Synthesis of Granulocyte–Macrophage Colony- Stimulating Factor As Homogeneous Glycoforms and Early Comparisons with Yeast Cell-Derived Material

Total Page:16

File Type:pdf, Size:1020Kb

Synthesis of Granulocyte–Macrophage Colony- Stimulating Factor As Homogeneous Glycoforms and Early Comparisons with Yeast Cell-Derived Material Synthesis of granulocyte–macrophage colony- stimulating factor as homogeneous glycoforms and early comparisons with yeast cell-derived material Qiang Zhanga,1, Eric V. Johnstona,1, Jae-Hung Shiehb, Malcolm A. S. Mooreb, and Samuel J. Danishefskya,c,2 aLaboratory for Bio-Organic Chemistry and bCell Biology Program, Sloan-Kettering Institute for Cancer Research, New York, NY 10065; and cDepartment of Chemistry, Columbia University, New York, NY 10027 Contributed by Samuel J. Danishefsky, January 7, 2014 (sent for review December 18, 2013) Granulocyte–macrophage colony-stimulating factor (GM-CSF) is bearing complex glycan domains at each native position, is illus- a medicinally important glycoprotein, used as an immunostimulant trative of the growing power of chemical synthesis to facilitate following bone-marrow transplant. On the basis of reports of its the study of medicinally relevant biologic targets (12–14). We potential utility as an anticancer vaccine adjuvant, we undertook describe herein the synthesis of homogeneous GM-CSF glyco- to develop a synthetic route toward single-glycoform GM-CSF. We proteins through a convergent route that offers ready access to describe herein a convergent total synthesis of GM-CSF aglycone a menu of glycoforms for further study. and two homogeneous glycoforms. Analytical and biological studies Structurally, GM-CSF consists of 127 aa with multiple sites of 27 confirm the structure and activity of these synthetic congeners. glycosylation (Fig. 1). Two N-linked glycans are located at Asn and Asn37 (15, 16). Interestingly, neither the position nor the glycoprotein synthesis | peptide ligation | alanine ligation extent of O-linked glycosylation has been unambiguously es- tablished. Studies suggest a range from two (Ser7 and Ser9/Thr10) 5 7 9 10 – to four (Ser , Ser , Ser , and Thr ) sites of glycosylation (17). ranulocyte macrophage colony-stimulating factor (GM- The tertiary structure is strongly influenced by two cross-linked GCSF) is a secreted glycoprotein that promotes cellular disulfide bonds. growth and proliferation. GM-CSF signaling initiates a cascade that culminates in the production of white blood cells through Results and Discussion stem-cell stimulation in the bone marrow (Fig. 1) (1). Thera- Our strategy for reaching homogeneous GM-CSF constructs peutically, this glycoprotein is valued for its properties as an relies upon powerful techniques developed for the synthesis of immunostimulant; GM-CSF impacts the production, differenti- complex biologics: namely, solid-phase peptide synthesis (SPPS), ation, and function of dendritic cells through potentiation of the + native chemical ligation (NCL), and metal-free dethiylation CD4 T-cell response (2, 3) and is regularly administered to (MFD). Merrifield’s SPPS method permits stepwise elongation patients undergoing chemotherapy or autologous bone-marrow of a growing peptide (18, 19). Convergence in the construction of CHEMISTRY transplant. GM-CSF is approved in Europe as the aglycone longer polypeptides, including small proteins, may be achieved (Molgramostim) (4) and in the United States as a glycosylated, through the use of the seminal NCL technology of Kent and mutant form (Sargramostim). At present, glycosylated GM-CSF coworkers, whereby fragments are merged at N-terminal cysteine is obtained exclusively via recombinant technologies using residues (20, 21). The possibility of expanding the scope of NCL yeast (Sargramostim) or Chinese hamster ovary (CHO) cell to encompass, for instance, alanine ligation was demonstrated in a key (Regramostim) technologies, which yield complex mixtures of paper by Yan and Dawson (22), who accomplished dethiylation glycoforms. The glycan heterogeneity reflects a lack of specificity in CHO-cell posttranslational glycosylation. The degree of Significance GM-CSF glycosylation has been reported to affect the in vivo properties of the glycoprotein (5, 6); the aglycone may cause As biologically active glycoproteins are increasingly investigated increased adverse side effects, perhaps due to its enhanced as potential therapeutic agents, there is a growing demand for susceptibility to truncation pathways (7). the development of strategies for the synthesis of homoge- In light of our longstanding interest in synthetic anticancer and neous, single-glycoform constructs for the purposes of rigorous HIV vaccines (8), we took note of reports suggesting that GM- evaluation. Currently, most glycoproteins are accessed through CSF might serve as a useful vaccine immunoadjuvant. Admin- recombinant methods as complex mixtures of glycoforms. istration of GM-CSF results in robust potentiation of the im- – mune response, and clinical studies suggest that the glycoprotein Granulocyte macrophage colony-stimulating factor (GM-CSF) is may hold promise as an adjuvant for anticancer vaccines (9, 10). an important glycoprotein therapeutic, used to stimulate the However, studies to date have used recombinantly derived GM- immune system following bone-marrow transplant and che- CSF mixtures, and results have been inconclusive (9); perhaps motherapy. GM-CSF is also being explored as a potential im- such translational issues might be addressed in a more in- munoadjuvant for anticancer vaccines. We have completed formative fashion with homogeneous GM-CSF agents. In a more a chemical synthesis of homogeneous, single-glycoform GM-CSF. speculative line of inquiry, we also wonder whether appendage of Through adaptation of this modular synthetic route, it will be tumor-associated carbohydrate antigens to the protein backbone possible to gain access to a menu of single-glycoform GM-CSF might yield powerful new anticancer vaccine candidates (11). congeners for a wide range of biological studies. Even beyond these fascinating medicinal questions, we recog- nized in GM-CSF a synthetically compelling glycoprotein target. Author contributions: Q.Z., E.V.J., J.-H.S., M.A.S.M., and S.J.D. designed research; Q.Z., E.V.J., With these considerations in mind, we undertook to design a and J.-H.S. performed research; Q.Z., E.V.J., J.-H.S., M.A.S.M., and S.J.D. analyzed data; and modular route to homogeneous GM-CSF glycoforms. In this Q.Z., E.V.J., J.-H.S., M.A.S.M., and S.J.D. wrote the paper. endeavor, we would rely upon key methodological and strategic The authors declare no conflict of interest. advances from many groups, including ours, in the synthesis of 1Q.Z. and E.V.J. contributed equally to this work. complex glycoproteins. The past decade has indeed witnessed 2To whom correspondence should be addressed. E-mail: [email protected]. a dramatic maturation of the field of “biologics” through chemical This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10. synthesis. Our recent synthesis of homogeneous erythropoietin, 1073/pnas.1400140111/-/DCSupplemental. www.pnas.org/cgi/doi/10.1073/pnas.1400140111 PNAS | February 25, 2014 | vol. 111 | no. 8 | 2885–2890 Downloaded by guest on October 1, 2021 Fig. 1. GM-CSF 3D structure and fully glycosylated GM-CSF sequence (1). The ribbon structure of GM-CSF is based on the X-ray of GM-CSF aglycone expressed by Escherichia coli. via Raney nickel mediation (22, 23). In 2007, our laboratory de- With the component fragments in hand, methods to accom- scribed mild MFD conditions that enable major expansion of the plish their merger were evaluated (Fig. 4). In the event, coupling menu of NCL beyond cysteine residues (24). Thus, subsequent to of fragments 1a (1) and 2a (2) in pH 7.0 kinetic NCL buffer cysteine-type ligation, the free thiol group may be readily removed afforded 3. The crude reaction mixture was directly subjected to through MFD to reveal either native alanines or a range of amino MFD. Happily, Cys34 was smoothly reduced to Ala34 (3→4)whereas 54 acid residues at the site of ligation (Fig. 2). the Thr -SEt functional group remained intact. NCL of fragments 3a (6) and 4a (7) followed by treatment with MeONH2•HCl Synthesis of the GM-CSF Aglycone provided polypeptide 8 with all of the cysteine residues depro- 4 8 We first set out to accomplish a synthesis of the GM-CSF agly- tected. The NCL-based coupling of and afforded the GM-CSF 9 9 cone. We envisioned dissection of our target into four fragments, aglycone primary sequence ( ). Processing of construct ,asshown 10 each hopefully accessible via SPPS. The key connections would in Fig. 4, produced fully synthetic, folded GM-CSF aglycone . [In one of the few papers that report yield (27), the authors include a kinetic alanine ligation between fragments 1a and 2a, – as well as two cysteine ligations to join fragments 2a, 3a, and 4a disclose a comparably low yield range, from 14 42%. That article (Fig. 3). As a critical design element, we envisioned that kinetic attributes the low yield to the aggregation-prone properties of ligation between fragments 1a and 2a would be followed by MFD the protein. In our estimation, the modest folding yield is due to at the ligation site (Cys34→Ala34) in the presence of a thioester at the aggregation as well as unspecific binding to the folding cassette.] The properties of aglycone 10 are described in Fully Synthetic C-terminal Thr53 residue. The cysteine residues of fragments 3a GM-CSF: Analytical Characterization and Biological Studies (28). and 4a would be protected as t-butyl thioethers; the thiols would be liberated in the course of the ligation. Adoption of this approach Synthesis of Glycosylated GM-CSF Analogs would obviate the need for extensive protection and deprotection of We now directed our attention to our long-term goal of reaching the cysteines slated for “survival” in the final target. single glycoform versions of GM-CSF. Although our central ob- Our synthetic vision for the GM-CSF aglycone was reduced jective was to install glycan domains of a high-complexity order, to practice (Fig. 4). The synthesis commenced with the prepa- 6 54 simulating those likely to be found in glycoprotein cytokines ration of fragment 3a ( ). Thus, protected polypeptide Thr - (29), we thought it prudent to begin with a more modest level of Pro94 (5) was retrieved from the SPPS resin by treatment with 95 glycosylation.
Recommended publications
  • Therapeutic Class Overview Colony Stimulating Factors
    Therapeutic Class Overview Colony Stimulating Factors Therapeutic Class Overview/Summary: This review will focus on the granulocyte colony stimulating factors (G-CSFs) and granulocyte- macrophage colony stimulating factors (GM-CSFs).1-5 Colony-stimulating factors (CSFs) fall under the naturally occurring glycoprotein cytokines, one of the main groups of immunomodulators.6 In general, these proteins are vital to the proliferation and differentiation of hematopoietic progenitor cells.6-8 The G- CSFs commercially available in the United States include pegfilgrastim (Neulasta®), filgrastim (Neupogen®), filgrastim-sndz (Zarxio®), and tbo-filgrastim (Granix®). While filgrastim-sndz and tbo- filgrastim are the same recombinant human G-CSF as filgrastim, only filgrastim-sndz is considered a biosimilar drug as it was approved through the biosimilar pathway. At the time tbo-filgrastim was approved, a regulatory pathway for biosimilar drugs had not yet been established in the United States and tbo-filgrastim was filed under its own Biologic License Application.9 Only one GM-CSF is currently available, sargramostim (Leukine). These agents are Food and Drug Administration (FDA)-approved for a variety of conditions relating to neutropenia or for the collection of hematopoietic progenitor cells for collection by leukapheresis.1-5 Due to the pathway taken, tbo-filgrastim does not share all of the same indications as filgrastim and these two products are not interchangeable. It is important to note that although filgrastim-sndz is a biosimilar product, and it was approved with all the same indications as filgrastim at the time, filgrastim has since received FDA-approval for an additional indication that filgrastim-sndz does not have, to increase survival in patients with acute exposure to myelosuppressive doses of radiation.1-3A complete list of indications for each agent can be found in Table 1.
    [Show full text]
  • Sargramostim (Leukine®)
    Policy Medical Policy Manual Approved Revision: Do Not Implement until 8/31/21 Sargramostim (Leukine®) NDC CODE(S) 71837-5843-XX LEUKINE 250MCG Solution Reconstituted (PARTNER THERAPEUTICS) DESCRIPTION Sargramostim is a recombinant human granulocyte-macrophage colony stimulating factor (rGM-CSF) produced by recombinant DNA technology in a yeast (S. cerevisiae) expression system. Like endogenous GM-CSF, rGM-CSF is a hematopoietic growth factor which stimulates proliferation and differentiation of hematopoietic progenitor cells in the granulocyte-macrophage pathways which include neutrophils, monocytes/macrophages and myeloid-derived dendritic cells. It is also capable of activating mature granulocytes and macrophages. Various cellular responses such as division, maturation and activation are induced by GM-CSF binding to specific receptors expressed on the cell surface of target cells. POLICY Sargramostim for the treatment of the following is considered medically necessary: o Acute myelogenous leukemia following induction or consolidation chemotherapy o Bone Marrow Transplantation (BMT) failure or Engraftment Delay o Individuals acutely exposed to myelosuppressive doses of radiation (Hematopoietic Subsyndrome of Acute Radiation Syndrome [H-ARS]) o Myeloid reconstitution after autologous or allogeneic bone marrow transplant (BMT) o Peripheral Blood Progenitor Cell (PBPC) mobilization and transplant Sargramostim for the treatment of chemotherapy-induced febrile neutropenia is considered medically necessary if the medical appropriateness
    [Show full text]
  • Regenerative Mechanisms and Novel Therapeutic Approaches
    brain sciences Review Neurodegenerative Diseases: Regenerative Mechanisms and Novel Therapeutic Approaches Rashad Hussain 1,*, Hira Zubair 2, Sarah Pursell 1 and Muhammad Shahab 2,* 1 Center for Translational Neuromedicine, University of Rochester, NY 14642, USA; [email protected] 2 Department of Animal Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; [email protected] * Correspondence: [email protected] (R.H.); [email protected] (M.S.); Tel.: +1-585-276-6390 (R.H.); +92-51-9064-3014 (M.S.) Received: 13 July 2018; Accepted: 12 September 2018; Published: 15 September 2018 Abstract: Regeneration refers to regrowth of tissue in the central nervous system. It includes generation of new neurons, glia, myelin, and synapses, as well as the regaining of essential functions: sensory, motor, emotional and cognitive abilities. Unfortunately, regeneration within the nervous system is very slow compared to other body systems. This relative slowness is attributed to increased vulnerability to irreversible cellular insults and the loss of function due to the very long lifespan of neurons, the stretch of cells and cytoplasm over several dozens of inches throughout the body, insufficiency of the tissue-level waste removal system, and minimal neural cell proliferation/self-renewal capacity. In this context, the current review summarized the most common features of major neurodegenerative disorders; their causes and consequences and proposed novel therapeutic approaches. Keywords: neuroregeneration; mechanisms; therapeutics; neurogenesis; intra-cellular signaling 1. Introduction Regeneration processes within the nervous system are referred to as neuroregeneration. It includes, but is not limited to, the generation of new neurons, axons, glia, and synapses. It was not considered possible until a couple of decades ago, when the discovery of neural precursor cells in the sub-ventricular zone (SVZ) and other regions shattered the dogma [1–4].
    [Show full text]
  • The Impact of Biosimilar Competition in Europe December 2020
    White Paper The Impact of Biosimilar Competition in Europe December 2020 PER TROEIN, Vice President, Strategic Partners, IQVIA MAX NEWTON, Senior Consultant, Global Supplier & Association Relations, IQVIA KIRSTIE SCOTT, Analyst, Global Supplier & Association Relations, IQVIA Table of contents Introduction 1 Key observations 2 Methodology 11 Country and therapy area KPIs 14 Human growth hormone (HGH) 14 Epoetin (EPO) 16 Granulocyte-colony stimulating factor (GCSF) 18 Anti-tumour necrosis factor (ANTI-TNF) 20 Fertility (FOLLITROPIN ALFA) 22 Insulins 24 Oncology 26 Low-molecular-weight heparin (LMWH) 28 Appendix 30 EMA list of approved biosimilars 30 List of Biosimilars under review by EMA 32 Introduction ‘The Impact of Biosimilar Competition in Europe’ report describes the effects on price, volume, and market share following the arrival of biosimilar competition in Europe. The report consists of: observations on competitive markets, and a set of Key Performance Indicators (KPIs) to monitor the impact of biosimilars in 23 European markets. The report has been a long-standing source of information on the status of the biosimilars market. This iteration has been delayed due to the COVID-19 pandemic across the globe and has provided an opportunity to provide full-year 2019 data, and an additional data point (June 2020 MAT) which incorporates the impact on patients in Europe across major therapeutic areas to 30th June 2020. The direct impact of which is visible in the Low Molecular Weight Heparin (LMWH), and Fertility (somatropin) markets. This report has been prepared by IQVIA at the The European Medicines Agency (EMA) has a central request of the European Commission services with role in setting the rules for biosimilar submissions, initial contributions on defining the KPIs from EFPIA, approving applications, establishing approved Medicines for Europe, and EuropaBio.
    [Show full text]
  • Sargramostim (Leukine) Reference Number: CP.PHAR.295 Effective Date: 12/16 Coding Implications Last Review Date: 10/16 Revision Log
    Clinical Policy: Sargramostim (Leukine) Reference Number: CP.PHAR.295 Effective Date: 12/16 Coding Implications Last Review Date: 10/16 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description The intent of the criteria is to ensure that patients follow selection elements established by Centene® clinical policy for sargramostim (Leukine® injection, for subcutaneous or intravenous use). Policy/Criteria It is the policy of health plans affiliated with Centene Corporation® that Leukine is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Acute Myeloid Leukemia (must meet all): 1. Leukine is prescribed for use following induction therapy for acute myeloid leukemia (AML); 2. Member has none of the following contraindications: a. Excessive leukemic myeloid blasts in the bone marrow/peripheral blood (≥ 10%); b. Known hypersensitivity to granulocyte-macrophage colony stimulating factor (GM-CSF), yeast-derived products or any component of the product; c. Concomitant use with chemotherapy/radiotherapy. Approval duration: 6 months B. Peripheral Blood Progenitor Cell Collection and Transplantation (must meet all): 1. Leukine is prescribed for either of the following: a. Mobilization of autologous hematopoietic progenitor cells into the peripheral blood for collection by leukapheresis in anticipation of transplantation after myeloablative chemotherapy; b. Following myeloablative chemotherapy and transplantation of autologous hematopoietic progenitor cells; 2. Member has none of the following contraindications: a. Excessive leukemic myeloid blasts in the bone marrow/ peripheral blood (≥ 10%); b. Known hypersensitivity to GM-CSF, yeast-derived products or any component of the product; c. Concomitant use with chemotherapy/radiotherapy. Approval duration: 6 months C.
    [Show full text]
  • Autoimmune Pulmonary Alveolar Proteinosis in an Adolescent Successfully Treated with Inhaled Rhgm-CSF
    Respiratory Medicine Case Reports 23 (2018) 167–169 Contents lists available at ScienceDirect Respiratory Medicine Case Reports journal homepage: www.elsevier.com/locate/rmcr Case report Autoimmune pulmonary alveolar proteinosis in an adolescent successfully T treated with inhaled rhGM-CSF (molgramostim) ∗ Marta E. Gajewskaa, , Sajitha S. Sritharana, Eric Santoni-Rugiub, Elisabeth M. Bendstrupa a Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Denmark b Department of Pathology, Copenhagen University Hospital, Denmark ARTICLE INFO ABSTRACT Keywords: Autoimmune pulmonary alveolar proteinosis (aPAP) is a rare parenchymal lung disease characterized by ac- Pulmonary alveolar proteinosis cumulation of surfactant in the airways with high levels of granulocyte-macrophage colony stimulating factor Granulocyte-macrophage colony-stimulating (GM-CSF) antibodies in blood. Disease leads to hypoxemic respiratory failure. Whole lung lavage (WLL) is factor considered the first line therapy, but procedure can be quite demanding, specifically for children. Recently GM-SCF alternative treatment options with inhaled GM-CSF have been described but no consensus about the standard Molgramostim treatment exists. We here describe a unique case of a 14-year-old patient who was successfully treated with WLL Inhalation therapy and subsequent inhalations with molgramostim – new recombinant human GM-CSF (rhGM-CSF). 1. Introduction eosinophilic on hematoxylin-and eosin staining (HE) and positive with the periodic acid-Schiff stain and diastase-resistant (PAS + D), which is Pulmonary alveolar proteinosis (PAP) is a rare parenchymal lung considered characteristic for PAP (Fig. 2). Blood assays showed ele- disease characterized by accumulation of surfactant in the airways that vated high levels of GM-CSF antibodies. There was no suspicion of leads to hypoxemic respiratory failure [1–3].
    [Show full text]
  • Leukine® (Sargramostim)
    Leukine® (sargramostim) (Subcutaneous/Intravenous) Document Number: MODA-0237 Last Review Date: 04/06/2021 Date of Origin: 10/17/2008 Dates Reviewed: 06/2009, 12/2009, 06/2010, 07/2010, 09/2010, 12/2010, 03/2011, 06/2011, 09/2011, 12/2011, 03/2012, 06/2012, 09/2012, 12/2012, 03/2013, 06/2013, 09/2013, 12/2013, 03/2014, 06/2014, 09/2014, 12/2014, 03/2015, 05/2015, 08/2015, 11/2015, 02/2016, 05/2016, 08/2016, 11/2016, 02/2017, 05/2017, 08/2017, 11/2017, 02/2018, 05/2018, 04/2019, 04/2020, 04/2021 I. Length of Authorization High Risk Neuroblastoma: − When used in combination with dinutuximab, coverage will be provided for five months and may not be renewed. − When used in combination with naxitamab, coverage will be provided for six months and may be renewed. All other indications: Coverage will be provided for four months and may be renewed. II. Dosing Limits A. Quantity Limit (max daily dose) [NDC Unit]: − Leukine 250 mcg vial: 28 vials per 14 days − Leukine 500 mcg vial: 14 vials per 14 days B. Max Units (per dose and over time) [HCPCS Unit]: • 15 billable units per day (acute radiation syndrome) • 10 billable units per day on days 1 through 14 of cycles 1, 3 and 5 (cycle length is 24 days) for a maximum of 5 cycles only (high-risk neuroblastoma in combination with dinutuximab) • 10 billable units per day for 10 days of each 28-day cycle for six cycles followed by subsequent cycles every 8 weeks thereafter (high-risk neuroblastoma in combination with naxitamab) • 10 billable units per day (all other indications) 1-11 III.
    [Show full text]
  • Colony Stimulating Factors Medical Policy
    Medical benefit drug policies are a source for BCBSM and BCN medical policy information only. These documents are not to be used to determine benefits or reimbursement. Please reference the appropriate certificate or contract for benefit information. This policy may be updated and therefore subject to change. Effective Date: 08/12/2021 Colony Stimulating Factors (CSFs) Fulphila™ (pegfilgrastim-jmbd) Granix® (tbo-filgrastim) Leukine® (sargramostim) Neulasta® (pegfilgrastim) Neulasta On-Pro® (pegfilgrastim) Neupogen® (filgrastim) Nivestym™ (filgrastim-aafi) Nyvepria™ (pegfilgrastim-apgf) Udenyca™ (pegfilgrastim-cbqv) Zarxio® (filgrastim-sndz) ZiextenzoTM (pegfilgrastim-bmez) FDA approval: Various HCPCS: Fulphila – J3490, Granix – J1447, Leukine – J2820, Neupogen – J1442, Neulasta – J2505, Nivestym J3490, Nyvepria - Q5122, Udenyca – Q5111, Zarxio – J3490, Zietxenzo – Q5120, C9058 Benefit: Both Policy: Requests must be supported by submission of chart notes and patient specific documentation. A. Coverage of the requested drug is provided for FDA approved indications and when all the following are met: a. Primary prophylaxis of chemotherapy-induced febrile neutropenia is considered clinically appropriate when ALL of the following are met: i. The individual has a non-myeloid malignancy ii. Chemotherapy intent must include one of the following: 1. Curative intent (adjuvant treatment for early stage disease, for example) OR 2. Intent is survival prolongation, and the use of a different regimen or dose reduction would reduce the likelihood of
    [Show full text]
  • Lenograstim and Filgrastim in the Febrile Neutropenia Prophylaxis Open Access to Scientific and Medical Research DOI
    Journal name: Journal of Blood Medicine Article Designation: Original Research Year: 2019 Volume: 10 Journal of Blood Medicine Dovepress Running head verso: Innocenti et al Running head recto: Lenograstim and filgrastim in the febrile neutropenia prophylaxis open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JBM.S186786 Open Access Full Text Article ORIGINAL RESEARCH Lenograstim and filgrastim in the febrile neutropenia prophylaxis of hospitalized patients: efficacy and cost of the prophylaxis in a retrospective survey Rolando Innocenti,1 Purpose: We conducted a retrospective study to evaluate the efficacy and related costs of Luigi Rigacci,1,2 Umberto using two different molecules of granulocyte-colony stimulating factor (G-CSF) (lenograstim Restelli,3,4 Barbara – LENO or filgrastim – FIL) as primary prophylaxis of chemotherapy-induced neutropenia in Scappini,1 Giacomo a hematological inpatient setting. Gianfaldoni,1 Rosa Fanci,1 Methods: The primary endpoints of the analysis were the efficacy of the two G-CSFs in terms of the level of white blood cells, hemoglobin and platelets at the end of the treatment and the Francesco Mannelli,1 per capita direct medical costs related to G-CSF prophylaxis. Francesca Scolari,3 For personal use only. Two hundred twelve patients (96 LENO, 116 FIL) have been evaluated. The follow- 3,4 Results: Davide Croce, Erminio ing statistically significant differences have been observed between FIL and LENO: the use of 5 6 Bonizzoni, Tania Perrone, a higher number of vials (11 vs 7; P<0.03) to fully recover bone marrow, a higher grade 3–4 1 Alberto Bosi neutropenia at the time of G-CSF discontinuation (29.3% vs 16.7%; P=0.031) and an increased 1Hematology Department, University number of days of hospitalization (8 vs 5; P<0.005).
    [Show full text]
  • Role of Cytokines As a Double-Edged Sword in Sepsis
    in vivo 27: 669-684 (2013) Review Role of Cytokines as a Double-edged Sword in Sepsis HINA CHAUDHRY1, JUHUA ZHOU2,3, YIN ZHONG2, MIR MUSTAFA ALI1, FRANKLIN MCGUIRE1, PRAKASH S. NAGARKATTI2 and MITZI NAGARKATTI2 1Division of Pulmonary and Critical Care Medicine, and 2Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, SC, U.S.A.; 3Institute for Tumor Immunology, Ludong University School of Life Sciences, Yantai, Shandong, P.R. China Abstract. Background: Sepsis is a deadly immunological results from imbalances in the inflammatory network (1). disorder and its pathophysiology is still poorly understood. Sepsis is exhibited as a whole-body or a systemic We aimed to determine if specific pro-inflammatory and anti- inflammatory response syndrome (SIRS), in the presence of inflammatory cytokines can be used as diagnostic and a known or suspected infection. It becomes severe following therapeutic targets for sepsis. Materials and Methods: organ dysfunction, which results from low blood pressure, or Recent publications in the MEDLINE database were insufficient blood flow to one or more organs due to lactic searched for articles regarding the clinical significance of acidosis, reduced urine production and altered mental status. inflammatory cytokines in sepsis. Results: In response to Severe sepsis is defined as sepsis with organ dysfunction pathogen infection, pro-inflammatory cytokines [interleukin- including hypotension (<90 mmHg or a reduction of 6 (IL-6), IL-8, IL-18 and tumor necrosis factor-α (TNF-α)] ≥40 mmHg from baseline), hypoxemia, oliguria, metabolic and anti-inflammatory cytokine (IL-10) increased in patients acidosis, thrombocytopenia and obtundation (2).
    [Show full text]
  • Leukine (Sargramostim)
    US License 1752 Leukine (sargramostim) A Recombinant GM-CSF–Yeast-Expressed Rx only DESCRIPTION ® LEUKINE (sargramostim) is a recombinant human granulocyte-macrophage colony stimulating factor (rhu GM-CSF) produced by recombinant DNA technology in a yeast (S. cerevisiae) expression system. GM-CSF is a hematopoietic growth factor which stimulates proliferation and differentiation of hematopoietic progenitor cells. LEUKINE is a glycoprotein of 127 amino acids characterized by three primary molecular species having molecular masses of 19,500, 16,800 and 15,500 daltons. The amino acid sequence of LEUKINE differs from the natural human GM-CSF by a substitution of leucine at position 23, and the carbohydrate moiety may be different from the native protein. Sargramostim has been selected as the proper name for yeast-derived rhu GM-CSF. The liquid LEUKINE presentation is formulated as a sterile, preserved (1.1% benzyl alcohol), injectable solution (500 mcg/mL) in a vial. Lyophilized LEUKINE is a sterile, white, preservative-free powder (250 mcg) that requires reconstitution with 1 mL Sterile Water for Injection, USP or 1 mL Bacteriostatic Water for Injection, USP. Liquid LEUKINE has a pH range of 6.7 - 7.7 and lyophilized LEUKINE has a pH range of 7.1 ­ 7.7. Liquid LEUKINE and reconstituted lyophilized LEUKINE are clear, colorless liquids suitable for subcutaneous injection (SC) or intravenous infusion (IV). Liquid LEUKINE 6 contains 500 mcg (2.8 x 10 IU/mL) sargramostim and 1.1% benzyl alcohol in a 1 mL 6 solution. The vial of lyophilized LEUKINE contains 250 mcg (1.4 x 10 IU/vial) sargramostim.
    [Show full text]
  • New Therapeutic Options in the Medical Management of Advanced Melanoma Jose Lutzky, MD, FACP
    New Therapeutic Options in the Medical Management of Advanced Melanoma Jose Lutzky, MD, FACP During the past 3 decades, the incidence, morbidity, and mortality of malignant melanoma have increased dramatically. Advanced melanoma has remained a disease that is for the most part incurable and has challenged all therapeutic efforts to make a dent in its natural history. Recent advances in the understanding of the molecular alterations in melanoma and in the immunologic mechanisms playing a role in this malignancy have brought hope that significant progress can be achieved, as evidenced by early encouraging clinical data. This review will summarize these recent developments and their impact on current clinical practice. Semin Cutan Med Surg 29:249-257 © 2010 Elsevier Inc. All rights reserved. lthough current epidemiologic data suggest decreasing have demonstrated initial positive results, triggering renewed Aincidence trends for a variety of malignancies, the inci- excitement to pursue clinical investigations in melanoma. dence and mortality of malignant melanoma appear to be This concise review will focus on some of these new para- increasing. For 2009 the American Cancer Society estimated digms and their current application in the treatment of mel- 68,720 new cases in the United States, with 8650 deaths.1 anoma. Although surgery remains the primary treatment of Unless detected at an early stage in patients, melanoma re- early melanoma and an important modality in the manage- mains difficult to treat effectively. Approved treatment for ment of advanced melanoma, the many controversies in sur- patients with locally advanced disease and at high-risk of gical management are out of the scope of this article, which recurrence is toxic and of limited benefit.2,3 The treatment of will concentrate on nonsurgical treatment of advanced dis- distant metastatic disease has been similarly frustrating, with ease.
    [Show full text]