nemiralisib是一种吸入式PI3激酶δ抑制剂,用于治疗活化的PI3激酶δ综合征

IF 3.3 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Malcolm Begg , Augustin Amour , Emily Jarvis , Teresa Tang , Sara Santos Franco , Andrew Want , Misba Beerahee , Disala Fernando , Yakshitha Karkera , Clare Sander , Thomas Southworth , Dave Singh , Jonathan Clark , Sergey Nejentsev , Klaus Okkenhaug , Alison Condliffe , Anita Chandra , Anthony Cahn , Edward Banham Hall
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引用次数: 3

摘要

活化的PI3Kδ综合征(APDS)是一种罕见的遗传性先天性免疫错误,由组成性激活磷酸肌醇3-激酶(PI3KΔ)的p110δ亚型的突变引起,导致反复肺部感染。目前没有获得许可的疗法。在这里,我们报告了一项开放标签试验的结果,在该试验中,五名受试者用吸入性PI3Kδ抑制剂奈米拉利西治疗12周,以确定安全性、全身暴露以及肺部和全身生物标志物图谱(Clinicaltrial.gov:NCT02593539),并采集血样以评估奈米拉利西布的药代动力学和系统生物标志物。Nemiralisib具有可接受的安全性和耐受性,咳嗽是最常见的不良事件,研究期间没有报告严重不良事件。奈米拉利西治疗后,诱导痰中的磷脂酰肌醇(3,4,5)-三磷酸(PIP3;PI3Kδ的酶产物)或下游炎症标志物没有观察到有意义的变化。同样,血液炎症标志物或淋巴细胞亚群也没有发生有意义的变化。与之前的观察结果相比,本研究受试者的内米拉利西系统水平更高。虽然奈米拉利西布具有可接受的安全性,但没有令人信服的证据表明吸入给药后肺部有靶点参与,也没有在肺部或血液室中观察到下游效应。我们推测,这可以解释为奈米拉利西布没有在肺部保留足够的时间,这可能是由于先前存在的结构性肺部损伤导致的全身暴露增加。在这项调查少数APDS受试者的研究中,奈米拉利西似乎是安全的,耐受性良好。然而,这项研究的数据并不支持奈米拉利西吸入治疗会使APDS患者受益的假设。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
An open label trial of nemiralisib, an inhaled PI3 kinase delta inhibitor for the treatment of Activated PI3 kinase Delta Syndrome

Activated PI3Kδ Syndrome (APDS) is a rare inherited inborn error of immunity caused by mutations that constitutively activate the p110 delta isoform of phosphoinositide 3-kinase (PI3Kδ), resulting in recurring pulmonary infections. Currently no licensed therapies are available. Here we report the results of an open-label trial in which five subjects were treated for 12 weeks with nemiralisib, an inhaled inhibitor of PI3Kδ, to determine safety, systemic exposure, together with lung and systemic biomarker profiles (Clinicaltrial.gov: NCT02593539).

Induced sputum was captured to measure changes in phospholipids and inflammatory mediators, and blood samples were collected to assess pharmacokinetics of nemiralisib, and systemic biomarkers.

Nemiralisib was shown to have an acceptable safety and tolerability profile, with cough being the most common adverse event, and no severe adverse events reported during the study. No meaningful changes in phosphatidylinositol (3,4,5)-trisphosphate (PIP3; the enzyme product of PI3Kδ) or downstream inflammatory markers in induced sputum, were observed following nemiralisib treatment. Similarly, there were no meaningful changes in blood inflammatory markers, or lymphocytes subsets. Systemic levels of nemiralisib were higher in subjects in this study compared to previous observations.

While nemiralisib had an acceptable safety profile, there was no convincing evidence of target engagement in the lung following inhaled dosing and no downstream effects observed in either the lung or blood compartments. We speculate that this could be explained by nemiralisib not being retained in the lung for sufficient duration, suggested by the increased systemic exposure, perhaps due to pre-existing structural lung damage.

In this study investigating a small number of subjects with APDS, nemiralisib appeared to be safe and well-tolerated. However, data from this study do not support the hypothesis that inhaled treatment with nemiralisib would benefit patients with APDS.

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来源期刊
CiteScore
6.20
自引率
0.00%
发文量
41
审稿时长
42 days
期刊介绍: Pulmonary Pharmacology and Therapeutics (formerly Pulmonary Pharmacology) is concerned with lung pharmacology from molecular to clinical aspects. The subject matter encompasses the major diseases of the lung including asthma, cystic fibrosis, pulmonary circulation, ARDS, carcinoma, bronchitis, emphysema and drug delivery. Laboratory and clinical research on man and animals will be considered including studies related to chemotherapy of cancer, tuberculosis and infection. In addition to original research papers the journal will include review articles and book reviews. Research Areas Include: • All major diseases of the lung • Physiology • Pathology • Drug delivery • Metabolism • Pulmonary Toxicology.
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