A Next-Generation Therapeutic for Treatment of TNFα-mediated Inflammatory Diseases

项目总结 炎症性肠病(IBD)、克罗恩病(CD)和溃疡性结肠炎(UC)都是令人衰弱的疾病， 困扰着大约1.3%的美国人口。批准的抗肿瘤坏死因子α生物制品阻断肿瘤坏死因子α引起的炎症 对于许多患者来说，这是一种有效的IBD治疗方法。然而，由于抗药物抗体而导致的疗效丧失 (ADAS)和严重感染等毒性通常会导致停用抗肿瘤坏死因子α生物制品。 我们已经开发出一种稳定的、抗蛋白酶的、抗肿瘤坏死因子α的D-肽，DBT178，它的设计是为了 口服，并原封不动地输送到IBD特有的炎症部位的胃肠道(GI)。其他治疗方法 由其他赞助商评估的候选人已经证明了口服抗病毒药物的活动证据 炎症性肠病患者的肿瘤坏死因子α生物制品。然而，这些药物主要作为口服IBD治疗药物并不可行。 由于低效性和对胃肠道蛋白水解酶的敏感性，对剂量的要求很高。 DBT178是通过镜像技术发现的一种8 kDa的高效、特异的抗肿瘤坏死因子αD-肽 噬菌体展示。多项体外试验表明，DBT178的效力明显高于 阿达利单抗(HUMIRA®)阻断肿瘤坏死因子α配体：受体结合和肿瘤坏死因子α介导的细胞杀伤 与由L氨基酸组成的自然肽不同，D-肽由镜像D-氨基酸组成 酸是其天然对映体的对映体。蛋白水解酶，包括那些在 Gut，已知具有手性特异性，因此D-肽对蛋白水解酶表现出显著的稳定性。在老鼠身上， 口服给药时，一种与DBT178密切相关的“模型”D-肽在大便中被完整地排出 并且没有被吸收到体循环中。因此，我们假设口服DBT178会 抑制肿瘤坏死因子α诱导的炎性肠病粘膜和粘膜下炎性反应 进入门静脉循环、全身分布或全身免疫抑制。 此外，D-肽也是最小的免疫原性，因为它们对蛋白水解性抗原具有抵抗力。 由抗原提呈细胞进行的处理，这是成功的免疫反应所必需的。预期 肠道限制和低免疫原性表明DBT178不太可能诱导抗药物抗体(ADA)或 在接受当前抗肿瘤坏死因子α生物制剂治疗的IBD患者中，约有30%的患者观察到相关的疗效丧失。 DBT178是一种很有前途的候选产品，有可能扰乱价值数十亿美元的抗肿瘤坏死因子α 治疗牛皮癣、炎症形式的关节炎、葡萄膜炎和IBD的治疗景观。为了这个 应用我们重点研究了它提供方便、肠道受限和非免疫原性口服的潜力 目前批准的抗肿瘤坏死因子α肠外生物制品的替代品。 在这份提案中，我们申请资金来制造和配制非GMP批次的DBT178，特征 在模拟胃液和肠液中的稳定性和活性，并评价其药代动力学和胃肠道组织 对小鼠口服时的渗透性。我们还将鉴定其在非人类灵长类动物中的免疫原性。

PROJECT SUMMARY Inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are debilitating disorders that afflict ~1.3% of the U.S. population. Blockade of TNFα-driven inflammation with approved anti-TNFα biologics has been an effective IBD treatment for many patients. However, loss of efficacy due to anti-drug antibodies (ADAs) and toxicities such as serious infections often lead to discontinuation of anti-TNFα biologics. We have developed a stable, protease-resistant, anti-TNFα D-peptide, DBT178, that is designed to be taken orally and delivered intact to gastrointestinal (GI) sites of inflammation characteristic of IBD. Other therapeutic candidates evaluated by other sponsors have already demonstrated proof of activity for orally administered anti- TNFα biologics in IBD patients. However, these agents have not been feasible as oral IBD therapeutics primarily due to high dosing requirements resulting from low potency and sensitivity to GI proteases. DBT178 is an ~8 kDa highly potent and specific anti-TNFα D-peptide that was discovered via mirror-image phage display. Multiple in vitro assays have demonstrated that DBT178 is substantially more potent than adalimumab (Humira®) antibody at blocking TNFα ligand:receptor binding and TNFα-mediated cell killing. Unlike natural peptides composed of L-amino acids, D-peptides are composed of mirror-image D-amino acids and are the enantiomers of their natural counterparts. Proteolytic enzymes, including those found in the gut, are known to exhibit chiral specificity, thus D-peptides demonstrate remarkable stability to proteases. In rats, when administered by oral gavage, a “model” D-peptide closely related to DBT178 was excreted intact in stool and was not absorbed into systemic circulation. Therefore, we hypothesize that orally administered DBT178 will inhibit TNFα -induced mucosal and submucosal inflammation characteristic of IBD without associated absorption into the portal circulation, systemic distribution, or systemic immunosuppression. Furthermore, D-peptides are also minimally immunogenic since they are resistant to the proteolytic antigen processing carried out by antigen presenting cells that is necessary for successful immune responses. Expected gut restriction and low immunogenicity suggest that DBT178 is unlikely to induce anti-drug antibodies (ADA) or the associated loss of efficacy observed in ~30% of IBD patients treated with current anti-TNFα biologics. DBT178 is a promising product candidate with the potential to disrupt the multi-billion-dollar anti-TNFα therapeutics landscape for treatment of psoriasis, inflammatory forms of arthritis, uveitis and IBD. For this application we have focused on its potential to provide a convenient, gut restricted and non-immunogenic oral alternative to the currently approved anti-TNFα parenteral biologics. In this proposal, we request funding to manufacture and formulate a non-GMP batch of DBT178, characterize its stability and activity in simulated gastric and intestinal fluids, and assess its pharmacokinetics and GI tissue penetration when given orally to mice. We will also characterize its immunogenicity in non-human primates.