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Developing long acting agonists and antagonists of glycoprotein hormones using gene fusion and gene transfer:
from bench to clinics
Prof. Fuad FaresProf. Fuad FaresUniversity of HaifaUniversity of Haifa
2nd International conference on EndocrinologyChicago
October 2014
Structure-Function studies Using site-directed
mutagenesis and gene transfer
Development of new analogs
Therapeutical Therapeutical Recombinant proteinsRecombinant proteins
1978 Human Growth 1978 Human Growth HormoneHormone
1979 Human Insulin1979 Human Insulin
The ProblemThe Problem
Cause adverse effects due to Cause adverse effects due to peak dose injectionpeak dose injection
Most therapeutic proteins are <30 Most therapeutic proteins are <30 kD and hencekD and hence::
• Are filtered out quickly by the kidneysAre filtered out quickly by the kidneys Are taken up by the liver and cleaved enzymaticallyAre taken up by the liver and cleaved enzymatically
Have to be injected frequently for optimal therapyHave to be injected frequently for optimal therapy
Success of Long-Lasting Success of Long-Lasting ProteinsProteins
PEGylationPEGylation - Interferon - Interferon (SGP/Roche)(SGP/Roche) PEGIntron/PegasysPEGIntron/Pegasys $3.2 billion in sales in 2006$3.2 billion in sales in 2006
PEGylationPEGylation - GCSF (Amgen) - GCSF (Amgen) NeulastaNeulasta $2.5 billion in sales in 2006 $2.5 billion in sales in 2006
Hyper Glycosylation Hyper Glycosylation - EPO - EPO (Amgen)(Amgen) Aranesp (DNA Modifications) Aranesp (DNA Modifications) $3.9 billion in sales in 2006 $3.9 billion in sales in 2006
Structure-Function of Structure-Function of Glycoprotein HormonesGlycoprotein Hormones
FSH FSH - Human Stimulating Hormone- Human Stimulating Hormone LHLH - Luteinizing Hormone - Luteinizing Hormone
hCGhCG - Human Chorionic Gonadotropin - Human Chorionic Gonadotropin
TSHTSH - Thyrotropin Hormone - Thyrotropin Hormone
DD
BB
CC
AATwo fertility hormones
hCG – maintains pregnancy and requires long T1/2
hLH – stimulates ovulation on a pulse mode requiring a short T1/2
Amino acid sequence of hCG & hLH is almost identical
The Technology was Created The Technology was Created By Nature During Evolution - By Nature During Evolution - the CTP the CTP ““cassettecassette””
EEThe 28 amino acid C-terminal peptide (CTP) of hCG with its 4 O-glycans does not exist in hLH
hCG
hLH
CTP
T1/2 of hCG is ~5 times longer than T1/2 of LH
Deletion of CTP from hCG
- No effect on the assembly of subunits
- No effect on receptor binding
- No effect on in vitro bioactivity
- Significantly decreased the bioactivity in vivo
NH2
NH2
Exon 3 Exon 4 Exon 2 COOH
CTPFSH Exon 2FSH Exon3FSH Exon 1 COOH
hFSH - CTP
1 -Assembly of the subunits
2- Binding to the receptor
3 -In vitro Bioactivity
4 -In vivo Bioactivity5 -Immunogenecity
1 3 10 WT4X
2.5IU
WT1X
10 IU
C
0/40/4 0/4
3/34/4
4/4
Nu
mb
er
of
ovu
late
d o
ocyt
es
0
10
30
20
40
50
Biological Biological ActivityActivity
0
10
20
30
40
50
FSH
-WT
FSH-C
TP
CHO Idl-D
E2
Pro
du
cti
on
(n
g/m
l)
FSH-C
TP
• FSH – CTP is effective in follicular stimulation
• FSH – CTP is safe
• FSH – CTP is not immunogenic
Organon - Merck
February 2, 2010 — The European Commission (EC) has approved
ELONVA (FSH-CTP) Merck Receives Positive Regulatory Opinion for European Marketing of Long-Acting CTP-Modified Fertility
Treatment ELONVA
Start Up Start Up CompanyCompany
“Enhancing the potency and
longevity of highly valuable
proteins”
CTP
Start Up CompanyStart Up Company
Public Company
• NASDAQ, Stock Exchange, NY,
USA.
• Tel-Aviv Stock Exchange, Tel-
Aviv, Israel.
Designing Long Acting Designing Long Acting ProteinsProteins
ErythropoietinErythropoietin Growth HormoneGrowth Hormone InterferonInterferon Factors, XI & VII Factors, XI & VII Short PeptidesShort Peptides
Erythropoietin (EPO)Erythropoietin (EPO)
The most common use is in people with anemia (low blood count) related to kidney dysfunction.
N-term
C-term
3 - D Structure Analysis
Conclusion: Strands of both termini are fairly long and accessible.
Human Erythropoietin (blue) with its Receptors (cyan)
CTP EPO - cDNA CTP CTP
5’ - - 3’
TCCTCTTCC…..CTCCCACAATAASer Ser Ser …. Leu Pro Gln Term118 119 120 …. 143 144 145
hCG-CTP
ATGGGGGTG….GGGGACAGAMet Gly Val….Gly Asp Arg 1 2 3 …. 190 191 192
EPO-cDNA
Xba I Not I
Human EPO-CTP3
Haem
ato
cri
te
)ch
an
ge f
rom
base
lin
e(%
,
40
30
20
10
Days
ControlrhEPO 3 x
weekEPO-(CTP)3
rhEPO 1 x week
Human EPO-CTP3
Pharmaceutical and Pharmaceutical and Biotechnological Uses of Biotechnological Uses of
Growth HormoneGrowth Hormone
To treat children of pathologicallyshort stature
C-term
N-term
Conclusion: Both termini pointing away from the receptors and are accessible
3-D Structure Analysis
Human Growth Hormone (blue) with its Receptors (cyan)
GH CTP
1 234
AgeI BamHI
5' ' 3
TCCTCTTCC…..CTCCCACAATAASer Ser Ser …. Leu Pro Gln Term118 119 120 …. 143 144 145
ATGGGGGTG….GGGGACAGAMet Gly Val….Gly Asp Arg 1 2 3 …. 190 191 192
GH-cDNA CG-CTP
GH CTP CTP
CTP GH CTP CTP
GHCTP
GHCTP CTP
A.
B.
C.
D.
E.
Fig.1.
Biotropin 0.6mg/kg
Biotropin 1.8mg/kg
GH-LA 0.6mg/kg
GH-LA 1.8mg/kg
Time (hours)
IGF
– I
(ng
/ml)
Biological Activity in vivo
GH – (CTP)3GH – (CTP)3
Expeiments in Rehsus Monkeys Expeiments in Rehsus Monkeys and human clinical trials phase and human clinical trials phase I that GH-Long- acting is safe I that GH-Long- acting is safe and and not immunogenicnot immunogenic
GH-(CTP)3 is in human GH-(CTP)3 is in human clinical trials phase IIIclinical trials phase III
ConclusionsConclusions
Ligation of the CTP cassette geneLigation of the CTP cassette gene bearing 4 O-linked bearing 4 O-linked Oligosaccharised chains to Oligosaccharised chains to different proteins is an interesting different proteins is an interesting strategy for increasing the strategy for increasing the in vivoin vivo half-life and half-life and in vivoin vivo bioactivity bioactivity
This may allow reducing: A) Drug dose
B) Number of injections
- WT NH2 ....... Asn -X-Thr...... Asn-X-Thr...
CHO CHO
52 78
- 1 NH2 ....... Asp -X-Thr...... Asn-X-Thr...
CHO
52 78
-2 NH2 ....... Asn -X-Thr...... Asp-X-Thr...
CHO
-1+2 NH2 ....... Asp-X-Thr...... Asp-X-Thr...
52 78
TSH - WT NH2 ...... Asn-X-Thr......
CHO
52 78
23
hTSH Variants
hTSH Single ChainhTSH Single Chain
hTSH Gene Gene
N N N
hTSH
hTSH Gene Gene CTP
N o o o o N N
hTSHCTP
Expressed in CHO cells
Binds to TSH Receptor in high affinity as will as the TSH-WT
Biologically active
hTSH Single Chain
hTSH hTSH –– Single Chain Single Chain VariantsVariants
hTSH Gene Gene CTP
hTSHCTPdeg
hTSH Gene Gene CTP
N o o o o
hTSHCTP1+2
o o o o
N N
hTSH
N
Receptor Binding TSH (Mutants)Receptor Binding TSH (Mutants)
TSH variants (u/ml)
125 I
bT
SH
Bou
nd )
%(
0
20
40
60
80
100
120
0.1 1 10 100 1000 10000
dimer
bCTPa1+2
bCTPa)deg(
dimerCTP
1+2 (sc)
CTP)deg((sc)
variantvariantvaluevalue
hTSH dimer hTSH dimer WTWT
200200
hTSHhTSHCTPCTP1818
hTSHhTSHCTPCTPddegeg
100100
IC50(U/ml)
In vitro Bioactivity
0
20
40
60
80
100
0.1 1 10 100
סידרה1
סידרה2
סידרה3
CTP
CTP1+2
CTP)deg(
cAM
P(p
mol
/we l
l)cA
MP
(pm
ol/w
ell)
hTSH (hTSH (U/ml)U/ml)
TSH AntagonistT
3
(fm
o/w
ell)
hTSH(50u/ml)+hTSH variants (u/ml)
0
400
800
1200
1600
2000
0.1 1 10 100 1000
דרה2 סי
דרה3 סי
hTSH+CTP1+2
hTSH+CTP (deg)
0
40
80
120
0.1 1 10 100 1000
דרה2 סי
דרה3 סי
hTSH+CTP1+2
hTSH+CTP (deg)
cAM
P(p
mol
/wel
l)
hTSH(50u/ml)+hTSH variants (U/ml)
T3 (
fmol/
well)
hTSH(50mu/ml)+hTSH variants (U/ml)
TSI AntagonistTSI Antagonist
0
500
1000
1500
2000
2500
0.1 1 10 100 1000
דרה1 סי
דרה2 סי
hTSI+CTP1+2
T3 (fm
ol/
well)
hTSI (0.75u/ml)+hTSH variants (u/ml)
hTSI+CTPdeg(
hTSI (0.75u/ml)+hTSH variants (u/ml)
0
20
40
60
80
100
0.1 1 10 100 1000
דרה1 סי
דרה2 סי
cAM
P(p
mol
/wel
l)
hTSI+CTP1+2
hTSI+CTPdeg(
ConclusionsConclusions Deletion of the N-linked oligosaccharides from TSH resulted in partial antagonists of TSH and TSI at the level of the receptor binding site.
TSH variants may offer a novel TSH variants may offer a novel
therapeutic strategy in the treatment oftherapeutic strategy in the treatment of
hyperthyroidism and Graves’ disease.hyperthyroidism and Graves’ disease.
Prof. Zaki Kraiem Prof. Irving Boime
Prof. Aaron Hsueh
Dr. Naeil Azam Dr. Avri Havron Orit Sadeh Dr. Eyal FimaFlonia LeviRinat Alenberg Mr. Shai Novik
Dr. Sharif GanimDr.Taleb Hajoj
Clinical Advisory PanelsClinical Advisory PanelsWorld Known Opinion World Known Opinion
LeadersLeaders hGHhGH
Ron Rosenfeld, MD, StanfordRon Rosenfeld, MD, Stanford Barry Sherman, MD, Genentech, BiParBarry Sherman, MD, Genentech, BiPar Zvi Zadik, MD, Hebrew UniversityZvi Zadik, MD, Hebrew University
EPOEPO Allen Nissenson, MD, UCLAAllen Nissenson, MD, UCLA Anatole Besarab, MD, Henry Ford, DetroitAnatole Besarab, MD, Henry Ford, Detroit
Interferon-betaInterferon-beta William Mobley, MD, StanfordWilliam Mobley, MD, Stanford Hillel Panitch, MD, VermontHillel Panitch, MD, Vermont Ron Milo, MD, IsraelRon Milo, MD, Israel
• National Institutes of Health (NIH)
•The Rockefeller Foundation
•United States - Israel Binational Science Foundation (BSF)
• Israel Science Foundation (ISF)
• The Israel Ministry of Science • The Israel Ministry of Industry and Trade
•Private Investors