A Study of the Igm Interaction with Complement Using Mouse Igmligg2b Domain-Switched Hybrids
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Guideline on Clinical Investigation of Recombinant and Human Plasma-Derived 9 Factor IX Products’ (EMA/CHMP/BPWP/144552/2009 Rev
1 15 November 2018 2 EMA/CHMP/BPWP/144552/2009 rev. 2 Corr. 1 3 Committee for medicinal products for human use (CHMP) 4 Guideline on clinical investigation of recombinant and 5 human plasma-derived factor IX products 6 Draft Draft Agreed by Blood Products Working Party (BPWP) August 2018 Adopted by Committee for Medicinal Products for Human Use (CHMP) 15 November 2018 Start of public consultation 3 December 2018 End of public consultation 30 June 2019 7 8 This guideline replaces ‘Guideline on clinical investigation of recombinant and human plasma-derived 9 factor IX products’ (EMA/CHMP/BPWP/144552/2009 Rev. 1, Corr. 1) 10 Comments should be provided using this template. The completed comments form should be sent to [email protected] 11 Keywords Recombinant factor IX, plasma-derived factor IX, efficacy, safety, immunogenicity, inhibitor, thrombogenicity, anaphylactic reactions, potency assays 30 Churchill Place ● Canary Wharf ● London E14 5EU ● United Kingdom Telephone +44 (0)20 3660 6000 Facsimile +44 (0)20 3660 5555 Send a question via our website www.ema.europa.eu/contact An agency of the European Union © European Medicines Agency, 2019. Reproduction is authorised provided the source is acknowledged. 12 Guideline on the clinical investigation of recombinant and 13 human plasma-derived factor IX products 14 Table of contents 15 Executive summary ..................................................................................... 4 16 1. Introduction (background) ..................................................................... -
MONONINE (“Difficulty ® Monoclonal Antibody Purified in Concentrating”; Subject Recovered)
CSL Behring IU/kg (n=38), 0.98 ± 0.45 K at doses >95-115 IU/kg (n=21), 0.70 ± 0.38 K at doses >115-135 IU/kg (n=2), 0.67 K at doses >135-155 IU/kg (n=1), and 0.73 ± 0.34 K at doses >155 IU/kg (n=5). Among the 36 subjects who received these high doses, only one (2.8%) Coagulation Factor IX (Human) reported an adverse experience with a possible relationship to MONONINE (“difficulty ® Monoclonal Antibody Purified in concentrating”; subject recovered). In no subjects were thrombo genic complications MONONINE observed or reported.4 only The manufacturing procedure for MONONINE includes multiple processing steps that DESCRIPTION have been designed to reduce the risk of virus transmission. Validation studies of the Coagulation Factor IX (Human), MONONINE® is a sterile, stable, lyophilized concentrate monoclonal antibody (MAb) immunoaffinity chromatography/chemical treatment step and of Factor IX prepared from pooled human plasma and is intended for use in therapy nanofiltration step used in the production of MONONINE doc ument the virus reduction of Factor IX deficiency, known as Hemophilia B or Christmas disease. MONONINE is capacity of the processes employed. These studies were conducted using the rel evant purified of extraneous plasma-derived proteins, including Factors II, VII and X, by use of enveloped and non-enveloped viruses. The results of these virus validation studies utilizing immunoaffinity chromatography. A murine monoclonal antibody to Factor IX is used as an a wide range of viruses with different physicochemical properties are summarized in Table affinity ligand to isolate Factor IX from the source material. -
The Central Role of Fibrinolytic Response in COVID-19—A Hematologist’S Perspective
International Journal of Molecular Sciences Review The Central Role of Fibrinolytic Response in COVID-19—A Hematologist’s Perspective Hau C. Kwaan 1,* and Paul F. Lindholm 2 1 Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA 2 Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; [email protected] * Correspondence: [email protected] Abstract: The novel coronavirus disease (COVID-19) has many characteristics common to those in two other coronavirus acute respiratory diseases, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). They are all highly contagious and have severe pulmonary complications. Clinically, patients with COVID-19 run a rapidly progressive course of an acute respiratory tract infection with fever, sore throat, cough, headache and fatigue, complicated by severe pneumonia often leading to acute respiratory distress syndrome (ARDS). The infection also involves other organs throughout the body. In all three viral illnesses, the fibrinolytic system plays an active role in each phase of the pathogenesis. During transmission, the renin-aldosterone- angiotensin-system (RAAS) is involved with the spike protein of SARS-CoV-2, attaching to its natural receptor angiotensin-converting enzyme 2 (ACE 2) in host cells. Both tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) are closely linked to the RAAS. In lesions in the lung, kidney and other organs, the two plasminogen activators urokinase-type plasminogen activator (uPA) and tissue plasminogen activator (tPA), along with their inhibitor, plasminogen activator 1 (PAI-1), are involved. The altered fibrinolytic balance enables the development of a hypercoagulable Citation: Kwaan, H.C.; Lindholm, state. -
Assembly of an Integrated Human Lung Cell Atlas Reveals That
medRxiv preprint doi: https://doi.org/10.1101/2020.06.02.20120634; this version posted June 4, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Assembly of an integrated human lung cell atlas reveals that SARS-CoV-2 receptor is co-expressed with key elements of the kinin-kallikrein, renin-angiotensin and coagulation systems in alveolar cells Davi Sidarta-Oliveira1,2, Carlos Poblete Jara1,3, Adriano J. Ferruzzi4, Munir S. Skaf4, William H. Velander5, Eliana P. Araujo1,3, Licio A. Velloso1 1Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, University of Campinas, Brazil 2 Physician-Scientist Graduate Program, School of Medical Sciences, University of Campinas, Brazil 3Nursing School, University of Campinas, Brazil 4Institute of Chemistry and Center for Computing in Engineering and Sciences University of Campinas, Brazil 5Department of Chemical and Biomolecular Engineering, University of Nebraska, Lincoln, USA Correspondence: Licio A. Velloso Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil Address: Rua Carl Von Lineaus s/n, Instituto de Biologia - Bloco Z. Campus Universitário Zeferino Vaz - Barão Geraldo, Campinas - SP, 13083-864 Phone: +55 19 3521-0025 E-mail: [email protected] Abstract SARS-CoV-2, the pathogenic agent of COVID-19, employs angiotensin converting enzyme-2 (ACE2) as its cell entry receptor. Clinical data reveal that in severe COVID- 19, SARS-CoV-2 infects the lung, leading to a frequently lethal triad of respiratory insufficiency, acute cardiovascular failure, and coagulopathy. -
Gene Therapy Expression Vectors Based on the Clotting Factor IX Promoter
Gene Therapy (1999) 6, 1584–1589 1999 Stockton Press All rights reserved 0969-7128/99 $15.00 http://www.stockton-press.co.uk/gt Gene therapy expression vectors based on the clotting Factor IX promoter H Hoag, J Gore, D Barry and CR Mueller Department of Biochemistry and Cancer Research Laboratories, Queen’s University, Kingston, Ontario, Canada The liver is one of the prime targets for gene therapy, and moter. Introduction of this element increases promoter the correction of defects in a variety of clotting factor genes activity at least 20-fold over the proximal promoter alone is one of the main goals of liver-directed therapies. The use when assayed in the human liver cell line Hep G2. This of transcriptional regulatory elements derived from these optimized promoter is significantly more active than the genes may provide for the optimal expression of trans- SV40 enhancer/early promoter. The expression of the opti- duced genes. We have applied our knowledge of the pro- mized Factor IX promoter is also more persistent in the moter structure of the clotting Factor IX gene to design short term. The inclusion of a liver-specific locus control optimized expression vectors for use in gene therapy. The region, derived from the apolipoprotein E/C locus, did not activity of the proximal promoter has been augmented by further augment expression levels. These Factor IX vectors the introduction of a multimerized upstream site which we also exhibit a high degree of tissue specificity, as meas- have previously shown to be a prime regulator of the pro- ured by transfection into breast and muscle cell lines. -
The Plasmin–Antiplasmin System: Structural and Functional Aspects
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Bern Open Repository and Information System (BORIS) Cell. Mol. Life Sci. (2011) 68:785–801 DOI 10.1007/s00018-010-0566-5 Cellular and Molecular Life Sciences REVIEW The plasmin–antiplasmin system: structural and functional aspects Johann Schaller • Simon S. Gerber Received: 13 April 2010 / Revised: 3 September 2010 / Accepted: 12 October 2010 / Published online: 7 December 2010 Ó Springer Basel AG 2010 Abstract The plasmin–antiplasmin system plays a key Plasminogen activator inhibitors Á a2-Macroglobulin Á role in blood coagulation and fibrinolysis. Plasmin and Multidomain serine proteases a2-antiplasmin are primarily responsible for a controlled and regulated dissolution of the fibrin polymers into solu- Abbreviations ble fragments. However, besides plasmin(ogen) and A2PI a2-Antiplasmin, a2-Plasmin inhibitor a2-antiplasmin the system contains a series of specific CHO Carbohydrate activators and inhibitors. The main physiological activators EGF-like Epidermal growth factor-like of plasminogen are tissue-type plasminogen activator, FN1 Fibronectin type I which is mainly involved in the dissolution of the fibrin K Kringle polymers by plasmin, and urokinase-type plasminogen LBS Lysine binding site activator, which is primarily responsible for the generation LMW Low molecular weight of plasmin activity in the intercellular space. Both activa- a2M a2-Macroglobulin tors are multidomain serine proteases. Besides the main NTP N-terminal peptide of Pgn physiological inhibitor a2-antiplasmin, the plasmin–anti- PAI-1, -2 Plasminogen activator inhibitor 1, 2 plasmin system is also regulated by the general protease Pgn Plasminogen inhibitor a2-macroglobulin, a member of the protease Plm Plasmin inhibitor I39 family. -
Plasmin (Human) 1.00 Mg
Plasmin (Human) 1.00 mg Ref#: HPLAS Lot#: xxxxxx Exp. Date: xxxx-xx Store at -10°C to -20°C For Research Use Only Not for Use in Diagnostic Procedures For in vitro use only Description: Plasmin Format: Frozen in 50mM Hepes/ 50 mM sodium acetate/ 50% glycerol/ pH 8.5 Host: Human Storage: Store between -10°C and -20°C Volume: 1 vial containing 0.962 mL Total Protein: 1.00 mg 1% Concentration: 1.04 mg/mL by Absorbance; Extinction Coefficient E 280 = 17.0 Activity: 228.00 nkat/mg Molecular weight: 83000 daltons Plasminogen is synthesized in the liver and circulates in plasma at a concentration of ~200 μg/mL (~2.3 μM). Plasminogen is a single-chain glycoprotein of ~88 kDa that consists of a catalytic domain followed by five kringle structures. Within these kringle structures are four low-affinity lysine binding sites and one high-affinity lysine binding site. It is through these lysine binding sites that plasminogen binds to fibrin and to α2-Antiplasmin. Native Plasminogen (Glu-Plasminogen) exists in two variants that differ in their extent of glycosylation, and each variant has up to six isoelectric forms with respect to sialic acid content, for a total of 12 molecular forms. Activation of Glu-Plasminogen by the Plasminogen activators Urokinase (UPA), or tissue Plasminogen Activator (tPA) occurs by cleavage after residue Arg560 to produce the two-chain active serine protease Plasmin. In a positive feedback reaction, the Plasmin generated cleaves an ~8 kDa peptide from Glu-Plasminogen, producing lys77- Plasminogen which has a higher affinity for Fibrin and when bound is a preferred substrate for Plasminogen activators such as Urokinase. -
Phenotypic Correction of Factor IX Deficiency in Skin Fibroblasts
Proc. Nati. Acad. Sci. USA Vol. 87, pp. 5173-5177, July 1990 Genetics Phenotypic correction of factor IX deficiency in skin fibroblasts of hemophilic dogs (molecular cloning/hemophilia B/retroviral vectors/endothelial cells/gene therapy) J. H. AXELROD*, M. S. READt, K. M. BRINKHOUSt, AND 1. M. VERMA*t *Molecular Biology and Virology Laboratory, Salk Institute, Post Office Box 85800, San Diego, CA 92138; and tDepartment of Pathology and Center for Thrombosis and Hemostasis, University of North Carolina, Chapel Hill, NC 27599 Contributed by K. M. Brinkhous, April 24, 1990 ABSTRACT Primary skin fibroblasts from hemophilic endothelial cells as potential targets for gene transfer in the dogs were transduced by recombinant retrovirus (LNCdF9L) treatment of hemophilia B. containing a canine factor IX cDNA. High levels of biologically active canine factor IX (1.0 ,ug per 106 cells per 24 hr) were secreted in the medium. The level of factor IX produced MATERIALS AND METHODS increased substantially if the cells were stimulated by basic Construction and Isolation of a Canine Factor IX cDNA. A fibroblast growth factor during infection. Additionally, we also canine liver cDNA library was constructed using total cel- report that endothelial cells transduced by this virus can lular poly(A)+ RNA isolated from mongrel dog liver. cDNA produce high levels ofbiologically active factor IX. We propose was prepared using a cDNA synthesis kit (Pharmacia) and that skin fibroblasts and endothelial cells from hemophilia B ligated in the vector AZAP (Stratagene), which was packaged dogs may serve as potential venues for the development and with Gigapack Plus (Stratagene) according to the manufac- testing of models for treatment of hemophilia B by retrovirally turer's instructions. -
Factor IX Complex (Human - Bebulin, Profilnine) Reference Number: ERX.SPMN.201 Effective Date: 01/17 Coding Implications Last Review Date: Revision Log
Clinical Policy: Factor IX complex (Human - Bebulin, Profilnine) Reference Number: ERX.SPMN.201 Effective Date: 01/17 Coding Implications Last Review Date: Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Policy/Criteria It is the policy of health plans affiliated with Envolve Pharmacy SolutionsTM that factor IX complex (Bebulin®, Profilnine®) is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Hemophilia B (must meet all): 1. Prescribed by or in consultation with a hematologist; 2. Diagnosis of hemophilia B; 3. Agent will used for prevention/control of bleeding episodes. Approval duration: 3 months B. Other diagnoses/indications: Refer to ERX.SPMN.16 - Global Biopharm Policy. II. Continued Approval A. Hemophilia B (must meet all): 1. Currently receiving medication via health plan benefit or member has previously met all initial approval criteria. Approval duration: 3 months B. Other diagnoses/indications (must meet 1 or 2): 1. Currently receiving medication via health plan benefit and documentation supports positive response to therapy; or 2. Refer to ERX.SPMN.16 - Global Biopharm Policy. Background Description/Mechanism of Action: Factor IX complex replaces deficient clotting factors including factor X. Hemophilia B, or Christmas disease, is an X-linked recessively inherited disorder of blood coagulation characterized by insufficient or abnormal synthesis of the clotting protein factor IX. Factor IX is a vitamin K-dependent coagulation factor which is synthesized in the liver. Factor IX is activated by factor XIa in the intrinsic coagulation pathway. Activated factor IX (IXa), in combination with factor VII: C, activates factor X to Xa, resulting ultimately in the conversion of prothrombin to thrombin and the formation of a fibrin clot. -
General Considerations of Coagulation Proteins
ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 8, No. 2 Copyright © 1978, Institute for Clinical Science General Considerations of Coagulation Proteins DAVID GREEN, M.D., Ph.D.* Atherosclerosis Program, Rehabilitation Institute of Chicago, Section of Hematology, Department of Medicine, and Northwestern University Medical School, Chicago, IL 60611. ABSTRACT The coagulation system is part of the continuum of host response to injury and is thus intimately involved with the kinin, complement and fibrinolytic systems. In fact, as these multiple interrelationships have un folded, it has become difficult to define components as belonging to just one system. With this limitation in mind, an attempt has been made to present the biochemistry and physiology of those factors which appear to have a dominant role in the coagulation system. Coagulation proteins in general are single chain glycoprotein molecules. The reactions which lead to their activation are usually dependent on the presence of an appropriate surface, which often is a phospholipid micelle. Large molecular weight cofactors are bound to the surface, frequently by calcium, and act to induce a favorable conformational change in the reacting molecules. These mole cules are typically serine proteases which remove small peptides from the clotting factors, converting the single chain species to two chain molecules with active site exposed. The sequence of activation is defined by the enzymes and substrates involved and eventuates in fibrin formation. Mul tiple alternative pathways and control mechanisms exist throughout the normal sequence to limit coagulation to the area of injury and to prevent interference with the systemic circulation. Introduction RatnofP4 eloquently indicates in an arti cle aptly entitled: “A Tangled Web. -
6. Interaction Between the Coagulation and Complement System
6. Interaction Between the Coagulation and Complement System Umme Amara1, Daniel Rittirsch 1, Michael Flierl 1, Uwe Bruckner 2, Andreas Klos 3, Florian Gebhard1, John D. Lambris4, and Markus Huber-Lang1,* 1Department of Traumatology, Hand-, Plastic-, and Reconstructive Surgery, University Hospital of Ulm, Ulm, Germany, [email protected] 2Division of Experimental Surgery, University Hospital of Ulm, Ulm, Germany, [email protected] 3Department of Medical Microbiology, Medical School Hannover, Hannover, Germany, [email protected] 4Department of Pathology, University of Pennsylvania, 401 Stellar Chance, Philadelphia, PA 19104, USA, [email protected]. Abstract. The complement system as a main column of innate immunity and the coagulation system as a main column in hemostasis undergo massive activation early after injury. Interactions between the two cascades have often been proposed but the precise molecular pathways of this interplay are still in the dark. To elucidate the mechanisms involved, the effects of various coagulation factors on complement activation and generation of anaphylatoxins were investigated and summarized in the light of the latest literature. Own in vitro findings suggest, that the coagulation factors FXa, FXIa and plasmin may cleave both C5 and C3, and robustly generate C5a and C3a (as detected by immunoblotting and ELISA). The produced anaphylatoxins were found to be biologically active as shown by a dose- dependent chemotactic response of neutrophils and HMC-1 cells, respectively. Thrombin did not only cleave C5 (Huber-Lang et al. 2006) but also in vitro-generated C3a when incubated with native C3. The plasmin-induced cleavage activity could be dose-dependently blocked by the serine protease inhibitor aprotinin and leupeptine. -
Activation of the Plasma Kallikrein-Kinin System in Respiratory Distress Syndrome
003 I-3998/92/3204-043 l$03.00/0 PEDIATRIC RESEARCH Vol. 32. No. 4. 1992 Copyright O 1992 International Pediatric Research Foundation. Inc. Printed in U.S.A. Activation of the Plasma Kallikrein-Kinin System in Respiratory Distress Syndrome OLA D. SAUGSTAD, LAILA BUP, HARALD T. JOHANSEN, OLAV RPISE, AND ANSGAR 0. AASEN Department of Pediatrics and Pediatric Research [O.D.S.].Institute for Surgical Research. University of Oslo [L.B.. A.O.A.], Rikshospitalet, N-0027 Oslo 1, Department of Surgery [O.R.],Oslo City Hospital Ullev~il University Hospital, N-0407 Oslo 4. Department of Pharmacology [H. T.J.],Institute of Pharmacy, University of Oslo. N-0316 Oslo 3, Norway ABSTRAm. Components of the plasma kallikrein-kinin proteins that interact in a complicated way. When activated, the and fibrinolytic systems together with antithrombin 111 contact factors plasma prekallikrein, FXII, and factor XI are were measured the first days postpartum in 13 premature converted to serine proteases that are capable of activating the babies with severe respiratory distress syndrome (RDS). complement, fibrinolytic, coagulation, and kallikrein-kinin sys- Seven of the patients received a single dose of porcine tems (7-9). Inhibitors regulate and control the activation of the surfactant (Curosurf) as rescue treatment. Nine premature cascades. C1-inhibitor is the most important inhibitor of the babies without lung disease or any other complicating contact system (10). It exerts its regulatory role by inhibiting disease served as controls. There were no differences in activated FXII, FXII fragment, and plasma kallikrein (10). In prekallikrein values between surfactant treated and non- addition, az-macroglobulin and a,-protease inhibitor inhibit treated RDS babies during the first 4 d postpartum.