Pharmacokinetics and Bioavailability of a Therapeutic Enzyme (Idursulfase) in Cynomolgus Monkeys after Intrathecal and Intravenous Administration

Intravenous enzyme replacement therapy with iduronate-2-sulfatase is an approved treatment for Hunter syndrome, however, conventional intravenous delivery cannot treat the neurologic manifestations of the disease due to its limited central nervous system penetration. Intrathecal administration of iduronate-2-sulfatase for delivery to the central nervous system is currently under investigation. The objective of this study was to evaluate the pharmacokinetics of idursulfase in the central nervous system of cynomolgus monkeys (Macaca fasicularis) after intravenous and intrathecal administration. Twenty-seven monkeys, treatment-naïve to enzyme replacement therapy, were placed into 4 groups according to body weight: Group 1 was administered 0.5 mg/kg idursulfase intravenously, Groups 2–4 were administered an intrathecal formulation (1-, 10-, and 30-mg doses). Blood samples and cerebrospinal fluid (sampled at the cisterna magna or lumbar level) were collected at the same time points for 72 hours post dosing. Following intravenous administration, a high maximum serum concentration and rapid distribution of iduronate-2-sulfatase out of the central compartment were observed (elimination half-life: 4.3 hours). Iduronate-2-sulfatase exposure in the cerebrospinal fluid was limited, suggesting intravenous administration provided minimal penetration of the blood–brain barrier. Following intrathecal administration, a high maximum observed concentration was immediately noted and elimination half-life ranged between 7.8–10 hours and 5.9–6.7 hours (cisterna magna and lumbar sampling, respectively). Cerebrospinal fluid pharmacokinetic profiles at different doses of iduronate-2-sulfatase were similar and the dose/exposure relationship was proportional. After intrathecal administration, movement of iduronate-2-sulfatase from cerebrospinal fluid to serum was observed (systemic bioavailability was 40–83%). The clear penetration of iduronate-2-sulfatase into the cerebrospinal fluid and the dose response suggest that intrathecal delivery of iduronate-2-sulfatase may be suitable for treating the central nervous system manifestations associated with Hunter syndrome.     

食蟹猴经股静脉导管长期给药方法的建立

目的建立一种可靠的食蟹猴经股静脉导管长期给药的方法.方法选取20只雄性食蟹猴,麻醉后经股静脉造口,插入静脉导管,将植入式通道与导管连接并将其埋植于背部皮下,通过与植入式通道相连的输液泵进行给药.分别于术前1周、术后1周及术后2周测定血常规、血凝、生化等值.结果全部动物都能完成为期3个月的给药,手术感染率、导管堵塞率较低,分别为10%和5%.术后两周89.5%的生理指标与术前相比,差异无统计学意义(P>0.05).结论该实验采用的食蟹猴经股静脉插管并通过输液泵进行长期给药是一种安全、有效的方法,可广泛用于药理学及毒理学实验.     

帕妥珠单抗生物类似药SMMU-27 静脉注射对食蟹猴的重复给药毒性探索研究

目的:观察帕妥珠单抗生物类似药SMMU-27四周静脉注射对食蟹猴的安全性。方法:20只健康食蟹猴按体重随机分为阳性对照组、SMMU-27低、中、高剂量组和辅料对照组,每组4只,雌雄各半。低、中、高剂量组剂量分别为15、150和450 mg/kg,阳性对照组给予150 mg/kg帕妥珠单抗(Pertuzumab),辅料对照组给予空白溶剂(0 mg/kg)。各组动物按相应体重慢速静脉注射给药,给药体积为15 m L/kg,给药速度约5 m L/min。每周给药1次,共给药4周,恢复期4周,期间进行各项毒理学指标检测。结果:一般症状结果显示给药期间与给药后,低、中、高剂量组和阳性对照组陆续有动物出现腹泻症状。高剂量组1只动物在d40时濒死剖解,其最早出现稀便,停药后腹泻状态也未见好转,生化指标显示在d28时碱性磷酸酶(Alkaline Phosphatase,ALP)升高,在d14和d40时尿素(Blood Urea,BU)升高,总蛋白(Total Protein,TP)、白蛋白(Albumin,ALB)降低。低、高剂量组和阳性对照组均有部分动物白细胞(White Blood Cell,WBC)给药后数值降低,各给药组在d14时及高剂量组和阳性对照组在d28时BU升高或有升高的趋势,恢复期时有恢复趋势。高剂量濒死动物骨髓检查发现核红细胞较多,各阶段粒细胞减少,出现较多裸核;病理检查发现肾脏可见散在多发的中度肾小管扩张,近曲小管上皮轻度变性。其余指标包括一般症状、体重、尿液、心电图、免疫学指标等未见明显与供试品相关的异常变化。结论:SMMU-27主要毒性靶部位是胃肠道(腹泻)、肾脏(血清BU升高)和血液系统(WBC下降),应与这些部位表达供试品结合的相关受体有关,属供试品的药理作用放大和延伸。因此本实验条件下食蟹猴的安全剂量(NOAEL)为150 mg/kg,致死剂量为450 mg/kg。SMMU-27与等剂量阳性对照药物毒性反应基本类似。     

Interleukin-21 Enhances Rituximab Activity in a Cynomolgus Monkey Model of B Cell Depletion and in Mouse B Cell Lymphoma Models

Rituximab, a monoclonal antibody targeting CD20 on B cells, is currently used to treat many subtypes of B cell lymphomas. However, treatment is not curative and response rates are variable. Recombinant interleukin-21 (rIL-21) is a cytokine that enhances immune effector function and affects both primary and transformed B cell differentiation. We hypothesized that the combination of rIL-21 plus rituximab would be a more efficacious treatment for B cell malignancies than rituximab alone. We cultured human and cynomolgus monkey NK cells with rIL-21 and found that their activity was increased and proteins associated with antibody dependent cytotoxicity were up-regulated. Studies in cynomolgus monkeys modeled the effects of rIL-21 on rituximab activity against CD20 B cells. In these studies, rIL-21 activated innate immune effectors, increased ADCC and mobilized B cells into peripheral blood. When rIL-21 was combined with rituximab, deeper and more durable B cell depletion was observed. In another series of experiments, IL-21 was shown to have direct antiproliferative activity against a subset of human lymphoma cell lines, and combination of murine IL-21 with rituximab yielded significant survival benefits over either agent alone in xenogeneic mouse tumor models of disseminated lymphoma. Therefore, our results do suggest that the therapeutic efficacy of rituximab may be improved when used in combination with rIL-21.     

Pharmacokinetics and Pharmacodynamic Effects of Flunixin after Intravenous,Intramuscular and Oral Administration to Dairy Goats

The pharmacokinetics and the prostaglandin (PG) synthesis inhibiting effect of flunixin were determined in 6 Norwegian dairy goats. The dose was 2.2 mg/kg body weight administered by intravenous (i.v.), intramuscular (i.m.) and oral (p.o.) routes using a cross-over design. Plasma flunixin content was analysed by use of liquid chromatography and the PG synthesis was evaluated by measuring plasma 15-ketodihydro-PGF_2α by a radioimmuno-assay. Results are presented as median (range). The elimination half-lives (t_1/2·λ) were 3.6 (2.0–5.0), 3.4 (2.6–6.8) and 4.3 (3.4–6.1) h for i.v., i.m. and p.o. administration, respectively. Volume of distribution at steady state (Vd_ss) was 0.35 (0.23–0.41) L/kg and clearance (CL), 110 (60–160) mL/h/kg. The plasma concentrations after oral administration showed a double-peak phenomenon with the two peaks occurring at 0.37 (0.25–1) and 3.5 (2.5–5.0) h, respectively. Both peaks were in the same order of magnitude. Bioavailability was 79 (53–112) and 58 (35%–120)% for i.m. and p.o. administration, respectively. 15-Ketodihydro-PGF_2α plasma concentrations decreased after flunixin administration independent of the route of administration.     

运输应激对食蟹猴血清生化指标、丙二醛及总抗氧化能力的影响

目的 研究食蟹猴在长途运输后血浆皮质醇、血清生化指标、丙二醛(MDA)及总抗氧化能力(TAOC)变化情况.方法 对雄性食蟹猴在运输前后不同时间采血,进行血清生化指标、血清MDA及TAOC测定.结果 运输后ALT、AST及LDH显著升高(P<0.05),BUN、CREA、TP及ALB显著下降(P<0.05);ALP、GLU及TBIL升高,TCHO及CK下降,但差异均不显著.除CK与LDH外,其余指标均在第29天时恢复正常.运输后血清MDA逐渐升高(P<0.01),第2天达到峰值,第29天趋于稳定;TAOC逐渐降低,第2天降至最低(P<0.05),第29天趋于稳定.结论 运输不仅可引起多个血清生化指标发生变化,还可以使食蟹猴处于氧化应激状态中;运输后至少应该有29天的适应饲养期,以保证血清生化指标恢复到正常水平及机体氧化与抗氧化状态恢复平衡.     

Rituximab infusion promotes rapid complement depletion and acute CD20 loss in chronic lymphocytic leukemia

Complement plays an important role in the immunotherapeutic action of the anti-CD20 mAb rituximab, and therefore we investigated whether complement might be the limiting factor in rituximab therapy. Our in vitro studies indicate that at high cell densities, binding of rituximab to human CD20(+) cells leads to loss of complement activity and consumption of component C2. Infusion of rituximab in chronic lymphocytic leukemia patients also depletes complement; sera of treated patients have reduced capacity to C3b opsonize and kill CD20(+) cells unless supplemented with normal serum or component C2. Initiation of rituximab infusion in chronic lymphocytic leukemia patients leads to rapid clearance of CD20(+) cells. However, substantial numbers of B cells, with significantly reduced levels of CD20, return to the bloodstream immediately after rituximab infusion. In addition, a mAb specific for the Fc region of rituximab does not bind to these recirculating cells, suggesting that the rituximab-opsonized cells were temporarily sequestered by the mononuclear phagocytic system, and then released back into the circulation after the rituximab-CD20 complexes were removed by phagocytic cells. Western blots provide additional evidence for this escape mechanism that appears to occur as a consequence of CD20 loss. Treatment paradigms to prevent this escape, such as use of engineered or alternative anti-CD20 mAbs, may allow for more effective immunotherapy of chronic lymphocytic leukemia.     

Intracoronary versus Intravenous Administration of Abciximab in Patients with Acute Coronary Syndrome: A Meta-Analysis

Background

Abciximab is a widely used adjunctive therapy for acute coronary syndrome (ACS). However, the effect of intracoronary (IC) administration of abciximab on cardiovascular events remains unclear when compared with intravenous (IV) therapy.

Methodology and Principal Findings

We systematically searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases and reference lists of articles and proceedings of major meetings for obtaining relevant literature. All eligible trials included ACS patients who received either IC administration of abciximab or IV therapy. The primary outcome was major cardiovascular events, and secondary outcomes included total mortality, reinfarction, and any possible adverse events. Of 660 identified studies, we included 9 trials reporting data on 3916 ACS patients. Overall, IC administration of abciximab resulted in 45% reduction in relative risk for major cardiovascular events (RR; 95% confidence interval [CI], 24−60%), 41% reduction in RR for reinfarction (95% CI, 7−63%), and 44% reduction in RR for congestive heart failure relative to IV therapy (95% CI, 8−66%); however, compared to IV therapy, IC administration of abciximab had no effect on total mortality (RR, 0.69; 95% CI, 0.45−1.07). No other significant differences were identified between the effect of IC abciximab administration and IV therapy.

Conclusions/Significance

IC administration of abciximab can reduce the risk of major cardiovascular events, reinfarction, and congestive heart failure when compared with IV therapy.     

美罗华对CD20 阳性NHL患者血清LDH、beta2- 微球蛋白及预后的影响*

目的：分析美罗华对CD20 阳性非霍奇金淋巴瘤(NHL)患者血清乳酸脱氢酶（LDH）、beta2- 微球蛋白（beta2-MG）水平及预后的影 响。方法：对2004 年1 月-2011 年6 月在我院收治的86 例NHL患者,分别采用CHOP（对照组,n=48）与RCHOP（治疗组,n=48）2 种不同的方案进行化疗,每21 天为一个周期,共6 个周期。比较两组临床疗效、不良反应、LDH和beta2-MG 水平变化及预后。结果： 治疗组的ORR 和DCR 分别为77.1 %和89.6 %,均显著高于对照组56.3 %和72.9 %（P<0.05）;化疗后,两组血清LDH、beta2-MG 均 较化疗前明显下降,而治疗组化疗后血清LDH、beta2-MG 均显著低于对照组(P<0.05);治疗组白细胞减少、恶心呕吐的并发症高于 对照组(P<0.05);化疗后1、2 年生存率两组之间均无显著性差异（P>0.05）,而治疗组化疗后3 年生存率明显升高(P<0.05)。结论：美 罗华联合CHOP方案治疗CD20 阳性NHL患者疗效明显,且耐受性好,可有效调节血清LDH、茁2-MG 水平,提高缓解率,改善患 者预后。     

Effects of Methamphetamine on Cortisone Concentration, NK Cell Activity and Mitogen Response of T-lymphocytes in Female Cynomolgus Monkeys.

As a model for studying methamphetamine (MAP) abuse, which has become a social problem in Japan, we investigated the changes in serum cortisone, NK cell activity and mitogenic response of T-lymphocytes after a single injection of MAP (3.0 mg/kg) in female cynomolgus monkeys. Serum cortisol concentration was significantly elevated to 2.66 times pre-injection levels at 6 h post-injection, and the effect was still observed 24 h later. NK cell activity was significantly elevated at 6 h after MAP injection, but at 24 h after injection had dropped markedly to 49.5% of baseline. Mitogen (PHA) response of lymphocytes was elevated when MAP was injected, and this increased level continued up to 24 h. We speculate that the transient increase in NK cell activity followed by a distinct drop, as well as the changes in T-lymphocytes, may be strongly related to the cortisone concentration.     

人工饲养恒河猴、食蟹猴的繁殖性能初报

目的探索北京地区人工饲养恒河猴与食蟹猴的繁殖性能,为温带地区猕猴的人工饲养和繁殖方式提供借鉴。方法对军事医学科学院实验动物中心饲养的317只恒河猴繁殖群（30只雄猴,287只雌猴）和78只食蟹猴繁殖群（8只雄猴,70只雌猴）近两年的繁殖性状进行观察和统计分析。结果恒河猴母猴妊娠率、繁殖率和成活率分别为60.73%、54.45%和96.89%。食蟹猴母猴妊娠率、繁殖率和成活率分别为79.86%、56.12%和75.00%。结论食蟹猴和恒河猴可以成功的在温带地区饲养和繁殖,但人工饲养食蟹猴的妊娠率与产仔率较恒河猴高,而仔猴成活率则低于恒河猴。     

Detection and Quantification of Male-Specific Fetal DNA in the Serum of Pregnant Cynomolgus Monkeys (Macaca fascicularis)

Because of their developmental similarities to humans, nonhuman primates are often used as a model to study fetal development for potential clinical applications in humans. The detection of fetal DNA in maternal plasma or serum offers a source of fetal genetic material for prenatal diagnosis. However, no such data have been reported for cynomolgus monkeys (Macaca fascicularis), an important model in biomedical research. We have developed a specific, highly sensitive PCR system for detecting and quantifying male-specific fetal DNA in pregnant cynomolgus monkeys. We used multiplex quantitative real-time PCR to analyze cell-free DNA in maternal blood serum obtained from 46 pregnant monkeys at gestational weeks 5, 12, and 22. The presence of SRY gene and DYS14 Y chromosomal sequences was determined in 28 monkeys with male-bearing pregnancies. According to confirmation of fetal sex at birth, the probe and primers for detecting the Y chromosomal regions at each time point revealed 100% specificity of the PCR test and no false-positive or false-negative results. Increased levels of the SRY-specific sequences (mean, 4706 copies/mL serum DNA; range, 1731 to 12,625) and DYS14-specific sequences (mean, 54,814 copies/mL serum DNA; range, 4175–131,250 copies) were detected at week 22. The SRY- and DYS14-specific probes appear to be an effective combination of markers in a multiplex PCR system. To our knowledge, this report is the first to describe the detection of cell-free DNA in cynomolgus monkeys.Abbreviations: C_t, threshold cycleAnalysis of cell-free circulating nucleic acids in human maternal plasma or serum has led to the development of risk-free methods for prenatal genetic diagnosis and the assessment of several fetal and maternal conditions, for example, sex determination for paternally inherited diseases, pregnancy-associated complications, sex-linked disorders for ambiguous genitalia, and embryo tracking.^{1,4,12,14,18,19} Technical challenges associated with detecting fetal DNA arise due to the low concentration of fetal DNA in maternal plasma during pregnancy and the difficulty of differentiating the genetic material of the fetus from that of the mother.^5,13,20 Fetal sex determination using sequences derived from the Y chromosome only is relatively simple and has a reported accuracy rate in humans of approximately 99.0% at 7 wk of gestation and 100% after 20 wk, depending on the protocol and methods used.^3,5,17,20 In other species, researchers have used real-time PCR assays during pregnancy to predict fetal sex from cell-free DNA at an accuracy of 100%.^9,10,11 Cell-free fetal DNA in the maternal circulation represents only 3% to 6% of the total free DNA obtained from plasma throughout pregnancy; however, this percentage is variable between pregnancies.^5,13,20In clinical biomedical research, it is essential to develop animal models for human diseases to reveal their mechanisms.^16,22 Continued progress in surgical intervention and molecular medicine suggests that it may soon be possible to develop potential treatments or even cures for several fetal genetic diseases at an early stage of pregnancy.¹⁵ Fetal developmental research during early pregnancy might be facilitated by using cell-free fetal DNA in the maternal blood rather than other methods, such as serum screening and ultrasonography. Nonhuman primates, especially macaques, are useful model animals for studying fetal development because of the similarity of the reproductive characteristics, placental structure, and developmental events between these animals and humans.^9,10 These developmental similarities highlight the importance of the study of cell-free fetal DNA in nonhuman primates and its usefulness as a marker to obtain genetic information about the fetus.In the current study, we investigated the presence of cell-free fetal DNA in the maternal plasma of cynomolgus monkeys by developing and using a standardized PCR system. To this end, we selected the SRY (sex-determining region Y) gene and DYS14 sequences of the cynomolgus monkey to use as sex-associated markers. The Y chromosome-specific sequences in the single-copy sex determination region of SRY and the multicopy (thus yielding increased sensitivity) sequences of DYS14 in the TSPY (testis-specific protein, Y-linked) gene have had wide clinical use in humans as molecular markers for detecting and quantifying cell-free fetal DNA.^3,7 In addition, TSPY has been used in bovines for detecting cell-free fetal DNA² and in rhesus macaques for long-term evaluation of microchimerism.⁸ Given the reports of fetal sex determination in rhesus macaques^9,10 and sheep¹¹ by analyzing Y chromosome-specific sequences from cell-free DNA, we hypothesized that we could predict the fetal sex of cynomolgus monkeys at different stages of gestation. This information has been extremely useful in optimizing the design of experimental studies in biomedical research and in managing a nonhuman primate breeding colony.¹⁰ Because cynomolgus and rhesus macaques are closely related members of the same genus, the current experiments are similar to a previous study.⁹We developed an efficient 2-color multiplex PCR system to detect and quantify fetal DNA in the maternal serum of cynomolgus monkeys during pregnancy. We used 2 loci on the Y chromosome in a single PCR test to minimize the likelihood of false-positive signals. Here we report the results of detection and analysis of fetal DNA at various weeks of gestation and evaluate our PCR system for its ability to determine fetal sex from pregnant monkeys’ cell-free DNA.     

T Cell Detection of a B-Cell Tropic Virus Infection: Newly-Synthesised versus Mature Viral Proteins as Antigen Sources for CD4 and CD8 Epitope Display

Viruses that naturally infect cells expressing both MHC I and MHC II molecules render themselves potentially visible to both CD8⁺ and CD4⁺ T cells through the de novo expression of viral antigens. Here we use one such pathogen, the B-lymphotropic Epstein-Barr virus (EBV), to examine the kinetics of these processes in the virally-infected cell, comparing newly synthesised polypeptides versus the mature protein pool as viral antigen sources for MHC I- and MHC II-restricted presentation. EBV-transformed B cell lines were established in which the expression of two cognate EBV antigens, EBNA1 and EBNA3B, could be induced and then completely suppressed by doxycycline-regulation. These cells were used as targets for CD8⁺ and CD4⁺ T cell clones to a range of EBNA1 and EBNA3B epitopes. For both antigens, when synthesis was induced, CD8 epitope display rose quickly to near maximum within 24 h, well before steady state levels of mature protein had been reached, whereas CD4 epitope presentation was delayed by 36–48 h and rose only slowly thereafter. When antigen expression was suppressed, despite the persistence of mature protein, CD8 epitope display fell rapidly at rates similar to that seen for the MHC I/epitope half-life in peptide pulse-chase experiments. By contrast, CD4 epitope display persisted for many days and, following peptide stripping, recovered well on cells in the absence of new antigen synthesis. We infer that, in virally-infected MHC I/II-positive cells, newly-synthesised polypeptides are the dominant source of antigen feeding the MHC I pathway, whereas the MHC II pathway is fed by the mature protein pool. Hence, newly-infected cells are rapidly visible only to the CD8 response; by contrast, latent infections, in which viral gene expression has been extinguished yet viral proteins persist, will remain visible to CD4⁺ T cells.     

An Enhanced Pre‐ and Postnatal Development Study in Cynomolgus Monkeys with Tabalumab: A Human IgG4 Monoclonal Antibody

Tabalumab, a human IgG4 monoclonal antibody (mAb) with neutralizing activity against both soluble and membrane B‐cell activating factor (BAFF), has been under development for the treatment of autoimmune diseases. The purpose of this study was to determine the potential adverse effects of maternal tabalumab exposure on pregnancy, parturition, and lactation of the mothers and on the growth, viability, and development of the offspring through postnatal day (PND) 204. Tabalumab was administered by subcutaneous injection to presumed pregnant cynomolgus monkeys (16–19 per group) every 2 weeks from gestation day (GD) 20 to 22 until parturition at doses of 0, 0.3, or 30 mg/kg. Evaluations in mothers and infants included clinical signs, body weight, toxicokinetics, blood lymphocyte phenotyping, T‐cell‐dependent antibody response (infants only), antitherapeutic antibody (ATA), organ weights (infants only), and gross and microscopic histopathology. Infants were also examined for external and visceral morphologic and neurobehavioral development. There were no adverse tabalumab‐related effects on maternal or infant endpoints. An expected pharmacological decrease in peripheral blood B‐lymphocytes occurred in adults and infants; however, B‐cell recovery was evident by PND154 in adults and infants at 0.3 mg/kg and by PND204 in infants at 30 mg/kg. At 30 mg/kg, a reduced IgM antibody response to T‐cell‐dependent antigen keyhole limpet hemocyanin (KLH) was observed following primary immunization. Following secondary KLH immunization, all infants in both dose groups mounted anti‐KLH IgM and IgG antibody responses similar to control. Placental and mammary transfer of tabalumab was demonstrated. In conclusion, the no‐observed‐adverse‐effect level for maternal and developmental toxicity was 30 mg/kg, the highest dose tested. Exposures at 30 mg/kg provide a margin of safety of 16× the anticipated clinical exposure.     

Pandemic Swine-Origin H1N1 Influenza Virus Replicates to Higher Levels and Induces More Fever and Acute Inflammatory Cytokines in Cynomolgus versus Rhesus Monkeys and Can Replicate in Common Marmosets

The close immunological and physiological resemblance with humans makes non-human primates a valuable model for studying influenza virus pathogenesis and immunity and vaccine efficacy against infection. Although both cynomolgus and rhesus macaques are frequently used in influenza virus research, a direct comparison of susceptibility to infection and disease has not yet been performed. In the current study a head-to-head comparison was made between these species, by using a recently described swine-origin pandemic H1N1 strain, A/Mexico/InDRE4487/2009. In comparison to rhesus macaques, cynomolgus macaques developed significantly higher levels of virus replication in the upper airways and in the lungs, involving both peak level and duration of virus production, as well as higher increases in body temperature. In contrast, clinical symptoms, including respiratory distress, were more easily observed in rhesus macaques. Expression of sialyl-α-2,6-Gal saccharides, the main receptor for human influenza A viruses, was 50 to 73 times more abundant in trachea and bronchus of cynomolgus macaques relative to rhesus macaques. The study also shows that common marmosets, a New World non-human primate species, are susceptible to infection with pandemic H1N1. The study results favor the cynomolgus macaque as model for pandemic H1N1 influenza virus research because of the more uniform and high levels of virus replication, as well as temperature increases, which may be due to a more abundant expression of the main human influenza virus receptor in the trachea and bronchi.