抗体药物开启生物医药发展新时代

<正>治疗性抗体药物在生物医药中的研究发展是最快的。自1986年美国FDA批准第一个治疗性抗体上市以来,抗体药物的研发得到快速发展。迄今已有35个抗体药物批准上市,目前处在临床研究的抗体药物350多个,处在Ⅲ期临床研究的抗体药物约有30个,用于癌症、炎症或免疫疾病、高胆固醇、骨质     

抗体药物现状及发展趋势

治疗性抗体作为一种具有独特优势的生物靶向治疗药物,已成为目前全球药物研发的热点。截止到2013年2月,已有34个治疗性抗体获得美国FDA批准上市,用于各种疾病的治疗。据统计,目前有多达350余种抗体产品正处于临床试验阶段,其中29个已进入III期临床试验。开发抗体新靶点和新适应证,研究和设计更为安全有效的新型抗体分子及抗体组合疗法,寻找生物标记指导抗体对病人的有效治疗,是当前和今后一段时期内该领域发展的主要方向。本文将综述国际抗体药物研发现状和发展趋势,并对国内抗体药物现状及发展策略予以简要陈述。     

国内外单抗药物市场概述

单抗药物具有特异性强、不良反应小等优势,近年来在肿瘤和自身免疫性疾病治疗等领域取得了快速发展。目前全球上市抗体药物共55个,2015年销售总额达到916.3亿美元。中国当前正处在抗体药物快速发展阶段,国家食品药品监督管理局(CFDA)共批准生产抗体药物22种,其中国产产品10个,进口产品12个。2014年国内单抗药物市场规模为50.34亿元,随着生物技术的不断发展,国内单抗药物的市场前景将会越来越广泛。     

抗体生产纯化技术进展

自1997年FDA批准第一个治疗淋巴癌的嵌合单抗药物Rituxan,Anti-CD-20抗体上市,并进入56个国家,至2007年,FDA已批准了20多种治疗性单抗药物,约一半用于治疗癌症（详见附录1）,多个已成为年销售额超十亿美元的“炸弹药物”（Blockbuster Drug,图1）。全球抗体药物的市场增长十分迅猛,有约200多种单抗在临床实验,占整个临床生物技术药品总数的三分之一多,     

抗体药物bevacizumab和受体酪氨酸激酶抑制剂陆续问世

新的抗体药物和受体激酶抑制剂相继问世，新药开发领域百花齐放。 除代谢拮抗药和疫苗之外，作用于新靶点的化合物相继上市。 具血管新生抑制作用的抗体药物bevacizumab市场销售势头强劲。     

国际重组蛋白药物市场和研发趋势的分析

从1982年美国批准第一个重组蛋白药物（重组人胰岛素Humulin）上市至今,已过去了四分之一世纪。重组蛋白药物虽仅占全球处方药市场的7％～8％,但却是增长最快的一类。目前,共有82个重组蛋白药物被用于临床,其中“重磅炸弹”15个,占总数的18％。2005年重组蛋白药物销售总额约410亿美元,而其中“重磅炸弹”的销售额合计约270亿美元,占总额的66％。2006年,美国和欧洲批准了第一个肺吸入型胰岛素上市;欧洲批准了第一个由转基因羊生产的重组人抗凝血酶用于临床,并批准了第一个重组蛋白仿制药物上市。重组蛋白药物市场已经从蛹发育为美丽的蝴蝶,但是,这只蝴蝶能够美丽多久,还受到多种因素的制约。本文以美国和欧洲重组蛋白药物市场为主,采用市场细分的方法,从重组蛋白药物种类的销售额入手,分析了市场及研发趋势,将对我们判断市场走向、提供创新思维和制定创新战略有实际的参考价值。     

治疗性单抗与抗体产业关键技术

抗体技术历经动物血清多克隆抗体、杂交瘤单克隆抗体,以及重组基因工程抗体等不同发展时期,尤其是后者使得治疗性抗体的生产进入产业化阶段.在已上市的抗体药物中,人源化抗体、全人源抗体由于免疫原性小,临床药效好,目前已经成为抗体药物的主流.随着抗体药物在癌症、免疫调节等治疗领域的广泛应用.抗体产业已经成为国际制药行业的主要组成部分.我国的抗体产业由于品种不足、技术落后,尚处于起步阶段,其行业发展受限于诸多技术瓶颈,如:工程细胞系构建与筛选、大规模培养工艺开发,单抗的纯化与质控等,上述产业化关键技术的突破可加快我国抗体产业的发展进程.     

重组完整抗体研究进展

重组分子抗体是一类潜在的治疗用药物,约占目前进入临床试验的生物制品类药物的三分之一,FDA批准上市的抗体药物有近十种,其中多数为重组的完整人源抗体（包括人鼠嵌合抗体和人源化抗体）,本对基因工程完整抗体的有关实验研究进行了综述。     

生物制药的现状和未来（二）：发展趋势与希望

随着基因组和蛋白质组研究的深入,越来越多的与人类疾病发展相关的靶标被确定,使得我们能够研发更精确的药物来防治这些疾病。这意味着生物制药将有更多机会获得突破性进展,最终将使更多更好的生物技术药物被批准上市。综述了生物制药发展的几个趋势,主要有:(1)哺乳动物细胞表达的产品将在相当长的时间内占统治地位;(2)治疗性抗体将会是生物制药领域第二次创新高潮;(3)越来越多分子量大、结构复杂的功能蛋白将被开发成生物技术药物,尤其是用于治疗遗传性疾病的药物;(4)对已批准上市的生物技术药物的化学修饰尤其是PEG化以改善药物性能;(5)通过某些药物的定点突变获得第二代新生物技术药物,如胰岛素、EPO和t-PA的突变体;(6)组织工程、细胞治疗和基因治疗充满了机遇和挑战。     

2014年全球新药研发报告——第二部分：趋势和挑战（Ⅳ）

2014 年制药和生物技术行业继续保持着高活力。截至2014 年12 月23 日,全球共有55 个新的化学药物和生物制品首次进入市场, 另有29 个重要的延伸性新药获批,还有19 个药物首次获批,但尚未来得及上市。此外,在传统的年底冲刺期间,一些国家的监管机构在 年底最后一刻还批准了其他一些药物,因此,这些获批药物未能被收录在内,所以2014 年实际获批的新药数量应该大于前面提到的数字。 除了新药的成功开发、注册和上市外,还有其他一些可反映整个行业现状和发展趋势的风向标,例如,监管机构采取新措施以刺激难治性 疾病药物的开发、制药公司定期并务实地对其研发项目进行甄选以及通过并购整合研发管线、投资项目和销售队伍。     

Therapeutic advances in the management of Huntington's disease

Trinucleotide repeat disorders are a set of genetic disorders characterized by the expansion of certain genes of a segment of DNA that contains a repeat of three nucleotides, thus exceeding the normal stable threshold. These repeats in the DNA cause repeats of a specific amino acid in the protein sequence, and it is the repeated amino acid that results in a defective protein. Huntington's disease is a well-known genetic disorder associated with trinucleotide repeat expansions. Patients first present clinically in midlife and manifest a typical phenotype of sporadic, rapid, and involuntary control of limb movement; stiffness of limbs; impaired cognition; severe psychiatric disturbances; and ultimately, death. There have been a number of therapeutic advances in the treatment of Huntington's disease, such as foetal neural transplantation, RNA interference, and transglutaminase inhibitor. Although there is intensive research into Huntington's disease and recent findings seem promising, effective therapeutic strategies may not be developed until the next few decades.     

外泌体介导的靶向基因运送及在心血管疾病中的应用

外泌体是体内几乎所有细胞分泌的具有双层脂质膜结构的纳米级小囊泡。外泌体大小均匀,平均直径为40～120 nm,存在于所有体液中。外泌体曾一度被认为是细胞成熟过程中清除废弃细胞器的‘垃圾袋’。但近年研究显示：外泌体含有丰富的来源于‘供体细胞’的信号分子,如蛋白质、DNA、mRNA、miRNA以及lncRNA等。当外泌体与‘受体细胞’融合时,这些信号分子便被运送到‘受体细胞’,从而实现细胞 细胞之间的通讯,影响‘受体细胞’的生理病理过程。虽然外泌体的研究目前主要集中在癌症等疾病的预防、诊断与治疗中,但是越来越多的研究显示,外泌体在心血管系统的生理及病理过程中同样发挥着重要作用。本文将对外泌体的起源、分离与纯化方法及外泌体介导的‘细胞 细胞’之间的通讯机制进行综述,并重点论述利用基因工程技术对外泌体进行靶向运输的方法及靶向外泌体运送在心血管疾病治疗中的应用。     

Cardiomyocyte overexpression of miR-27b induces cardiac hypertrophy and dysfunction in mice

Recent studies have begun to reveal critical roles of microRNAs (miRNAs) in the pathogenesis of cardiac hypertrophy and dysfunction. In this study, we tested whether a transforming growth factor-β (TGF-β)-regulated miRNA played a pivotal role in the development of cardiac hypertrophy and heart failure (HF). We observed that miR-27b was upregulated in hearts of cardiomyocyte-specific Smad4 knockout mice, which developed cardiac hypertrophy. In vitro experiments showed that the miR-27b expression could be inhibited by TGF-β1 and that its overexpression promoted hypertrophic cell growth, while the miR-27b suppression led to inhibition of the hypertrophic cell growth caused by phenylephrine (PE) treatment. Furthermore, the analysis of transgenic mice with cardiomyocyte-specific overexpression of miR-27b revealed that miR-27b overexpression was sufficient to induce cardiac hypertrophy and dysfunction. We validated the peroxisome proliferator-activated receptor-γ (PPAR-γ) as a direct target of miR-27b in cardiomyocyte. Consistently, the miR-27b transgenic mice displayed significantly lower levels of PPAR-γ than the control mice. Furthermore, in vivo silencing of miR-27b using a specific antagomir in a pressure-overload-induced mouse model of HF increased cardiac PPAR-γ expression, attenuated cardiac hypertrophy and dysfunction. The results of our study demonstrate that TGF-β1-regulated miR-27b is involved in the regulation of cardiac hypertrophy, and validate miR-27b as an efficient therapeutic target for cardiac diseases.     

硫氧还蛋白还原酶：一种新型有效的胃癌化疗疗效监测标志物

胃癌是国际上发病率较高的肿瘤,寻找新型有效的肿瘤标志物用于胃癌的诊断和疗效评估,对于胃癌的临床治疗有较大的帮助。本研究选取经临床确诊的155例胃癌患者为研究对象,探究血浆硫氧还蛋白还原酶（thioredoxin reductase, TR）在胃癌化疗后临床获益人群与未获益人群中检测水平的差异,以及其与治疗效果的关系。结果显示,未获益组TR阳性率为82.67%,显著高于获益组TR阳性率（48.94%）。受试者操作特征曲线（receiver operating characteristic curve,ROC）分析显示,未获益组人群与获益组人群的TR活性诊断阈值为8.95 U/mL,ROC曲线下面积（area under the curve,AUC）为0.8423,明显优于常规胃癌标志物癌胚抗原（carcinoembryonic antigen,CEA）,肿瘤特异性抗原（cancer antigen,CA）19-9和CA72-4。同时,TR与常规胃癌标志物的联合检测提高阳性检出率至98.49%。TR被认为是一种新型的胃癌临床化疗疗效监测标志物,与临床疗效评价具有较高的一致性。     

硫氧还蛋白还原酶：一种新型有效的胃癌化疗疗效监测标志物

胃癌是国际上发病率较高的肿瘤,寻找新型有效的肿瘤标志物用于胃癌的诊断和疗效评估,对于胃癌的临床治疗有较大的帮助。本研究选取经临床确诊的155例胃癌患者为研究对象,探究血浆硫氧还蛋白还原酶（thioredoxin reductase, TR）在胃癌化疗后临床获益人群与未获益人群中检测水平的差异,以及其与治疗效果的关系。结果显示,未获益组TR阳性率为82.67%,显著高于获益组TR阳性率（48.94%）。受试者操作特征曲线（receiver operating characteristic curve,ROC）分析显示,未获益组人群与获益组人群的TR活性诊断阈值为8.95 U/mL,ROC曲线下面积（area under the curve,AUC）为0.8423,明显优于常规胃癌标志物癌胚抗原（carcinoembryonic antigen,CEA）,肿瘤特异性抗原（cancer antigen,CA）19-9和CA72-4。同时,TR与常规胃癌标志物的联合检测提高阳性检出率至98.49%。TR被认为是一种新型的胃癌临床化疗疗效监测标志物,与临床疗效评价具有较高的一致性。     

In Vitro and in Vivo Effects of Nitrofurantoin on Experimental Toxoplasmosis

Toxoplasma gondii is an important opportunistic pathogen that causes toxoplasmosis, which has very few therapeutic treatment options. The most effective therapy is a combination of pyrimethamine and sulfadiazine; however, their utility is limited because of drug toxicity and serious side effects. For these reasons, new drugs with lower toxicity are urgently needed. In this study, the compound, (Z)-1-[(5-nitrofuran-2-yl)methyleneamino]-imidazolidine-2,4-dione (nitrofurantoin), showed anti-T. gondii effects in vitro and in vivo. In HeLa cells, the selectivity of nitrofurantoin was 2.3, which was greater than that of pyrimethamine (0.9). In T. gondii-infected female ICR mice, the inhibition rate of T. gondii growth in the peritoneal cavity was 44.7% compared to the negative control group after 4-day treatment with 100 mg/kg of nitrofurantoin. In addition, hematology indicators showed that T. gondii infection-induced serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, biochemical parameters involved in liver injury, were reduced by nitrofurantoin significantly. Moreover, nitrofurantoin exerted significant effects on the index of antioxidant status, i.e., malondialdehyde (MDA) and glutathione (GSH). The nitrofurantoin-treated group inhibited the T. gondii-induced MDA levels while alleviating the decrease in GSH levels. Thus, nitrofurantoin is a potential anti-T. gondii candidate for clinical application.     

Antibody-mediated phagocytosis contributes to the anti-tumor activity of the therapeutic antibody daratumumab in lymphoma and multiple myeloma

Daratumumab (DARA) is a human CD38-specific IgG1 antibody that is in clinical development for the treatment of multiple myeloma (MM). The potential for IgG1 antibodies to induce macrophage-mediated phagocytosis, in combination with the known presence of macrophages in the tumor microenvironment in MM and other hematological tumors, led us to investigate the contribution of antibody-dependent, macrophage-mediated phagocytosis to DARA''s mechanism of action. Live cell imaging revealed that DARA efficiently induced macrophage-mediated phagocytosis, in which individual macrophages rapidly and sequentially engulfed multiple tumor cells. DARA-dependent phagocytosis by mouse and human macrophages was also observed in an in vitro flow cytometry assay, using a range of MM and Burkitt''s lymphoma cell lines. Phagocytosis contributed to DARA''s anti-tumor activity in vivo, in both a subcutaneous and an intravenous leukemic xenograft mouse model. Finally, DARA was shown to induce macrophage-mediated phagocytosis of MM cells isolated from 11 of 12 MM patients that showed variable levels of CD38 expression. In summary, we demonstrate that phagocytosis is a fast, potent and clinically relevant mechanism of action that may contribute to the therapeutic activity of DARA in multiple myeloma and potentially other hematological tumors.     

Peptide‐based therapeutic cancer vaccine: Current trends in clinical application

The peptide‐based therapeutic cancer vaccines have attracted enormous attention in recent years as one of the effective treatments of tumour immunotherapy. Most of peptide‐based vaccines are based on epitope peptides stimulating CD8⁺ T cells or CD4⁺ T helper cells to target tumour‐associated antigens (TAAs) or tumour‐specific antigens (TSAs). Some adjuvants and nanomaterials have been exploited to optimize the efficiency of immune response of the epitope peptide to improve its clinical application. At present, numerous peptide‐based therapeutic cancer vaccines have been developed and achieved significant clinical benefits. Similarly, the combination of peptide‐based vaccines and other therapies has demonstrated a superior efficacy in improving anti‐cancer activity. We delve deeper into the choices of targets, design and screening of epitope peptides, clinical efficacy and adverse events of peptide‐based vaccines, and strategies combination of peptide‐based therapeutic cancer vaccines and other therapies. The review will provide a detailed overview and basis for future clinical application of peptide‐based therapeutic cancer vaccines.     

The molecular mode of action and species specificity of canakinumab,a human monoclonal antibody neutralizing IL-1β

Interleukin-1β (IL-1β) plays a key role in autoinflammatory diseases, such as systemic juvenile idiopathic arthritis (sJIA) or cryopyrin-associated periodic syndrome (CAPS). Canakinumab, a human monoclonal anti-IL-1β antibody, was recently approved for human use under the brand name Ilaris®. Canakinumab does not cross-react with IL-1β from mouse, rat, rabbit, or macaques. The crystal structure of the canakinumab Fab bound to human IL-1β was determined in an attempt to rationalize the species specificity. The X-ray analysis reveals a complex surface epitope with an intricate network of well-ordered water molecules at the antibody-antigen interface. The canakinumab paratope is largely pre-organized, as demonstrated by the structure determination of the free Fab. Glu 64 of human IL-1β is a pivotal epitope residue explaining the exquisite species specificity of canakinumab. We identified marmoset as the only non-human primate species that carries Glu 64 in its IL-1β and demonstrates full cross-reactivity of canakinumab, thereby enabling toxicological studies in this species. As demonstrated by the X-ray structure of the complex with IL-1β, canakinumab binds IL-1β on the opposite side with respect to the IL-1RAcP binding site, and in an approximately orthogonal orientation with respect to IL-1RI. However, the antibody and IL-1RI binding sites slightly overlap and the V_H region of canakinumab would sterically interfere with the D1 domain of IL-1RI, as shown by a structural overlay with the IL-1β:IL-1RI complex. Therefore, direct competition with IL-1RI for IL-1β binding is the molecular mechanism of neutralization by canakinumab, which is also confirmed by competition assays with recombinant IL-1RI and IL-1RII.     

Gene therapy in rheumatoid arthritis: Strategies to select therapeutic genes

Significant advances have been achieved in recent years to ameliorate rheumatoid arthritis (RA) in animal models using gene therapy approaches rather than biological treatments. Although biological agents serve as antirheumatic drugs with suppressing proinflammatory cytokine activities, they are usually accompanied by systemic immune suppression resulting from continuous or high systemic dose injections of biological agents. Therefore, gene transfer approaches have opened an interesting perspective to deliver one or multiple genes in a target-specific or inducible manner for the sustained intra-articular expression of therapeutic products. Accordingly, many studies have focused on gene transferring methods in animal models by using one of the available approaches. In this study, the important strategies used to select effective genes for RA gene therapy have been outlined. Given the work done in this field, the future looks bright for gene therapy as a new method in the clinical treatment of autoimmune diseases such as RA, and by ongoing efforts in this field, we hope to achieve feasible, safe, and effective treatment methods.