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Summary of Signaling and Signaling Pathways

Summary of Signaling and Signaling Pathways

Author and Curator: Larry H Bernstein, MD, FCAP

In the imtroduction to this series of discussions I pointed out JEDS Rosalino’s observation about the construction of a complex molecule of acetyl coenzyme A, and the amount of genetic coding that had to go into it.  Furthermore, he observes –  Millions of years later, or as soon as, the information of interaction leading to activity and regulation could be found in RNA, proteins like reverse transcriptase move this information to a more stable form (DNA). In this way it is easier to understand the use of CoA to make two carbon molecules more reactive.

acetylCoA

acetylCoA

In the tutorial that follows we find support for the view that mechanisms and examples from the current literature, which give insight into the developments in cell metabolism, are achieving a separation from inconsistent views introduced by the classical model of molecular biology and genomics, toward a more functional cellular dynamics that is not dependent on the classic view.  The classical view fits a rigid framework that is to genomics and metabolomics as Mendelian genetics if to multidimentional, multifactorial genetics.  The inherent difficulty lies in two places:

  1. Interactions between differently weighted determinants
  2. A large part of the genome is concerned with regulatory function, not expression of the code

The goal of the tutorial was to achieve an understanding of how cell signaling occurs in a cell.  Completion of the tutorial would provide

  1. a basic understanding signal transduction and
  2. the role of phosphorylation in signal transduction.
Regulation of the integrity of endothelial cell–cell contacts by phosphorylation of VE-cadherin

Regulation of the integrity of endothelial cell–cell contacts by phosphorylation of VE-cadherin

In addition – detailed knowledge of –

  1. the role of Tyrosine kinases and
  2. G protein-coupled receptors in cell signaling.
serine

serine

threonine

threonine

protein kinase

protein kinase

We are constantly receiving and interpreting signals from our environment, which can come

  • in the form of light, heat, odors, touch or sound.

The cells of our bodies are also

  • constantly receiving signals from other cells.

These signals are important to

  • keep cells alive and functioning as well as
  • to stimulate important events such as
  • cell division and differentiation.

Signals are most often chemicals that can be found

  • in the extracellular fluid around cells.

These chemicals can come

  • from distant locations in the body (endocrine signaling by hormones), from
  • nearby cells (paracrine signaling) or can even
  • be secreted by the same cell (autocrine signaling).

Notch-mediated juxtacrine signal between adjacent cells. 220px-Notchccr

Signaling molecules may trigger any number of cellular responses, including

  • changing the metabolism of the cell receiving the signal or
  • result in a change in gene expression (transcription) within the nucleus of the cell or both.
controlling the output of ribosomes.

controlling the output of ribosomes.

To which I would now add..

  • result in either an inhibitory or a stimulatory effect

The three stages of cell signaling are:

Cell signaling can be divided into 3 stages:

Reception: A cell detects a signaling molecule from the outside of the cell.

Transduction: When the signaling molecule binds the receptor it changes the receptor protein in some way. This change initiates the process of transduction. Signal transduction is usually a pathway of several steps. Each relay molecule in the signal transduction pathway changes the next molecule in the pathway.

Response: Finally, the signal triggers a specific cellular response.

signal transduction

signal transduction

http://www.hartnell.edu/tutorials/biology/images/signaltransduction_simple.jpg

The initiation is depicted as follows:

Signal Transduction – ligand binds to surface receptor

Membrane receptors function by binding the signal molecule (ligand) and causing the production of a second signal (also known as a second messenger) that then causes a cellular response. These types of receptors transmit information from the extracellular environment to the inside of the cell.

  • by changing shape or
  • by joining with another protein
  • once a specific ligand binds to it.

Examples of membrane receptors include

  • G Protein-Coupled Receptors and
Understanding these receptors and identifying their ligands and the resulting signal transduction pathways represent a major conceptual advance.

Understanding these receptors and identifying their ligands and the resulting signal transduction pathways represent a major conceptual advance.

  • Receptor Tyrosine Kinases.
intracellular signaling

intracellular signaling

http://www.hartnell.edu/tutorials/biology/images/membrane_receptor_tk.jpg

Intracellular receptors are found inside the cell, either in the cytopolasm or in the nucleus of the target cell (the cell receiving the signal).

Note that though change in gene expression is stated, the change in gene expression does not here imply a change in the genetic information – such as – mutation.  That does not have to be the case in the normal homeostatic case.

This point is the differentiating case between what JEDS Roselino has referred as

  1. a fast, adaptive reaction, that is the feature of protein molecules, and distinguishes this interaction from
  2. a one-to-one transcription of the genetic code.

The rate of transcription can be controlled, or it can be blocked.  This is in large part in response to the metabolites in the immediate interstitium.

This might only be

  • a change in the rate of a transcription or a suppression of expression through RNA.
  • Or through a conformational change in an enzyme
 Swinging domains in HECT E3 enzymes

Swinging domains in HECT E3 enzymes

Since signaling systems need to be

  • responsive to small concentrations of chemical signals and act quickly,
  • cells often use a multi-step pathway that transmits the signal quickly,
  • while amplifying the signal to numerous molecules at each step.

Signal transduction pathways are shown (simplified):

Signal Transduction

Signal Transduction

Signal transduction occurs when an

  1. extracellular signaling molecule activates a specific receptor located on the cell surface or inside the cell.
  2. In turn, this receptor triggers a biochemical chain of events inside the cell, creating a response.
  3. Depending on the cell, the response alters the cell’s metabolism, shape, gene expression, or ability to divide.
  4. The signal can be amplified at any step. Thus, one signaling molecule can cause many responses.

In 1970, Martin Rodbell examined the effects of glucagon on a rat’s liver cell membrane receptor. He noted that guanosine triphosphate disassociated glucagon from this receptor and stimulated the G-protein, which strongly influenced the cell’s metabolism. Thus, he deduced that the G-protein is a transducer that accepts glucagon molecules and affects the cell. For this, he shared the 1994 Nobel Prize in Physiology or Medicine with Alfred G. Gilman.

Guanosine monophosphate structure

Guanosine monophosphate structure

In 2007, a total of 48,377 scientific papers—including 11,211 e-review papers—were published on the subject. The term first appeared in a paper’s title in 1979. Widespread use of the term has been traced to a 1980 review article by Rodbell: Research papers focusing on signal transduction first appeared in large numbers in the late 1980s and early 1990s.

Signal transduction involves the binding of extracellular signaling molecules and ligands to cell-surface receptors that trigger events inside the cell. The combination of messenger with receptor causes a change in the conformation of the receptor, known as receptor activation.

This activation is always the initial step (the cause) leading to the cell’s ultimate responses (effect) to the messenger. Despite the myriad of these ultimate responses, they are all directly due to changes in particular cell proteins. Intracellular signaling cascades can be started through cell-substratum interactions; examples are the integrin that binds ligands in the extracellular matrix and steroids.

Integrin

Integrin

Most steroid hormones have receptors within the cytoplasm and act by stimulating the binding of their receptors to the promoter region of steroid-responsive genes.

steroid hormone receptor

steroid hormone receptor

Various environmental stimuli exist that initiate signal transmission processes in multicellular organisms; examples include photons hitting cells in the retina of the eye, and odorants binding to odorant receptors in the nasal epithelium. Certain microbial molecules, such as viral nucleotides and protein antigens, can elicit an immune system response against invading pathogens mediated by signal transduction processes. This may occur independent of signal transduction stimulation by other molecules, as is the case for the toll-like receptor. It may occur with help from stimulatory molecules located at the cell surface of other cells, as with T-cell receptor signaling. Receptors can be roughly divided into two major classes: intracellular receptors and extracellular receptors.

Signal transduction cascades amplify the signal output

Signal transduction cascades amplify the signal output

Signal transduction cascades amplify the signal output

G protein-coupled receptors (GPCRs) are a family of integral transmembrane proteins that possess seven transmembrane domains and are linked to a heterotrimeric G protein. Many receptors are in this family, including adrenergic receptors and chemokine receptors.

Arrestin binding to active GPCR kinase (GRK)-phosphorylated GPCRs blocks G protein coupling

signal transduction pathways

signal transduction pathways

Arrestin binding to active GPCR kinase (GRK)-phosphorylated GPCRs blocks G protein coupling

Arrestin binding to active GPCR kinase (GRK)-phosphorylated GPCRs blocks G protein coupling

Signal transduction by a GPCR begins with an inactive G protein coupled to the receptor; it exists as a heterotrimer consisting of Gα, Gβ, and Gγ. Once the GPCR recognizes a ligand, the conformation of the receptor changes to activate the G protein, causing Gα to bind a molecule of GTP and dissociate from the other two G-protein subunits.

The dissociation exposes sites on the subunits that can interact with other molecules. The activated G protein subunits detach from the receptor and initiate signaling from many downstream effector proteins such as phospholipases and ion channels, the latter permitting the release of second messenger molecules.

Receptor tyrosine kinases (RTKs) are transmembrane proteins with an intracellular kinase domain and an extracellular domain that binds ligands; examples include growth factor receptors such as the insulin receptor.

 insulin receptor and and insulin receptor signaling pathway (IRS)

insulin receptor and and insulin receptor signaling pathway (IRS)

To perform signal transduction, RTKs need to form dimers in the plasma membrane; the dimer is stabilized by ligands binding to the receptor.

RTKs

RTKs

The interaction between the cytoplasmic domains stimulates the autophosphorylation of tyrosines within the domains of the RTKs, causing conformational changes.

Allosteric_Regulation.svg

Subsequent to this, the receptors’ kinase domains are activated, initiating phosphorylation signaling cascades of downstream cytoplasmic molecules that facilitate various cellular processes such as cell differentiation and metabolism.

Signal-Transduction-Pathway

Signal-Transduction-Pathway

As is the case with GPCRs, proteins that bind GTP play a major role in signal transduction from the activated RTK into the cell. In this case, the G proteins are

  • members of the Ras, Rho, and Raf families, referred to collectively as small G proteins.

They act as molecular switches usually

  • tethered to membranes by isoprenyl groups linked to their carboxyl ends.

Upon activation, they assign proteins to specific membrane subdomains where they participate in signaling. Activated RTKs in turn activate

  • small G proteins that activate guanine nucleotide exchange factors such as SOS1.

Once activated, these exchange factors can activate more small G proteins, thus

  • amplifying the receptor’s initial signal.

The mutation of certain RTK genes, as with that of GPCRs, can result in the expression of receptors that exist in a constitutively activate state; such mutated genes may act as oncogenes.

Integrin

 

Integrin

Integrin

Integrin-mediated signal transduction

An overview of integrin-mediated signal transduction, adapted from Hehlgens et al. (2007).

Integrins are produced by a wide variety of cells; they play a role in

  • cell attachment to other cells and the extracellular matrix and
  • in the transduction of signals from extracellular matrix components such as fibronectin and collagen.

Ligand binding to the extracellular domain of integrins

  • changes the protein’s conformation,
  • clustering it at the cell membrane to
  • initiate signal transduction.

Integrins lack kinase activity; hence, integrin-mediated signal transduction is achieved through a variety of intracellular protein kinases and adaptor molecules, the main coordinator being integrin-linked kinase.

As shown in the picture, cooperative integrin-RTK signaling determines the

  1. timing of cellular survival,
  2. apoptosis,
  3. proliferation, and
  4. differentiation.
integrin-mediated signal transduction

integrin-mediated signal transduction

Integrin signaling

Integrin signaling

ion channel

A ligand-gated ion channel, upon binding with a ligand, changes conformation

  • to open a channel in the cell membrane
  • through which ions relaying signals can pass.

An example of this mechanism is found in the receiving cell of a neural synapse. The influx of ions that occurs in response to the opening of these channels

  1. induces action potentials, such as those that travel along nerves,
  2. by depolarizing the membrane of post-synaptic cells,
  3. resulting in the opening of voltage-gated ion channels.
RyR and Ca+ release from SR

RyR and Ca+ release from SR

An example of an ion allowed into the cell during a ligand-gated ion channel opening is Ca2+;

  • it acts as a second messenger
  • initiating signal transduction cascades and
  • altering the physiology of the responding cell.

This results in amplification of the synapse response between synaptic cells

  • by remodelling the dendritic spines involved in the synapse.

In eukaryotic cells, most intracellular proteins activated by a ligand/receptor interaction possess an enzymatic activity; examples include tyrosine kinase and phosphatases. Some of them create second messengers such as cyclic AMP and IP3,

cAMP

cAMP

Inositol_1,4,5-trisphosphate.svg

Inositol_1,4,5-trisphosphate.svg

  • the latter controlling the release of intracellular calcium stores into the cytoplasm.

Many adaptor proteins and enzymes activated as part of signal transduction possess specialized protein domains that bind to specific secondary messenger molecules. For example,

  • calcium ions bind to the EF hand domains of calmodulin,
  • allowing it to bind and activate calmodulin-dependent kinase.
calcium movement and RyR2 receptor

calcium movement and RyR2 receptor

PIP3 and other phosphoinositides do the same thing to the Pleckstrin homology domains of proteins such as the kinase protein AKT.

Signals can be generated within organelles, such as chloroplasts and mitochondria, modulating the nuclear
gene expression in a process called retrograde signaling.

Recently, integrative genomics approaches, in which correlation analysis has been applied on transcript and metabolite profiling data of Arabidopsis thaliana, revealed the identification of metabolites which are putatively acting as mediators of nuclear gene expression.

http://fpls.com/unraveling_retrograde_signaling_pathways:_finding_candidate_signaling_molecules_via_metabolomics_and_systems_biology_driven_approaches

Related articles

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Nutrients 2014, 6, 3245-3258; http://dx.doi.org:/10.3390/nu6083245

Omega-3 (ω-3) fatty acids are one of the two main families of long chain polyunsaturated fatty acids (PUFA). The main omega-3 fatty acids in the mammalian body are

  • α-linolenic acid (ALA), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

Central nervous tissues of vertebrates are characterized by a high concentration of omega-3 fatty acids. Moreover, in the human brain,

  • DHA is considered as the main structural omega-3 fatty acid, which comprises about 40% of the PUFAs in total.

DHA deficiency may be the cause of many disorders such as depression, inability to concentrate, excessive mood swings, anxiety, cardiovascular disease, type 2 diabetes, dry skin and so on.

On the other hand,

  • zinc is the most abundant trace metal in the human brain.

There are many scientific studies linking zinc, especially

  • excess amounts of free zinc, to cellular death.

Neurodegenerative diseases, such as Alzheimer’s disease, are characterized by altered zinc metabolism. Both animal model studies and human cell culture studies have shown a possible link between

  • omega-3 fatty acids, zinc transporter levels and
  • free zinc availability at cellular levels.

Many other studies have also suggested a possible

  • omega-3 and zinc effect on neurodegeneration and cellular death.

Therefore, in this review, we will examine

  • the effect of omega-3 fatty acids on zinc transporters and
  • the importance of free zinc for human neuronal cells.

Moreover, we will evaluate the collective understanding of

  • mechanism(s) for the interaction of these elements in neuronal research and their
  • significance for the diagnosis and treatment of neurodegeneration.

Epidemiological studies have linked high intake of fish and shellfish as part of the daily diet to

  • reduction of the incidence and/or severity of Alzheimer’s disease (AD) and senile mental decline in

Omega-3 fatty acids are one of the two main families of a broader group of fatty acids referred to as polyunsaturated fatty acids (PUFAs). The other main family of PUFAs encompasses the omega-6 fatty acids. In general, PUFAs are essential in many biochemical events, especially in early post-natal development processes such as

  • cellular differentiation,
  • photoreceptor membrane biogenesis and
  • active synaptogenesis.

Despite the significance of these

two families, mammals cannot synthesize PUFA de novo, so they must be ingested from dietary sources. Though belonging to the same family, both

  • omega-3 and omega-6 fatty acids are metabolically and functionally distinct and have
  • opposing physiological effects. In the human body,
  • high concentrations of omega-6 fatty acids are known to increase the formation of prostaglandins and
  • thereby increase inflammatory processes [10].

the reverse process can be seen with increased omega-3 fatty acids in the body.

Many other factors, such as

  1. thromboxane A2 (TXA2),
  2. leukotriene
  3. B4 (LTB4),
  4. IL-1,
  5. IL-6,
  6. tumor necrosis factor (TNF) and
  7. C-reactive protein,

which are implicated in various health conditions, have been shown to be increased with high omega-6 fatty acids but decreased with omega-3 fatty acids in the human body.

Dietary fatty acids have been identified as protective factors in coronary heart disease, and PUFA levels are known to play a critical role in

  • immune responses,
  • gene expression and
  • intercellular communications.

omega-3 fatty acids are known to be vital in

  • the prevention of fatal ventricular arrhythmias, and
  • are also known to reduce thrombus formation propensity by decreasing platelet aggregation, blood viscosity and fibrinogen levels

.Since omega-3 fatty acids are prevalent in the nervous system, it seems logical that a deficiency may result in neuronal problems, and this is indeed what has been identified and reported.

The main

In another study conducted with individuals of 65 years of age or older (n = 6158), it was found that

  • only high fish consumption, but
  • not dietary omega-3 acid intake,
  • had a protective effect on cognitive decline

In 2005, based on a meta-analysis of the available epidemiology and preclinical studies, clinical trials were conducted to assess the effects of omega-3 fatty acids on cognitive protection. Four of the trials completed have shown

a protective effect of omega-3 fatty acids only among those with mild cognitive impairment conditions.

A  trial of subjects with mild memory complaints demonstrated

  • an improvement with 900 mg of DHA.

We review key findings on

  • the effect of the omega-3 fatty acid DHA on zinc transporters and the
  • importance of free zinc to human neuronal cells.

DHA is the most abundant fatty acid in neural membranes, imparting appropriate

  • fluidity and other properties,

and is thus considered as the most important fatty acid in neuronal studies. DHA is well conserved throughout the mammalian species despite their dietary differences. It is mainly concentrated

  • in membrane phospholipids at synapses and
  • in retinal photoreceptors and
  • also in the testis and sperm.

In adult rats’ brain, DHA comprises approximately

  • 17% of the total fatty acid weight, and
  • in the retina it is as high as 33%.

DHA is believed to have played a major role in the evolution of the modern human –

  • in particular the well-developed brain.

Premature babies fed on DHA-rich formula show improvements in vocabulary and motor performance.

Analysis of human cadaver brains have shown that

  • people with AD have less DHA in their frontal lobe
  • and hippocampus compared with unaffected individuals

Furthermore, studies in mice have increased support for the

  • protective role of omega-3 fatty acids.

Mice administrated with a dietary intake of DHA showed

  • an increase in DHA levels in the hippocampus.

Errors in memory were decreased in these mice and they demonstrated

  • reduced peroxide and free radical levels,
  • suggesting a role in antioxidant defense.

Another study conducted with a Tg2576 mouse model of AD demonstrated that dietary

  • DHA supplementation had a protective effect against reduction in
  • drebrin (actin associated protein), elevated oxidation, and to some extent, apoptosis via
  • decreased caspase activity.

 

Zinc

Zinc is a trace element, which is indispensable for life, and it is the second most abundant trace element in the body. It is known to be related to

  • growth,
  • development,
  • differentiation,
  • immune response,
  • receptor activity,
  • DNA synthesis,
  • gene expression,
  • neuro-transmission,
  • enzymatic catalysis,
  • hormonal storage and release,
  • tissue repair,
  • memory,
  • the visual process

and many other cellular functions. Moreover, the indispensability of zinc to the body can be discussed in many other aspects,  as

  • a component of over 300 different enzymes
  • an integral component of a metallothioneins
  • a gene regulatory protein.

Approximately 3% of all proteins contain

  • zinc binding motifs .

The broad biological functionality of zinc is thought to be due to its stable chemical and physical properties. Zinc is considered to have three different functions in enzymes;

  1. catalytic,
  2. coactive and

Indeed, it is the only metal found in all six different subclasses

of enzymes. The essential nature of zinc to the human body can be clearly displayed by studying the wide range of pathological effects of zinc deficiency. Anorexia, embryonic and post-natal growth retardation, alopecia, skin lesions, difficulties in wound healing, increased hemorrhage tendency and severe reproductive abnormalities, emotional instability, irritability and depression are just some of the detrimental effects of zinc deficiency.

Proper development and function of the central nervous system (CNS) is highly dependent on zinc levels. In the mammalian organs, zinc is mainly concentrated in the brain at around 150 μm. However, free zinc in the mammalian brain is calculated to be around 10 to 20 nm and the rest exists in either protein-, enzyme- or nucleotide bound form. The brain and zinc relationship is thought to be mediated

  • through glutamate receptors, and
  • it inhibits excitatory and inhibitory receptors.

Vesicular localization of zinc in pre-synaptic terminals is a characteristic feature of brain-localized zinc, and

  • its release is dependent on neural activity.

Retardation of the growth and development of CNS tissues have been linked to low zinc levels. Peripheral neuropathy, spina bifida, hydrocephalus, anencephalus, epilepsy and Pick’s disease have been linked to zinc deficiency. However, the body cannot tolerate excessive amounts of zinc.

The relationship between zinc and neurodegeneration, specifically AD, has been interpreted in several ways. One study has proposed that β-amyloid has a greater propensity to

  • form insoluble amyloid in the presence of
  • high physiological levels of zinc.

Insoluble amyloid is thought to

  • aggregate to form plaques,

which is a main pathological feature of AD. Further studies have shown that

  • chelation of zinc ions can deform and disaggregate plaques.

In AD, the most prominent injuries are found in

  • hippocampal pyramidal neurons, acetylcholine-containing neurons in the basal forebrain, and in
  • somatostatin-containing neurons in the forebrain.

All of these neurons are known to favor

  • rapid and direct entry of zinc in high concentration
  • leaving neurons frequently exposed to high dosages of zinc.

This is thought to promote neuronal cell damage through oxidative stress and mitochondrial dysfunction. Excessive levels of zinc are also capable of

  • inhibiting Ca2+ and Na+ voltage gated channels
  • and up-regulating the cellular levels of reactive oxygen species (ROS).

High levels of zinc are found in Alzheimer’s brains indicating a possible zinc related neurodegeneration. A study conducted with mouse neuronal cells has shown that even a 24-h exposure to high levels of zinc (40 μm) is sufficient to degenerate cells.

If the human diet is deficient in zinc, the body

  • efficiently conserves zinc at the tissue level by compensating other cellular mechanisms

to delay the dietary deficiency effects of zinc. These include reduction of cellular growth rate and zinc excretion levels, and

  • redistribution of available zinc to more zinc dependent cells or organs.

A novel method of measuring metallothionein (MT) levels was introduced as a biomarker for the

  • assessment of the zinc status of individuals and populations.

In humans, erythrocyte metallothionein (E-MT) levels may be considered as an indicator of zinc depletion and repletion, as E-MT levels are sensitive to dietary zinc intake. It should be noted here that MT plays an important role in zinc homeostasis by acting

  • as a target for zinc ion binding and thus
  • assisting in the trafficking of zinc ions through the cell,
  • which may be similar to that of zinc transporters

Zinc Transporters

Deficient or excess amounts of zinc in the body can be catastrophic to the integrity of cellular biochemical and biological systems. The gastrointestinal system controls the absorption, excretion and the distribution of zinc, although the hydrophilic and high-charge molecular characteristics of zinc are not favorable for passive diffusion across the cell membranes. Zinc movement is known to occur

  • via intermembrane proteins and zinc transporter (ZnT) proteins

These transporters are mainly categorized under two metal transporter families; Zip (ZRT, IRT like proteins) and CDF/ZnT (Cation Diffusion Facilitator), also known as SLC (Solute Linked Carrier) gene families: Zip (SLC-39) and ZnT (SLC-30). More than 20 zinc transporters have been identified and characterized over the last two decades (14 Zips and 8 ZnTs).

Members of the SLC39 family have been identified as the putative facilitators of zinc influx into the cytosol, either from the extracellular environment or from intracellular compartments (Figure 1).

The identification of this transporter family was a result of gene sequencing of known Zip1 protein transporters in plants, yeast and human cells. In contrast to the SLC39 family, the SLC30 family facilitates the opposite process, namely zinc efflux from the cytosol to the extracellular environment or into luminal compartments such as secretory granules, endosomes and synaptic vesicles; thus decreasing intracellular zinc availability (Figure 1). ZnT3 is the most important in the brain where

  • it is responsible for the transport of zinc into the synaptic vesicles of
  • glutamatergic neurons in the hippocampus and neocortex,

Figure 1: Subcellular localization and direction of transport of the zinc transporter families, ZnT and ZIP. Arrows show the direction of zinc mobilization for the ZnT (green) and ZIP (red) proteins. A net gain in cytosolic zinc is achieved by the transportation of zinc from the extracellular region and organelles such as the endoplasmic reticulum (ER) and Golgi apparatus by the ZIP transporters. Cytosolic zinc is mobilized into early secretory compartments such as the ER and Golgi apparatus by the ZnT transporters. Figures were produced using Servier Medical Art, http://www.servier.com/.   http://www.hindawi.com/journals/jnme/2012/173712.fig.001.jpg

Figure 2: Early zinc signaling (EZS) and late zinc signaling (LZS). EZS involves transcription-independent mechanisms where an extracellular stimulus directly induces an increase in zinc levels within several minutes by releasing zinc from intracellular stores (e.g., endoplasmic reticulum). LSZ is induced several hours after an external stimulus and is dependent on transcriptional changes in zinc transporter expression. Components of this figure were produced using Servier Medical Art, http://www.servier.com/ and adapted from Fukada et al. [30].

omega-3 fatty acids in the mammalian body are

  1. α-linolenic acid (ALA),
  2. docosahexenoic acid (DHA) and
  3. eicosapentaenoic acid (EPA).

In general, seafood is rich in omega-3 fatty acids, more specifically DHA and EPA (Table 1). Thus far, there are nine separate epidemiological studies that suggest a possible link between

  • increased fish consumption and reduced risk of AD
  • and eight out of ten studies have reported a link between higher blood omega-3 levels

DHA and Zinc Homeostasis

Many studies have identified possible associations between DHA levels, zinc homeostasis, neuroprotection and neurodegeneration. Dietary DHA deficiency resulted in

  • increased zinc levels in the hippocampus and
  • elevated expression of the putative zinc transporter, ZnT3, in the rat brain.

Altered zinc metabolism in neuronal cells has been linked to neurodegenerative conditions such as AD. A study conducted with transgenic mice has shown a significant link between ZnT3 transporter levels and cerebral amyloid plaque pathology. When the ZnT3 transporter was silenced in transgenic mice expressing cerebral amyloid plaque pathology,

  • a significant reduction in plaque load
  • and the presence of insoluble amyloid were observed.

In addition to the decrease in plaque load, ZnT3 silenced mice also exhibited a significant

  • reduction in free zinc availability in the hippocampus
  • and cerebral cortex.

Collectively, the findings from this study are very interesting and indicate a clear connection between

  • zinc availability and amyloid plaque formation,

thus indicating a possible link to AD.

DHA supplementation has also been reported to limit the following:

  1. amyloid presence,
  2. synaptic marker loss,
  3. hyper-phosphorylation of Tau,
  4. oxidative damage and
  5. cognitive deficits in transgenic mouse model of AD.

In addition, studies by Stoltenberg, Flinn and colleagues report on the modulation of zinc and the effect in transgenic mouse models of AD. Given that all of these are classic pathological features of AD, and considering the limiting nature of DHA in these processes, it can be argued that DHA is a key candidate in preventing or even curing this debilitating disease.

In order to better understand the possible links and pathways of zinc and DHA with neurodegeneration, we designed a study that incorporates all three of these aspects, to study their effects at the cellular level. In this study, we were able to demonstrate a possible link between omega-3 fatty acid (DHA) concentration, zinc availability and zinc transporter expression levels in cultured human neuronal cells.

When treated with DHA over 48 h, ZnT3 levels were markedly reduced in the human neuroblastoma M17 cell line. Moreover, in the same study, we were able to propose a possible

  • neuroprotective mechanism of DHA,

which we believe is exerted through

  • a reduction in cellular zinc levels (through altering zinc transporter expression levels)
  • that in turn inhibits apoptosis.

DHA supplemented M17 cells also showed a marked depletion of zinc uptake (up to 30%), and

  • free zinc levels in the cytosol were significantly low compared to the control

This reduction in free zinc availability was specific to DHA; cells treated with EPA had no significant change in free zinc levels (unpublished data). Moreover, DHA-repleted cells had

  • low levels of active caspase-3 and
  • high Bcl-2 levels compared to the control treatment.

These findings are consistent with previous published data and further strengthen the possible

  • correlation between zinc, DHA and neurodegeneration.

On the other hand, recent studies using ZnT3 knockout (ZnT3KO) mice have shown the importance of

  • ZnT3 in memory and AD pathology.

For example, Sindreu and colleagues have used ZnT3KO mice to establish the important role of

  • ZnT3 in zinc homeostasis that modulates presynaptic MAPK signaling
  • required for hippocampus-dependent memory

Results from these studies indicate a possible zinc-transporter-expression-level-dependent mechanism for DHA neuroprotection.

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Announcement of UPDATES to New Medicine-Oncology KnowledgeBase Data Base for September 2014

Curator: Katie Siafaca

 

Latest Updates

September 2014 New Drug Updates and Additions

Designation Brand Name Generic Name
OncoVEX GM-CSF, OncoVEXGMCSF, OncoVEXGM-CSF, Tvec, t-vec Talimogene laherparepvec
IL-17E
BIBF 1120 Vargatef Nintedanib
CV9202
CV9104
EPZ005687, EPZ-6438, E7438
EPZ-5676, EPZ004777
RG3638, anti-c-Met, PRO143966, RO5490258 MetMab Onartuzumab
G-202 Mipsagargin
AB0024, GS-6624 Simtuzumab
GS-5745
PEGPH20
L-DOS47
IPI-145 Duvelisib
KTN3379
5B1
MEDI4736
L-BLP25, BLP-25 (formerly BP1-7-KLH), EMD531444, emepepimut-S Formerly Stimuvax Tecemotide
MSB0010718C
MM-121, MM121, SAR256212
PEP02, MM-398, nal-IRI
CRA-024781, CG-781, PCI-24781, S-78454 Abexinostat
RX-3117
TG4010, MVA-MUC-1-IL-2, MVA-MUC1-IL-2

 

 

September 2014 Marketed Drug Updates and Additions

Brand Name Generic Name Other Designation
Pixuvri Pixantrone dimaleate BBR 2778
Cyramza Ramucirumab IMC-1121b, IMC 1121B, LY3009806
Perjeta (formerly Omnitarg) Pertuzumab RG1273, R1273, 2C4, rhuMAb-2C4
Zydelig Idelalisib CAL-101, GS-1101
Keytruda Pembrolizumab (formerly lambrolizumab) MK-3475
Lymphoseek Technetium Tc 99m tilmanocept
Zykadia Ceritinib LDK378
Afinitor Everolimus RAD001, RAD001C
Zelboraf Vemurafenib PLX4032, PLX4720, RG7204, RO5185426

 

 

September 2014 Company Updates and Additions

  • AADi
  • Abcodia
  • Accelovance
  • Adimab
  • Affymax
  • Akinion Pharmaceuticals
  • Aprea
  • Aptose Biosciences
  • BeiGene
  • Bioceros
  • Biogen Idec
  • Blueprint Medicines
  • BTG
  • Can-Fite BioPharma
  • Caris Life Sciences
  • Celgene
  • Cellerant Therapeutics
  • Champions Oncology
  • CureVac
  • DanDrit Biotech
  • Epizyme
  • Eutropics Pharmaceuticals
  • F2G
  • Genetic Technologies
  • Ignyta
  • ImaginAb
  • Johnson & Johnson (J&J)
  • Karolinska Development
  • Kolltan Pharmaceuticals
  • Lpath
  • Merus
  • Novartis
  • OncoCyte
  • Oncology Analytics (OA)
  • OncoNOx
  • Oncothyreon
  • Personal Genome Diagnostics (PGDx)
  • ProNAi Therapeutics
  • Propanc Health Group
  • Protagonist Therapeutics
  • Regeneron Pharmaceuticals
  • Relmada Therapeutics
  • Rosetta Genomics
  • Scholar Rock
  • Sentinel Oncology
  • Sevion Therapeutics
  • SutroVax
  • to-BBB Technologies (to-BBB)
  • Transgene
  • Veracyte
  • Zenith Epigenetics

 

 

September 2014 Targets in Oncology Updates and Additions

  • Fibroblast growth factor receptor 4 (FGFr4)
  • KIT
  • MUC16
  • V-raf murine sarcoma viral oncogene homolog B1 (BRAF)

SOURCE

http://www.nmok.net/oksite/updates.html

From: info <info@newmedinc.com>
Reply-To: <info@newmedinc.com>
Date: Wed, 29 Oct 2014 13:41:44 -0700
To: “Aviva Lev-Ari, PhD, RN” <avivalev-ari@alum.berkeley.edu>
Subject: DB coverage

 

Read Full Post »

Larry H. Bernstein, MD, FCAP, Reporter, Reposted

Leaders in Pharmaceutical Intelligence

DR ANTHONY MELVIN CRASTO …..FOR BLOG HOME CLICK HERE

http://pharmaceuticalintelligence.com/10/29/2010/larryhbern/Rofecoxib

ROFECOXIB

MK-966, MK-0966, Vioxx

162011-90-7

C17-H14-O4-S
314.3596
\
Percent Composition: C 64.95%, H 4.49%, O 20.36%, S 10.20%
LitRef: Selective cyclooxygenase-2 (COX-2) inhibitor. Prepn: Y. Ducharme et al., WO 9500501; eidem, US5474995 (both 1995 to Merck Frosst).
Therap-Cat: Anti-inflammatory; analgesic.

Rofecoxib /ˌrɒfɨˈkɒksɪb/ is a nonsteroidal anti-inflammatory drug (NSAID) that has now been withdrawn over safety concerns. It was marketed by Merck & Co. to treat osteoarthritis, acute pain conditions, and dysmenorrhoea. Rofecoxib was approved by the Food and Drug Administration (FDA) on May 20, 1999, and was marketed under the brand names Vioxx, Ceoxx, and Ceeoxx.

Rofecoxib

Rofecoxib

Rofecoxib gained widespread acceptance among physicians treating patients with arthritis and other conditions causing chronic or acute pain. Worldwide, over 80 million people were prescribed rofecoxib at some time.[1]

On September 30, 2004, Merck withdrew rofecoxib from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. Merck withdrew the drug after disclosures that it withheld information about rofecoxib’s risks from doctors and patients for over five years, resulting in between 88,000 and 140,000 cases of serious heart disease.[2] Rofecoxib was one of the most widely used drugs ever to be withdrawn from the market. In the year before withdrawal, Merck had sales revenue of US$2.5 billion from Vioxx.[3] Merck reserved $970 million to pay for its Vioxx-related legal expenses through 2007, and have set aside $4.85bn for legal claims from US citizens.

Rofecoxib was available on prescription in both tablet-form and as an oral suspension. It was available by injection for hospital use.

 

 Mode of action
 Cyclooxygenase (COX) has two well-studied isoforms, called COX-1 and COX-2.
  • COX-1 mediates the synthesis of prostaglandins responsible for protection of the stomach lining, while
  • COX-2 mediates the synthesis of prostaglandins responsible for pain and inflammation.
prostaglandin PGE2

prostaglandin PGE2

By creating “selective” NSAIDs that inhibit COX-2, but not COX-1, the same pain relief as traditional NSAIDs is offered, but with greatly reduced risk of fatal or debilitating peptic ulcers. Rofecoxib is a selective COX-2 inhibitor, or “coxib”.

Others include Merck’s etoricoxib (Arcoxia), Pfizer’s celecoxib (Celebrex) and valdecoxib (Bextra). Interestingly, at the time of its withdrawal, rofecoxib was the only coxib with clinical evidence of its superior gastrointestinal adverse effect profile over conventional NSAIDs. This was largely based on the VIGOR (Vioxx GI Outcomes Research) study, which compared the efficacy and adverse effect profiles of rofecoxib and naproxen.[4]

Pharmacokinetics

The therapeutic recommended dosages were 12.5, 25, and 50 mg with an approximate bioavailability of 93%.[5][6][7] Rofecoxib crossed the placenta and blood–brain barrier,[5][6][8]and took 1–3 hours to reach peak plasma concentration with an effective half-life (based on steady-state levels) of approximately 17 hours.[5][7][9] The metabolic products are cis-dihydro and trans-dihydro derivatives of rofecoxib[5][9] which are primarily excreted through urine.

Fabricated efficacy studies

On March 11, 2009, Scott S. Reuben, former chief of acute pain at Baystate Medical Center, Springfield, Mass., revealed that data for 21 studies he had authored for the efficacy of the drug (along with others such as celecoxib) had been fabricated in order to augment the analgesic effects of the drugs. There is no evidence that Reuben colluded with Merck in falsifying his data. Reuben was also a former paid spokesperson for the drug company Pfizer (which owns the intellectual property rights for marketing celecoxib in the United States). The retracted studies were not submitted to either the FDA or the European Union’s regulatory agencies prior to the drug’s approval. Drug manufacturer Merckhad no comment on the disclosure.[10]

Adverse drug reactions

VIOXX sample blister pack.jpg

Aside from the reduced incidence of gastric ulceration, rofecoxib exhibits a similar adverse effect profile to other NSAIDs.

Prostaglandin is a large family of lipids. Prostaglandin I2/PGI2/prostacyclin is just one member of it. Prostaglandins other than PGI2 (such as PGE2) also play important roles in vascular tone regulation. Prostacyclin/thromboxane are produced by both COX-1 and COX-2, and rofecoxib suppresses just COX-2 enzyme, so there is no reason to believe that prostacyclin levels are significantly reduced by the drug. And there is no reason to believe that only the balance between quantities of prostacyclin and thromboxane is the determinant factor for vascular tone.[11] Indeed Merck has stated that there was no effect on prostacyclin production in blood vessels in animal testing.[12] Other researchers have speculated that the cardiotoxicity may be associated with maleic anhydride metabolites formed when rofecoxib becomes ionized under physiological conditions. (Reddy & Corey, 2005)

 Adverse cardiovascular events

VIGOR study and publishing controversy

The VIGOR (Vioxx GI Outcomes Research) study, conducted by Bombardier, et al., which compared the efficacy and adverse effect profiles of rofecoxib and naproxen, had indicated a significant 4-fold increased risk of acute myocardial infarction (heart attack) in rofecoxib patients when compared with naproxen patients (0.4% vs 0.1%, RR 0.25) over the 12 month span of the study. The elevated risk began during the second month on rofecoxib. There was no significant difference in the mortality from cardiovascular events between the two groups, nor was there any significant difference in the rate of myocardial infarction between the rofecoxib and naproxen treatment groups in patients without high cardiovascular risk. The difference in overall risk was by the patients at higher risk of heart attack, i.e. those meeting the criteria for low-dose aspirin prophylaxis of secondary cardiovascular events (previous myocardial infarction, angina, cerebrovascular accident, transient ischemic attack, or coronary artery bypass).

Merck’s scientists interpreted the finding as a protective effect of naproxen, telling the FDA that the difference in heart attacks “is primarily due to” this protective effect (Targum, 2001). Some commentators have noted that naproxen would have to be three times as effective as aspirin to account for all of the difference (Michaels 2005), and some outside scientists warned Merck that this claim was implausible before VIGOR was published.[13] No evidence has since emerged for such a large cardioprotective effect of naproxen, although a number of studies have found protective effects similar in size to those of aspirin.[14][15] Though Dr. Topol’s 2004 paper criticized Merck’s naproxen hypothesis, he himself co-authored a 2001 JAMA article stating “because of the evidence for an antiplatelet effect of naproxen, it is difficult to assess whether the difference in cardiovascular event rates in VIGOR was due to a benefit from naproxen or to a prothrombotic effect from rofecoxib.” (Mukherjee, Nissen and Topol, 2001.)

The results of the VIGOR study were submitted to the United States Food and Drug Administration (FDA) in February 2001. In September 2001, the FDA sent a warning letter to the CEO of Merck, stating, “Your promotional campaign discounts the fact that in the VIGOR study, patients on Vioxx were observed to have a four to five fold increase in myocardial infarctions (MIs) compared to patients on the comparator non-steroidal anti-inflammatory drug (NSAID), Naprosyn (naproxen).”[16] This led to the introduction, in April 2002, of warnings on Vioxx labeling concerning the increased risk of cardiovascular events (heart attack and stroke).

Months after the preliminary version of VIGOR was published in the New England Journal of Medicine, the journal editors learned that certain data reported to the FDA were not included in the NEJM article. Several years later, when they were shown a Merck memo during the depositions for the first federal Vioxx trial, they realized that these data had been available to the authors months before publication. The editors wrote an editorial accusing the authors of deliberately withholding the data.[17] They released the editorial to the media on December 8, 2005, before giving the authors a chance to respond. NEJM editor Gregory Curfman explained that the quick release was due to the imminent presentation of his deposition testimony, which he feared would be misinterpreted in the media. He had earlier denied any relationship between the timing of the editorial and the trial. Although his testimony was not actually used in the December trial, Curfman had testified well before the publication of the editorial.[18]

The editors charged that “more than four months before the article was published, at least two of its authors were aware of critical data on an array of adverse cardiovascular events that were not included in the VIGOR article.” These additional data included three additional heart attacks, and raised the relative risk of Vioxx from 4.25-fold to 5-fold. All the additional heart attacks occurred in the group at low risk of heart attack (the “aspirin not indicated” group) and the editors noted that the omission “resulted in the misleading conclusion that there was a difference in the risk of myocardial infarction between the aspirin indicated and aspirin not indicated groups.” The relative risk for myocardial infarctions among the aspirin not indicated patients increased from 2.25 to 3 (although it remained statitistically insignificant). The editors also noted a statistically significant (2-fold) increase in risk for serious thromboembolic events for this group, an outcome that Merck had not reported in the NEJM, though it had disclosed that information publicly in March 2000, eight months before publication.[19]

The authors of the study, including the non-Merck authors, responded by claiming that the three additional heart attacks had occurred after the prespecified cutoff date for data collection and thus were appropriately not included. (Utilizing the prespecified cutoff date also meant that an additional stroke in the naproxen population was not reported.) Furthermore, they said that the additional data did not qualitatively change any of the conclusions of the study, and the results of the full analyses were disclosed to the FDA and reflected on the Vioxx warning label. They further noted that all of the data in the “omitted” table were printed in the text of the article. The authors stood by the original article.[20]

NEJM stood by its editorial, noting that the cutoff date was never mentioned in the article, nor did the authors report that the cutoff for cardiovascular adverse events was before that for gastrointestinal adverse events. The different cutoffs increased the reported benefits of Vioxx (reduced stomach problems) relative to the risks (increased heart attacks).[19]

Some scientists have accused the NEJM editorial board of making unfounded accusations.[21][22] Others have applauded the editorial. Renowned research cardiologist Eric Topol,[23] a prominent Merck critic, accused Merck of “manipulation of data” and said “I think now the scientific misconduct trial is really fully backed up”.[24] Phil Fontanarosa, executive editor of the prestigious Journal of the American Medical Association, welcomed the editorial, saying “this is another in the long list of recent examples that have generated real concerns about trust and confidence in industry-sponsored studies”.[25]

On May 15, 2006, the Wall Street Journal reported that a late night email, written by an outside public relations specialist and sent to Journal staffers hours before the Expression of Concern was released, predicted that “the rebuke would divert attention to Merck and induce the media to ignore the New England Journal of Medicine‘s own role in aiding Vioxx sales.”[26]

“Internal emails show the New England Journal’s expression of concern was timed to divert attention from a deposition in which Executive Editor Gregory Curfman made potentially damaging admissions about the journal’s handling of the Vioxx study. In the deposition, part of the Vioxx litigation, Dr. Curfman acknowledged that lax editing might have helped the authors make misleading claims in the article.” The Journal stated that NEJM‘s “ambiguous” language misled reporters into incorrectly believing that Merck had deleted data regarding the three additional heart attacks, rather than a blank table that contained no statistical information; “the New England Journal says it didn’t attempt to have these mistakes corrected.”[26]

APPROVe study

In 2001, Merck commenced the APPROVe (Adenomatous Polyp PRevention On Vioxx) study, a three-year trial with the primary aim of evaluating the efficacy of rofecoxib for theprophylaxis of colorectal polyps. Celecoxib had already been approved for this indication, and it was hoped to add this to the indications for rofecoxib as well. An additional aim of the study was to further evaluate the cardiovascular safety of rofecoxib.

The APPROVe study was terminated early when the preliminary data from the study showed an increased relative risk of adverse thrombotic cardiovascular events (includingheart attack and stroke), beginning after 18 months of rofecoxib therapy. In patients taking rofecoxib, versus placebo, the relative risk of these events was 1.92 (rofecoxib 1.50 events vs placebo 0.78 events per 100 patient years). The results from the first 18 months of the APPROVe study did not show an increased relative risk of adverse cardiovascular events. Moreover, overall and cardiovascular mortality rates were similar between the rofecoxib and placebo populations.[28]

In summary, the APPROVe study suggested that long-term use of rofecoxib resulted in nearly twice the risk of suffering a heart attack or stroke compared to patients receiving a placebo.

Other studies

Several very large observational studies have also found elevated risk of heart attack from rofecoxib. For example, a recent retrospective study of 113,000 elderly Canadians suggested a borderline statistically significant increased relative risk of heart attacks of 1.24 from Vioxx usage, with a relative risk of 1.73 for higher-dose Vioxx usage. (Levesque, 2005). Another study, using Kaiser Permanente data, found a 1.47 relative risk for low-dose Vioxx usage and 3.58 for high-dose Vioxx usage compared to current use of celecoxib, though the smaller number was not statistically significant, and relative risk compared to other populations was not statistically significant. (Graham, 2005).

Furthermore, a more recent meta-study of 114 randomized trials with a total of 116,000+ participants, published in JAMA, showed that Vioxx uniquely increased risk of renal (kidney) disease, and heart arrhythmia.[31]

Other COX-2 inhibitors

Any increased risk of renal and arrhythmia pathologies associated with the class of COX-2 inhibitors, e.g. celecoxib (Celebrex), valdecoxib (Bextra), parecoxib (Dynastat),lumiracoxib, and etoricoxib is not evident,[31] although smaller studies[32][33] had demonstrated such effects earlier with the use of celecoxib, valdecoxib and parecoxib.

Nevertheless, it is likely that trials of newer drugs in the category will be extended in order to supply additional evidence of cardiovascular safety. Examples are some more specific COX-2 inhibitors, including etoricoxib (Arcoxia) and lumiracoxib (Prexige), which are currently (circa 2005) undergoing Phase III/IV clinical trials.

Besides, regulatory authorities worldwide now require warnings about cardiovascular risk of COX-2 inhibitors still on the market. For example, in 2005, EU regulators required the following changes to the product information and/or packaging of all COX-2 inhibitors:[34]

  • Contraindications stating that COX-2 inhibitors must not be used in patients with established ischaemic heart disease and/or cerebrovascular disease (stroke), and also in patients with peripheral arterial disease
  • Reinforced warnings to healthcare professionals to exercise caution when prescribing COX-2 inhibitors to patients with risk factors for heart disease, such as hypertension, hyperlipidaemia (high cholesterol levels), diabetes and smoking
  • Given the association between cardiovascular risk and exposure to COX-2 inhibitors, doctors are advised to use the lowest effective dose for the shortest possible duration of treatment

Other NSAIDs

Since the withdrawal of Vioxx it has come to light that there may be negative cardiovascular effects with not only other COX-2 inhibitiors, but even the majority of other NSAIDs. It is only with the recent development of drugs like Vioxx that drug companies have carried out the kind of well executed trials that could establish such effects and these sort of trials have never been carried out in older “trusted” NSAIDs such as ibuprofen, diclofenac and others. The possible exceptions may be aspirin and naproxen due to their anti-platelet aggregation properties.

Withdrawal

Due to the findings of its own APPROVe study, Merck publicly announced its voluntary withdrawal of the drug from the market worldwide on September 30, 2004.[35]

In addition to its own studies, on September 23, 2004 Merck apparently received information about new research by the FDA that supported previous findings of increased risk of heart attack among rofecoxib users (Grassley, 2004). FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market.[36]

On November 5, the medical journal The Lancet published a meta-analysis of the available studies on the safety of rofecoxib (Jüni et al., 2004). The authors concluded that, owing to the known cardiovascular risk, rofecoxib should have been withdrawn several years earlier. The Lancet published an editorial which condemned both Merck and the FDA for the continued availability of rofecoxib from 2000 until the recall. Merck responded by issuing a rebuttal of the Jüni et al. meta-analysis that noted that Jüni omitted several studies that showed no increased cardiovascular risk. (Merck & Co., 2004).

In 2005, advisory panels in both the U.S. and Canada encouraged the return of rofecoxib to the market, stating that rofecoxib’s benefits outweighed the risks for some patients. The FDA advisory panel voted 17-15 to allow the drug to return to the market despite being found to increase heart risk. The vote in Canada was 12-1, and the Canadian panel noted that the cardiovascular risks from rofecoxib seemed to be no worse than those from ibuprofen—though the panel recommended that further study was needed for all NSAIDs to fully understand their risk profiles. Notwithstanding these recommendations, Merck has not returned rofecoxib to the market.[37]

In 2005, Merck retained Debevoise & Plimpton LLP to investigate Vioxx study results and communications conducted by Merck. Through the report, it was found that Merck’s senior management acted in good faith, and that the confusion over the clinical safety of Vioxx was due to the sales team’s overzealous behavior. The report that was filed gave a timeline of the events surrounding Vioxx and showed that Merck intended to operate honestly throughout the process. Any mistakes that were made regarding the mishandling of clinical trial results and withholding of information was the result of oversight, not malicious behavior….The report was published in February 2006, and Merck was satisfied with the findings of the report and promised to consider the recommendations contained in the Martin Report. Advisers to the US Food and Drug Administration (FDA) have voted, by a narrow margin, that it should not ban Vioxx — the painkiller withdrawn by drug-maker Merck.

They also said that Pfizer’s Celebrex and Bextra, two other members of the family of painkillers known as COX-2 inhibitors, should remain available, despite the fact that they too boost patients’ risk of heart attack and stroke. url = http://www.nature.com/drugdisc/news/articles/433790b.html The recommendations of the arthritis and drug safety advisory panel offer some measure of relief to the pharmaceutical industry, which has faced a barrage of criticism for its promotion of the painkillers. But the advice of the panel, which met near Washington DC over 16–18 February, comes with several strings attached.

For example, most panel members said that manufacturers should be required to add a prominent warning about the drugs’ risks to their labels; to stop direct-to-consumer advertising of the drugs; and to include detailed, written risk information with each prescription. The panel also unanimously stated that all three painkillers “significantly increase the risk of cardiovascular events”.

External links

For more details and references.. they are provided in the entirety in the original post

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Gilead’s Harvoni includes sofosbuvir marketed as Sovaldi and Eisai’s Akynzeo – 1st Two Winners under FDA’s FDC exclusivity policy, 10/2014

 

Reporter: Aviva Lev-Ari, PhD, RN

 

SOURCE

http://www.raps.org/Regulatory-Focus/News/2014/10/13/20549/FDA-Changes-Policy-Hours-Before-Approvals-Giving-Companies-Gift-Potentially-Worth-Billions/#sthash.nfTaPZNZ.dpuf

 

FDA Changes Policy Hours Before Approvals, Giving Companies Gift Potentially Worth Billions

Posted 13 October 2014By Alexander Gaffney, RAC

placeholder+image

On Friday, two companies were the lucky recipients of gifts never before given by the US Food and Drug Administration (FDA)—gifts potentially worth millions, if not billions of dollars in value.

Background

In the US, pharmaceutical manufacturers who obtain approval to market a “new” drug from FDA are eligible for varying degrees of market- (rather than patent-) based exclusivity.

For New Chemical Entities (NCEs), that means five years of protection during which time FDA will not approve any generic equivalents. For “new” drugs that represent a new use for an old drug, or a new dose of an old drug, FDA is able to grant just three years of patent protection.

Historically, that meant that a fixed-dose combination (FDC) product consisting of at least one already-approved entity was ineligible for five years of exclusivity—just three.

New Guidance

But on the morning of 10 October 2014, FDA released a new, final policy which markedly changed its interpretation of the drug marketing exclusivity provisions of the Federal Food, Drug and Cosmetic Act (FD&C Act) in response to multiple petitions from the pharmaceutical industry.

“Accordingly, a 5-year NCE exclusivity determination will be made for each drug substance in a drug product, not for the drug product as a whole,” FDA wrote in the guidance, New Chemical Entity Exclusivity Determinations for Certain Fixed-Dose Combination Drug Products.

“As a result, an application for a fixed-combination submitted under section 505(b) of the FD&C Act will be eligible for 5-year NCE exclusivity if it contains a drug substance, no active moiety of which has been approved in any other application under section 505(b).30,” FDA explained. “For example, a fixed-combination drug product that contains a drug substance with a single, new active moiety would be eligible for 5-year NCE exclusivity, even if the fixed-combination also contains a drug substance with a previously approved active moiety.”

However, the policy came with a significant setback for industry: The new policy would only be effective as of 10 October 2014, and not retroactively.

New Approvals

But while that policy was a potential setback for the sponsors of 19 already-approved FDCs (some of which might not be eligible for the protection), it’s now a boon for two FDCs approved on 10 October 2014.

Just hours after FDA released its final FDC exclusivity policy, it announced the approval of Gilead’s Harvoni (ledipasvir and sofosbuvir), a FDC used to treat chronic hepatitis C virus genotype 1 infections, and Eisai’s Akynzeo (netupitant and palonosetron), an FDC used to treat nausea and vomiting in patients undergoing cancer chemotherapy.

Had the drugs been approved just one day earlier, neither would have been eligible for NCE exclusivity. Gilead’s Harvoni includes sofosbuvir, a drug approved in 2014 and marketed as Sovaldi. Eisai’s Akynzeo includes oral palonosetron, approved in 2008 under the brand name Aloxi.

But in addition to the existing drugs, both products contain new chemical entities that boost the effectiveness of the products. Harvoni’s ledipasvir, for example, allows the drug to be used without interferon or ribavirin. Akynzeo’s netupitant apparently boosts the effectiveness of the drug, protecting a patient from nausea and vomiting “during both the acute phase and delayed phase after the start of chemotherapy.”

For both companies, the additional two years of market exclusivity could potentially be valuable. Harvoni is expected to become a blockbuster, meaning Gilead will have at least two extra years to reap billions in revenue before it has to begin defending its patents on the drug in earnest. Gilead said it plans to sell the product for $94,500 for a 12-week course of treatment.

And while projected sale data for Akynzeo was not available, it’s hard to envision a scenario in which an extra two years of exclusivity could possibly hurt a company’s bottom line. Sales of the drug’s predecessor, Alixo, reached $537 million in 2011 according to data from Evaluate.

Both Harvoni’s and Akynzeo’s market exclusivity periods end on 10 October 2019,

 

FDA Approval Notices: (Harvoni) (Akynzeo)

– See more at: http://www.raps.org/Regulatory-Focus/News/2014/10/13/20549/FDA-Changes-Policy-Hours-Before-Approvals-Giving-Companies-Gift-Potentially-Worth-Billions/#sthash.nfTaPZNZ.dpuf

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Mapping the Universe of Pharmaceutical Business Intelligence: The Model developed by LPBI and the Model of Best Practices LLC

Mapping the Universe of Pharmaceutical Business Intelligence: The Model developed by LPBI and the Model of Best Practices LLC

 

Author and Curator of Model A: Aviva Lev-Ari, PhD, RN

Reporter on Model B: Aviva Lev-Ari, PhD, RN

 

This article provides the e-Reader with a MAP for navigation through two different Business Models that Co-exist in the EcoSystem of an industry called Pharmaceutical Business Intelligence.

Model A: is represented by Six Ventures of Leaders in Pharmaceutical Business Intelligence (LPBI), based in Boston, Philadelphia, CT, CA and Israel

Model B: is represented by Best Practices, LLC, headquartered in Chapel Hill, NC, with Offices in NYC and in Mumbai, India.

 

We concluded that the two models are viable, represent fast growth, the models and non-competing and are in full complementarity, thus, expanding the domain and the practice of the industrial sector, aka, Pharmaceutical Business Intelligence.

 

 

Model A:

Leaders in Pharmaceutical Business Intelligence (LPBI),

Boston, Philadelphia, CT, CA and Israel 

Team members

 

Our Growth Needs: Leaders in Pharmaceutical Business Intelligence

 

 Our Business Portfolio

VENTURE #1:

e-Publishing: Medicine, HealthCare, Life Sciences, BioMed, Pharmaceutical

  • Open Access Online Scientific Journal

http://pharmaceuticalintelligence.com Site statistics http://pharmaceuticalintelligence.com/wp-admin/index.php?page=stats

  • Scoop.it!.com

  1. http://www.scoop.it/t/cardiotoxicity
  2. http://www.scoop.it/t/cardiovascular-and-vascular-imaging
  3. http://www.scoop.it/t/cardiovascular-disease-pharmaco-therapy

VENTURE #2:

1. BioMedical e-Books e-Series: Cardiovascular, Genomics, Cancer, BioMed, Patient Centered Medicine

http://pharmaceuticalintelligence.com/biomed-e-books/

2. on Amazon’s Kindle e-Books List since 6/2013

3. Plans for Volume 1,2,3 – Hardcover

VENTURE #3:

International Scientific Delegations

http://pharmaceuticalintelligence.com/scientific-delegation/

  • Shanghai, May 2015
  • Barcelona, Spain, November 2015
  • Amsterdam, May 2016
  • Geneva, November 2016

 

VENTURE #4:

Funding, Deals & Partnerships

http://pharmaceuticalintelligence.com/joint-ventures/

 

VENTURE #5:

IP Invented HERE!

1.  Development of a NEW Nitric Oxide monitor to Alpha Szenszor Inc. sensor portfolio. A concept for a low cost POC e-nose, capable of real time ppb detection of Cancer The Cancer Team at Leaders in Pharmaceutical Business Intelligence under the leadership of Dr. Williams

2.  Development of a NEW Nitric Oxide monitor to Alpha Szenszor Inc. sensor portfolio. A concept for Inhaled Nitric Oxide for the Adult HomeCare Market – IP by Dr. Pearlman and Dr. A. Lev-Ari

a.  iknow iNO is i-kNOw – Inhaled Nitric Oxide for the HomeCare Markethttp://pharmaceuticalintelligence.com/2013/10/16/iknow-ino-is-i-know-inhaled-nitric-oxide-for-the-homecare-market/

b. electronic Book on Nitric Oxide by Nitric Oxide Team @ Leaders in Pharmaceutical Business Intelligence (LPBI)

Perspectives on Nitric Oxide in Disease Mechanisms

http://www.amazon.com/dp/B00DINFFY

c. The rationale and use of inhaled NO in Pulmonary Artery Hypertension and Right Sided Heart Failure Larry H. Bernstein 8/20/2012

d. Inhaled Nitric Oxide in Adults: Clinical Trials and Meta Analysis Studies – Recent Findings

Aviva Lev-Ari, PhD, RN, 6/2/2013

e. Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care

Aviva Lev-Ari, PhD, RN, 6/3/2013

3.  Cancer Genomics for NEW product development in diagnosis and treatment of Cancer Patients using sensory technology with applications for Radiation Therapy –The Cancer Team at Leaders in Pharmaceutical Business Intelligence under leadership of TBA

4.  Developing Mitral Valve Disease: MRI Methods and Devices for Percutaneous Mitral Valve Replacement and Mitral Valve Repair Augmentation of Patented Technology using RF – Dr. Pearlman’s IP Non-Hardware Mitral Annuloplasty – Dr. Justin D. Pearlman

http://pharmaceuticalintelligence.com/joint-ventures/valvecure-llc/non-hardware-mitral-annuloplasty-dr-justin-d-pearlman/

5.  Novel Technology using MRI for Vascular Lesions, Tumors, Hyperactive Glands and non-Surgical Cosmetic Reconstruction – Dr. Pearlman’s IP

http://pharmaceuticalintelligence.com/biomed-e-books/series-a-e-books-on-cardiovascular-diseases/httppharmaceuticalintelligence-combiomed-e-bookscardiovascular-diseases-causes-risks-and-management/cvd-business-affairs/mitral-valve-disease-mri-methods-and-devices/

 

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Development Of Super-Resolved Fluorescence Microscopy

 

Author and Curator: Larry H. Bernstein, MD, FCAP

CSO, Leaders in Pharmaceutical Business Intelligence

Article ID #153: Development Of Super-Resolved Fluorescence Microscopy. Published on 10/12/2014

WordCloud Image Produced by Adam Tubman

Development Of Super-Resolved Fluorescence Microscopy

 

Part I. Nobel Prize For Chemistry 2014: Eric Betzig, Stefan W. Hell
and William E. Moerner Honored For Development Of Super-
Resolved Fluorescence Microscopy

The 2014 Nobel Prize in Chemistry was awarded on 10/08/2014 to
Eric Betzig, Stefan W. Hell and William E. Moerner for
“the development of super-resolved fluorescence microscopy.”

The invention of the electron microscope by Max Knoll and Ernst Ruska at the
Berlin Technische Hochschule in 1931 finally overcame the barrier to higher
resolution that had been imposed by the limitations of visible light. Since then
resolution has defined the progress of the technology.

The ultimate goal was atomic resolution – the ability to see atoms – but this would
have to be approached incrementally over the course of decades. The earliest microscopes merely proved the concept: electron beams could, indeed, be tamed
to provide visible images of matter. By the late 1930s electron microscopes with theoretical resolutions of 10 nm were being designed and produced, and by 1944
this was further reduced to 2 nm. (The theoretical resolution of a an optical light microscope is 200 nm.)

Increases in the accelerating voltage of the electron beam accounted for much of
the improvement in resolution. But voltage was not everything. Improvements in electron lens technology minimized aberrations and provided a clearer picture,
which also contributed to improved resolution, as did better vacuum systems and brighter electron guns. So increasing the resolution of electron microscopes was a main driving force throughout the instrument’s development.

With nanoscopy, scientists could observe viruses, proteins and molecules there
are smaller than 0.0000002 metres.

Three researchers won the 2014 Nobel Prize in Chemistry on Wednesday,
October 8, for giving microscopes much sharper vision than was thought possible, letting scientists peer into living cells with unprecedented detail to seek the roots
of disease.  It was awarded to U.S. researchers Eric Betzig and William Moerner
and German scientist Stefan Hell. They found ways to use molecules that glow on demand to overcome what was considered a fundamental limitation for optical microscopes.

Hell, 52, of Germany, is the director at the Max Planck Institute for Biophysical Chemistry and the division head at the German Cancer Research Center in
Heidelberg. He was honored for his work on fluorescence microscopy, a kind
of nano-flashlight where scientists use fluorescent molecules to see parts of a
cell. Later in his career, he developed the STED microscope, which collects light
from “a multitude of small volumes to create a whole.”

Moerner, a 61-year-old professor in chemistry and applied physics at Stanford University in California, is the recipient of the 2008 Wolf Prize in Chemistry, the
2009 Irving Langmuir Award and the 2013 Peter Debye Award. In 1989, he
was the first scientist to be able to measure the light absorption of a single molecule.
This inspired many chemists to begin focusing on single molecules, including Betzig.

Betzig, 54, the group leader at Janelia Farm Research campus at the Howard
Hughes Medical Institute in Virginia, developed new optical imaging tools for
biology. His work involved taking images of the same area multiple times, and illuminating just a few molecules each time. These images were then
superimposed to create a dense super image at the nano level,

The limitation of optical microscopy was thought to have been determined in a calculation published in 1873 that defined the limit of how tiny a detail could be revealed by optical microscopes. Based on experimental evidence and basic principles of physics, Ernst Abbe and Lord Rayleigh defined and formulated
this diffraction-limited resolution in the late 19th century (Abbe, 1873; Rayleigh,
1896
).  However, only cellular structure and objects that were at least 200 to
350 nm apart could be resolved by light microscopy because, the optical resolution
of light microscopy was limited to approximately half of the wavelength of the light used.  Later key innovations—including fluorescence and confocal laser scanning microscopy (CLSM)—made optical microscopy one of the most powerful and
versatile diagnostic tools in modern cell biology. Using highly specific fluorescent labeling techniques such as immunocytochemistry, in situ hybridization, or
fluorescent protein tags, the spatial distribution and dynamics of virtually every subcellular structure, protein, or genomic sequence of interest can be analyzed in chemically fixed or living samples (Conchello and Lichtman, 2005; Giepmans et al., 2006).

The result of their advance is “really a window into the cell which we didn’t have before,” said Catherine Lewis, director of the cell biology and biophysics division
of the National Institute of General Medical Sciences in Bethesda, Maryland.

“You can observe the behavior of individual molecules in living cells in real time.
You can see … molecules moving around inside the cell. You can see them interacting with each other.”

The research of the three men has let scientists study diseases such as
Parkinson’s, Alzheimer’s and Huntington’s at a molecular level, the Royal
Swedish Academy of Sciences said.

Part II. Electron microscopy limitations

Manfred Von Ardenne in Berlin produced the earliest scanning-transmission
electron microscope in 1937. At the University of Toronto in Canada, Cecil Hall, James Hillier, and Albert Prebus, working under the direction of Eli Burton,
produced an advanced 1938 Toronto Model electron microscope that would
later become the basis for Radio Corporation of America’s Model B, the first commercial electron microscope in North America. Ruska at Siemens in
Germany produced the first commercial electron microscope in the world in 938.

Starting in 1939, scientists in Japan gathered to decide on the best way to build
an electron microscope. This group evolved into the Japan Electron Optics Laboratory (JEOL) that would eventually produce more models and varieties
of electron microscopes than any other company. Hitachi and Toshiba in Japan
also played a major role in the early development process.

The 1960s through the 1990s produced many innovative instruments and trends.
The introduction of the first commercial scanning electron microscopes (SEMs)
in 1965 opened up a new world of analysis for materials scientists. Ultrahigh
voltage TEM instruments (up to 3 MeV at CEMES-LOE/CNRS in Toulouse,
France, and at Hitachi in Tokyo, Japan), in the 1960s and 1970s gave electrons higher energy to penetrate more deeply into thick samples. The evolution and incorporation of other detectors (electron microprobes, electron energy loss spectroscopy (EELS), etc.) made the SEM into a true analytical electron
microscope (AEM) beginning in the 1970s. The development of brighter
electron sources, such as the lanthanum hexaboride filament (LAB6) and the
field emission gun in the 1960s, and their commercialization in the 1970s
brought researchers a brighter source of electrons and with it better imaging
and resolution. Tilting specimen stages permitting examination of the specimen
from different angles aided significantly in the determination of crystal structure.
In the late 1980s and throughout the 1990s, the environmental electron
microscopes that allow scientists to examine samples under more natural
conditions of temperature and pressure have dramatically expanded the
types of samples that can be examined.

In medicine, the EM made a unique contribution to diagnostic anatomic
pathology in renal biopsy analysis. However, the small sample had to be
embedded, and in the early days one cut the specimen by breaking glass
for the cutting of the specimen. But even though EM ushered in a new era of molecular pathology, the contribution was limited, despite incremental
improvements.

In the past, the use of microscopes was limited by a physical restriction;
scientists could only see items that were larger than roughly half the
wavelength of light (.2 micrometers)
. However, the groundbreaking work
of the Nobel laureates bypassed the maximum resolution of traditional
microscopes and launched optical microscopy into the nanodimension.

Part III. Super resolution fluorescence microscopy

Bo Huang,1,2 Mark Bates,3 and Xiaowei Zhuang1,2,4
Author information ► Copyright and License information ►
Annu Rev Biochem. 2009; 78: 993–1016.
http://dx.doi.org:/10.1146/annurev.biochem.77.061906.092014
PMCID: PMC2835776  NIHMSID: NIHMS179491

Achieving a spatial resolution that is not limited by the diffraction of
light, recent developments of super-resolution fluorescence microscopy
techniques allow the observation of many biological structures not
resolvable in conventional fluorescence microscopy. New advances
in these techniques now give them the ability to image three-dimensional
(3D) structures, measure interactions by multicolor colocalization, and
record dynamic processes in living cells at the nanometer scale. It is
anticipated that super-resolution fluorescence microscopy will become
a widely used tool for cell and tissue imaging to provide previously
unobserved details of biological structures and processes.

Keywords: Sub-diffraction limit, single-molecule, multicolor imaging,
three-dimensional imaging, live cell imaging, single-particle tracking,
photoswitchable probe

Among the various microscopy techniques, fluorescence microscopy is
one of the most widely used because of its two principal advantages:
Specific cellular components may be observed through molecule-specific
labeling, and light microscopy allows the observation of structures inside
a live sample in real time. Compared to other imaging techniques such
as electron microscopy (EM), however, conventional fluorescence
microscopy is limited by relatively low spatial resolution because of the
diffraction of light. This diffraction limit, about 200–300 nm in the lateral
direction and 500–700 nm in the axial direction, is comparable to or larger
than many subcellular structures, leaving them too small to be observed in
detail. In recent years, a number of “super-resolution” fluorescence microscopy techniques have been invented to overcome the diffraction barrier, including techniques that employ nonlinear effects to sharpen the point-spread function
of the microscope, such as stimulated emission depletion (STED) microscopy
(1, 2), related methods using other reversible saturable optically linear
fluorescence transitions (RESOLFTs) (3), and saturated structured-illumination microscopy (SSIM) (4), as well as techniques that are based on the localization
of individual fluorescent molecules, such as stochastic optical reconstruction microscopy (STORM) (5), photoactivated localization microscopy (PALM) (6),
and fluorescence photoactivation localization microscopy (FPALM) (7). These methods have yielded an order of magnitude improvement in spatial resolution
in all three dimensions over conventional light microscopy.

THE RESOLUTION LIMIT IN OPTICAL MICROSCOPY

Microscopes can be used to visualize fine structures in a sample by providing
a magnified image. However, even an arbitrarily high magnification does not
translate into the ability to see infinitely small details. Instead, the resolution
of light microscopy is limited because light is a wave and is subject to diffraction.

The diffraction limit

An optical microscope can be thought of as a lens system that produces a
magnified image of a small object. In this imaging process, light rays from
each point on the object converge to a single point at the image plane. However,
the diffraction of light prevents exact convergence of the rays, causing a sharp
point on the object to blur into a finite-sized spot in the image. The three-
dimensional (3D) intensity distribution of the image of a point object is called
the point spread function (PSF). The size of the PSF determines the resolution
of the microscope: Two points closer than the full width at half-maximum
(FWHM) of the PSF will be difficult to resolve because their images overlap substantially.

The FWHM of the PSF in the lateral directions (the x–y directions perpendicular
to the optical axis) can be approximated as Δxy ≈ 0.61λ / NA, where λ is the wavelength of the light, and NA is the numerical aperture of the objective
defined as NA = n sinα, with n being the refractive index of the medium and
α being the half-cone angle of the focused light produced by the objective.
The axial width of the PSF is about 2–3 times as large as the lateral width
for ordinary high NA objectives. When imaging with visible light (λ ≈ 550 nm),
the commonly used oil immersion objective with NA = 1.40 yields a PSF with
a lateral size of ~200 nm and an axial size of ~500 nm in a refractive index-
matched medium (Figure 1) (8).

Figure 1

The PSF of a common oil immersion objective with NA = 1.40, showing the
focal spot of 550 nm light in a medium with refractive index n = 1.515. The
intensity distribution in the x-z plane of the focus spot is computed numerically.

PFS of oil immersion microscope

PFS of oil immersion microscope

Because the loss of high-frequency spatial information in optical microscopy
results from the diffraction of light when it propagates through a distance larger
than the wavelength of the light (far field), near-field microscopy is one of the
earliest approaches sought to achieve high spatial resolution. By exciting the fluorophores or detecting the signal through the nonpropagating light near the fluorophore, high-resolution information be retained. Near-field scanning optical microscopy (NSOM) acquires an image by scanning a sharp probe tip across
the sample, typically providing a resolution of 20–50 nm (9–11). Wide-field
imaging has also been recently demonstrated in the near-field regime using
a super lens with negative refractive index (12, 13). However, the short range
of the near-field region (tens of nanometers) compromises the ability of light microscopy to look into a sample, limiting the application of near-field microscopy
to near-surface features only. This limit highlights the need to develop far-field
high-resolution imaging methods.

Among far-field fluorescence microscopy techniques, confocal and multiphoton microscopy are among the most widely used to moderately enhance the spatial resolution (14, 15). By combining a focused laser for excitation and a pinhole for detection, confocal microscopy can, in principle, have a factor of √2 improvement
in the spatial resolution. In multiphoton microscopy, nonlinear absorption processes reduce the effective size of the excitation PSF. However, this gain in the PSF size
is counteracted by the increased wavelength of the excitation light. Thus, instead
of improving the resolution, the main advantage of confocal and multi-photon microscopy over wide-field microscopy is the reduction of out-of-focus fluorescence background, allowing optical sectioning in 3D imaging.

Two techniques, 4Pi and I5M microscopy, approach this ideal situation by using
two opposing objectives for excitation and/or detection (16, 17). By acquiring
multiple images with illumination patterns of different phases and orientations,
a high-resolution image can be reconstructed. Because the illumination pattern
itself is also limited by the diffraction of light, structured illumination microscopy
(SIM) is only capable of doubling the spatial resolution by combining two diffraction-limited sources of information.  The best achievable result using these methods
would be an isotropic PSF with an additional factor of 2 in resolution improvement. This would correspond to ~100-nm image resolution in all three dimensions, as
has been demonstrated by the I5S technique, which combines I5M and SIM (22). Albeit a significant improvement, this resolution is still fundamentally limited by
the diffraction of light.

SUPER RESOLUTION FLUORESCENCE MICROSCOPY BY SPATIALLY PATTERNED EXCITATION

One approach to attain a resolution far beyond the limit of diffraction, i.e., to
realize super-resolution microscopy, is to introduce sub-diffraction-limit features
in the excitation pattern so that small-length-scale information can be read out.
We refer to this approach, including STED, RESOLFT, and SSIM, as super-
resolution microscopy by spatially patterned excitation or the “patterned excitation” approach.

The concept of STED microscopy was first proposed in 1994 (1) and subsequently demonstrated experimentally (2). Simply speaking, it uses a second laser (STED laser) to suppress the fluorescence emission from the fluorophores located off the center of the excitation. This suppression is achieved through stimulated emission: When an excited-state fluorophores encounters a photon that matches the energy difference between the excited and the ground state, it can be brought back to
the ground state through stimulated emission before spontaneous fluorescence emission occurs. This process effectively depletes excited-state fluorophores
capable of fluorescence emission (Figure 2a,b).

Figure 2

The principle of STED microscopy. (a) The process of stimulated emission. A
ground state (S0) fluorophore can absorb a photon from the excitation light and
jump to the excited state (S1).

STED microsopy

STED microsopy

The pattern of the STED laser is typically generated by inserting a phase mask
into the light path to modulate its phase-spatial distribution (Figure 2b). One such phase mask generates a donut-shaped STED pattern in the xy plane (Figure 2c)
and has provided an xy resolution of ~30 nm (24). STED can also be employed
in 4Pi microscopy (STED-4Pi), resulting in an axial resolution of 30–40 nm (25). STED has been applied to biological samples either immuno-stained with
fluorophore labeled antibodies (26) or genetically tagged with fluorescent
proteins (FPs) (27). Dyes with high photostability under STED conditions and
large stimulated emission cross sections in the visible to near infrared (IR) range
are preferred. Atto 532 and Atto 647N are among the most often used dyes for
STED microscopy.

Stimulated emission is not the only mechanism capable of suppressing
undesired fluorescence emission. A more general scheme using saturable
depletion to achieve super resolution has been formalized with the name
RESOLFT microscopy (3). This scheme employs fluorescent probes that
can be reversibly photoswitched between a fluorescent on state and a dark
off state. The off state can be the ground state of a fluorophores as in the
case of STED, the triplet state as in ground-state-depletion microscopy
(28, 29), or the dark state of a reversibly photoswitchable fluorophore (30).  RESOLFT has been demonstrated using a reversibly photoswitchable
fluorescent protein as FP595 which leads to a resolution better than 100 nm
at a depletion laser intensity of 600 W/cm2(30).

The same concept of employing saturable processes can also be applied
to SIM by introducing sub-diffraction-limit spatial features into the excitation
pattern. SSIM has been demonstrated using the saturation of fluorescence
emission, which occurs when a fluorophore is illuminated by a very high
intensity of excitation light (4). Under this strong excitation, it is immediately
pumped to the excited state each time it returns to the ground state. In SSIM,
where the sample is illuminated with a sinusoidal pattern of strong excitation
light, the peaks of the excitation pattern can be clipped by fluorescence
saturation and become flat, whereas fluorescence emission is still absent
from the zero points in the valleys (Figure 3a). These effects add higher order
spatial frequencies to the excitation pattern. Mixing this excitation pattern with
the high-frequency spatial features in the sample can effectively bring the sub-diffraction-limit spatial features into the detection range of the microscopy
(Figure 3b).

Figure 3

The principle of SSIM. (a) The generation of the illumination pattern. A
diffractive grating in the excitation path splits the light into two beams. Their interference after emerging from the objective and reaching the sample creates
a sinusoidal illumination

SSIM

SSIM

Although the image of a single fluorophore, which resembles the PSF, is a
finite-sized spot, the precision of determining the fluorophores position from
its image can be much higher than the diffraction limit, as long as the image
results from multiple photons emitted from the fluorophore. Fitting an image
consisting of N photons can be viewed as N measurements of the fluorophore position, each with an uncertainty determined by the PSF (8), thus leading to
a localization precision approximated by:

Δloc≈ΔN−−√

where Δloc is the localization precision and Δ is the size of the PSF. This
scaling of the localization precision with the photon number allows super-
resolution microscopy with a resolution not limited by the diffraction of light.

High-precision localization of bright light has reached a precision as high
as ~1 Å (33). Taking advantage of single-molecule detection and imaging
(34, 35), nanometer localization precision has been achieved for single
fluorescent molecules (36).

Using fluorescent probes that can switch between a fluorescent and a dark
state, a recent invention overcomes this barrier by separating in the time
domain the otherwise spatially overlapping fluorescent images. In this approach, molecules within a diffraction limited region can be activated at different time
points so that they can be individually imaged, localized, and subsequently deactivated (Figure 4). Massively parallel localization is achieved through
wide-field imaging, so that the coordinates of many fluorophores can be
mapped and a super-resolution images subsequently reconstructed. This
concept has been independently conceived and implemented by three labs,
and it was given the names STORM (5), PALM (6), and FPALM (7), respectively.

Iterating the activation and imaging process allows the locations of many
fluorophores to be mapped and a super-resolution image to be constructed
from these fluorophore locations. In the following, we refer to this approach
as super-resolution microscopy by single-molecule localization.

Figure 4

The principle of stochastic optical reconstruction microscopy (STORM), photoactivated localization microscopy (PALM), and fluorescence photo-
activation localization microscopy (FPALM). Different fluorescent probes
marking the sample structure are activated.

STORM

STORM

After capturing the images with a digital camera, the point-spread functions
of the individual molecules are localized with high precision based on the
photon output before the probes spontaneously photo-bleach or switch to
a dark state. The positions of localized molecular centers are indicated with
black crosses. The process is repeated in Figures (c) through (e) until all of
the fluorescent probes are exhausted due to photo-bleaching or because the background fluorescence becomes too high. The final super-resolution image
(Figure (f)) is constructed by plotting the measured positions of the fluorescent probes.
http://microscopyu.com/tutorials/flash/superresolution/storm/index.html

The resolution of this technique is limited by the number of photons detected
per photoactivation event, which varies from several hundred for FPs (6) to
several thousand for cyanine dyes such as Cy5 (5, 46). These numbers
theoretically allow more than an order of magnitude improvement in spatial
resolution according to the √N scaling rule. In practice, a lateral resolution
of ~20 nm has been established experimentally using the photoswitchable
cyanine dyes (5, 46). Super-resolution images of biological samples have
been reported with directly labeled DNA structures and immunostained DNA-
protein complexes in vitro (5) as well as with FPtagged or immunostained
cellular structures (6, 44, 46).

Table 1   Photoswitchable fluorophores used in super resolution
fluorescence microscopy

Photoswitchable fluorophores

Photoswitchable fluorophores

Recent advances in super-resolution fluorescence microscopy
(including the capability for 3D, multicolor, live-cell imaging) enable
new applications in biological samples. These technical advances
were made possible through the development of both imaging optics
and fluorescent probes.

  • 3D imaging using the single-molecule localization approach
  • 3D imaging using the patterned excitation approach
  • Multicolor imaging
  • Multicolor imaging using the patterned excitation approach
  • Multicolor imaging using the single-molecule localization approach
  • Live cell imaging

Fluorescence imaging of a live cell has two requirements: specific labeling
of the cell and a time resolution that is high enough to record relevant
dynamics in the cell.  Many fluorescent proteins and organic dyes, including
cyanine dyes (46) and caged dyes, have been shown switchable in live cells.

Because STED has a much smaller PSF than scanning confocal microscopy,
STED would inherently take more time to scan though the same size of image
field. By increasing the scanning speed and limiting the field of view to a few µm, Westphal and coworkers have observed Brownian motion of a dense suspension
of nanoparticles with an impressive rate of 80 frames per second (fps) using
STED microscopy (63). More recently, they have demonstrated video-rate
(28 fps) imaging of live hippocampal neurons and observed the movement of individual synaptic vesicles with 60–80-nm resolution (64).

Sub-diffraction-limit imaging of focal adhesion proteins in live cells has recently
been demonstrated (65). Photoswitchable fluorescent protein, EosFP, was used
to label the focal adhesion protein paxillin. A time resolution of ~25–60 seconds
per frame was obtained, and during this time interval, approximately 103
fluorophores were activated and localized per square micrometer, providing
an effective resolution of 60–70 nm by the Nyquist criterion (65). More recently, super-resolution imaging has also been demonstrated in live bacteria with photoswitchable enhanced yellow fluorescent protein (EYFP), allowing the
MreB structure in the cell to be traced (66).

The optical resolution

Optical resolution is the intrinsic ability of a given method to resolve a structure
and can be defined as the ability to distinguish two point sources in proximity.
For the patterned excitation approaches, such as STED, SSIM, and RESOLFT,
the optical resolution is represented by the size of the effective PSF. For the
single-molecule localization approach, such as STORM/PALM/FPALM, the
precision of determining the positions of individual fluorescent probes is the
principal measure of optical resolution.

By using a spatially patterned excitation profile, this approach achieves super resolution by generating an effective excitation volume with dimensions far
below the diffraction limit. Taking STED as an example, the sharpness of the
PSF results from the saturation of depletion of excited-state fluorophores in
the region neighboring the zero point of the STED laser (which coincide with
the focal point of the excitation laser). With an increasing STED laser power,
the saturated region expands toward the zero point, but fluorophores at the
zero point are not affected by the STED laser if the zero point is strictly kept
at zero intensity. Therefore, a theoretically unlimited gain in spatial resolution
may be achieved if the zero point in the depletion pattern is ideal.

The single-molecule localization approach achieves super resolution through
high precision localization of individual fluorophores. The number of photons
collected from a fluorophore is a principal factor limiting the localization
precision and hence the resolution of the final image.

Several photoswitchable fluorophores have been reported to give thousands
of photons detected per activation event [e.g., 6000 from Cy5 (46)].With the
PSF fitting procedure and the mechanical stability of the system optimized,
the background signal suppressed, and the nonuniformity of camera pixels
corrected, optical resolution of just a few nanometers could potentially be
achieved, reaching the molecular scale. As in the case of the patterned
excitation approach, the optical resolution here is also unlimited, in principle,
given a sufficient number of photons detected from the fluorescent probes.

Part III. A guide to super-resolution fluorescence microscopy

L Schermelleh1, R Heintzmann2,3,4, and H Leonhardt1
JCB Jul 19, 2010 // 190(2): 165-175
The Rockefeller University Press,
http://dx.doi.org:/10.1083/jcb.201002018

Based on experimental evidence and basic principles of physics, Ernst Abbe
and Lord Rayleigh defined and formulated this diffraction-limited resolution in
the late 19th century (Abbe, 1873; Rayleigh, 1896). Later key innovations—including fluorescence and confocal laser scanning microscopy (CLSM)—made optical microscopy one of the most powerful and versatile diagnostic
tools in modern cell biology.

The optical resolution defines the physical limit of the smallest structure it
can resolve. When imaging a biological sample, the effective resolution is
also affected by several sample-specific factors, including the labeling density,
probe size, and how well the ultrastructures are preserved during sample
preparation.

The diffraction (Abbe) limit of detection

Resolution is often defined as the largest distance at which the image of
two point-like objects seems to amalgamate. Thus, most resolution criteria
(Rayleigh limit,Sparrow limit, full width at half maximum of the PSF) directly
relate to properties of the PSF. These are useful resolution criteria for visible
observation of specimen, but there are several shortcomings of such a definition
of resolution: (1) Knowing that the image is an image of two particles, these
can in fact be discriminated with the help of a computer down to arbitrary
smaller distances. Determining the positions of two adjacent particles thus
becomes a question of experimental precision and most notably photon statistics
rather than being described by the Rayleigh limit. (2) These limits do not
necessarily correspond well to what level of detail can be seen in images or
real world objects; e.g., the Rayleigh limit is defined as the distance from the
center to the first minimum of the point spread function, which can be made
arbitrarily small with the help of ordinary linear optics (e.g., Toraldo-filters),
albeit at the expense of the side lobes becoming much higher than the central
maximum. (3)

Abbe’s formulation of a resolution limit avoids all of the above shortcomings
at the expense of a less direct interpretation. The process of imaging can be
described by a convolution operation. With the help of a Fourier transformation,
every object (whether periodic or not) can uniquely be described as a sum of
sinusoidal curves with different spatial frequencies (where higher frequencies
represent fine object details and lower frequencies represent coarse details).
The rather complex process of convolution can be greatly simplified by looking
at the equivalent operation in Fourier space: The Fourier-transformed object
just needs to be multiplied with the
Fourier-transformed PSF to yield the Fourier-transformed ideal image (without
the noise). Because the Fourier-transformed PSF now describes how well each
spatial frequency of the Fourier-transformed object gets transferred to appear in the
image, this Fourier-transformed PSF is called the optical transfer function, OTF
(right panel). Its strength at each spatial frequency (e.g., measured in oscillations
per meter) conveniently describes the contrast that a sinusoidal object would
achieve in an image.

Abbe limit

Abbe limit

Interestingly, the detection OTF of a microscope has a fixed frequency
border (Abbe limit frequency, right panel). The maximum-to-maximum
distance Λmin of the corresponding sine curve is commonly referred to
as Abbe’s limit (left panel). In other words: The Abbe limit is the smallest
periodicity in a structure, which can be discriminated in its image. As a
point object contains all spatial frequencies, this Abbe limit sine curve
needs to also be present in the PSF. A standard wide-field microscope
creates an image of a point object (e.g., an emitting molecule) by capturing
the light from that molecule at various places of the objective lens, and
processing it with further lenses to then interfere at the image plane.
Conveniently due to the reciprocity principle in optics, the Abbe limit Λmin
along an in-plane direction in fluorescence imaging corresponds to the
maximum-to-maximum distance of the intensity structure one would get by
interfering two waves at extreme angles captured by the objective lens:
where λ/n is the wavelength of light in the medium of refractive index n.
The term NA = n sin(α) conveniently combines the half opening angle α
of the objective and the refractive index n of the embedding medium.

Abbe’s famous resolution limit is so attractive because it simply depends
on the maximal relative angle between different waves leaving the
object and being captured by the objective lens to be sent to the image.
It describes the smallest level of detail that can possibly be imaged with
this PSF “brush”. No periodic object detail smaller than this shortest
wavelength can possibly be transferred to the image.

Confocal laser scanning microscopy employs a redesigned optical
path and specialized hardware. A tightly focused spot of laser light is
used to scan the sample and a small aperture (or pinhole) in the
confocal image plane of the light path allows only light originating
from the nominal focus to pass (Cremer and Cremer, 1978; Sheppard
and Wilson, 1981
; Brakenhoff et al., 1985). The emitted light is
detected by a photomultiplier tube (PMT) or an avalanche photodiode
(APD) and the image is then constructed by mapping the detected
light in dependence of the position of the scanning spot. CLSM can
achieve a better resolution than wide-field fluorescence microscopy
but, to obtain a significant practical advantage, the pinhole needs to
be closed to an extent where most of the light is discarded
(Heintzmann et al., 2003).

Wide-field deconvolution and CLSM have long been the gold standards
in optical bioimaging, but we are now witnessing a revolution in light
microscopy that will fundamentally expand our perception of the cell.
Recently, several new technologies,collectively termed super-resolution
microscopy or nanoscopy, have been developed that break or bypass
the classical diffraction limit and shift the optical resolution down to
macromolecular or even molecular levels (Table I).

Super-resolution light microscopy methods

super resolution microscopy

super resolution microscopy

http://zeiss-campus.magnet.fsu.edu/articles/superresolution/introduction.html

Conceptually, one can discern near-field from far-field methods and
whether the subdiffraction resolution is based on a linear or nonlinear
response of the sample to its locally illuminating (exciting or depleting) irradiance. The required nonlinearity is currently achieved by using reversible saturable optical fluorescence transitions (RESOLFT) between molecular states (Hofmann et al., 2005; Hell, 2007).

Besides these saturable optical fluorescence transitions also other
approaches, e.g., Rabi oscillations, could be used to generate the
required nonlinear response.

Note that each of the novel imaging modes has its individual signal-
to-noise consideration depending on various factors.  A full
discussion of this issue is beyond the scope of this review, but as a
general rule, single-point scanning systems, albeit fundamentally limited
in speed by fluorescence saturation effects, can have better signal-
to-noise performance for thicker samples.

With three-dimensional SIM (3D-SIM), an additional twofold increase
in the axial resolution can be achieved by generating an excitation
light modulation along the z-axis using three-beam interference
(Gustafsson et al., 2008; Schermelleh et al.,2008) and processing a
z-stack of images accordingly. Thus, with 3D-SIM an approximately eightfold smaller volume can be resolved in comparison to conventional microscopy (Fig. 2). To computationally reconstruct a three-dimensional dataset of a typical mammalian cell of 8-µm height with a
z-spacing of 125 nm, roughly 1,000 raw images (512 × 512 pixels) are
recorded. Because no special photophysics is needed, virtually all modern fluorescent labels can be used provided they are sufficiently photostable
to accommodate the additional exposure cycles.

Resolvable volumes obtained with current commercial super-resolution microscopes.

A schematic 3D representation of focal volumes is shown for the indicated
emission maxima. The approximate lateral (x,y) and axial (z) resolution
and resolvable volumes are listed. Note that STED/CW-STED and 3D-SIM
can reach up to 20 µm into the sample, whereas PALM/STORM is usually
confined to the evanescent wave field near the sample bottom. It should be
noted that deconvolution approaches can further improve STED resolution.
For comparison the “focal volume” for PALM/STORM was estimated based
on the localization precision in combination with the z-range of TIRF.

Resolvable volumes obtained

Resolvable volumes obtained

Super-resolution microscopy of biological samples.

(A) Conventional wide-field image (left) and 3D-SIM image of a mouse
C2C12 prometaphase cell stained with primary antibodies against
lamin B and tubulin, and secondary antibodies conjugated to Alexa 488
(green) and Alexa 594 (red), respectively. Nuclear chromatin was stained
with DAPI (blue). 3D image stacks were acquired with a DeltaVision OMX
prototype system (Applied Precision). The bottom panel shows the
respective orthogonal cross sections. (B) HeLa cell stained with primary
antibodies against the nuclear pore complex protein Nup153 and
secondary antibodies conjugated with ATTO647N. The image was
acquired with a TCS STED confocal microscope (Leica). (C) TdEosFP-
paxillin expressed in a Hep G2 cell to label adhesion complexes at
the lower surface. The image was acquired on an ELYRA P.1
prototype system (Carl Zeiss, Inc.) using TIRF illumination. Single
molecule positional information was projected from 10,000 frames
recorded at 30 frames per second. On the left, signals were summed
up to generate a TIRF image with conventional wide-field lateral
resolution. Bars: 5 µm (insets, 0.5 µm).

biological images

biological images

APPLICATIONS IN BIOLOGICAL SYSTEMS

The cytoskeleton of mammalian cells, especially microtubules
(Figure 5a) (29, 44, 46, 52), is the most commonly used benchmark
structure for super-resolution imaging. Other cytoskeletal structures
imaged so far include actin filaments in the lamellipodium (6),
keratin intermediate filaments (59), neurofilaments (26, 83) and
MreB in Caulobacter (66).

Figure 5

cytoskeleton. f5.

cytoskeleton. f5.

Examples of super-resolution images of biological samples.
(a) Two-color STORM imaging of immunostained microtubule (green)
and clathrin-coated pits (red) (From Reference 46. Reprinted with
permission from AAAS).

Organelles, such as the endoplasmic reticulum (27), lysosome (6),
endocytic and exocytic vesicles (46, 52, 64), and mitochondria
(6, 53, 56), have also been imaged. For example, using the single-molecule localization approach, 3D STORM imaging has clearly
resolved the ~150-nm diameter, hemispherical cage shape of clathrin-coated pits (46, 52), which only appear as diffraction-limited spots
without any feature in conventional fluorescence microscopy (Figure 5a,b).
Two-color 3D STED has resolved the hollow shape of the mitochondrial
outer membrane (marked by the translocase protein Tom20), enclosing
a matrix protein Hsp60 (56), even though the diameter of mitochondria is
only about 300–500 nm (Figure 5c). The outer membrane structure of
mitochondria and their interactions with microtubules have been resolved
by two-color 3D STORM (53). The transport of synaptic vesicles
has been recorded at video rate using 2D STED (Figure 5d ) (64).

Many plasma membrane proteins or membrane associated protein
complexes have also been studied by super-resolution fluorescence
microscopy. For example, synaptotagmin clusters after exocytosis in
primary cultured hippocampal neurons (84), the donut-shaped
clusters of Drosophila protein Bruchpilot at the neuromuscular
synaptic active zone (85), and the size distribution of syntaxin clusters
have all been imaged (86, 87). Photoactivation has enabled the tracking
of the influenza protein hemagglutinin and the retroviral protein Gag in
live cells, revealing the membrane microdomains (67) and the spatial
heterogeneity of membrane diffusion (68). The morphology and transport
of the focal adhension complex has also been observed using live-cell
PALM (Figure 5e) (65).

Summary points

  1. Super resolution fluorescence microscopy with a spatial resolution not limited by the diffraction of
    light has been implemented using saturated depletion/excitation or single-molecule localization
    of switchable fluorophores.
  2. Three-dimensional imaging with an optical resolution as high as ~20 nm in the lateral direction
    and 40–50 nm in axial dimension has been achieved.
  3. The resolution of these super-resolution fluorescence microscopy techniques can in principle
    reach molecular scale.
  4. In practice, the resolution of the images are not only limited by the intrinsic optical resolution,
    but also by sample specific factors including the labeling density, probe size and sample preservation.
  5. Multicolor super resolution imaging has been implemented, allowing colocalization measurements
    to be performed at nanometer scale resolution and molecular interaction to be more précisely
    identified in cells.
  6. Super-resolution fluorescence imaging allows dynamic processes to be investigated at the tens of
    nanometer resolution in living cells.
  7. Many cellular structures have been imaged at sub-diffraction-limit resolution.

Future issues

  1. Achieving molecular scale resolution (a few nanometers or less).
  2. Fast super resolution imaging of a large view field by multi-point scanning or high-speed single-molecule switching/localization.
  3. Developing new fluorescent probes that are brighter, more photostable and switchable fluorophores
    that have high on-off contrast and fast switching rate.
  4. Developing fluorescent labeling methods that can stain the target with small molecules at high specificity,
    high density and good ultrastructure preservation.
  5. Application of super resolution microscopy to provide novel biological insights

Acronyms

FP

Fluorescent Protein

FPALM

Fluorescence PhotoActivation Localization Microscopy

I5M

Combination of I2M (Illumination Interference Microscopy) and I3M
(Incoherent Imaging Interference Microscopy)

PALM

PhotoActivated Localization Microscopy

PSF

Point Spread Function

RESOLFT

REversible Saturable Optically Linear Fluorescence Transition

SIM

Structured Illumination Microscopy

SSIM

Saturated Structured Illumination Microscopy

STED

STimulated Emission Depletion

STORM

STochastic Optical Reconstruction Microscopy

glossary

Numerical aperture (NA)

The numerical aperture of an objective characterizes the solid angle
of light collected from a point light source at the focus of the objective.

Stimulated emission

The process that an excited state molecule or atom jumps to the
ground state by emitting another photon that is identical to the incoming
photon. It is the basis of laser.

Fluorescence saturation

At high excitation intensity, the fluorescence lifetime instead of the excitation
rate becomes the rate limiting step of fluorescence emission, causing the
fluorescence signal not to increase proportionally with the excitation intensity.

Nyquist criterion

To determine a structure, the sampling interval needs to be no larger than
half of the feature size.

Mitochondria

Organelles in eukaryotic cells for APT generation, consisting of two
membrane (inner and outer) enclosing the inter membrane space and
the matrix inside the inner membrane.

Clathrin-coated pit

Vesicle forming machinery involved in endocytosis and intracellular
vesicle transport, consisting of clathrin coats, adapter proteins, and
other regulatory proteins.

Focal adhesion

The macromolecular complex serving as the mechanical connection
and signaling hub between a cell and the extracellular matrix or other cells.

Selected references with abstract

Near-Field Optics: Microscopy, Spectroscopy, and Surface
Modification Beyond the Diffraction Limit
Eric Betzig,  Jay K. Trautman
AT&T Bell Laboratories, Murray Hill, NJ 07974
Science 10 Jul 1992; 257(5067) pp. 189-195
http://dx.doi.org:/0.1126/science.257.5067.189

 The near-field optical interaction between a sharp probe and a sample
of interest can be exploited to image, spectroscopically probe, or modify
surfaces at a resolution (down to ∼12 nm) inaccessible by traditional far-field
techniques. Many of the attractive features of conventional optics are
retained, including noninvasiveness, reliability, and low cost. In addition, most
optical contrast mechanisms can be extended to the near-field regime,
resulting in a technique of considerable versatility. This versatility
is demonstrated by several examples, such as the imaging of nanometric-scale features in mammalian tissue sections and the creation of ultrasmall,
magneto-optic domains having implications for high density data storage.
Although the technique may find uses in many diverse fields, two of the
most exciting possibilities are localized optical spectroscopy of semiconductors
and the fluorescence imaging of living cells.

Imaging Intracellular Fluorescent Proteins at Nanometer Resolution

 E Betzig1,2,*,†, GH. Patterson3, R Sougrat3, O.W Lindwasser3,
S Olenych4, JS. Bonifacino3, MW. Davidson4, JL Schwartz3, HF. Hess5,*  1 Howard Hughes Medical Institute, Janelia Farm Research Campus,
Ashburn, VA   2 New Millennium Research, LLC, Okemos, MI.   3 Cell Biology and Metabolism Branch, National Institute of Child Health
and Human Development (NICHD), Bethesda, MD.  4 National High
Magnetic Field Laboratory, Florida State University, Tallahassee, FL.
5 NuQuest Research, LLC, La Jolla, CA.
Science 15 Sep 2006; 313(5793): pp. 1642-1645
http://dx.doi.org:/10.1126/science.1127344

We introduce a method for optically imaging intracellular proteins at
nanometer spatial resolution. Numerous sparse subsets of photo-activatable fluorescent protein molecules were activated, localized
(to ∼2 to 25 nanometers), and then bleached. The
aggregate position information from all subsets was then assembled
into a super-resolution image. We used this method—termed photo-
activated localization microscopy to image specific target proteins
in thin sections of lysosomes and mitochondria; in fixed whole cells,
we imaged vinculin at focal adhesions, actin within a lamellipodium,
and the distribution of the retroviral protein Gag at the plasma
membrane.

Toward fluorescence nanoscopy.

Hell SW.   Author information 
Nat Biotechnol. 2003 Nov; 21(11):1347-55.
http://www.ncbi.nlm.nih.gov/pubmed/14595362

For more than a century, the resolution of focusing light microscopy
has been limited by diffraction to 180 nm in the focal plane and to
500 nm along the optic axis. Recently, microscopes have been
reported that provide three- to seven-fold improved axial
resolution in live cells. Moreover, a family of concepts has emerged
that overcomes the diffraction barrier altogether. Its first exponent,
stimulated emission depletion microscopy, has so far displayed a
resolution down to 28 nm. Relying on saturated optical transitions,
these concepts are limited only by the attainable saturation level.
As strong saturation should be feasible at low light intensities,
nanoscale imaging with focused light may be closer than ever.
PMID: 14595362

Far-field optical nanoscopy.

Hell SW.  Author information 
Science. 2007 May 25;316(5828):1153-8.
http://www.ncbi.nlm.nih.gov/pubmed/17525330

In 1873, Ernst Abbe discovered what was to become a well-known
paradigm: the inability of a lens-based optical microscope to
discern details that are closer together than half of the wavelength
for its most popular imaging mode, fluorescence microscopy, the
diffraction barrier is crumbling. Here, I discuss the physical concepts
that have pushed fluorescence microscopy to the nanoscale, once
the prerogative of electron and scanning probe microscopes. Initial
applications indicate that emergent far-field optical nanoscopy will
have a strong impact in the life sciences and in other areas benefiting
from nanoscale visualization.
PMID:  17525330

Imaging intracellular fluorescent proteins at nanometer resolution.

Betzig E1, Patterson GH, Sougrat R, Lindwasser OW, Olenych S,
Bonifacino JS, Davidson MW, Lippincott-Schwartz J, Hess HF.
Author information
Science. 2006 Sep 15;313(5793):1642-5. Epub 2006 Aug 10
http://www.ncbi.nlm.nih.gov/pubmed/16902090

We introduce a method for optically imaging intracellular proteins at
nanometer spatial resolution. Numerous sparse subsets of photo-ctivatable fluorescent protein molecules were activated, localized
(to approximately 2 to 25 nanometers), and then bleached. The
aggregate position information from all subsets was then assembled
into a super-resolution image. We used this method–termed photo-activated localization microscopy–to image specific target proteins in
thin sections of lysosomes and mitochondria; in fixed whole cells,
we imaged vinculin at focal adhesions, actin within a lamellipodium,
and the distribution of the retroviral protein Gag at the plasma
membrane.

Comment in

PMID:  16902090  [PubMed – indexed for MEDLINE]

Illuminating single molecules in condensed matter.

Moerner WE1, Orrit M.  Author information 
Science. 1999 Mar 12;283(5408):1670-6.
http://www.ncbi.nlm.nih.gov/pubmed/10073924

Efficient collection and detection of fluorescence coupled with careful
minimization of background from impurities and Raman scattering
now enable routine optical microscopy and study of single molecules
in complex condensed matter environments. This ultimate method
for unraveling ensemble averages leads to the observation of
new effects and to direct measurements of stochastic fluctuations.
Experiments at cryogenic temperatures open new directions in
molecular spectroscopy, quantum optics, and solid-state dynamics.
Room-emperature investigations apply several techniques
(polarization microscopy, single-molecule imaging, emission time
dependence, energy transfer, lifetime studies, and the like) to a
growing array of biophysical problems where new insight may be
gained from direct observations of hidden static and dynamic
inhomogeneity.  PMID: 10073924

Fluorescence microscopy with super-resolved optical sections.

Egner A1, Hell SW.  Author information 
Trends Cell Biol. 2005 Apr;15(4):207-15.
http://www.ncbi.nlm.nih.gov/pubmed/15817377

The fluorescence microscope, especially its confocal variant, has
become a standard tool in cell biology research for delivering
3D-images of intact cells. However, the resolution of any standard
optical microscope is atleast 3 times poorer along the axis of the
lens that in its focal plane. Here, we review principles and applications
of an emerging family of fluorescence microscopes, such as 4Pi
microscopes, which improve axial resolution by a factor of seven by
employing two opposing lenses. Noninvasive axial sections of 80-160 nm
thickness deliver more faithful 3D-images of subcellular features,
providing a new opportunity to significantly enhance our understanding
of cellular structure and function. PMID: 15817377

4Pi-confocal microscopy provides three-dimensional images of the
microtubule network with 100- to 150-nm resolution.

Nagorni M1, Hell SW.  Author information 
J Struct Biol. 1998 Nov;123(3):236-47.

We show the applicability of 4Pi-confocal microscopy to three-dimensional imaging of the microtubule network in a fixed mouse
fibroblast cell.Comparison with two-photon confocal resolution
reveals a fourfold better axial resolution in the 4Pi-confocal case.
By combining 4Pi-confocal microscopy with Richardson-Lucy
image restoration a further resolution increase is achieved.
Featuring a three-dimensional resolution in the range 100-150 nm,
the 4Pi-confocal (restored) images are intrinsically more detailed
than their confocal counterparts. Our images constitute what
to our knowledge are the best-resolved three-dimensional
images of entangled cellular microtubules obtained with light
to date.  PMID: 9878578

Part IV. Super-resolution microscopy

Super-resolution microscopy is a form of light microscopy. Due
to the diffraction of light, the resolution of conventional light
microscopy is limited as stated by Ernst Abbe in 1873.[1]
A good approximation of the resolution attainable is the full
width at half maximum 
 (FWHM) of the point spread function,
and a precise wide-field microscope with high numerical
aperture
 and visible light usually reaches a resolution of ~250 nm.

Super-resolution techniques allow the capture of images with
a higher resolution than the diffraction limit. They fall into
two broad categories,
“true” super-resolution techniques, which capture information
contained in evanescent waves, and “functional” super-
resolution techniques, which use clever experimental
techniques and known limitations on the matter being
imaged to reconstruct a super-resolution image.[2]

True subwavelength imaging techniques include those that
utilize the Pendry Superlens and near field scanning optical
microscopy
, the 4Pi Microscope and structured illumination
microscopy technologies like SIM and SMI. However, the
majority of techniques of importance in biological imaging
fall into the functional category.

Groups of methods for functional super-resolution microscopy:

  1. Deterministic super-resolution: The most commonly used emitters in biological
    microscopy, fluorophores, show a nonlinear response to excitation, and this
    nonlinear response can be exploited to enhance resolution. These
    methods include STED, GSD, RESOLFTand SSIM.
  2. Stochastic super-resolution: The chemical complexity of many molecular
    light sources gives them a complex temporal behaviour, which can be used
    to make several close-by fluorophores emit light at separate times and
    thereby become resolvable in time.  These methods include SOFI and all
    single-molecule localization methods (SMLM) such as SPDM,
    SPDMphymod, PALM, FPALM, STORM and dSTORM.

Part V. HIV-1

Conformational dynamics of single HIV-1 envelope
trimers on the surface of native virions

James B. Munro1,*,‡, Jason Gorman2, Xiaochu Ma1,
Zhou Zhou3, James Arthos4,
Dennis R. Burton5,6, et al.
1Department of Microbial Pathogenesis, Yale University
School of Medicine, New Haven, CT. 2Vaccine Research
Center, National Institute of Allergy and Infectious
Diseases, National Institutes of Health, Bethesda, MD .
3Department of Physiology and Biophysics, Weill
Cornell Medical College of Cornell University, New York, NY .
4Laboratory of Immunoregulation, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, Bethesda,
MD . 5Department of Immunology and Microbial Science, and
IAVI Neutralizing Antibody Center, The Scripps Research
Institute, La Jolla, CA . 6Ragon Institute of MGH, MIT, and
Harvard, Cambridge, MA. 7International AIDS Vaccine Initiative
(IAVI), New York, NY . 8Department of
Chemistry, University of Pennsylvania, Philadelphia, PA.

The HIV-1 envelope (Env) mediates viral entry into host cells.
To enable the direct imaging of conformational dynamics
within Env we introduced fluorophores into variable
regions of the gp120 subunit and measured single-molecule
fluorescence resonance energy transfer (smFRET) within
the context of native trimers on the surface of HIV-1 virions.
Our observations revealed unliganded HIV-1 Env to be
intrinsically dynamic, transitioning between three distinct
pre-fusion conformations, whose relative occupancies
were remodeled by receptor CD4 and antibody binding.
The distinct properties of neutralization-sensitive and
neutralization-resistant HIV-1 isolates support a dynamics-based mechanism of immune evasion and ligand recognition.

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RAbD Biotech Presents at 1st Pitch Life Sciences-Philadelphia-September 16, 2014

Reporter: Stephen J. Williams, PhD

UPDATE 12/09/2022

The following is background material of RAbD technology, bispecific antibodies:

Current landscape and future directions of bispecific antibodies in cancer immunotherapy

Jing Wei1†, Yueyao Yang2†, Gang Wang2 and Ming Liu1*
  • 1Gastric Cancer Center/Cancer Center, West China Hospital, Sichuan University, Chengdu, China
  • 2National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China

Recent advances in cancer immunotherapy using monoclonal antibodies have dramatically revolutionized the therapeutic strategy against advanced malignancies, inspiring the exploration of various types of therapeutic antibodies. Bispecific antibodies (BsAbs) are recombinant molecules containing two different antigens or epitopes identifying binding domains. Bispecific antibody-based tumor immunotherapy has gained broad potential in preclinical and clinical investigations in a variety of tumor types following regulatory approval of newly developed technologies involving bispecific and multispecific antibodies. Meanwhile, a series of challenges such as antibody immunogenicity, tumor heterogeneity, low response rate, treatment resistance, and systemic adverse effects hinder the application of BsAbs. In this review, we provide insights into the various architecture of BsAbs, focus on BsAbs’ alternative different mechanisms of action and clinical progression, and discuss relevant approaches to overcome existing challenges in BsAbs clinical application.

1 Introduction

Immunotherapy breakthroughs in cancer treatment with synthetic multifunctional biotherapeutics have fueled cancer immunotherapy and the exploration of antibody alternative modes of action (1, 2). Conventional targeted or immunotherapeutic drugs can only be used to inhibit one or one class of targets, thus giving birth to some unique combination drug regimens. Currently, Constant engineering technical breakthroughs in antibody development have aided in producing many BsAb designs (3) (Figures 1C, D). Bispecific antibodies, constructed via quadroma, chemical conjugation, and genetic recombination (4), exert effector functions beyond natural antibodies through redirecting cells or modulating different pathways, providing numerous possibilities for therapeutic application and contributing to improving treatment responses in refractory tumor patients. Although more than a hundred BsAbs are currently under clinical evaluation in cancer treatment, most are still in the early stages (4), and only four BsAbs have been approved by FDA (Table 1). These include Catumaxomab (Fresenius/Trion’s Removab®) which was withdrawn from the market in 2017, Blinatumomab (Amgen’s Blincyto®), Amivantamab-vmjw (Janssen’s Rybrevant®), and Tebentafusp-tebn (Immunocore’s Kimmtrak®) (5–11).

Figure 1
www.frontiersin.orgFIGURE 1 CD3+ bispecific T-cell engaging antibodies exert function in Hematological Malignancies and recruit immune cells into the solid tumor microenvironment for cancer immunotherapy. The schematic depicts the mechanism of action of BsAbs in solid tumors (A) and Hematological Malignancies (B). besides, there shows partial fragments of antibody as well as the derivatives formats constructed from them in diagram (C) and various architecture of BsAbs in diagram (D) mentioned in this review.

Table 1
www.frontiersin.orgTABLE 1 Bispecific Antibody Approved by the FDA.

Furthermore, multiple studies investigate the mechanisms of action by which BsAbs detect various tumor targets such as angiogenesis, proliferation, invasion, and immune modulation. However, potential immunotherapy side effects must be considered, whereas toxicity in normal tissues and systemic immune responses limit the use of BsAbs (12–15). We concentrate on the advances in BsAbs design, mechanisms of action, and clinical trial development in this review (Table 2). We also talk about difficulties and potential solutions for enhancing drug delivery.

Table 2
www.frontiersin.orgTABLE 2 Bispecific Antibody Clinical Trials Ongoing.

2 BsAb construct formats

In natural bivalent antibodies, the two antigen binding sites are identical and consist of variable regions of the heavy chain and light chain. Bispecific antibodies (BsAbs) are dual-specificity molecules binding two different epitopes simultaneously, the concept of which has been first described decades ago by Nisonoff et al. (1). Since there are no naturally occurring bispecific antibodies, BsAbs were initially developed by chemically coupling two monoclonal antibody fragments or creating quadroma cell lines combined with two homologous hybridomas. The field of recombinant bispecific antibodies for diagnostic and therapeutic purposes has been transformed by the quickly developing engineering technologies and pharmaceutical industry, leading to a variety of BsAbs with varying size, half-life, valency, flexibility, and permeability (2). Recombinant DNA technology is now the most used technique for producing bispecific antibodies.

IgG-like antibody types (containing an Fc unit) and non-IgG-like (without an Fc unit) antibody formats are the two broad categories into which BsAbs can be generally categorized (3). The intention of this classification mechanism well emphasizes the existence of the Fc domain, which not only facilitates the functionality mentioned above but contributes to the solubility, stability, and purification of the BsAbs (4). Additionally, this region can be genetically altered to abolish antibody-dependent cell-mediated cytotoxicity (ADCC) or complement dependent cytotoxicity (CDC) while retaining the potential for a lengthy half-life (5). Although non-IgG-like antibody formats exert therapeutic activities depending on antigen-recognition domains, smaller size enables them to enhance tissue penetration while rapid renal clearance results in a relatively short plasma half-life.

Heavy and light chain mispairing poses serious problems for bispecific antibodies made in IgG formats from two distinct polypeptides, leading to ineffective antibodies or unwanted homodimers. In the interim, mitigation measures have been taken for such issues. For example, the “knobs-into-hole” approach has been developed to mutate the corresponding amino acid size of the third constant domain of the antibody for correctly pairing the heavy chain (6). In contrast, “the light chain mispairing” problems can be well circumvented by the “CrossMab” strategy by swapping the CL (light chain constant region) domain of the light chain with the corresponding CH1 domain of the heavy chain to construct a correct light chain association (7, 12). Other established and mature techniques to prevent light chain mispairing include Eli Lilly’s “Orthogonal Fab interface” by introducing amino acid mutations to the light chain and the tcBsIgG (tethered-variable CL bispecific IgG) platform developed by the Genentech, which focuses on linking the VL (light chain variable region) to VH (heavy chain variable region) via the G4S linker (8, 9). In addition, the asymmetric heavy chains also form the basis for constructing multi-specific antibodies, such as trispecific, trivalent, or tetravalent antibodies, with greater targeting specificities for cancer therapy.

The production of non-IgG-like BsAbs without an Fc unit can be accomplished using Fab fragments or by joining the variable light-heavy domains of two antibodies. These antibodies can be broadly categorized into scFv (single-chain variable fragment)-based bsAbs, Nanobodies, Dock-and-lock (DNL) method-building antibodies, and other bispecific/multi-specific molecules (10). The specificity and ability to bind to antigens of full-length antibodies are maintained by scFv, composed of the VL and VH domains connected by a flexible peptide. Additionally, the linker length significantly impacts how scFv molecules associate, resulting in various polymerizations such as dimers, trimers, or tetramers. The Tandem scFvs constructed by the Bispecific T-cell Engager (BiTE®) antibody platform link two scFvs with a repeat glycine-serine short motifs (11), which enables antigen recognizing sites to rotate flexibly.

In contrast, the linking method of the Diabody format is slightly different from Tandem scFvs (13). Heterodimerization of those fragments is induced by crossing the VH and VL domains of the two scFvs by two shorter polypeptide chains. Even if the two peptides linker facilitates the molecular stability to a certain extent, the intramolecular association between the VH and VL domains from the same scFv is hampered (14).

Further research on crystal structures suggests that the Fv contact’s instability impacts overall flexibility, and the diabodies are too rigid to crystallize. As a result, “Dual-affinity retargeting molecules”—an inter-chain disulfide bond—have been created to strengthen the structural stability of the diabodies (DARTs) (15, 16). However, the small size of this format makes the DARTs molecule rapidly eliminate from the serum, and this issue has been well solved by the strategy of Fc fragment fusion to the part of the DARTs, promoting FcRn-mediated recycling at the same time. The emergence of this constructive format of bispecific antibodies called “DART-Fc” was designed by MacroGenics. Besides, the polymerization of two diabodies connected by two polypeptide chains forms the “Tandem diabodies” (TandAbs), the tetravalent derivatives possessing two antigen-recognizing moieties for each antigen.

In addition to being synthesized from the constituents of various antibodies, BsAbs can be fused to other protein domains to improve their functions for future adaptive therapeutic uses. For example, the scFv-based BsAbs have relatively great tissue permeability and decreased immunogenicity for the lack of Fc unit. However, short half-lives caused by relatively low molecular mass will affect the serum circulating level, which induces the Increased administration and doses of therapeutic agents, thus limiting the clinical promoting application. The format “scFv-HSA-scFv”, fusing two scFvs to the albumin, and conjugation of Polyethylene glycol PEGylation are available application strategies for circulating half-life extension (17). Furthermore, the Dock-and-lock (DNL) method, creating multivalent and multifunctional antibody derivatives such as trivalent bispecific antibodies by heterodimerizing protein domains fused with Fab domains or integral antibodies, is another available antibody platform enabling more promising antibody construction with retained bioactivity (18) (Figure 1C).

3 BsAbs redirecting immune effector cells and reactivating anti-tumor immunity

3.1 Bispecific T-Cell Engagers (BiTE) recruiting adaptive effector cells for tumor redirection

Adaptive immunity is essential for monitoring and suppressing tumorigenesis and cancerous progression. T-cells are the focal point of many immunotherapies and have a potent tumor-killing effect as a crucial part of adaptive immunity. BiTE is a potential immunological drug that directs T lymphocytes against tumor cells to treat a variety of malignancies. The ideal BiTE molecular design needs to consider the following factors: firstly, a suitable CD3 binding arm should be selected; secondly, the affinity between TAA binding sites and anti-CD3 units should differ by at least 10-fold to achieve sequential binding to tumor cells and immune cells, thus reducing the risk of severe cytokine release syndrome (CRS); finally, an appropriate physical distance between the two antibody binding units can also play a role in improving the efficacy and reducing the risk of CRS.

The high affinity of CD3 binding will allow BiTE to occupy CD3 antigen and activate T cells continuously, eventually leading to T cell depletion. However, suitable affinity will bind to and dissociate from the CD3 antigen of distinct T cells and the repeated binding to T cells will cause a “waterfall effect” to cluster T cells, ultimately resulting in many T cells activating to attain the greatest tumor-killing effect. In addition, high CD3 binding affinity will make BiTE more concentrated in the spleen, thus making it difficult to reach tumor tissues, especially solid tumors. Physically bridging T cells with tumor cells by BiTEs enables catalyzing the formation of an optimal immunologic synapse, which’s important for T cells activation and robust cytotoxicity to target tumor cells, ultimately leading to apoptosis via membrane disruption mediated by perforin releasing. In addition, multiple cytokine secretion from T cells activated by BiTEs, like IL-2, IFN-γ, and TNF-α, enhance their effectiveness in the anti-tumor function (Figures 1A, B). Strategies that harness the potential of T cells to identify and kill cancer cells in a targeted manner have ushered in a new era of cancer therapy and led to the development of a wide range of immunotherapy devices.

3.1.1 BiTEs in hematologic malignancies

Due to the distinct traits of hematopoietic malignancies, immunotherapy for leukemia and lymphoma has assumed a leadership role and made significant advancements. Given the unique property of the hematological system, malignancy cells constantly interact with immune cells, making it easier for BiTE to exert anti-tumor actions (19). Among various forms of immunotherapy, engaging T cells in hematological malignancies mediated by bispecific antibodies (BsAbs) has been demonstrated as an attractive strategy for providing alternative treatment options for recurrent and/or refractory hematological malignancies patients (20). Bispecific T-cell engagers (BiTEs), consisting of two binding sites simultaneously for a selective tumor antigen and CD3 molecule expressed on host T cells, has been emerged as the most promising BsAb form (Figure 1B). A diverse variety of BiTEs have emerged for cancer immunotherapy, and the specific targets are mainly CD19, CD20, CD123, CD33, CD38, and B-cell maturation antigen (BCMA) in hematological malignancies. Ideal target antigens must satisfy the criteria uniquely expressed on malignant cells to avoid on-target/off-cancer toxicity and reduce the possibility of antigen-loss variants. Even though few target antigens satisfy the above demands simultaneously (21, 22), various types of BiTE with different antigen-recognition domains have been under exploration for hematological malignancies.

Blinatumomab (MT103), the first BiTE tested in clinical trials specifically designed to target T cells based on the recognition of CD3ϵ to CD19 expressing B cell hematologic malignancies, can induce immune-mediated B-cell lymphoblasts lysis led by cytotoxic T cells. CD19 is a transmembrane molecule relatively specific to B cells persisting throughout B-cell differentiation and existed on the surface of most B cell hematologic malignancies, which is a superior target for cancer immunotherapy achieving exceptional curative effect with R/R B cell ALL (Acute Lymphocytic Leukemia) patients. And the body’s function will not be seriously affected while the missing of normal B cells or bone marrow cells can be continuously replenished by hematopoietic stem cells.

A 7.1-month overall survival and a CR/CRh of 36%, including partial patients with a T315I mutation, were achieved in an open-label phase II study evaluating the efficacy and tolerability of Blinatumomab in Ph-positive (Ph+) B-precursor ALL in the setting of relapsing or refractory to TKI-based therapy. This study findings helped the FDA expand its approval for Ph+ ALL indication in July 2017 (23). MRD is the most powerful prognosticator of relapse in ALL, and MRD-negative status has become increasingly clear that significantly associated with better event-free survival (24, 25). series of clinical trials have demonstrated the potency and efficacy of Blinatumomab in eradicating persistent or relapsed MRD in B-ALL patients with an increased MRD response rate (26–30). Based on these encouraging clinical findings, Blinatumomab acquired accelerated approval by the FDA to expand clinical indications to patients with MRD-positive ALL in 2018 (30). Blinatumomab has also been studied in phase 1/2 dose-escalation experiments for R/R Non-Hodgkin lymphoma (NHL), including diffuse large B-cell lymphoma (DLBCL), reaching an overall response rate of more than 40% (31, 32).

Although the clinical benefits for B-ALL patients from Blinatumomab is obvious, there are still problems with severe neurological events (encephalopathy, aphasia, and seizures) and cytokine release syndrome. In most studies, about 10% of patients reported ≥ grade 3 CRS and/or neurological complications. Dexamethasone or treatment interruption can alleviate these unfavorable side effects. In spite of this, about 10% of patients discontinued with Blinatumomab application because of treatment-related toxicity. Lunsumio (Mosunetuzumab) was recently granted conditional marketing authorization by the European Commission, a CD20 × CD3 T-cell binding bispecific antibody, for treating adult patients with relapsed or refractory follicular lymphoma (FL) who have received at least two prior systemic treatments. Roche is also working on Glofitamab, a CD20 × CD3 bispecific antibody with a different structure than Mosunetuzumab. Mosunetuzumab is similar to a natural human antibody but contains two different Fab regions, one of which targets CD20 and the other targets CD3. Glofitamab has a novel “2:1” structural pattern with two Fab regions targeting CD20 and one Fab region targeting CD3. This novel structural design allows higher binding to CD20 at the B cell surface.

The classification of hematological tumors is complex and varied. Acute myeloid leukemia (AML) is a genetically diverse disease defined by leukemic cell clonal proliferation. BiTEs are an effective treatment for AML because AML cells are especially vulnerable to the cytotoxic effects of functioning immune cells. CD33 expression is limited in non-hematopoietic tissues but is highly expressed in AML cells. The differential expression of CD33 on the surface of malignant AML cells makes it an ideal target for immunotherapy. AMG 330, the first CD33 × CD3 BiTE applied for acute myeloid leukemia (AML) patients, has shown promising cytolytic activity against AML cells in preclinical studies even at low CD33 antigen densities on target cells, making it a candidate for targeting a broad range of CD33+ leukemias (33–35). AMG330, similar to Blinatumomab, requires a 2-4 week cycle of continuous intravenous (IV) infusion. AMG330 was found to upregulate PD-L1 on primary ALL cells in vitro. As a result, when paired with PD-1/PD-L1 blocking therapy, AMG 330-mediated tumor cell lysis was dramatically increased (36, 37).

A bifunctional PD-1 × CD3 × CD33 immune checkpoint inhibitory T-cell engaging (CiTE) antibody simultaneously targeting PD-1, CD3 and CD33 has shown high therapeutic effect with complete AML (Acute Myelocytic Leukemia) eradication in preclinical experiments (38). Many clinical trials are ongoing with combination therapy of bispecific T cell-engaging antibodies and PD-1/PD-L1 axis inhibitors. The administration period depends largely on the structure of the antibody. The design of bispecific antibody-like Blinatumomab needs to consider the half-life. AMG673 will have an increased half-life of about 21 days in humans after fusing the binding domain of CD33 and CD3 to the N-terminal end of the IgG Fc region. In this way, the cycle time for intravenous infusion can be reduced. However, more attention needs to be paid to adverse effects. The drug AMV564 has a higher affinity for both antigens and possesses a tetravalent anti-CD33 × anti-CD3 tandem diabody (TandAb) structure with two CD3 binding sites and two CD33 binding sites. Whether T cells are overactivated is a concern for AMV564. Compared to AMG330, AMV564 is administered by continuous intravenous infusion at 14-day intervals. Preclinical studies in vitro and in vivo have demonstrated the ability of AMV564 to induce effective cytotoxicity to CD33+ AML cell lines in a dose-dependent manner.

CRS is the main toxic reaction in patients treated with CD33-targeted bispecific antibodies. Still, differences in the frequency and severity of CRS may depend on the leukemic load, the effector target ratio at baseline, the specific bispecific antibody structure, and its affinity for CD3.

More bispecific antibody for AML is undergoing clinical trials, such as CD123 × CD3 DuoBody (NCT02715011) and CD123 × CD3 DART (NCT02152956), and preclinical evaluation for adult patients, such as targeting CLL-1 and CD47. Target selection and efficacy assessment must be more cautious when treating AML in pediatric patients. More than 30% of AML pediatric patients have a highly tumor-specific target called MSLN. Recently, BsAbs targeting the MSLN and CD3 proximal area epitopes have increased lifetimes by increasing T cell activation and decreasing the tumor’s bone marrow AML cell load in MSLN-positive mice (39).

3.1.2 BiTEs in solid malignancies

Bispecific T cell engagers (BiTEs) have revolutionized success in hematological malignancies treatment and revitalized the field of solid tumor immunotherapy with promising outcomes from preclinical and clinical trials. Even if the checkpoint inhibitors hold the majority of approvals in recent years in various solid tumor types, the T cell redirection and recruitment approaches are extremely promising. Contrarily, the solid tumor microenvironment has incredibly complex features that affect the infiltration, activity, and persistence of immune effector cells vital to anti-tumor immunotherapy (3, 11) (Figure 1A).

Catumaxomab (Removab) was the first bispecific T cell engagers (TCE) approved by the European medicines agency (EMA) for malignant ascites clinical intraperitoneal treatment in 2009 (40, 41). It is the intact trifunctional mouse/rat chimeric bispecific IgG antibody, with one arm from mouse IgG2a half-antibody identifying epithelial cell adhesion molecule (anti-EpCAM) on tumoral cells and another arm from rat IgG2b targeting CD3 subunit (anti-CD3) on T-cells. Additionally, the functional Fc fragment binds to different immune accessory cells with Fcγ receptors (FcγR), such as natural killer (NK) cells, dendritic cells (DC), monocytes, and macrophages resulting in T-cell-mediated lysis, ADCC, and accessory cells mediating phagocytosis (42). It employs humoral immunity, on the one hand, activates cellular immunity on the other, and delivers co-activation signals via attachable immune cells to eliminate truculent tumor cells, as well as allowing the body’s immune system to generate a specific immune memory, which acts as a cancer vaccine and inhibits tumor metastasis and recurrence. Catumaxomab’s effectiveness has been proven in key phase I/III research and other phase I/II studies (40).

However, intravenous applications of Catumaxomab were connected with severe adverse events like cytokine release syndrome (CRS) and dose-dependent liver toxicity (43), attributing to the off-target activity of other immune cells with FcγRs expressing, and it was withdrawn in 2017 from the market for some commercial reasons (44). The efficacy, safety, and tolerability of Catumaxomab are currently being studied in clinical trials for various indications involving patients with non-muscle invasive bladder cancer (NMIBC) and advanced or recurrent gastric carcinoma with peritoneal metastasis (NCT04819399; NCT04222114) (45).

Driven by the clinical success of Blinatumomab, various T cell-engaging BsAbs targeting solid tumors have been explored and evaluated in preclinical mouse xenograft tumor models and clinical trials. Various antigen being investigated for CD3 TCE bsAbs such as CEA, HER2, prostate-specific membrane antigen (PSMA), GlycoproteinA33 (gpA33), and Glypican 3 (GPC3), etc. (46–49). On-target off-tumor toxicity, a restricted number of effector cells in the tumor microenvironment (TME), and decreased T cell activation in tumors are all problems with CD3 bispecific antibodies in solid tumors. Anti-bispecific antibody designs and techniques for numerous challenges are also available. As a result, several novel formats of TCEs and prodrugs have been investigated for improved efficacy, such as a TCE with a monovalent CD3 binding region and a multivalent TAA binding region, which has been shown to effectively transform a poorly infiltrated tumor microenvironment (TME) into a highly inflamed TME with increased infiltration frequency of activated T cells. Besides, these new multivalent TAA binding regions enable avoiding on-target/off-tumor toxicities after being altered into low-affinity TAA binding domains since most TAAs are also generally expressed at low levels in normal tissue cells (50, 51).

Dionysos Slaga and colleagues have demonstrated a proof of concept. They have generated an anti-HER2/CD3 TCE BsAbs which can target HER2-overexpressing tumor tissue cells with selectivity and high potency while very low binding to normal tissue cells with low amounts of HER2 expressing, thus circumvents the risk of adverse effects to a certain extent (52). Current prodrugs utilize the characteristics of tumor microenvironment such as lower pH, oxygen levels, and proteolytic enzyme levels, allowing for tumor-specific activation of BsAb that are inactive in the circulation or normal tissue thus avoiding attack normal cells. Furthermore, the most fundamental strategy to avoid on-target/off-tumor toxicity is to choose targets only expressed in solid tumors. Immune-mobilizing monoclonal TCRs against cancer (ImmTAC) is a remarkable TCE bsAb format that targets MHC-presented intracellular neoantigen peptides on the surface of tumoral cells (53). This engineered antibody format consisted of an anti-CD3 scFv and TCR peptides with enhanced affinity, enabling to recruit and selectively activate a majority of polyclonal effector T cells to infiltrate to reverse the “cold” TME into an inflammatory TME and lysis cancer cells with low surface oncoprotein epitope densities in the context of HLA-A*0201 subsequently, which demonstrates significant anti-tumor efficacy (54). Tebentafusp (IMCgp100), an ImmTAC molecule, for example, targets melanocyte differentiation antigen polypeptide glycoprotein100 (gp100), showing clinical activity in Metastatic Uveal Melanoma with low tumor mutational burden. Tebentafusp outperformed a single-agent treatment of ipilimumab, pembrolizumab, or dacarbazine in an open-label phase 3 trial for extending overall survival in newly diagnosed patients with metastatic uveal melanoma (NCT03070392) (55).

Whether changing the valence of antibodies, bispecific antibodies in the form of prodrugs, or finding new targets can only solve the problem of on-target off-tumor, T cell infiltration and activity in solid tumors can mostly only be changed by the mode of administration or combination therapy. TAA-based targeting may underestimate the use of CD3 bispecific antibodies in solid tumors. A bispecific antibody against both PD-L1 and CD3 successfully connected T cells to PD-L1-expressing tumor cells, improved T cell cytotoxicity against multiple NSCLC-derived cell lines by releasing granzyme B and cytokines, and decreased tumor growth in mice (56). However, a more potent mechanism of action may exist for the PD-L1 × CD3 bispecific antibody, which was found to target dendritic cells rather than tumor cells in multiple homozygous tumor mouse models. Bispecific antibodies redirecting T cells to APCs by enhancing B7/CD28 co-stimulation to activate T cells may represent a general means of T-cell rejuvenation for durable cancer immunotherapy. PD-L1 × CD3 treatment is undoubtedly dual-acting by simultaneously blocking negative signaling (PD-L1) and engaging positive signaling (CD3). More targeting approaches are now conceivable with the identification of immune checkpoints, and more mechanisms of action are being examined (57).

Any single technique for treating solid tumors will either limit tumor growth or temporarily remove the tumor. A combination of multiple techniques is required to achieve the optimal treatment result. More target combinations and antibody screening modalities are being developed for solid tumors. Using Patient-derived organoids (PDOs), bispecific antibodies can be screened on a large scale, and their efficacy can be evaluated more reliably than in cell experiments.

3.2 BsAbs recruiting Natural Killer (NK) cells for tumor redirection

NK cells, derived from multipotent hematopoietic stem cells, were identified in 1975 and have been considered the first line of defense against tumor cells with the robust anti-tumor ability (58, 59). With MHC-independent cytotoxicity, cytokine synthesis, and immunological memory, NK cells have a unique anti-tumor function, making them crucial participants in the innate and adaptive immune response system. These cells are conventionally divided into two subtypes, CD56dim CD16+ NK, and CD56bright CD16– NK cells. The former possesses powerful cytotoxicity and constitutes most of the peripheral blood and spleen subpopulation. At the same time, the latter is mainly equipped with immunomodulatory characteristics and constitutes a major subtype in lymph node tissues with weak cytotoxicity and maturity.

Diverse inhibitory and activating receptors are expressed on the surface of NK cells, determining the outcome of NK-cell activation by mediating the balance between those signals, which is pivotal for distinguishing and eliminating aberrant from normal cells through cytotoxic granules secretion based on TRAIL receptors and FAS ligand (FasL) expression as well as the release of other cytokines, growth factors, and chemokines. Inhibitory receptors on the surface of NK cells can recognize and bind to MHC Class I (MHC-I) molecules to alleviate autoimmune reactions. In contrast, the down-regulated expression of the MHC-I molecule can induce NK cell-mediated killing under cellular stress conditions, known as “missing self-recognition”. During tumorigenesis, the expression of MHC-I molecules is generally lost or in a defective condition for escaping from immune surveillance. Still, the unique characteristic of NK cells plays a necessary role in bypassing downregulated presentation of tumor neoantigens and effectively eliminating early aberrant cells (58).

A high frequency of NK-cell infiltration is usually connected with a better prognosis. However, Clara Degos and colleagues found an impoverished NK cell infiltration in the tumor microenvironment. IFN-γ secretion and cytotoxicity of Tumor-infiltrated NK cells are impaired, with significantly attenuated tumor-killing ability (60). Bispecific killer cell engager (BiKE) is a promising strategy to engage NK cells to tumor cells; Fc receptor (FcγRIII, CD16A)-mediated recruitment as a function of bsAb can be achieved by binding of CD16 on the surface of NK cells to the Fc region of bsAb, or by one end of a bi-specific antibody targeting CD16A (CD16A antibody). By inducing ADCC, the activating NK cell receptor CD16A (FcγRIIIA), which is mostly expressed on mature NK cells, might facilitate the destruction of tumor cells (61).

Both the composition and form of the BiKE affect the effectiveness of ADCC induction. The design of BiKE for Fc-mediated NK cell recruitment faces the challenge that the chosen form needs to ensure the effective binding of the Fc structural domain to CD16. Same as the Fc-mediated ADCC antibodies, the ADCC efficiency of BiKE, which recruits NK cells through partial regional CD16 antibody, is also similarly dependent on the choice of antibody’s form. ADCC-induced binding of the tumor-associated antigen (TAA) CD30 and CD16A is superior to monovalent CD30/CD16A binding in the dual CD16A-bound TandAb (tandem diabody) form than in the diabody form (62).

The AFM13 (ROCK®), a tetravalent bispecific anti-CD30 × anti-CD16A TandAb targeting CD30+ malignancies like Hodgkin lymphoma, has shown efficacy and cytotoxicity in an early clinical trial (NCT01221571) (63). Besides, in a phase 1b study aiming to evaluate the curative effect of AFM13 in combination with pembrolizumab to investigate further a rational treatment modality in patients with relapsed/refractory Hodgkin lymphoma (R/R HL), the objective response rate reached 88% at the highest treatment dose. The overall response rate is 83% for recipients with an acceptable safety profile and tolerability (64). Furthermore, AFM13 has reached a phase II clinical study to improve therapeutic efficacy by optimizing the dosing schedule (63). The AFM24, a different CD16A-based IgG1-scFv fusion BsAb that targets EGFR-expressing tumor cells with varying EGFR expression levels and KRAS/BRAF mutational status, has also demonstrated a strong potential for therapeutic application investigation and is now being studied in clinical trials (NCT04259450) (65).

Apart from targeting CD16A, a small number of studies have targeted activation receptors on NK cells, such as NKG2D, NKp30, and NKp46. A study constructed a homodimeric recombinant antibody combining two NKG2D-binding and two ErbB2 (HER2)-specific single-chain fragment variable (scFv) domains, linked by an IgG4 Fc region in a single tetravalent molecule, known as NKAB-ErbB2 (66).

The NKAB-ErbB2 increased lysis of ErbB2-positive breast carcinoma cells by peripheral blood-derived NK cells endogenously expressing NKG2D. NKG2D is unlike the other targets because mAb-mediated cross-linking does not result in cytokine release. In contrast, stimulation with soluble recombinant NKG2D ligands (MICA, ULBP-1, or ULBP-2) induces the expression of IFN-γ, GM-CSF and MIP-1β. A novel dual-targeting antibody composed of antibody cG7 and MICA was named cG7-MICA. The cG7 part is a natural antibody targeting CD24, and MICA is attached to the antibody behind CH3 via a G4S linker. When cG7-MICA coupled to CD24 on tumor cells, inducing NK cell-mediated cytotoxicity, HCC cells were identified by NK cells via MICA. As the Fc binds to its receptors on the surface of NK cells and macrophages, ADCC, CDC effects, and a longer half-life following engagement with neonatal receptors are all triggered (67). But shedding or downregulation of NKG2D ligands (NKG2DL) can prevent NKG2D activation, resulting in the escape of cancer cells from NKG2D-dependent immune surveillance.

There has been particularly little research into bispecific antibodies targeting NKp30 and NKp46 (68). CTX8573 is the first NKp30 × BCMA bispecific antibody that targets BCMA+ plasma cells and NK cells (69). The C-terminus of the antibody is attached to the anti-NKp30 Fab, and the mismatch is resolved using the same light chain. The Fc-terminus is given a de-fucose treatment to increase the impact on NK cells further. Intrinsic cells are effectively attracted to and activated by the binding of NKp30 and CD16A. Compared to monoclonal antibodies targeting CD16A, the ADCC potency is increased by more than 100 times using the NKp30 bispecific platform, which also maintains activity when CD16A is downregulated. Bispecific antibodies against NK redirection are still mainly used to treat hematological tumors. It is also unclear whether NK cells will enter solid tumors more readily than T cells for solid tumors. NK cells can produce relevant cytokines to attract other immune cells, which may further enhance the anti-tumor response. There is no doubt that strategies to increase the involvement of NK cells in anti-tumor response will be the future of tumor immunotherapy.

3.3 Bispecific antibody targeting immune checkpoint and co-stimulator for immune cell restoration

3.3.1 Immune checkpoint

Clinical cancer therapy approaches have undergone a revolutionary change due to recent discoveries on the roles of immune checkpoints in allowing cancers to avoid the innate/adapted immune system (70, 71). Immune checkpoint receptors of co-inhibitory molecules such as programmed cell death 1 (PD-1) and/or cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) are critical in maintaining self-tolerance and avoiding immune-mediated adverse effects on the host. However, numerous studies have shown that the (TILs) exhibit substantially elevated co-inhibitory receptors, which represent an exhausted phenotype and limited anti-tumor action (72). In addition, preclinical evidence suggests that T cell response has been inhabited on account of the upregulated expression level of programmed cell death 1 ligand 1 (PD-L1) on the surface of malignant cells to conducive tumor cell’s immune escape and limit the efficacy of anti-tumor immunotherapies (73). Immune checkpoint blockades (ICBs) have been established based on the mechanism mentioned above to break those negative regulators that prevent pre-existing anti-tumor immune responses from being activated. Some ICBs have shown notable efficacy in various cancers and have entered routine clinical implementation (74). Besides, A clinical trial reported the 5-year outcomes that nivolumab (anti-PD-1) combined with ipilimumab (anti-CTLA-4) among advanced melanoma patients has resulted in sustained long-term progression-free and overall survival (52%) compared with nivolumab group (44%) and ipilimumab group (26%) (75).

The therapeutic idea of blocking two inhibitory immune checkpoints has led to the rational design and development of bispecific antibodies that simultaneously target two inhibitory checkpoints expressed on the surface of the same or different cells. This has been made possible by the innovative success of ICBs immunotherapies and the improved clinical benefit rate observed in patients who have received combined treatment with ICBs. MGD019 is a monovalent investigational PD-1 × CTLA-4 bispecific DART compound designed to increase CTLA-4 checkpoint blockage in the TME based on a PD-1 binding mechanism. This single-molecule showed complete blockade of the PD-1/PD-L1 axis and Variable Inhibition of CTLA-4 in vitro and is well tolerated in non-human primates with increased T cell proliferation and expansion. Furthermore, the first-in-human study with MGD019 is ongoing in patients with multiple advanced solid tumors. After the dose-escalation phase, the analysis revealed acceptable safety and objective responses in various tumor types typically unresponsive to checkpoint inhibitor therapy (NCT03761017) (76). MEDI5752, fusing an anti–PD-1 mAb and the variable binding domains of Tremelimumab (anti-CTLA4) onto a DuetMab backbone, optimally designed with triple amino acid mutations of the human IgG1 constant heavy chain to reduce Fc-mediated immune effector functions. Dovedi, S.J. et al. discovered that this engineered molecule preferentially localizes and inhibits CTLA4 on PD-1+ T cells and rapidly induces internalization and degradation of PD-1.

As a result, the affinity for the CTLA4 receptor is markedly increased and saturated, increasing clinical benefit and minimizing further harm. In addition, current first-in-human research using MEDI5752 to treat advanced solid cancers showed promising partial responses with acceptable side effects (77). Different from MEDI5752, AK104 is an anti-PD-1/CTLA-4 bispecific antibody with the symmetrical structure of 4-valent IgG1-scfv developed by Akeso Biology. AK104 can rapidly mediate independent endocytosis of PD-1 or CTLA-4 based on good antigenic differentiated binding with high retention in tumor tissue. Recently, Cadonilimab (AK104) has been approved in China for treating patients with recurrent or metastatic cervical cancer who have failed prior platinum-containing chemotherapy.

Nowadays, most of these BsAbs target the next wave of inhibitory receptors expressed on TILs with one binding arm and block the PD-1/PD-L1 axis with the other binding arm to reverse acquired T cell exhaustion-driven resistance. Dual immunomodulator MGD013 targets LAG-3 and PD-1. Both target molecules are expressed on T cells following antigen stimulation. Based on the DART® form, MGD013 has been shown to effectively inhibit the binding of PD-1 to PD-L1 and PD-L2 while inhibiting the binding of LAG-3 and MHC II, which activate T cells by acting together. This bispecific antibody is in clinical phase I studies (NCT03219268). Similar preclinical dual immunomodulators include FS118 targeting PD-L1/LAG-3 and LY3415244 targeting PD-L1/TIM-3 (78, 79).

3.3.2 Co-stimulatory molecules

Co-stimulation assists the immune system in determining whether responses to antigenic stimuli and co-stimulatory receptors have been utilized for cancer immunotherapy. The targets of immune co-stimulation mainly focus on the B7-CD28 and TNFR family. In the B7-CD28 family, CD28 and ICOS are the main co-stimulatory receptors. OX40, CD40, CD27, 4-1BB, GITR, and CD30 belong to the TNFR family. CD28, one of the first identified co-stimulatory molecules constructively expressed on the surface of T cells, contributes to lowering the threshold, which is critical for TCR-mediated T cell activation and subsequently results in enhanced T cell proliferation, cytokine production, and release, as well as cell survival (80). Six healthy volunteers who participated in the first human clinical trial for TeGenero’s CD28 hyperagonist antibody TGN1412 had severe cytokine release syndrome and multiple organ failure. Because antibodies activate T cells even when the TCR is not involved, they create an immunological response that targets everyone.

Other co-stimulatory receptors are promising targets, transiently expressed on activated T cells via TCR-mediated signal identification rather than constituent expression like CD28. The affinity of agonistic antibodies for their targets must be optimized, not maximized. It is not the affinity but the intermittent exposure of co-stimulatory receptors that may become more crucial. Excitatory antibodies, though, are still in their infancy compared to immune checkpoint inhibitors. Utilizing excitatory antibodies alone might not be the best course of action. Co-stimulatory receptors play a unique role, and PD-1 therapeutic effectiveness depends on the CD28/B7 co-stimulatory pathway. PD-1 is widely believed to inhibit signal transduction through T-cell receptors (TCR). The study indicated that TCR co-stimulatory receptor CD28 is the primary target of PD-1 signal transduction (81). Lung cancer patients who responded to PD-1 therapy had more CD28+T cells, suggesting that CD28 may predict treatment response. Toxicity can be largely avoided by combining CD28 antibodies with another target.

TSA × CD28 bispecific antibodies have shown little or no toxicity in humanized immune system mice or primate models when used alone or combined with PD-1 antibodies (82). As a result, it might offer a safe “off-the-shelf” combination immunotherapy that could greatly improve anti-tumor effectiveness and trigger long-lasting anti-tumor immunity. Preclinical research on CD28 triple antibodies has recently demonstrated considerable promise, and this therapy is now widely recognized in theory. Sanofi created an anti-HER2, anti-CD3, and anti-CD28 tri-specific antibody to target, stimulate, and prolong the lifespan of T cells in malignancies (83).

The dissociation constants for HER2, CD28, and CD3 are 1.28, 1.0, and 1.43 nM, respectively. Each antigen arm shows a comparable affinity to the analogous single antigen arm in the presence of the other two antigens, demonstrating minimal interference between the various arms. The tri-specific antibody could promote tumor regression at low doses and achieve effective tumor suppression in both high and low HER2 expressing tumors. It was also found that CD4 cells, but not CD8 cells, were critical in promoting tumor growth arrest. The CD137 (4-1BB) is the most promising target in studies targeting co-stimulatory receptors. To reduce the toxicity of systemic CD137 agonists to the liver while maintaining efficacy, targeting CD137 with a bispecific molecule that binds to the tumor-associated antigen (TAA) and confining CD137+ T cell agonists to the tumor microenvironment appears to be an ideal approach. Targeting non-tumor toxic cytokine release syndrome is decreased by triggering only antigen-exposed T cells (CD137+ T cells). Independent of MHC, CD137 activation can expand tumor-reactive memory T cells. Additionally, CD137-targeted antibodies may be more resilient to antigen loss than CD3-targeted antibodies. Nevertheless, the clinical development of bispecific antibodies has been severely hampered by dose-dependent hepatotoxicity found in clinical studies with co-stimulatory molecules recognizing agonistic antibodies (84–90).

Thus tumor-localized co-stimulatory bispecific antibodies have been developed to alleviate systemic toxicity after systemic effector T cell co-stimulation. PRS-343, engaging 4-1BB-specific Anticalin proteins to a modified variant of trastuzumab with a mutation modified IgG4 isotype to avoid the risk of ADCC and non–tumor-target activation of 4-1BB-positive lymphocytes, facilitates HER2+ tumor-localized co-stimulation of T cells with reduced peripheral toxicity (84). In addition, PRS-344/S095012, a synthesized tetravalent PD-L1/4-1BB bispecific antibody, showed stronger antitumoral activity and synergistic impact compared to the combination of mAbs via a tumor-localized 4-1BB-mediated activation (91). Preclinical models reflect that PRS-344/S095012-mediated 4-1BB activation depends on PD-L1, reducing the risk of peripheral toxicity and that 4-1BB co-stimulation occurs only in synchrony with TCR signaling, limiting its activity to antigen-specific T cells. Furthermore, DuoBody-PD-L1×4-1BB (GEN1046), the first-in-class bispecific immunotherapy agent, formed by the K409R and F405L mutations in the Fc CH3 region of two IgG1 antibodies and demonstrated pharmacodynamic immune effects and a manageable safety profile in a phase I trial of dose escalation in heavily pre-treated patients with multiple advanced refractory solid tumors (NCT03917381) (92).

In addition to bispecific antibodies, research for the CD28 and the 4-1BB target has been extended to triple and quadruple antibodies. However, the market for numerous distinct cancer antibody therapeutics is still in its infancy, and much research on its effectiveness and safety is still needed. Hepatotoxicity is being studied in the next generation of co-stimulation-targeted bispecific antibodies without compromising efficacy.

4 Bispecific antibody targeting non-immune cells in the TME for restricting tumor diffusion

The tumor microenvironment mainly consists of tumor cells and their surrounding immune and inflammatory cells, cancer-associated fibroblasts (CAFs), nearby mesenchymal tissue, microvasculature, and various cytokines and chemokines (Figure 2). It can be roughly divided into immune microenvironment based on immune cells and non-immune microenvironment. Angiogenesis, the process by which new blood vessels emerge from an already-existing vascular network, is crucial to tumor growth, progression, and metastasis (93). During the process, low oxygen tension (hypoxia) is a significantly important component of the TME driving tumor angiogenesis, which could upregulate multifarious proangiogenic growth factors like VEGF, placenta growth factor (PlGF), and angiopoietin 2 (Ang2) that correlate with the formation of new vessels through directly engaging in vessel growth (94, 95). VEGF family (VEGF-F) and Ang1-2/Tie-2 pathway are equally important in mediating tumor angiogenesis, and Ang-2 regulates vessel maturation in the later stage of angiogenesis, which contributes to promoting vascular formation with VEGF in the different stages. Upregulated levels of VEGF and Ang-2 demonstrated a worse prognosis factor in various tumor types (96), the blocking of the signaling pathway Ang-2 shows the effect of tumor growth inhibition with the decreased vascular formation. It normalizes remaining blood vessels with increased pericyte coverage (97–99). Furthermore, the above blocking pathways have more significant effects when combined with anti-VEGFA drugs, even in certain tumor types with resistance (100–102).

Figure 2
www.frontiersin.orgFIGURE 2 Bispecific antibodies exert anti-tumor effects in the immunosuppressive tumor microenvironment. In the complex tumor microenvironment, activated fibroblasts communicate with tumor cells, various inflammatory cells as well as stroma cells via secreting growth factors (TGFβ, VEGF, etc.) and other chemokines to provide potentially oncogenic signals and interact with the microvasculature, which induces an accelerated oncogenic extracellular-matrix microenvironment. BsAbs, aiming at blocking the interacting mechanism, transform the “cold” immune environment into the “hot” immune environment.

In addition to showing strong anti-tumor, antiangiogenic, and micrometastasis growth reducing effects in subcutaneous and orthotopic syngeneic mouse xenotransplantations, Ang-2-VEGF CrossMab also exhibits these effects in patient or cell line-derived humanized tumor xenografts with acceptable side effects compared to Ang-1 inhibition combined with anti-VEGF treatment on physiologic vessel growth (103). Furthermore, Kloepper, Riedemann et al. found that dual Ang-2/VEGF (CrossMab, A2V) antibody can prolong the survival of mice bearing orthotopic syngeneic (Gl261) GBMs or human (MGG8) GBM xenografts based on only VEGF pathway blocking failing to enhance overall survival of patients with GBM (104). The logical combination therapy of immune checkpoints and angiogenesis provides greater therapeutic effects, according to Schmittnaegel et al. On the other hand, increased intratumoral immune effector cell activation results in increased PD-L1 expression in tumoral endothelial cells (105).

The PD-L1 blockade could prolong the angiostatic effects of angiogenic factors receptor inhibition, enhancing vascular normalization to a certain extent. However, lacking tumor-infiltrating lymphocytes is related to primary resistance to ICIs. At the same time, dysfunctional tumor vasculature restricts lymphocyte T cell permeating into tumors, thus limiting the curative effect of immune-checkpoint blockade. Therefore, rational dual therapy modalities of anti-angiogenesis and immune checkpoint blocking like PD-1/PD-L1 signal pathways have broad clinical applicability (91, 105). The HB0025, with dual recognition of VEGFR and PD-L1 based on mAb-Trap technology, has shown enhanced anti-tumor benefits than either single drug treatment (106).

In addition to VEGF, the Notch pathway’s essential ligand delta-like ligand 4 (DLL4) plays a key role in tumor neo-angiogenesis and regulates the VEGF pathway’s signaling to prevent excessive vascularization (107). Due to severe target toxicities (such as hepatotoxicity and pulmonary hypertension) seen in the clinic, the DLL4 monoclonal antibody’s development has been stopped. The research strategy then shifted to bispecific antibodies for VEGF and DLL4. Navicixizumab (OMP-305B83), an IgG2 humanized BsAb, targets DLL4 and VEGF simultaneously. The data from the phase 1a study showed manageable toxicities and anti-tumor activity in various tumor types, which encouraged an ongoing phase 1b clinical trial to further assess the curative effect in pre-treated ovarian cancer patients with platinum resistance (NCT03030287) (108). Besides, ABL001 (VEGF × DLL4), with enhanced biological anti-tumor activity in xenograft models than VEGF or DLL4 monoclonal therapeutic antibodies alone, is under phase 1 clinical study to evaluate combination therapy effect with heavy chemotherapy (NCT03292783) (92).

Cancer-associated fibroblasts (CAFs), ranking in the stromal cell population, which compose of diverse subpopulations with distinct functions in cancer, represent the most considerable component of the tumor microenvironment (TME) (109). Abundant studies have confirmed that CAF populations could exert different but mutual functions modulating tumor growth, proliferation, tumor metastatic dissemination, and extracellular matrix components remodeling, simultaneously correlated to immunosuppression TME establishment and chemoradiotherapy resistance (109–113). Recently, an in-depth study on the crucial role that CAFs play in the tumor immune microenvironment’s (TIME) pro-oncogenic functions has been done, showing CAFs as a promising therapeutic target (114). Fibroblast Activation Protein (FAP), a marker expressed on the surface of CAFs and detected in various cancer types of poor prognosis, has appeared as a novel strategy for targeted immunotherapies. Bispecific FAP-targeted 4-1BB ligand (RG7826), correctly assembled through CH1-CL domain crossover, knob into hole (KIH) amino acid mutation in the fragment crystallizable (Fc) domain, as well as mutations in CH1 (EE) and CL (RK) (12, 115), led to intensive IFN-γ and granzyme B secretion in human tumor samples while combined with tumor antigen-targeted (CEA) T cell bispecific (TCB) molecules (89, 116). A new FAP-DR5 (death receptor 5) tetravalent bispecific antibody called RG7386 aims to activate extrinsic DR5. In preclinical patient-derived xenograft models, hyperclustering dependent on the tumor cells’ apoptotic pathway and binding to FAP-positive stroma led to durable tumor reduction, which is currently being assessed in phase-I clinical research (117, 118).

5 Bispecific antibody changing TGF-β signal pathway to improve the tumor microenvironment

Transforming growth factor (TGF)-β is a multifunctional cytokine that plays a dual role, tumor suppressor or promoter, in a cellular or context-dependent manner, known as the TGF-β “paradox”. In early-stage tumors, the TGF-β pathway induces apoptosis and inhibits tumor cell proliferation. In contrast, it has a tumor-promoting role in advanced stages by regulating genomic instability, epithelial-mesenchymal transition (EMT), neoangiogenesis, immune evasion, and cell metastasis (Figure 2). Previous research suggests that response rates to TGF-β monoclonal antibody therapy are low, which could be related to the fact that it is not a tumor promoter. As a result, one of the primary avenues of advancement in this sector has been combination therapies, which include combinations with ICIs (e.g., PD-1/PD-L1 antibodies), cytotoxic drugs, radiotherapy, cancer vaccines, and so on.

The discovery that TGF-β antibody induces potent anti-tumor immunity when combined with PD-L1 antibodies was made in a study of patients with uroepithelial carcinoma who metastasized after receiving PD-L1 antibodies (119). In this study, CD8+ T cells were found in the patients’ tumor interstitium containing fibroblasts and collagen but not in the tumor interior, TGF-β signal limits T cell infiltration. At the same time, some researchers fused TGF-β receptor II and PD-L1 antibodies into a tetravalent BsAb, M7824, and found that the bispecific antibody had better anti-tumor effects than the monotherapies in homozygous mouse models of breast and colon carcinoma. The Phase I clinical study (NCT03917381) of M7824 patients with non-small cell lung cancer (NSCLC) evaluated its efficacy and safety. The median follow-up was 51.9 weeks, with an objective remission rate (ORR) of 21.3%, partial remission (PR) of 21.3%, stable disease (SD) of 16.3%, and disease progression (PD) of 48.8% for all patients; disease control rate (DCR) of 40%; overall survival (OS) of 13.6 months; median progression-free survival (PFS) of 2.6 months; The 12-month PFS rate was 20.1%; median duration of remission (DOR) was 14.1 months. A dose of 1200 mg was determined to be the recommended dose for the Phase II study. But German Merck and collaborator Glaxo finally announced that a Phase III (INTR@PID Lung 037) interim analysis of bintrafusp alfa (M7824) showed that it could not outperform PD-1 antibody Keytruda. Bintrafusp alfa was then stopped as a single-agent second-line treatment for locally progressed or metastatic biliary tract carcinoma (BTC) in Phase II INTR@PID BTC 047 due to failure to reach the primary endpoint. Bintrafusp alfa has failed four clinical trials in a row since 2021. M7824 is also being tested in various indications, including esophageal, biliary tract, and gastric cancers. With the discovery that transforming growth factor-β (TGF-β) inhibits T helper cell (Th2)-mediated cancer immunity, researchers constructed a bispecific antibody targeting CD4 and TGF-β, 4T-Trap, which selectively inhibits TGF-β signaling by CD4+ T cells in lymph nodes (120, 121), leading to cancer cell apoptosis and vascular rearrangement. Due to TGF-β multifunctionality and the potential for major side effects from the total blockade, inhibition of TGF-β in cancer therapy has not been successful. However, 4T-Trap focuses TGF-β blocking compounds directly on CD4+ T cells to minimize adverse effects. And combining 4T-Trap with a VEGF inhibitor may help to prevent the spread of vascular-mediated malignancy.

Due to the diversity of TGF-β signaling, combinations are likely to be effective only when TGF-β is the tumor-promoting signal. The efficacy of anti-TGF-β must be carefully analyzed when TGF-β exerts tumor-suppressive effects or when the receptor for TGF-β is mutated. In addition, the combination of drugs may cause a strong immune response in patients; whether the patient can tolerate it and the deepening of side effects is also a question worthy of consideration. A deeper understanding of the communication and interactions between the various components of the tumor patient’s organism and TGF-β signaling is key to improving clinical efficacy.

6 Approaches to avoid on-target off-tumor adverse effects

A reinvigorated anti-tumor immunity can be a double-edged weapon while many programs explore alternative modes of action correlated with bispecific antibodies’ target pathways. The efficacy of genetically modified bispecific antibodies against cancer has increased greatly at the expense of improved toxicities in normal tissues and systemic cytokine release immune responses (122, 123). Strategies of conditionally activating T cells within tumors and modifying target affinities to mitigate or conquer the “on-target off-tumor” adverse effect of bispecific antibodies have been taken into consideration and investigation (52, 124–126).

To avoid T cell autoreactivity to normal target-expressing tissues while there is generally lacking tumor-specific targets in solid tumors, Slaga, D., and colleagues have designed and exploited a T cell-dependent bispecific (TDB) antibody with a bivalent low-affinity HER2 recognition binding domain which can selectively target HER2-overexpressing tumor cells from normal human tissues with low amounts of HER2 expressing (52). Besides, antibody binding affinity is a major factor for overall tolerability, while the higher affinity for CD3 is related to rapidly increasing peripheral cytokine concentrations. While having no impact on anti-tumor effectiveness, anti-HER2/CD3 TDBs with lower CD3 binding affinity is better tolerated in vivo. Higher HER2 affinity aids in tumor-killing action but also causes more severe toxicity, including cytokine release syndrome, in HER2-expressing tissues. a dose-fractionation technique, which offers an application strategy for the affinities-modulated antibodies, has been used to address such a problem (124).

Disorganized tumor tissue growth and rapid cell division contribute to complicated extracellular features of the TME, such as a hypoxia environment with low pH, increased extracellular matrix remodeling, and upregulated proteolysis, which has contributed to the exploration of conditionally activating T cells in the TME based on the preferentially binding of BsAbs at hypoxic extracellular conditions as well as local liberation of the BsAbs antigen-binding sites released by tumor-associated proteases (126–135). Preclinical research has shown that T cell recruiting BsAbs (TCBs) conditionally activated by intratumorally proteolytic cleavage can prolong therapeutic windows, successfully avoid dose-limiting toxicities, and significantly prolong tumor regression (131–133). Furthermore, Geiger, M. and colleagues have generated a protease cleavable activated anti-folate receptor 1 TCB (Prot-FOLR1-TCB) via masking the anti-CD3 binding domain with an anti-idiotypic anti-CD3 scFv N-terminally connected to the anti-CD3 variable heavy chain through a protease cleavable linker, which has shown validly releasing of the anti-CD3 binding moiety in active proteases enriched tumor microenvironment, thus effectively reducing potential on-target toxicity through sparing normal tissues with low degrees FOLR1 expression while mediating efficient anti-tumor ability in FOLR1-positive tumor tissue (126). Besides, binding sites of the BsAb assembling intratumorally from two half-molecules is an ideal approach to further increasing tumor selectivity (125, 136).

7 Conclusion and prospect

As a result of the FDA’s approval of Blinatumomab for the treatment of recurrent ALL and the ongoing need for BsAbs, novel formats aimed at enhancing therapeutic efficacy and safety have been developing for the treatment of solid tumors as well as hematologic malignancies. BsAbs have gained momentum over the past decade. Despite promising progress in the clinical application field of bispecific immunomodulatory antibodies in part of human tumor types, more prominent anti-tumor efficacy in most solid tumors still needs constant exploration. Furthermore, dozens of BsAbs with different targets combinations have exhibited potent anti-tumor effect in preclinical studies, but most of the positive preclinical outcomes could not be further validated in the clinic. With increasingly diverse BsAbs entering preclinical and clinical trials, various challenges have emerged hampering the development of BsAbs. The development of BsAbs is dimensionally more difficult than that of a monoclonal antibody. Selecting the optimal targets combination is only the first step, followed by the right choosing of a rational format and designing the molecule according to the targets as well as the biology of the diseases. Besides, inappropriate clinical design and administration regimens will expose patients into significantly higher toxicities, which can be avoided via optimization of treatment strategies, dosage, timing, and sequence to some extent. We anticipate that more comprehensive exploration in the field of bispecific immunomodulatory antibodies will broaden the prospect of cancer immunotherapy.

Author contributions

All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.

Funding

This work was supported by 1.3.5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (Grant No. ZYJC21043), the National Natural Science Foundation of China (31971390), and Sichuan Science and Technology Program (2021YFH0142).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of insterest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

RAbD is a new biotechnology company founded by Fox  Chase Cancer Center investigators Gregory Adams, Ph.D., Matthew Robinson, Ph.D. and Roland Dunbrack, Ph.D. that is focused on the knowledge-based design of antibodies that bind to key functional, often highly conserved and difficult to target epitopes. We are using homology modeling, crystal structures, protein docking and design software and algorithms to drive combinatorial sampling of CDRs to computationally design new antibodies and then express, validate and perform further design in an iterative manner.Brian Smith, Ph.D., MBA is RAbD Biotech’s Business Development Lead.

Contact information for RAbD Biotech:

Website  http://rabdbiotech.com/

LinkedIn

Twitter @RAbDBiotech

The overall goal of RAbD is to

“drug the undruggable”

The company using in silico design methods to design to produce novel antibodies and biomimetics. The company is developing a first in class biomimetic, RaD-003, for the treatment of ovarian cancer.  Ovarian  cancer is one of the most deadly of all women’s cancers, with very low 5 year survival rates.  An expected 22,000 US women a year will be diagnosed and expected 16,000 will die every year.  Cisplatin/paclitaxel therapy is only approved and effective chemotherapy for ovarian cancer yet resistance develops quickly and is common. RaD-003  targets the MISII receptor (Mullerian Inhibiting Substance Type II Receptor), which is expressed on ovarian cancer cells but not on normal ovarian epithelium.

It has been shown that activation of this receptor by the Mullerian Inhibiting Substance (MIS) has antitumor activity in ovarian cancer.

The MISII receptor had been considered undruggable as

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Therefore, the company used their computational platform to produce a “first in class” chimeric biomimetic to more effectively target and activate MISIIR.

For  more information about this meeting and the Mid-Atlantic Bioangels and 1st Pitch please see posting on this site

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Hastke Inc. Presents at 1st Pitch Life Sciences-Philadelphia-September 16, 2014

Reporter: Stephen J Williams, PhD

Article ID #150: Hastke Inc. Presents at 1st Pitch Life Sciences-Philadelphia. Published on 9/17/2014

WordCloud Image Produced by Adam Tubman

 

 

Hastke Inc. presented at Mid-Atlantic BioAngels 1st Pitch Life Sciences in  Philadelphia Tuesday Sept. 16, 2014.

Hastke, Inc., a Princeton University spin-out, captures dynamic cellular events IN REAL TIME in live cells at an unprecendented level of detail in 3D using proprietary 3D microscopy in conjunction with nanotechnology-based tags and sensors. The resolution up to 10 nm in all directions and 10 us precision, orders of magnitude superior than other methods, can be achieved.  The company is using this technology to determine extent of uptake of drugs on a cellular level and to visualize drug-receptor interaction.  Their goal is to use their ability to visualize comound-cell interaction and uptake to enhance the drug screening process.

Their company is currently comprised of three team members:

Stephanie Budijono is the President and CEO of Hastke Inc. Prior to Hastke, she developed a nanoparticle platform for targeted cancer therapy and imaging. She received her PhD from Princeton University.

Haw Yang is the leading inventor of the technology. He is a Professor at Princeton University, leading a research lab developing new methods to understand molecular reactivity in complex systems.

Kevin Welsher is a co-invetor of the technology. He is a prolific scientist whose works have been consistently featured in world-leading journals. His previous experience also includes developing new materials for in-vivo fluorescent imaging. He received his PhD from Stanford University.

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1st Pitch Life Science- Philadelphia: “Eavesdropping on Investors’ Closed Door Discussions”

Reporter: Stephen J. Williams, PhD

Article ID #149: 1st Pitch Life Science- Philadelphia- What VCs Really Think of your Pitch. Published on 9/17/2014

WordCloud Image Produced by Adam Tubman

Mid Atlantic Bio Angels group (MABA), an angel investor group focused exclusively on new and emerging life science companies hosted a meeting Tuesday, September 16 2014 5:30pm – 8:30pm Other Time Presented by:

“

 

“Eavesdropping on investors‘ closed door discussions” gives entrepreneurs the inside track on what happens after a start-up company presents to investors.  Typically, after a start up company’s team leaves the room investors have a private discussion about whether the opportunity merits further investigation and possible investment.  1st Pitch Life Science-Philadelphia offers local company presenters and audience participants the chance to listen in on these closed door discussions to learn what really matters to investors.  This event offers excellent networking opportunities for investors, university technology transfer professionals, entrepreneurs, and business professionals in the Philadelphia entrepreneurial ecosystem.   It provides a supportive learning environment for entrepreneurs.

                                                                                                                                                                                                    “

For more information about Mid-Atlantic BioAngels and to make a submission for evaluation of your startup please visit their

website: http://bioangels.net/.

MABA: LinkedIn:
MABA: Twitter

 

Mid-Atlantic Bioangels was formed in 2013 to provide an unmet need in the Mid-Atlantic region for early-stage life-science entrepreneurship,  providing early life science entrepreneurs a venue to  present their companies, obtain funding and provide mentoring, feedback, networking, and information for corporate development.  A great article by  can be found here

http://tech.co/mid-atlantic-bio-angels-life-sciences-investors-2013-06

 

More information on the !st Pitch Life Sciences meetings can be found at www.1stpitchlifescienc.com.  Further information can be obtained at nfo@1stpitchlifescience.com.For sponsorship questions please email Bernie@bioangels.net.

Meeting Coverage

Three companies are to be presented

Hastke Inc is a device company with a best-in-class, real-time 3D visualization technology that can de-risk the drug development process for pharma.  In the future, their technology has the potential to become an important diagnostic tool for physicians.

LytPhage is a new biotech company using novel bioengineering to develop therapeutics to address the worldwide crisis of antibiotic resistant organisms.  They are developing a treatment for vancomycin resistant systemic infections with their platform, which can be adapted for other problematic organisms.

RAbD Biotech uses proprietary computational methods to design biologic agents capable of treating severe diseases.  RAbD’s lead product candidate is a potential first-in-class treatment for ovarian cancer, a disease characterized by late detection, few therapeutic options, and high mortality.

The meeting format includes:

  1. 15-20 minute meeting presentation
  2. group discussion/questions
  3. panel opinions (panel of experienced venture capitalists)

Notes from the meeting will be put in future postings.

Please also see Twitter handles for meeting coverage using the following hashtags and handles

 

hashtags                                                                                                   handles

             #MABA   #lifescience   #PHL   #biotech         #startup                                @BioAngelsGroup   @pharma_BI   @RAbDBiotech

              #VC  #venturecapital   # bioangels    #entrepreneur

              #angelinvestor 

 

The meeting had a live voting on Surveymonkey for each presentation using your smartphone.  The address for the voting was

www.1stpitchlifescience.com/vote

where event participants vote on each individual presentation and a “Best in Show”.

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Dompe’ Receives FDA orphan drug designation for rhNGF in the treatment of Neurotrophic Keratitis (NK).

Reporter: Stephen J Williams, PhD

 

The U.S. FDA granted Dompe’ an orphan drug designation for rhNGF (recombinant human nerve growth factor) in the treatment of Neurotrophic Keratitis (NK).

Neurotrophic Keratitis (NK) is a rare, degenerative corneal disease caused by an impairment of corneal innervation (the distribution or supply of nerves), leading to a decrease or absence of corneal sensation and dysfunction of the corneal epithelium and abnormal corneal epithelial healing. The development of persistent epithelial defects or corneal ulcers can result in vision loss.

Severe NK is consistently recognized by clinicians as a serious condition lacking a highly effective treatment option.

The epidemiology of NK has not been well-defined. The estimated prevalence of patients with moderate-to-severe NK (stage 2-3) is less than 1 person in 5,000 globally.

Clinical trials in the U.S. are expected to begin in the next few months in leading research centers.

Dompé will be present at the American Association of Ophthalmology Annual meeting (Chicago, October 18-21). Currently, the enrollment is ongoing for the company’s Phase II trial with rhNGF in the treatment of NK.
Background – Dompé and its R&D

  • Dompé is a leading Italian biopharmaceutical company (with headquarters in Milan) committed to the development of innovative treatment solutions for rare, often orphan, diseases that have a high social impact, in areas where unmet treatment needs still exist.
  • The Company focuses its R&D activities in diabetes, ophthalmology, oncology and organ transplants.
  • The R&D activities are carried out in the Dompé biotech plant located in L’Aquila (Abruzzo), which has an internationally recognized expertise in the field of rare diseases.  
  • This year (2014), Dompé opened an office in New York, staffed with scientists and R&D teams in order to carry out and coordinate the scientific activities in the U.S.

 

Dompé commitment in ophthalmology – rhNGF

  • In ophthalmology, Dompé is promoting the research and development of Nerve Growth Factor (NGF), a soluble protein that stimulates the growth, maintenance and survival of neurons, whose discovery led to Prof. Rita Levi Montalcini being awarded the Nobel Prize in 1986.
  • Recombinant human Nerve Growth Factor (rhNGF) has been studied and produced exclusively at Dompé’s production site in L’Aquila, Italy, and is undergoing an international Phase II trial, called “REPARO”, to evaluate its efficacy and safety in the treatment of Neurotrophic Keratitis, a rare orphan disease. The trial is being conducted in 39 centers and nine European countries.

The medicine recently has been designated an orphan drug for the treatment of Retinitis Pigmentosa (RP), a severe, genetic rare disease that can lead to blindness for which there is currently no treatment available. A clinical trial in the EU, involving patients with RP, started in the first quarter of 2014 with the enrolment of the first patient.

SOURCE

From: Gail Thornton <gailsthornton@yahoo.com>
Reply-To: Gail Thornton <gailsthornton@yahoo.com>
Date: Wed, 23 Jul 2014 07:02:05 -0700
To: Aviva Lev-Ari <avivalev-ari@alum.berkeley.edu>
Subject: Dompe’ Receives FDA orphan drug designation for rhNGF

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