in italics.
The CDRs are boldfaced and underlined (based on the Kabat numbering ).
DX—293O Heavy Chain Amino Acid Sequence (451 amino acids, 49439.02 Da)
MGWSCILFLVATATGAHSEVQLLESGGGLVQPGGSLRLSCAASGFTFSHYIMM
GKGLEWVSGIYSSGGITVYADSVKGRFTISRDNSKNTLYLQMNSL
RAEDTAVYYCAYRRIGVPRRDEFDIWGQGTMVTVSSASTKGPSVFPLAPSSK
STSGGTAALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSVV
TVPSSSLGTQTYICNVNHKPSNTKVDKRVEPKSCDKTHTCPPCPAPELLGGPS
VFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDGVEVHNAKTKP
REEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQP
REPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPP
VLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQKSLSLSPG
(SEQ ID NO: 1)
DX—2930 Light Chain Amino Acid Sequence (213 amino acids, 23419.08 Da)
MGWSCILFLVATATGAHSDIQMTQSPSTLSASVGDRVTITCRASSQSISSWLAWY
QQKPGKAPKLLIYKASTLESGVPSRFSGSGSGTEFTLTISSLQPDDFATYYCm
YNTYWTFGQGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASVVCLLNNFYPREA
KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACE
VTHQGLSSPVTKSFNRGEC (SEQ ID NO: 2)
DX—293O Heavy Chain Variable Domain Amino Acid Sequence
EVQLLESGGGLVQPGGSLRLSCAASGFTFSHYIMMWVRQAPGKGLEWVSQ
TVYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAYRRIG
VPRRDEFDIWGQGTMVTVSS (SEQ ID NO: 3)
DX—2930 Light Chain Variable Domain Amino Acid Sequence
DIQMTQSPSTLSASVGDRVTITCRASSQSISSWLAWYQQKPGKAPKLLIYKAST
SRFSGSGSGTEFTLTISSLQPDDFATYYCS 2gzYNTYWTFGQGTKVEIK
(SEQ ID NO: 4)
Table 1. CDRs for DX-2930.
HeavychainCDR2 GIYSSGGITVYADSVKG (SEQ ID
NO: 6)
QQYNTYWT (SEQ ID NO: 10)
Antibody Preparation
An antibody as described herein (e.g., DX-2930) can be made by any method
known in the art. See, for example, Harlow and Lane, (1988) Antibodies: A
Laboratory Manual, Cold Spring Harbor Laboratory, New York and Greenfield,
(2013) dies: A Laboratory Manual, Second edition, Cold Spring Harbor
Laboratory Press.
The sequence encoding the antibody of interest, e.g., DX—2930, may be
maintained in vector in a host cell and the host cell can then be expanded and frozen
for future use. In an alternative, the polynucleotide sequence may be used for genetic
manipulation to “humanize” the antibody or to improve the affinity (affinity
maturation), or other characteristics of the antibody. For example, the constant region
may be engineered to more resemble human constant regions to avoid immune
response if the antibody is used in al trials and treatments in humans. It may be
desirable to genetically manipulate the dy sequence to obtain r ty to
the target antigen and greater efficacy in inhibiting the ty of PKal. It will be
nt to one of skill in the art that one or more polynucleotide changes can be
made to the antibody and still maintain its binding specificity to the target antigen.
In other embodiments, fully human dies can be obtained by using
commercially available mice that have been engineered to express specific human
immunoglobulin proteins. enic animals that are designed to produce a more
desirable (e. g., fully human antibodies) or more robust immune response may also be
used for generation of zed or human antibodies. Examples of such logy
are XenomouseRTM from Amgen, Inc. (Fremont, Calif.) and HuMAb—MouseRTM and
TC MouseTM from Medarex, Inc. (Princeton, NJ.) In another alternative, antibodies
may be made recombinantly by phage y or yeast technology. See, for example,
US. Pat. Nos. 5,565,332; 5,580,717; 5,733,743; and 6,265,150; and Winter et al.,
(1994) Annu. Rev. Immunol. 12:433-455. Alternatively, the phage display
technology (McCafferty et al., (1990) Nature 348:552-553) can be used to produce
human antibodies and antibody fragments in vitro, from immunoglobulin variable (V)
domain gene repertoires from unimmunized donors.
Antigen—binding nts of an intact antibody (full—length antibody) can be
prepared via routine methods. For example, F(ab')2 fragments can be produced by
pepsin digestion of an dy molecule, and Fab fragments that can be generated by
reducing the disulfide bridges of F(ab')2 fragments.
Genetically engineered dies, such as humanized antibodies, chimeric
antibodies, single—chain dies, and bi—specific dies, can be produced via,
e.g., conventional recombinant technology. In one example, DNA encoding a
monoclonal antibodies specific to a target antigen can be readily isolated or
synthesized. The DNA may be placed into one or more expression vectors, which are
then transfected into host cells such as E. coli cells, simian COS cells, Chinese
hamster ovary (CHO) cells, or myeloma cells that do not otherwise produce
immunoglobulin protein, to obtain the synthesis of monoclonal antibodies in the
inant host cells. See, e. g., PCT ation No. WO 87/04462. The DNA can
then be modified, for example, by substituting the coding sequence for human heavy
and light chain constant domains in place of the homologous murine sequences,
Morrison et al., (1984) Proc. Nat. Acad. Sci. 8126851, or by ntly joining to the
immunoglobulin coding sequence all or part of the coding sequence for a non—
immunoglobulin polypeptide. In that manner, genetically engineered antibodies, such
as "chimeric" or "hybrid" antibodies; can be prepared that have the binding icity
of a target antigen.
Techniques ped for the production of “chimeric antibodies” are well
known in the art. See, e.g., Morrison et a1. (1984) Proc. Natl. Acad. Sci. USA 81,
6851; Neuberger et al. (1984) Nature 312, 604; and Takeda et al. (1984) Nature
3 14:452.
Methods for constructing humanized antibodies are also well known in the art.
See, e.g., Queen et al., Proc. Natl. Acad. Sci. USA, 86:10029—10033 (1989). In one
example, variable regions of VH and VL of a parent non—human dy are
subjected to three-dimensional molecular modeling analysis following methods
known in the art. Next, framework amino acid residues predicted to be important for
the formation of the correct CDR structures are identified using the same molecular
modeling analysis. In parallel, human VH and VL chains having amino acid
ces that are homologous to those of the parent non—human antibody are
identified from any antibody gene database using the parent VH and VL ces as
search queries. Human VH and VL acceptor genes are then selected.
The CDR regions within the selected human acceptor genes can be replaced
with the CDR regions from the parent non—human antibody or functional variants
thereof. When necessary, residues within the framework regions of the parent chain
that are ted to be important in interacting with the CDR regions (see above
description) can be used to substitute for the corresponding residues in the human
acceptor genes.
A single-chain antibody can be prepared via recombinant technology by
g a nucleotide sequence coding for a heavy chain variable region and a
nucleotide sequence coding for a light chain variable region. Preferably, a ?exible
linker is incorporated between the two variable regions. Alternatively, ques
described for the production of single chain antibodies (US. Patent Nos. 4,946,778
and 4,704,692) can be adapted to produce a phage or yeast scFv library and scFv
clones specific to a PKal can be identified from the library following routine
ures. ve clones can be subjected to further screening to identify those that
inhibits PKal activity.
Some antibodies, e.g., Fabs, can be produced in bacterial cells, e.g., E. coli
cells (see e.g., Nadkarni, A. et al., 2007 Protein Expr Purif 52(1):2l9—29). For
example, if the Fab is encoded by sequences in a phage display vector that es a
suppressible stop codon between the y entity and a iophage protein (or
fragment thereof), the vector nucleic acid can be transferred into a bacterial cell that
cannot suppress a stop codon. In this case, the Fab is not fused to the gene 111 protein
and is secreted into the periplasm and/or media.
Antibodies can also be produced in eukaryotic cells. In one embodiment, the
dies (e. g., scFv’s) are expressed in a yeast cell such as Pichia (see, e.g., Powers
et al., 2001, J. Immunol. Methods. 251: 123—35; Schoonooghe S. et al., 2009 BMC
Biotechnol. 9:70; Abdel-Salam, HA. et al., 2001 Appl Microbiol Biotechnol 56(1—
2):157-64; Takahashi K. et al., 2000 Biosci Biotechnol Biochem 64(10):2138-44;
Edqvist, J. et al., 1991 J Biotechnol 291-300), Hanseula, or Saccharomyces.
One of skill in the art can optimize antibody production in yeast by zing, for
example, oxygen conditions (see e.g., Baumann K., et al. 2010 BMC Syst. Biol.
4:141), osmolarity (see e.g., its, M. et al., 2010 BMC Genomics 11:207),
temperature (see e.g., Dragosits, M. et al., 2009 J Proteome Res. 8(3):l380—92),
fermentation conditions (see e.g., Ning, D. et al. 2005 J. Biochem. and Mol. Biol.
38(3): 294—299), strain of yeast (see e.g., Kozyr, AV et a1. 2004 M01 Biol (Mosk)
38(6):1067—75; Horwitz, AH. et al., 1988 Proc Natl Acad Sci U S A 85(22):8678—82;
Bowdish, K. et a1. 1991 J Biol Chem ): 1 1901-8), overexpression of proteins to
e antibody production (see e.g., Gasser, B. et al., 2006 Biotechol. Bioeng.
353—61), level of acidity of the culture (see e.g., Kobayashi H., et al., 1997
FEMS Microbiol Lett 152(2):235—42), concentrations of substrates and/or ions (see
e.g., Ko JH. et al., 2996 Appl Biochem hnol 60(1):41—8). In addition, yeast
systems can be used to produce antibodies with an extended half-life (see e.g., Smith,
BJ. et a1. 2001 Bioconjug Chem 12(5):750-756),
In one preferred embodiment, antibodies are produced in mammalian cells.
Preferred mammalian host cells for expressing the clone antibodies or antigen—binding
fragments thereof include Chinese Hamster Ovary (CHO cells) (including dhfr— CHO
cells, described in Urlaub and , 1980, Proc. Natl. Acad. Sci. USA 77:4216—
4220, used with a DHFR selectable marker, e.g., as described in Kaufman and Sharp,
1982, Mol. Biol. 159:601 621), lymphocytic cell lines, e.g., NSO myeloma cells and
SP2 cells, COS cells, HEK293T cells (J. Irnmunol. Methods (2004) 289(1—2):65—80),
and a cell from a transgenic animal, e.g., a transgenic mammal. For e, the cell
is a mammary epithelial cell.
In some embodiments, plasma kallikrein binding antibodies are produced in a
plant or cell—free based system (see e.g., Galeffi, P., et al., 2006 J Transl Med 4:39).
In addition to the nucleic acid ce encoding the diversified
immunoglobulin domain, the recombinant expression vectors may carry additional
sequences, such as sequences that regulate replication of the vector in host cells (e.g.,
origins of replication) and selectable marker genes. The selectable marker gene
facilitates ion of host cells into which the vector has been introduced (see e.g.,
US. Patent Nos. 4,399,216, 4,634,665 and 5,179,017). For example, typically the
selectable marker gene confers resistance to drugs, such as G418, hygromycin or
rexate, on a host cell into which the vector has been introduced. Preferred
selectable marker genes include the dihydrofolate ase (DHFR) gene (for use in
dhfr' host cells with methotrexate selection/amplification) and the neo gene (for G418
selection).
In an ary system for recombinant expression of an antibody, or antigen—
binding portion thereof, a recombinant expression vector encoding both the antibody
heavy chain and the antibody light chain is introduced into dhfr' CHO cells by
calcium phosphate—mediated transfection. Within the inant expression vector,
the antibody heavy and light chain genes are each ively linked to
enhancer/promoter regulatory elements (e.g., derived from SV40, CMV, adenovirus
and the like, such as a CMV enhancer/AdMLP promoter regulatory element or an
SV40 enhancer/AdMLP promoter regulatory element) to drive high levels of
ription of the genes. The recombinant expression vector also carries a DHFR
gene, which allows for selection of CHO cells that have been transfected with the
vector using methotrexate ion/ampli?cation. The selected transformant host
cells are cultured to allow for expression of the antibody heavy and light chains and
intact antibody is recovered from the culture medium. Standard molecular biology
ques are used to prepare the recombinant sion vector, ect the host
cells, select for transformants, culture the host cells and recover the antibody from the
culture medium. For example, some antibodies can be isolated by affinity
chromatography with a Protein A or Protein G coupled matrix.
For antibodies that include an Fc domain, the antibody production system may
produce antibodies in which the Fc region is glycosylated. For example, the Fc
domain of IgG molecules is glycosylated at asparagine 297 in the CH2 domain. This
asparagine is the site for modification with biantennary—type oligosaccharides. It has
been demonstrated that this glycosylation is required for effector functions mediated
by ch receptors and complement Clq (Burton and Woof, l992, Adv. Immunol. 51:1—
84; Jefferis et al., 1998, Immunol. Rev. 163259—76). In one embodiment, the Fc
domain is produced in a mammalian sion system that appropriately
glycosylates the residue corresponding to gine 297. The PC domain can also
include other eukaryotic post-translational modi?cations.
Antibodies can also be produced by a transgenic animal. For e, US.
Pat. No. 5,849,992 describes a method of expressing an antibody in the y
gland of a transgenic mammal. A transgene is constructed that includes a milk-
specific promoter and nucleic acids encoding the antibody of interest and a signal
sequence for ion. The milk ed by females of such transgenic mammals
includes, secreted—therein, the antibody of interest. The antibody can be purified from
the milk, or for some ations, used directly.
An dy as bed herein (e.g., DX-2930) can be present in a
composition, 2. g. a pharmaceutically acceptable composition or pharmaceutical
ition. The antibody as described herein (e.g., DX—2930) can be formulated
together with a pharmaceutically able carrier. In some embodiments, 30 mg—
400 mg of DX—2930 antibody are present in a composition, ally with a
pharmaceutically acceptable carrier, (e.g., a pharmaceutically acceptable composition
or pharmaceutical composition. In some embodiments, 30 mg, 100 mg, 150 mg, 300
mg, or 400 mg of DX-2930 antibody are present in a composition optionally with a
pharmaceutically acceptable carrier, e.g., a pharmaceutically able composition
or pharmaceutical composition.
A pharmaceutically acceptable carrier es any and all solvents, dispersion
media, coatings, antibacterial and antifungal agents, isotonic and absorption ng
agents, and the like that are logically compatible. Preferably, the carrier is
suitable for subcutaneous, intravenous, intramuscular, parenteral, spinal, or epidermal
administration (e.g., by injection or infusion), although rs suitable for inhalation
and intranasal stration are also contemplated. In some ments, the
pharmaceutically acceptable carrier is one or more of sodium phosphate, citric acid,
histidine, sodium chloride, and Tween 80. In some embodiments, the
pharmaceutically able carrier is sodium phosphate, citric acid, histidine, sodium
chloride, and Tween 80. In some embodiments, the antibody, such as DX—2930, is
formulated in 30 mM sodium phosphate, 8.6 mM citric acid, 50 mM histidine, 90 mM
sodium chloride, 0.01% Tween 80, pH 6.0. In some embodiments, the composition
comprises or consists of 100 mg DX—2930 per 1 mL solution of 30 mM sodium
phosphate, 8.6 mM citric acid, 50 mM histidine, 90 mM sodium chloride, 0.01%
Tween 80.
A pharmaceutically acceptable salt is a salt that retains the desired biological
activity of the compound and does not impart any undesired toxicological effects (see
e.g., Berge, S.M., et al., 1977, J. Pharm. Sci. 66: 1—19). Examples of such salts include
acid addition salts and base addition salts. Acid addition salts include those derived
from nontoxic nic acids, such as hydrochloric, nitric, phosphoric, sulfuric,
hydrobromic, hydroiodic, phosphorous, and the like, as well as from nontoxic organic
acids such as aliphatic mono— and dicarboxylic acids, phenyl—substituted alkanoic
acids, hydroxy alkanoic acids, aromatic acids, aliphatic and aromatic sulfonic acids,
and the like. Base addition salts e those derived from alkaline earth metals,
such as sodium, potassium, magnesium, calcium, and the like, as well as from
nontoxic organic amines, such as N,N'—dibenzylethylenediamine, N—methylglucamine,
chloroprocaine, choline, diethanolamine, nediamine, ne, and the like.
The compositions may be in a variety of forms. These include, for example,
liquid, semi-solid and solid dosage forms, such as liquid solutions (e.g., injectable and
infusible solutions), dispersions or suspensions, tablets, pills, powders, mes and
suppositories. The form can depend on the ed mode of administration and
therapeutic application. Many compositions are in the form of injectable or ble
solutions, such as compositions similar to those used for administration of humans
with antibodies. An exemplary mode of stration is parenteral (e.g.,
intravenous, subcutaneous, intraperitoneal, intramuscular). In one embodiment, the
plasma kallikrein binding protein is administered by intravenous infusion or injection.
In another preferred embodiment, the plasma kallikrein binding protein is
administered by intramuscular or subcutaneous injection. In another preferred
embodiment, the plasma kallikrein binding protein is administered by eritoneal
injection.
The phrases “parenteral stration” and “administered parenterally” as
used herein means modes of administration other than enteral and l
administration, usually by ion, and includes, without limitation, intravenous,
intramuscular, intraarterial, intrathecal, intracapsular, intraorbital, intracardiac,
intradermal, intraperitoneal, transtracheal, subcutaneous, subcuticular, intraar'ticular,
subcapsular, subarachnoid, intraspinal, epidural and intrasternal injection and
infusion.
The composition can be formulated as a solution, microemulsion, dispersion,
liposome, or other ordered structure suitable to high drug concentration. Sterile
injectable solutions can be prepared by incorporating the binding protein in the
ed amount in an appropriate solvent with one or a combination of ingredients
enumerated above, as required, ed by ?ltered sterilization. lly,
dispersions are prepared by incorporating the active compound into a e vehicle
that contains a basic dispersion medium and the required other ingredients from those
enumerated above. In the case of sterile powders for the preparation of sterile
injectable solutions, the preferred methods of ation are vacuum drying and
freeze—drying that yields a powder of the active ingredient plus any onal desired
ingredient from a previously sterile—filtered solution thereof. The proper fluidity of a
solution can be maintained, for example, by the use of a coating such as lecithin, by
the maintenance of the required particle size in the case of dispersion and by the use
of tants. Prolonged absorption of injectable itions can be brought about
by including in the composition an agent that delays absorption, for example,
monostearate salts and gelatin.
An antibody as described herein (e.g., DX-2930) can be administered by a
variety of methods, including intravenous injection or infusion. For e, for
some therapeutic applications, the antibody can be administered by intravenous
infusion at a rate of less than 30, 20, 10, 5, or 1 mg/min to reach a dose of about 1 to
100 mg/m2 or 7 to 25 mg/m2. The route and/or mode of administration will vary
depending upon the desired results. In certain ments, the active compound
may be prepared with a carrier that will protect the nd against rapid release,
such as a controlled release formulation, including implants, and microencapsulated
delivery systems. Biodegradable, biocompatible polymers can be used, such as
ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters,
and ctic acid. Many methods for the ation of such formulations are
available. See, e. g., Sustained and Controlled Release Drug Delivery Systems, J .R.
Robinson, ed., 1978, Marcel Dekker, Inc., New York.
ceutical compositions can be administered with medical devices. For
example, in one embodiment, a pharmaceutical composition disclosed herein can be
administered with a device, e.g., a needleless hypodermic injection device, a pump, or
implant.
In certain embodiments, an antibody as described herein (e.g., DX—2930) can
be formulated to ensure proper distribution in vivo. For e, the blood-brain
barrier (BBB) excludes many highly hydrophilic compounds. To ensure that the
eutic compounds disclosed herein cross the BBB (if desired), they can be
formulated, for example, in liposomes. For methods of manufacturing liposomes, see,
e.g., US. Pat. Nos. 4,522,811; 548; and 5,399,331. The liposomes may
comprise one or more moieties that are selectively transported into specific cells or
organs, thus e targeted drug delivery (see, e.g., V.V. Ranade, 1989, J. Clin.
Pharmacol. 29:685).
Dosage ns are adjusted to provide the optimum desired response (e.g., a
therapeutic response). For example, a single bolus may be administered, several
divided doses may be administered over time or the dose may be proportionally
reduced or sed as indicated by the cies of the therapeutic situation. It is
especially advantageous to formulate parenteral compositions in dosage unit form for
ease of administration and uniformity of dosage. Dosage unit form as used herein
refers to physically discrete units suited as unitary dosages for the subjects to be
treated; each unit contains a predetermined quantity of active compound calculated to
produce the d therapeutic effect in ation with the required pharmaceutical
carrier. The specification for the dosage unit forms can be dictated by and directly
dependent on (a) the unique characteristics of the active compound and the particular
eutic effect to be achieved, and (b) the limitations inherent in the art of
compounding such an active compound for the treatment of sensitivity in individuals.
An ary, non—limiting range for a therapeutically or prophylactically
effective amount of an antibody as described herein (e.g., DX—2930) is 30 mg to 400
mg, or any integer in between, for example, 100—400 mg, 100—300 mg, or 300—400
mg. In some embodiments, the therapeutically or prophylactically effective amount is
mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, or 400 mg.
In some embodiments, the therapeutically or prophylactically effective amount
of an antibody described herein (e.g., DX—2930) is 30 mg, 100 mg, 150 mg, 300 mg,
or 400 mg. In some ments, the therapeutically or prophylactically ive
amount is 150 mg. In some embodiments, the therapeutically or prophylactically
effective amount is 300 mg. In some embodiments, the therapeutically or
prophylactically effective amount is 400 mg.
In some embodiments, the therapeutically or prophylactically effective amount
is administered at least two times, at least three times, at least four times, at least five
times, at least six times, at least seven times, at least eight times, at least nine times, at
least ten times, or more. In some embodiments, the therapeutically or
prophylactically effective amount is administered every other week (i.e., every two
weeks). In some embodiments, the therapeutically or prophylactically effective
amount is 300 mg or 400 mg and the amount is administered every two weeks. In
some embodiments, the eutically or prophylactically effective amount is 300
mg and this amount of the antibody is stered every two weeks. In some
embodiments, the therapeutically or prophylactically effective amount is 400 mg and
this amount of the antibody is administered every two weeks.
In some embodiments, treatment of any of the anti—pKal antibody such as DX—
2930 involves a treatment regimen comprising at least a loading period and a
maintenance period. In some embodiments, the therapeutically or prophylactically
effective amount of the antibody for the loading period is 100 to 300 mg (e.g., 150 mg
or 300 mg) per each stration. During this period, the antibody may be
administered every week (e.g., every week for one, two or three weeks). In one
example, the loading period is 2 weeks and the antibody is administered at day 0, day
7, and day 14.
Alternatively or in addition, the therapeutically or prophylactically effective
amount for the nance period is about 100 to 300 mg (e.g., 150 mg or 300 mg)
per each administration. During this period, the antibody can be administered every
other week (i. 6., every two weeks), every three weeks, or every four weeks (e.g.,
every two weeks for ten weeks, resulting in delivery of 5 doses total). In one
example, the maintenance period may last for 10 weeks and the antibody is
administered at day 28, day 42, day 56, day 70, and day 84.
In some embodiments, the anti—pKal dy such as DX—2930 is
administered at 150 mg or 300 mg and the amount is first administered every week
for a suitable period (e.g., every week for one, two or three weeks) and subsequently
stered every two to four weeks (e.g., every two, three or four weeks) for a
suitable period.
In any of the methods described herein, the treatment regimen may further
comprise a follow-up period after the maintenance period. In the follow—up period,
the antibody such as DX-2930 may be administered every 2-4 weeks at 100-300 mg,
for example 300 mg. In some instances, the dosage may increase to 400 mg in one or
more of the g period, the maintenance period, and the follow—up .
The pharmaceutical compositions disclosed herein may include a
“therapeutically ive amount” or a “prophylactically effective amount” of an
antibody as described herein (e.g., DX—2930).
An antibody as described herein (e.g., DX-2930) can be provided in a kit, e.g.,
as a component of a kit. For example, the kit includes (a) a DX—2930 antibody, e.g.,
a composition (e.g., a pharmaceutical composition) that includes the antibody, and,
optionally (b) informational material. The informational material can be descriptive,
instructional, marketing or other material that relates to a method described herein
and/or the use of an antibody as described herein (e.g., DX—2930), e.g., for a method
described herein. In some embodiments, the kit comprises one or more doses of DX-
2930. In some embodiments, the one or more doses are 30 mg, 100 mg, 150 mg, 300
mg or 400 mg.
The informational al of the kit is not limited in its form. In one
embodiment, the informational material can include information about production of
the compound, molecular weight of the compound, concentration, date of expiration,
batch or production site information, and so forth. In one embodiment, the
informational material relates to using the antibody to treat, prevent, or diagnosis of
disorders and conditions, e.g., a plasma kallikrein associated disease or condition.
In one embodiment, the informational al can include instructions to
administer n antibody as described herein (e.g., DX—2930) in a suitable manner to
perform the methods bed herein, e.g., in a suitable dose, dosage form, mode of
administration or dosing schedule (e.g., a dose, dosage form, dosing schedule or mode
of administration described herein). In another ment, the informational
material can include ctions to administer an antibody as described herein (e.g.,
DX—2930) to a suitable subject, e.g., a human, e.g., a human having, or at risk for, a
plasma kallikrein associated e or condition. For example, the al can
include instructions to administer an antibody as bed herein (e.g., DX—2930) to a
t with a disorder or condition described herein, e.g., a plasma kallikrein
associated e, e.g., ing to a dosing schedule described . The
informational material of the kits is not limited in its form. In many cases, the
ational material, e.g., instructions, is provided in print but may also be in other
formats, such as computer readable material.
An antibody as described herein (e.g., 0) can be provided in any form,
e.g., liquid, dried or lyophilized form. It is preferred that an antibody be substantially
pure and/or sterile. When an antibody is provided in a liquid solution, the liquid
on preferably is an aqueous solution, with a sterile aqueous solution being
preferred. When an antibody is provided as a dried form, reconstitution generally is
by the addition of a suitable t. The solvent, e.g., sterile water or buffer, can
optionally be ed in the kit.
The kit can include one or more containers for the composition containing an
antibody as bed herein (e.g., DX—2930). In some ments, the kit contains
separate containers, dividers or compartments for the composition and informational
material. For example, the composition can be contained in a bottle, Vial, or syringe,
and the informational material can be ned in association with the container. In
other embodiments, the separate elements of the kit are contained within a single,
undivided container. For example, the ition is contained in a bottle, vial or
syringe that has attached thereto the informational material in the form of a label. In
some embodiments, the kit includes a plurality (e.g., a pack) of individual containers,
each containing one or more unit dosage forms (e.g., a dosage form described herein)
of an antibody as described herein (e.g., DX—2930). For example, the kit includes a
ity of es, ampules, foil packets, or blister packs, each containing a single
unit dose of an antibody as described herein (e.g., DX—2930). The containers of the
kits can be air tight, waterproof (e.g., impermeable to changes in moisture or
evaporation), and/or light—tight.
The kit optionally includes a device suitable for administration of the
composition, e.g., a e, or any such delivery device. In one embodiment, the
device is an implantable device that dispenses metered doses of the antibody. The
disclosure also features a method of providing a kit, e.g., by combining components
described herein.
Treatment
In some aspects, the disclosure provides the use of an dy as described
herein (e.g., DX-2930) in ng HAE.
Hereditary Angioedema
Hereditary angioedema (HAE) is also known as “Quincke edema,” Cl
esterase inhibitor deficiency, Cl inhibitor deficiency, and hereditary angioneurotic
edema (HANE). HAE is characterized by recurrent es of severe swelling
(angioedema), which can affect, e.g., the limbs, face, genitals, gastrointestinal tract,
and airway. Symptoms of HAE include, e.g., swelling in the arms, legs, lips, eyes,
tongue, and/or throat; airway ge that can involve throat swelling and sudden
ness; repeat episodes of abdominal cramping without obvious cause; and/or
swelling of the intestines, which can be severe and can lead to abdominal cramping,
vomiting, dehydration, diarrhea, pain, and/or shock. About one—third of individuals
with this HAE develop a non-itchy rash called erythema marginatum during an attack.
Swelling of the airway can be life threatening and causes death in some
ts. Mortality rates are estimated at 15-33%. HAE leads to about 15,000-30,000
emergency ment visits per year.
Trauma or , e.g., dental procedures, sickness (e.g., viral illnesses such as
colds and the ?u), menstruation, and surgery can r an attack of angioedema. To
prevent acute s of HAE, patients can attempt to avoid specific stimuli that have
previously caused attacks. r, in many cases, an attack occurs without a known
trigger. Typically, HAE ms first appear in childhood and worsen during
puberty. On average, untreated individuals have an attack every 1 to 2 weeks, and
most episodes last for about 3 to 4 days (ghr.nlm.nih.gov/condition/hereditary—
angioedema). The frequency and duration of attacks vary greatly among people with
hereditary angioedema, even among people in the same family.
There are three types of HAE, known as types I, II, and 111, all of which can be
treated by the methods described herein. It is estimated that HAE s l in 50,000
people, that type I accounts for about 85 percent of cases, type II accounts for about
percent of cases, and type III is very rare. Patients having type I or type II HAE
are typically deficient in Cl—INH. Such patients either have a defective Cl—INH gene
and thus do not produce Cl-INH, or produce al Cl—INH proteins. Type III is
the most newly described form and was originally thought to occur only in women,
but families with affected males have been identified. Type III HAE is believed to be
unassociated with Cl-INH. Patients having type III HAE may have normal Cl-INH
proteins.
HAE is inherited in an autosomal dominant pattern, such that an affected
person can inherit the mutation from one affected parent. New ons in the gene
can also occur, and thus HAE can also occur in people with no history of the disorder
in their family. It is estimated that 20—25% of cases result from a new spontaneous
mutation.
Mutations in the SERPINGl gene cause hereditary angioedema type I and
type II. The SERPINGl gene provides instructions for making the C1 inhibitor
protein, which is ant for controlling ation. C1 inhibitor blocks the
activity of certain proteins that promote in?ammation. Mutations that cause hereditary
angioedema type I lead to reduced levels of Cl inhibitor in the blood. In contrast,
mutations that cause type II result in the production of a C1 inhibitor that functions
abnormally. t the proper levels of functional C1 inhibitor, excessive s
of bradykinin are generated. Bradykinin promotes in?ammation by increasing the
leakage of ?uid through the walls of blood vessels into body tissues. ive
accumulation of ?uids in body tissues causes the episodes of swelling seen in
individuals with hereditary dema type I and type II.
Mutations in the F12 gene are associated with some cases of hereditary
angioedema type III. The F12 gene provides instructions for making coagulation
factor XII. In addition to g a critical role in blood clotting lation), factor
XII is also an important stimulator of in?ammation and is involved in the production
of bradykinin. Certain mutations in the F12 gene result in the production of factor XII
with increased activity. As a result, more bradykinin is generated and blood vessel
walls become more leaky, which leads to episodes of ng. The cause of other
cases of hereditary angioedema type III remains unknown. Mutations in one or more
as—yet unidentified genes may be sible for the disorder in these cases.
HAE can present similarly to other forms of angioedema resulting from
allergies or other medical conditions, but it differs significantly in cause and
treatment. When hereditary angioedema is misdiagnosed as an allergy, it is most
ly treated with antihistamines, steroids, and/or hrine, which are
typically ineffective in HAE, although epinephrine can be used for life—threatening
reactions. Misdiagnoses have also resulted in ssary exploratory surgery for
patients with abdominal swelling, and in some HAE patients abdominal pain has been
incorrectly diagnosed as psychosomatic.
C1 inhibitor therapies, as well as other therapies for HAE, are described in
, A.P., J Allergy Clin Immunol, 2010, 126(5):918—925.
Acute treatment of HAE attacks is provided to halt progression of the edema
as quickly as possible. C1 inhibitor concentrate from donor blood, which is
administered intravenously, is one acute treatment; however, this treatment is not
available in many countries. In emergency situations where Cl inhibitor concentrate
is not available, fresh frozen plasma (FFP) can be used as an alternative, as it also
contains Cl inhibitor.
Purified Cl inhibitor, d from human blood, has been used in Europe
since 1979. Several Cl inhibitor treatments are now available in the U.S. and two Cl
inhibitor products are now available in Canada. Berinert P (CSL Behring), which is
pasteurized, was approved by the FDA. in 2009 for acute attacks. Cinryze
(ViroPharma), which is ltered, was ed by the FDA. in 2008 for
prophylaxis. Rhucin (Pharming) is a recombinant Cl inhibitor under development that
does not carry the risk of infectious disease transmission due to human blood—bome
pathogens.
Treatment of an acute HAE attack also can include medications for pain relief
and/or IV ?uids.
Other treatment ties can stimulate the synthesis of Cl inhibitor, or
reduce Cl inhibitor ption. Androgen medications, such as danazol, can reduce
the frequency and severity of attacks by stimulating production of Cl inhibitor.
Helicobacter pylori can trigger abdominal attacks. otics to treat h. pylori
will decrease abdominal attacks.
Newer ents attack the contact cascade. Ecallantide (KALBITOR®, DX—
88, Dyax) ts plasma kallikrein and has been approved in the U.S.. Icatibant
(FIRAZYR®, Shire) inhibits the bradykinin B2 receptor, and has been approved in
Europe and the U.S.
Diagnosis of HAE can rely on, e.g., family history and/or blood tests.
Laboratory findings associated with HAE types I, II, and III are described, e. g., in
Kaplan, A.P., J Allergy Clin Immunol, 2010, l26(5):9l8—925. In type IHAE, the
level of Cl inhibitor is decreased, as is the level of C4, whereas Clq level is normal.
In type II HAE, the level of Cl inhibitor is normal or increased; however, Cl inhibitor
on is abnormal. C4 level is decreased and Clq level is . In type III, the
levels of Cl inhibitor, C4, and Clq can all be normal.
Symptoms of HAE can be assessed, for example, using questionnaires, e.g.,
onnaires that are completed by patients, clinicians, or family members. Such
questionnaires are known in the art and include, for example, visual analog scales.
See, e.g., McMillan, C.V. et al. Patient. 2012;5(2):ll3—26.
Treating HAE with Kal antibodies
The disclosure provides methods of ng (e.g., ameliorating, stabilizing, or
eliminating one or more ms) of hereditary angioedema (HAE) by
stering an antibody described herein (e.g., a therapeutically effective amount of
an antibody described herein) to a subject having or suspected of having HAE, e.g.,
according to a dosing schedule bed herein. Additionally provided are methods
of treating HAE by administering an antibody described herein (e. g., a therapeutically
effective amount of an antibody described ), e.g., according to a dosing
schedule described , or in combination with a second therapy, e.g., with one
other agent, e.g., described herein. The disclosure also provides methods of
preventing HAE or a symptom thereof by administering an antibody described herein
(e.g., a prophylactically effective amount of an antibody described ) to a subject
at risk of developing HAE (e. g., a subject having a family member with HAE or a
genetic predisposition thereto), e. g., ing to a dosing schedule described .
In some examples, the subject may be a human patient who has no HAE symptoms at
the time of the treatment.
Treating includes stering an amount effective to alleviate, relieve, alter,
remedy, ameliorate, improve or affect the disorder, the symptoms of the disorder or
the predisposition toward the disorder. The treatment may also delay onset, e.g.,
prevent onset, or prevent deterioration of a disease or condition.
Methods of administering DX—2930 antibodies are also described in
“Pharmaceutical Compositions.” Suitable dosages of the antibody used can depend
on the age and weight of the t and the particular drug used. The antibody can
be used as competitive agents to inhibit, reduce an undesirable interaction, e.g.,
between plasma kallikrein and its substrate (e.g., Factor XII or HMWK). The dose of
the antibody can be the amount sufficient to block 90%, 95%, 99%, or 99.9% of the
activity of plasma kallikrein in the patient, especially at the site of disease. This may
require 30 mg, 100 mg, 300 mg, or 400 mg, e.g., administered every two weeks.
In one embodiment, the antibodies are used to inhibit an activity (e.g., inhibit
at least one activity of plasma kallikrein, e.g., reduce Factor XIIa and/or bradykinin
production) of plasma kallikrein, e.g., in vivo. The binding proteins can be used by
themselves or conjugated to an agent, e.g., a cytotoxic drug, cytotoxin enzyme, or
radioisotope.
The antibodies can be used directly in vivo to eliminate antigen—expressing
cells via natural complement—dependent cytotoxicity (CDC) or antibody dependent
cellular xicity (ADCC). The antibodies described herein can include
complement binding effector , such as the Fc portions from IgGl, —2, or —3 or
corresponding portions of IgM which bind complement. In one embodiment, a
population of target cells is ex vivo treated with an antibody described herein and
appropriate effector cells. The treatment can be supplemented by the addition of
ment or serum containing complement. Further, phagocytosis of target cells
coated with an antibody described herein can be improved by binding of complement
proteins. In another ment target, cells coated with the antibody which includes
a complement binding effector domain are lysed by complement.
Methods of administering DX—2930 antibodies are described in
“Pharmaceutical Compositions.” Suitable s of the molecules used will depend
on the age and weight of the subject and the ular drug used. The dies can
be used as competitive agents to inhibit or reduce an undesirable interaction, e.g.,
between a natural or pathological agent and the plasma kallikrein.
A therapeutically effective amount of an antibody as described , can be
stered to a subject having, suspected of having, or at risk for HAE, thereby
treating (e.g., ameliorating or improving a symptom or feature of a disorder, slowing,
stabilizing and/or halting disease ssion) the disorder.
The antibody described herein can be administered in a therapeutically
effective amount. A eutically effective amount of an antibody is the amount
which is effective, upon single or multiple dose stration to a subject, in treating
a subject, e. g., curing, alleviating, relieving or improving at least one symptom of a
disorder in a t to a degree beyond that expected in the absence of such
treatment.
Dosage regimens can be adjusted to provide the optimum desired se
(e. g., a therapeutic response). For example, a single bolus may be administered,
several divided doses may be administered over time or the dose may be
proportionally reduced or increased as indicated by the exigencies of the therapeutic
situation. It is especially advantageous to ate parenteral compositions in
dosage unit form for ease of stration and uniformity of dosage. Dosage unit
form as used herein refers to physically discrete units suited as unitary dosages for the
subjects to be treated; each unit contains a predetermined quantity of active compound
calculated to e the d therapeutic effect in association with the required
pharmaceutical carrier.
In some embodiments, the DX—2930 antibody is administered by multiple
doses such as once every 2 weeks, once every 3 weeks, once every four weeks, once
every 6 weeks, once every 8 weeks or less frequent. Each of the multiple doses can
be 30 mg, 100 mg, 150 mg, 300 mg, 350 mg. or 400 mg. In some instances, a patient
may be given multiple doses once every 2 weeks, for a suitable period of time. In
some embodiments, DX—2930 can be administered at 300 mg or 400 mg every two
weeks. In other embodiments, DX—2930 can be administered at 300 mg or 400 mg
every four weeks. In yet other embodiments, DX—2930 can be administered at 150
mg every four weeks. In any of the methods described herein, a subject treated by
DX—2930 for le doses as described herein may be followed up with a
maintenance treatment.
In any of the methods described herein, a t may be d by DX—2930
for multiple doses in a loading period and then followed up with a maintenance
period. In the loading period, the subject may be treated with DX—2930 at about 100
mg to about 400 mg (e.g., 100—300 mg or 150-300 mg, for example, 100 mg, 150 mg,
200 mg, 300 mg, or 400 mg) once every 2—4 weeks (for example, every 2 weeks,
every 3 weeks, or every 4 weeks) for a suitable period. In the loading period, the
t may be treated with DX-2930 at about 100 mg to about 300 mg (e.g., 100—300
mg or 150—300 mg, for example, 100 mg, 150 mg, 200 mg, or 300 mg) once every 2—4
weeks (for example, every 2 weeks, every 3 weeks, or every 4 weeks) for a le
period.
In some embodiments, the patient can be monitored for side effects (e.g.,
elevation of creatine atase levels) and/or inhibition levels of pKal by the
antibody (e.g., serum or plasma concentration of the antibody or the pKal activity
level) before and after the ent or during the course of treatment. If adverse
effect is observed, the dose of the antibody might be reduced or the treatment might
be terminated. If the inhibition level is below a minimum therapeutic level, further
doses of the antibody might be administered to the patient.
In some embodiments, the plasma or serum concentration of the dy
(e.g., DX—2930) may be measured during the course of the treatment (e.g., after the
l dosage) for assessing the efficacy of the treatment. If the plasma or serum
concentration of the antibody is lower than about 80 nM, a follow—up dosage may be
needed, which may be the same or higher than the initial dosage. The plasma or
serum concentration of the antibody may be measured by determining the protein
level of the antibody in a plasma or serum sample ed from the subject, e.g., by
an immune assay or MS assay. The plasma or serum concentration of the antibody
may also be measured by determining the tory level of pKal in a plasma or
serum sample obtained from a subject treated with the antibody. Such assays may
include the synthetic substrate assay or the Western blot assay for measuring cleaved
kininogen as described herein.
Alternatively or in addition, the plasma or serum level of creatine kinase can
be monitored during the course of the treatment. If the plasma or serum level of
creatine kinase is found to elevate during the ent, the dosage of the antibody
may be reduced or the treatment may be terminated.
In some embodiments, an optimal dosage (e.g., optimal prophylactic dosage or
optimal eutic dosage) of the antibody (e.g., DX—2930) may be determined as
s. The antibody is given to a t in need of the treatment at an initial dose.
The plasma concentration of the antibody in the subject is measured. If the plasma
concentration is lower than 80 nM, the dose of the antibody is increased in a
subsequent administration. A dosage of the antibody that maintains the antibody
plasma concentration above about 80 nM can be chosen as the optimal dosage for the
subject. The creatine phosphokinase level of the subject can be monitored during the
course of treatment and the optimal dosage for that subject can be further adjusted
based on the creatine phosphokinase level, e.g., the dosage of the dy might be
reduced is elevation of creatine phosphokinase is observed during treatment. In some
embodiments, the dy such as DX-2930 is administered to reduce the level of
cleaved kininogen to levels comparable to healthy subjects.
In some embodiments, any of the antibodies disclosed herein, such as DX—
2930 and its onal variants, may be used to prevent HAE attack or reduce the rate
of HAE attack in human patients having history of HAE attack. In some examples,
the human patients experienced at least two HAE attacks per year and optionally at
least one within the 6 months prior to the ent. In other es, the human
patients experienced at least two HAE attacks within 3 months prior to the treatment.
In other examples, the human patients had at least 9 HAE attacks within 3 months
prior to the treatment and optionally at least 25 attacks (e.g., 36 attacks) within 12
months prior to the treatment.
An antibody as bed herein (e.g., DX-2930) can be administered in
combination with one or more of the other therapies for treating a disease or condition
associated with plasma kallikrein activity, e.g., a disease or condition described
herein. For example, an antibody as described herein (e.g., DX—2930) can be used
therapeutically or prophylactically with surgery, another anti- plasma kallikrein Fab
or IgG (6.g. another Fab or IgG described herein), another plasma kallikrein inhibitor,
a peptide inhibitor, or small molecule inhibitor. es of plasma kallikrein
inhibitors that can be used in combination y with a plasma kallikrein binding
antibodies bed herein include plasma kallikrein inhibitors described in, e. g. WO
95/21601 or
One or more plasma kallikrein inhibitors can be used in combination with an
antibody as described herein (e.g., DX—2930). For example, the combination can
result in a lower dose of the inhibitor being needed, such that side effects are reduced.
An antibody as described herein (e.g., 0) can be administered in
combination with one or more current therapies for treating HAE. For example, DX—
2930 antibody can be d with a second anti—HAE therapeutic agent such as
ecallantide, a Cl esterase inhibitor (e.g., CINRYZETM), aprotinin (TRASYLOL®),
and/or a bradykinin B2 receptor inhibitor (6.3., icatibant (FIRAZYR®)).
The term “combination” refers to the use of the two or more agents or
therapies to treat the same patient, wherein the use or action of the agents or ies
overlaps in time. The agents or therapies can be administered at the same time (e.g.,
as a single formulation that is administered to a patient or as two te
formulations administered concurrently) or sequentially in any order. Sequential
administrations are strations that are given at different times. The time
between administration of the one agent and another agent can be minutes, hours,
days, or weeks. The use of a plasma kallikrein binding antibody described herein can
also be used to reduce the dosage of another therapy, e.g., to reduce the side effects
associated with another agent that is being stered. Accordingly, a ation
can include administering a second agent at a dosage at least 10, 20, 30, or 50% lower
than would be used in the absence of the plasma kallikrein binding antibody.
A combination therapy can include administering an agent that reduces the
side s of other therapies. The agent can be an agent that reduces the side effects
of a plasma kallikrein associated disease treatment.
Without further elaboration, it is believed that one skilled in the art can, based
on the above description, utilize the present invention to its fullest extent. The
following specific embodiments are, therefore, to be construed as merely illustrative,
and not limitative of the remainder of the disclosure in any way whatsoever. All
ations cited herein are incorporated by reference for the purposes or subject
matter referenced herein.
EXAMPLES
Example 1: A Phase 1b, Double-Blind, Multiple Ascending Dose Study to Assess
Safety, Tolerability and Pharmacokinetics of 0 in
Hereditary Angioedema Subjects
A phase lb trial was conducted to assess safety and tolerability of le
subcutaneous administrations of DX—2930 at ent dose levels in hereditary
angioedema (HAE) subjects. HAE patients included in the study included those with
documented diagnosis of HAE (Type I or Type 11) based upon all of the following:
documented clinical history consistent with HAE (subcutaneous or mucosal,
ritic swelling episodes without accompanying ria), Cl inhibitor (Cl—
INH) antigen or functional level < 40% of the normal level (Subjects with antigen or
functional Cl-INH level 40-50% of the normal level were enrolled if they also had a
C4 level below the normal range and a family history consistent with HAE Type I or
II), age at reported onset of first angioedema ms 3 30 years or a family history
consistent with HAE Type I or II, and experiencing 22 HAE s per year, with at
least 1 attack in the past 6 months reported by the subject. HAE patients ed
were randomized in a 2:1 ratio of active drug to placebo and administered
subcutaneous doses of DX—2930 at 30 mg (n24), 100 mg (n24), 300 mg (n=5), and
400 mg (n=l l) or placebo (n=l3) in two doses separated by 14 days. One patient in
the 400 mg group ed only one dose and then was unavailable for the second
dose and was ed. The replacement patient was also unable to complete the
study for reasons not related to the study, resulting a total of 10 patients completing
the 400 mg dose and being included in the assessment. Plasma was collected at time
points following stration out to day 120 (15 weeks), except in the group that
received the 400 mg dose, where data was available up to day 50. Analyses ed
safety, pharmacokinetics, pharmacodynamics (biomarkers), and efficacy. The drug
group and the placebo group were baled in terms of age, race, ethnicity, and BMI,
although there were ly more females present in the DX-2930 (67%) vs placebo
(54%) groups.
Pharmacokinetics of DX—2930
DX—293O drug levels were measured in plasma by a validated immunoassay
that used an anti—idiotypic antibody against DX—2930 D02). From the plot of
mean plasma drug levels for each dose group versus days following DX—293O
administration, it was evident that drug levels were dose dependent and exhibited a
prolonged half—life, typical of a human monoclonal antibody. Key pharmacokinetic
observations are summarized in Table 2 and Figure 1. First, Cmax drug levels increased
with increasing dose, as expected. In addition, the Tmax following the second dose was
about 20 days and the half—life was approximately 14 days. These parameters were
consistent with values obtained in a phase la study in healthy eers and
supported either once or twice a month dosing.
Table 2. Pharmacokinetic observations
17.9(1.1) 14.2 (0.8)
18.0 (0.5) 14.6 (3.4)
18.2(1.5) 13.8 (3.3)
.0) 15.0 (2.4)
Values presented are the mean values for the evaluated patients with the standard
deviation in parentheses.
Pharmacodynamic Activity of DX—2930: Fluorogenic ty Assay
Two different biomarker assays were used to investigate the
pharmacodynamic (PD) ty of DX—2930 in HAE patient plasma. The first PD
assay is referred to as the Fluorogenic Activity assay, and it provides a measure of the
bioactivity of DX—2930 in citrated plasma obtained from treated patients at the same
time points following dosing as used to determine the pharmacokinetic properties of
DX-2930. This assay measured the amount of active plasma rein that is
generated in d plasma after activation of the contact pathway. Specifically,
dilute plasma was spiked with active Factor XIIa (FXIIa) which propagates the
enzymatic cascade of the contact pathway, after 2 minutes the FXIIa inhibitor Corn
Trypsin tor was added to stop the reaction, and the amount of active plasma
kallikrein present in the sample was ed by its y to hydrolyze a pro—
fluorescent synthetic e substrate. The presence of increasing levels of DX—293O
in the plasma of treated healthy volunteers (phase 1a study) or HAE patients (phase
lb study) was associated with a dose dependent reduction in the observed plasma
kallikrein enzymatic rate (Figure 2). The percent inhibition observed at each time
point was calculated relative to the amount of plasma kallikrein activity in the pre—
dose samples for each patient. The observed bioactivity in Figure 2 was well
correlated with the pharmacokinetic properties of DX—2930 in Figure l. Marked
inhibition was ed in the 300 and 400 mg doses following dosing. Intermediate
inhibition was ed in the 100 mg dose and no apparent inhibition was evident in
the 30 mg dose.
Pharmacodynamic Activity of DX—2930: Western Blot Assay
HAE patients are deficient in Cl—Inhibitor, the endogenous inhibitor of plasma
kallikrein. As a result, these patients have elevated active plasma kallikrein, which
converts its 1-chain high molecular weight kininogen ate to 2-chain and
bradykinin, the key or of pain and edema in HAE. DX-2930 is a highly potent
inhibitor of active plasma kallikrein that blocks 2-chain and bradykinin generation.
A Western blot assay was developed to measure the relative amounts of 1—
chain and 2—chain high molecular weight kininogen in plasma in different plasma anti—
coagulants and treatment conditions. Figure 3 shows the %2—chain that was ed
in HAE patient plasma collected in the presence of protease inhibitors (SCAT169
plasma). The presence of 9 plasma prevented the activation of the contact
system and subsequent 2—chain generation that can occur during blood collection and
sing to plasma. Hence, this level of 2—chain was expected to closely match that
of endogenous levels in HAE patients in in the phase lb trial (27%) and in healthy
volunteers (12%). DX—2930 treated HAE patients exhibited lower 2—chain levels as
measured in samples collected either 8 or 22 days after .
In Figure 4, pre-dose citrated plasma obtained from the HAE ts in the
phase 1b trial contained approximately 52% 2-chain. In contrast, citrated plasma
samples from healthy volunteers obtained in a phase 1a study contained
approximately 8% 2—chain. Mean 2—chain levels in plasma of phase lb subjects
collected on days 8 and 22 were also investigated and are shown in Figure 4. The
statistically significant ion in 2—chain levels in the 300 and 400 mg dose groups
versus pre—dose levels demonstrated pharmacodynamic activity of DX—2930.
Figure 5 shows that citrated plasma from DX—2930 dosed HAE patients
exhibited less 2—chain following ex vivo tion with coagulation factor XIIa
(FXIIa). The 300 and 400 mg dose groups reduced the amount of 2—chain to a level
below that observed in healthy volunteers. This ex vivo activation may be considered
an in vitro model of a severe HAE .
Both of these PD biomarker assays supported dose selection that would
achieve drug levels obtained at the 300 and 400 mg dose groups.
Safety
A summary of adverse events is shown in Table 3 below. There was no
imbalance in treatment emergent adverse events (TEAEs) that would indicated a
safety concern of DX—2930. Most common AEs were HAE attacks, injection site
pain, and headache. There were 3 severe TEAEs tion site pain lasting 1 min,
worsening headache lasting 1 minute and night sweats). No safety s were
identified for clinical laboratory abnormalities or s from baseline, vital signs or
physical examinations, or abnormalities or changes in electrocardiogram (ECG).
These results suggest that DX—2930 appears to be well tolerated in HAE patients at
doses up to 400 mg.
Table 3. Summary of treatment adverse events
- DX-2930 DX-2930 DX-2930
14 (58%) 10 (77%)
Deaths or
subject
discontinuations
2 5 (21%) 5 (39%)
Related 1 2 4 7 (29%) 5 (39%)
TEAEs**
* TEAE: Treatment Emergent Adverse . An AB is treatment emergent if the
onset time is after administration of study drug through the Day 120 post dose final
follow—up Visit, or in the event that onset time precedes study drug administration, the
AE increases in severity during the 120 day post dose follow—up period. **
Treatment—related AEs: Relatedness of ABS to study drug was assessed by a blinded
investigator.
Immunogenicity
patients were anti—drug antibody positive (2 of the 5 had intermittent,
?uctuating results). r, no positive s were neutralizing, there was no
clinical evidence of hypersensitivity, and no apparent effects on pharmacokinetics or
biomarkers.
Efficacy assessment
A prospective primary efficacy analysis was performed, which focused on the
300 and 400 mg doses of DX-2930, individually and combined, compared to placebo.
A six week primary ment period (Day 8 to Day 50) was used (Figure 6A and
6B), as PK modeling from phase 1a ted e drug exposure during this time
interval. The primary analysis focused upon subjects with a minimum baseline
history of at least 2 attacks in the past 3 months. Most of the subjects fulfilled the
minimum ed baseline y of at least 2 attacks in the past 3 months. Of the 13
placebo subjects, 11 met this requirement. Of the 16 subjects treated with 300 or 400
mg DX—2930, 15 met this requirement. The ne HAE attack rates in the o,
300 mg, and 400 mg groups were 0.39, 0.33, and 0.55 attacks per week, respectively.
The baseline rate in the combined 300 and 400 mg group was 0.49 attacks per week.
The primary approach was an intent—to—treat (ITT) analysis. A model of
repeated measurements was used, with an analysis of variance (ANOVA) employing
baseline attack rates as a ate. The read—out was expressed as a percent reduction
in HAE attacks by DX-2930 in comparison to the placebo attack rates, and p values
were calculated.
Results of the efficacy assessment are shown in Table 4 and 5 and in Figure 7,
which both show a reduction in HAE attack rate with the 300 and 400 mg doses of
DX—2930, individually and combined, compared to the placebo. In particular, 13 of
the 15 DX—2930 subjects treated with 300 or 400 mg were attack—free for the duration
of the study, whereas for the placebo group, only 3 of the 11 subjects were attack—free.
Table 4. Reduction in HAE attack rate from day 8 to 50
DX-2930 DX-2930 DX-2930
300 mg 400 mg Combined
(N: 4) (N: 11) 300 and 400 mg
P—value vs placebo <0.0001 0.005 0.0012
Note: Only subjects who have a baseline attack rate of at least 2 s in the last 3
months were ed.
* Mixed Model Repeated Measurements with Analysis of Variance (baseline attack
frequency as ate) and assuming Poisson bution.
Table 5. Proportion of subjects who were attack-free
DX-2930 DX-2930 DX-2930
300 mg 400 mg Combined
(N = 4) (N = 11) 300 and 400 mg
= 15)
Attack-free 4/4 (100%) 9/11 (82%) 13/15 (87%) 3/11 (27%)
subjects (Day 8 to p = 0.026 p = 0.030 p = 0.004
Among the placebo subjects, there were a total of 24 attacks during the
primary efficacy assessment period. Of these 24 attacks, the primary attack location
was abdominal in 13 and laryngeal in l of them. 10 of the attacks were severe and 6
were moderate. Acute treatment for the attacks was received in 22 of the 24 attacks.
Among subjects treated with 300 or 400 mg DX—2930, one subject treated
with 400 mg had a single HAE attack. This attack was peripheral, mild, lasted 8
hours, and did not require any acute ent. The other 400 mg DXtreated
subject experiencing s had two peripheral attacks. One attack was moderate and
the other was severe; both attacks were treated with acute therapy. A summary of the
characteristics of the HAE s is shown in Table 6.
Table 6. Characteristics of HAE attacks (Day 8 to 50)
DX-2930 DX-2930
300 mg 400 mg
(N = 4) (N = 11)
Acute s requiring 0 2
treatment
Next, a modified intent—to—treat (mITT) oc analysis was undertaken.
The ITT population was used except 2 subjects were excluded (one subject that did
not receive 2 strations and 1 subject that did not have HAE type 1 or type 2).
Results of the modified analysis are shown in Table 7. In this modified intent—to—treat
analysis, from Day 8 to Day 50 in ison to placebo, the 300 mg DX—2930 group
had a 100% reduction in s with a p value of less than 0.0001. The 400 mg DX—
2930 group had a 95% reduction in attacks with a p value of 0.0022. The combined
300 and 400 mg DX—2930 group had a 97% reduction in HAE attacks, with a p value
Table 7. y efficacy analysis (Day 8 to 50) (modified intent-to-treat
analysis)
DX-2930 DX-2930 DX-2930
300 mg 400 mg Combined
(N: 4) N=9 300 and 400 mg
(N: 13)
P—value vs placebo <0.0001 0.0022 0.0007
Note: Only subjects who have a baseline attack rate of at least 2 attacks in the last 3
months are ed. MITT population excludes 2 subjects, one t t type
I or II HAE and one subject who received only 1 administration of DX—2930.
* Mixed Model Repeated ements with Analysis of Variance (baseline attack
frequency as covariate) and ng Poisson distribution.
The incidence of HAE attacks in relation to drug exposure over time was also
evaluated. Without wishing to be bound by theory, the hypothesis was that higher
drug levels should be correlated with prevention of HAE attacks, meaning (a) that
before dosing as well as in the few days after dosing, attacks should be observed, (b)
that as drug levels accumulate, attacks should become rare or even absent, and (c) that
as the drug levels decline, attacks should re—emerge. The results of this evaluation are
shown in Figures 8-13.
In the placebo group high incidence of attacks was evident (Figure 8). These
events were distributed throughout the entire duration of the study without any
particular pattern.
In the 30 and 100 mg 0 groups, no attacks occurred from Day 8 to Day
50 (Figures 9 and 10). However, the baseline attack rates for these groups were
relatively lower and the pharmacodynamic effect for the 30 mg group was not
appreciably different from that for placebo. In the 300 mg DX—2930 group, there
were attacks that occurred prior to . As drug levels rose, the subjects became
attack—free and as drug levels declined, attacks re-emerged (Figure 11). A r
pattern was also observed in the 400 mg DX—2930 group (Figure 12). Attack
incidence substantially decreased during a period of notable drug exposure,
particularly within the Day 8 to Day 50 time interval. This period was bracketed by
attacks occurring during times of lower drug exposure, either prior to drug
accumulation or as drug levels waned. These results show that there is a clear
ation between DX-2930 drug exposure and prevention of HAE attacks.
To further assess the efficacy of 0, the therapeutic effects of DX-2930
were also observed in HAE patients with high baseline attack rates were explored.
Subjects with at least 9 attacks in the past 3 months prior to dosing were identified
and evaluated. There were 6 such subjects— 1 treated with placebo, 1 treated with 300
mg DX—2930, and 4 d with 400 mg DX—2930.
In the placebo subject, attacks occurred throughout the observation period at a
high rate (Figure 13, panel A). In contrast, the subject treated with 300 mg DX—2930
was attack—free when drug levels were high. (Figure 13, panel B).
In the four subjects with high baseline attack rates who were treated with 400
mg DX—2930, all four of these subjects were attack—free during the Day 8 to Day 50
time interval (Figures 13, panels C—F). This ed one subject with a very high
baseline rate of 36 attacks in the past 3 months. The n of attacks in these DX—
2930—treated subjects was consistent with that seen in the 300 and 400 mg groups
overall. These individuals did not experience any attacks when drug levels were high.
Attacks only occurred when drug levels were low, either prior to meaningful drug
accumulation or after drug levels declined.
From these data, it was observed that the therapeutic effect of 0 was
also evident in HAE ts with high baseline attack rates.
In summary, this study shows (a) that there were no apparent safety signals for
DX-2930, (b) that the PK profile was consistent overall with a monoclonal dy
and ted a regimen of dosing once every 2 weeks or even less frequently, (c)
that pharmacodynamic data demonstrated that DX—2930 normalizes the aberrant
instability of HAE plasma, at least in the context of the kininogen biomarker ,
and (d) that a highly statistically significant finding of HAE attack prevention by DX—
2930 was observed. Specifically, in comparison to placebo, there were 100% and
88% reduction in attacks by the 300 and 400 mg DX—2930 treatment groups
respectively. This clinical effect was lly associated with drug exposure over
time and was also observed in the subset of patients with high baseline attack rates.
These data demonstrate proof of concept for 0 in erm
prophylaxis against HAE attacks.
Example 2 : Pharmacodynamic Effect of DX-2930 on Plasma Kallikrein in
Hereditary Angioedema Patients
Attacks of hereditary angioedema (HAE) result from uncontrolled t
system activation which generates a burst of plasma kallikrein (pKal) that cleaves
high—molecular—weight kininogen (HMWK) to produce 2—chain HMWK and the
inducing peptide, bradykinin. DX—2930 is a human monoclonal antibody
inhibitor of pKal in development for the prevention of HAE attacks. The
pharmacodynamic bioactivity of DX—2930 was assessed in subjects with HAE.
As described in Example 1 above, the phase lb center, double—blind
study, randomized subjects with Type 1 or 2 HAE to receive 2 subcutaneous doses of
0 in dose groups of 30, 100, 300 or 400 mg (n=4, 4, 5, 11) or placebo (n=l3).
Blood samples were obtained prior to and following administration of study drug
(Days 1, 8, 22, 64, 92, 120). The ability of DX-2930 to inhibit pKal in basal and
FXIIA—activated citrated plasma was assessed using Western blot for 2—chain HMWK.
The s obtained from this study showed that mean 2—chain HMWK levels
were significantly reduced and essentially normalized in the 300 and 400 mg dose
groups on Days 8 and 22, and on Days 8, 22 and 50, respectively, when compared to
placebo d subjects. Treatment with 300 or 400 mg DX—2930 also attenuated the
burst in 2—chain generation to levels at or below that observed in healthy individuals
in FXIIA—activated samples. Levels of 2—chain HMWK did not differ from pre—dose
plasma samples in either ted or inactivated samples collected on Days 64, 92 or
120 ing DX-2930, which correspond to periods of low drug exposure.
In sum, this study indicates that DX-2930 ts pKal in a dose and time-
dependent manner in HAE patients.
Example 3 : Relationship between Drug Exposure and Clinical Response
Observed in the Phase 1b Study of DX-2930 in Subjects with
Hereditary Angioedema
DX—2930 is a human monoclonal antibody inhibitor of plasma kallikrein in
development for the prevention of tary dema (HAE) attacks. Data from
the phase lb study of DX—2930 in HAE subjects as described in Example 1 above was
ed to characterize the relationship between drug exposure and al response.
This phase lb multi-center, —blind study, randomized subjects with
Type 1 or 2 HAE to receive 2 subcutaneous doses of DX—2930 in dose groups of 30,
100, 300 or 400 mg (n=4, 4, 5, 11) or o (n=13). In this post—hoc analysis, the
incidence of HAE attacks was ted in relation to drug exposure over time. In
addition, a oc modified intent-to-treat ef?cacy analysis (MITT) was conducted
to assess clinical effect in the context of subjects receiving the full dose regimen of
DX—2930.
Placebo—treated subjects reported HAE attacks throughout the study (9
subjects, 65 HAE attacks). In the 300 and 400 mg dose groups, HAE attacks were
reported prior to or just after initial dosing. When drug levels were high (Day 8 to 50),
all but 1 subject was attack—free. As drug levels waned, attacks re—emerged. In the
MlTT efficacy analysis, from Day 8 to 50 in comparison to placebo, the 300 and 400
mg DX—2930 groups had a 100% (P < 0.0001) and 95% (P = 0.0022) reduction in
attacks, respectively.
Thus, this study indicates that HAE attacks were substantially sed or
were eliminated during periods of notable drug exposure consistent with the
suggestion that higher drug levels should correlate with HAE attack prevention.
Example 4 : Modeling and Analyses to Identify Potential Dosing Regimens of
DX-2930 for the Long-Term Prophylaxis of Hereditary Angioedema
DX—2930 is a human monoclonal antibody inhibitor of plasma rein in
development for the prevention of hereditary angioedema (HAE) attacks. Data from
the Phase 1 studies of DX-2930 as described in Example 1 above were modeled and
analyzed to identify potential dosing regimens.
Pharmacokinetic, codynamic and ef?cacy data from the Phase 1
clinical studies were examined. The incidence of HAE attacks was evaluated in
relation to plasma drug trations to estimate steady-state trough drug levels
necessary to t attacks.
Dosing ns of 300 mg DX—2930 every 2 (q2) or 4 (q4) weeks, and 150
mg q4 weeks are being considered for the l efficacy study. Pharmacokinetic
modeling predicts —state trough plasma concentrations of 27,000, 9,500, and
4,750 ng/mL, respectively. In the Phase lb study, at 27,000 ng/mL (corresponding to
imate drug levels at Day 22 for 300 mg DX—2930), 2—chain high—molecular—
weight gen was suppressed to a level approximating that observed in healthy
subjects. Three-hundred mg q2 is therefore predicted to normalize the instability of
HAE plasma at steady state. As sful HAE prophylaxis may not require such a
high level of pharmacodynamic effect, an analysis of al effect in relation to
plasma drug trations was also conducted. In the Phase lb study following DX—
2930 treatment, 24/25 attacks (96%), 21/25 (84%), and 18/25 s (72%) occurred
below plasma concentrations of 27,000, 9,500, and 4,750 ng/mL, respectively,
suggesting a meaningful range of al response is ated with this range of
drug exposure.
In this is, potential dosing regimens of DX—2930 were identified for
further clinical investigation in the pivotal efficacy study.
Example 5 : Hereditary Angioedema is Associated with Neuropathic Pain,
Systemic Lupus Erythematosis and Systemic Mastocytosis in an
Analysis of a Health Analytics Claims Database
The plasma kallikrein kinin system (KKS) has been associated with a variety
of diseases in addition to being a key mediator of hereditary angioedema (HAE). It
was explored in this study whether HAE patients were predisposed to develop such
KKS associated diseases: abdominal aortic aneurysm, anaphylaxis, cardiac egia
syndrome, Crohn’s disease, diabetic macular edema, idiopathic anaphylaxis,
neuropathic pain, psoriasis, psoriatic arthritis, retinopathy, rheumatoid arthritis,
systemic lupus erythematosus (SLE), system mastocytosis, systemic vasculitis,
thrombotic cerebrovascular accident, and ulcerative colitis.
The Truven MarketScan Database containing individual-level claims data
from medical payers and Medicare supplemental plans for 80 million lives in the US.
from 1/2010 through 7/2014 was utilized in this study. Within this dataset, an HAE
population (n=1063) and 2 control populations: an angioedema population
(n=138,851) and the general population (n=79,971,098) exclusive of HAE patients
were d using a combination of ICD—9 and prescription drug codes. Claims for
comorbid diseases were identified and compared across the populations with
calculated odds ratios and 95% confidence intervals (CI).
As shown in the Table 8 below, in the HAE population, SLE was observed 2.3
times more often (OR 2.30, 95%CI: 1.47—3.59) than the angioedema control
population. Neuropathic pain was observed 1.45 times (OR 1.45, 95%CI: 1.01—2.09)
and ic mastocytosis 4.79 times (OR 4.79, 95%CI: 1.51—15 .18) more often than
the angioedema control population.
Table 8. Association between HAE and Other KSS-related Diseases
HAE Angioedema
Associated Disease Population Control Odds Ratio (95%
Abnormal aortic aneurysm 0.56 583 0.42 1.35 (0.60, 3.02)
(AAA)
Anaphylaxis ‘l15293 11.01 0.72 89)
Cardiac egia syndromeN 2.97 (0.73, 12.09)
ic r edema --—- 1.87 (0.46, 7.55)
Idiopathic anaphylaxis 8,442 0.91 (0.70, 1. 18)
Neuropathic pain 1.45 (1.01, 2.09)
—--P' t' th ‘t‘ 4 0.38 -0.28 1.37 I 0.51, 3.67 I
Retinopathy 019_m3.08 (0.76, 12.52)
Rheumatoid arthritis 3, 093 -2 1. 27 (0. 89, 1. 84)
Systemic lupus erythe 3 2.30 (1.47, 3.59)
Systemic mastocytosis _ 0 6 4.79 (151,1518)
Thrombo cerebrovasc accident 2 0.19 0.27 0.70 (0.17, 2.80)
(CVA)
In sum, an analysis of a large longitudinal claims database revealed that
id diseases of SLE, neuropathic pain and systemic mastocytosis had a greater
representation in HAE patients than other types of angioedema, suggesting that
activity of the KKS may be contributing to the manifestations of these diseases.
Accordingly, patients having or at risk for HAE may be predisposed to KKS—
associated es, including neuropathic pain, systemic lupus erythrmatosus, and
ic mastocytosis. Thus, treatment with a pKal inhibitor, such as DX—2930 may
reduce the risk for the development of such a KKS—associated disease.
Example 6: A Double-Blind Study including 3 Load Period and a Maintenance
Period
A randomized, double-blind, placebo-controlled, parallel arm study is carried
out. Patients are selected for having HAE type I or II patients with at least 1 attack
per 4 weeks. A run—in period is used to evaluate baseline HAE attack rate. The
patients are subjected to a 1:1:1 randomization into 3 ent treatment arms (300
mg DX—2930, 150 mg DX—2930, or placebo) which are administered by subcutaneous
injection. The study is designed with a load period and a maintenance period (Figure
14). Subjects are treated on Days 0, 7, and 14 during the loading period, followed by
dosing every 2 weeks during the maintenance period (Days 28, 42, 56, 70, and 84).
OTHER EMBODIMENTS
All of the features disclosed in this specification may be combined in any
combination. Each e disclosed in this specification may be replaced by an
alternative feature serving the same, equivalent, or r purpose. Thus, unless
expressly stated otherwise, each feature disclosed is only an e of a generic
series of equivalent or similar features.
From the above ption, one skilled in the art can easily ascertain the
essential characteristics of the present invention, and without departing from the spirit
and scope f, can make various changes and modifications of the invention to
adapt it to various usages and conditions. Thus, other embodiments are also within
the .
EQUIVALENTS
While several inventive ments have been described and illustrated
herein, those of ordinary skill in the art will readily envision a variety of other means
and/or structures for performing the on and/or obtaining the results and/or one
or more of the advantages described herein, and each of such variations and/or
modifications is deemed to be within the scope of the inventive embodiments
described herein. More generally, those skilled in the art will readily appreciate that
all parameters, dimensions, als, and urations described herein are meant
to be exemplary and that the actual parameters, dimensions, als, and/or
urations will depend upon the speci?c ation or applications for which the
ive teachings is/are used. Those skilled in the art will recognize, or be able to
ascertain using no more than routine experimentation, many equivalents to the
specific inventive embodiments described herein. It is, therefore, to be understood
that the foregoing embodiments are presented by way of examples only and that,
within the scope of the appended claims and equivalents thereto, inventive
embodiments may be practiced otherwise than as specifically described and claimed.
Inventive embodiments of the present disclosure are directed to each individual
feature, system, article, material, kit, and/or method described herein. In addition, any
combination of two or more such features, systems, articles, materials, kits, and/or
methods, if such features, systems, es, materials, kits, and/or s are not
mutually inconsistent, is included within the inventive scope of the present sure.
All definitions, as defined and used herein, should be understood to control
over dictionary definitions, definitions in documents incorporated by reference, and/or
ordinary meanings of the defined terms.
The indefinite articles “a” and “an,” as used herein in the specification and in
the claims, unless clearly indicated to the contrary, should be understood to mean “at
least one.”
The phrase “and/or,” as used herein in the specification and in the claims,
should be understood to mean “either or both” of the elements so conjoined, i.e.,
elements that are conjunctively present in some cases and disjunctively t in
other cases. Multiple elements listed with “and/or” should be ued in the same
fashion, i.e., “one or more” of the elements so conjoined. Other elements may
optionally be t other than the ts specifically identified by the “and/or”
clause, whether related or unrelated to those ts specifically identified. Thus, as
a non—limiting example, a reference to “A and/or B”, when used in conjunction with
open—ended language such as “comprising” can refer, in one embodiment, to A only
(optionally including elements other than B); in another embodiment, to B only
(optionally including elements other than A); in yet another embodiment, to both A
and B (optionally including other ts); etc.
As used herein in the specification and in the claims, “or” should be
tood to have the same meaning as “and/or” as defined above. For example,
when separating items in a list, “or” or “and/or” shall be reted as being
inclusive, i.e., the inclusion of at least one, but also including more than one, of a
number or list of elements, and, optionally, additional ed items. Only terms
clearly indicated to the contrary, such as “only one of” or “exactly one of,” or, when
used in the claims, “consisting of,” will refer to the inclusion of exactly one element
of a number or list of elements. In general, the term “or” as used herein shall only be
interpreted as indicating ive alternatives (i.e. “one or the other but not bot ”)
when preceded by terms of exclusivity, such as “either,39 65 one of,” “only one of,” or
“exactly one of.” “Consisting essentially of,” when used in the claims, shall have its
ordinary meaning as used in the field of patent law.
As used herein in the specification and in the claims, the phrase “at least one,”
in reference to a list of one or more elements, should be tood to mean at least
one element selected from any one or more of the ts in the list of elements, but
not necessarily ing at least one of each and every element specifically listed
within the list of elements and not excluding any combinations of elements in the list
of elements. This definition also allows that ts may optionally be present other
than the elements specifically identified within the list of elements to which the
phrase “at least one” refers, whether related or unrelated to those elements specifically
identified. Thus, as a non—limiting example, “at least one of A and B” (or,
equivalently, “at least one of A or B,” or, equivalently “at least one of A and/or B”)
can refer, in one embodiment, to at least one, optionally including more than one, A,
with no B present (and optionally including elements other than B); in another
embodiment, to at least one, optionally including more than one, B, with no A present
(and optionally including elements other than A); in yet another embodiment, to at
least one, optionally ing more than one, A, and at least one, optionally including
more than one, B (and optionally including other elements); etc.
It should also be understood that, unless clearly indicated to the contrary, in
any methods claimed herein that include more than one step or act, the order of the
steps or acts of the method is not necessarily limited to the order in which the steps or
acts of the method are d.
In the claims, as well as in the specification above, all transitional phrases
such as “comprising,a, cn‘including,’9 c4carrying,” “having,39 “containing,39 lving,”
“holding,” “composed of,” and the like are to be understood to be open—ended, i.e., to
mean including but not limited to. Only the transitional phrases sting of” and
“consisting essentially of" shall be closed or semi—closed transitional phrases,
respectively, as set forth in the United States Patent Office Manual of Patent
Examining Procedures, Section 21 1 1.03.
Claims (3)
1. Use of an antibody in the manufacture of a medicament for preventing hereditary dema (HAE) attack or reducing the rate of HAE attack in a subject, wherein the antibody comprises a heavy chain (HC) complementarity determining region (CDR) 1 having the amino acid ce HYIMM (SEQ ID NO: 5), a HC CDR2 having the amino acid sequence GIYSSGGITVYADSVKG (SEQ ID NO: 6), a HC CDR3 having the amino acid sequence RRDEFDI (SEQ ID NO: 7), a light chain (LC) CDR1 having the amino acid sequence RASQSISSWLA (SEQ ID NO: 8), a LC CDR2 having the amino acid sequence KASTLES (SEQ ID NO: 9), and a LC CDR3 having the amino acid sequence QQYNTYWT (SEQ ID NO: 10), wherein the antibody is formulated in a pharmaceutically acceptable carrier comprising sodium phosphate at a tration of 30 mM, citric acid, histidine at a concentration of 50 mM, sodium chloride at a concentration of 90 mM, and polysorbate 80 at 0.01%, pH 6.0, wherein the medicament is to be administered at about 300 mg of the antibody every two to four weeks at least two times, and wherein the subject is a patient experiencing at least two HAE attacks per year prior to the administration.
2. The use according to claim 1, wherein the antibody comprises a HC variable domain having the amino acid sequence EVQLLESGGGLVQPGGSLRLSCAASGFTFSHYIMMWVRQAPGKGLEWVSGIYSSGGI TVYADSVKGRFTISRDNSKNTLYLQMNSLRAEDTAVYYCAYRRIGVPRRDEFDIWG QGTMVTVSS (SEQ ID NO: 3) and a light chain (LC) variable domain having the amino acid sequence SPSTLSASVGDRVTITCRASQSISSWLAWYQQKPGKAPKLLIYKASTLESGV PSRFSGSGSGTEFTLTISSLQPDDFATYYCQQYNTYWTFGQGTKVEIK (SEQ ID NO:
3. The use according to claim 1 or 2, wherein the antibody is a full length antibody or an antigen-binding fragment thereof.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
NZ774543A NZ774543B2 (en) | 2016-03-30 | Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack |
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US201562140289P | 2015-03-30 | 2015-03-30 | |
US201562140277P | 2015-03-30 | 2015-03-30 | |
US201562214293P | 2015-09-04 | 2015-09-04 | |
PCT/US2016/024921 WO2016160926A1 (en) | 2015-03-30 | 2016-03-30 | Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack |
Publications (2)
Publication Number | Publication Date |
---|---|
NZ735659A NZ735659A (en) | 2023-08-25 |
NZ735659B2 true NZ735659B2 (en) | 2023-11-28 |
Family
ID=
Similar Documents
Publication | Publication Date | Title |
---|---|---|
AU2020244370B2 (en) | Plasma kallikrein binding proteins and uses thereof in treating hereditary angioedema | |
US20220169749A1 (en) | Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack | |
US20230104754A1 (en) | Plasma kallikrein inhibitors and uses thereof for treating hereditary angioedema attack | |
EP3938404A1 (en) | Plasma kallikrein inhibitors and uses thereof for treating hereditary angioedema attack | |
US20230192889A1 (en) | Plasma kallikrein inhibitors and uses thereof for treating pediatric hereditary angioedema attack | |
NZ735659B2 (en) | Plasma kallikrein inhibitors and uses thereof for preventing hereditary angioedema attack | |
EA048026B1 (en) | PLASMA KALLIKREIN INHIBITORS AND THEIR APPLICATIONS FOR THE TREATMENT OF AN ATTACK OF HEREDITARY ANGIONEUROTIC EDEMA | |
EA046649B1 (en) | PLASMA KALLIKREIN INHIBITORS AND THEIR APPLICATION FOR PREVENTION OF ATTACK OF HEREDITARY ANGIOEDEMA |