Browsing by Subject "Drug Discovery"
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Item Open Access A new trial design to accelerate tuberculosis drug development: the Phase IIC Selection Trial with Extended Post-treatment follow-up (STEP).(BMC Med, 2016-03-23) Phillips, Patrick PJ; Dooley, Kelly E; Gillespie, Stephen H; Heinrich, Norbert; Stout, Jason E; Nahid, Payam; Diacon, Andreas H; Aarnoutse, Rob E; Kibiki, Gibson S; Boeree, Martin J; Hoelscher, MichaelBACKGROUND: The standard 6-month four-drug regimen for the treatment of drug-sensitive tuberculosis has remained unchanged for decades and is inadequate to control the epidemic. Shorter, simpler regimens are urgently needed to defeat what is now the world's greatest infectious disease killer. METHODS: We describe the Phase IIC Selection Trial with Extended Post-treatment follow-up (STEP) as a novel hybrid phase II/III trial design to accelerate regimen development. In the Phase IIC STEP trial, the experimental regimen is given for the duration for which it will be studied in phase III (presently 3 or 4 months) and patients are followed for clinical outcomes of treatment failure and relapse for a total of 12 months from randomisation. Operating characteristics of the trial design are explored assuming a classical frequentist framework as well as a Bayesian framework with flat and sceptical priors. A simulation study is conducted using data from the RIFAQUIN phase III trial to illustrate how such a design could be used in practice. RESULTS: With 80 patients per arm, and two (2.5 %) unfavourable outcomes in the STEP trial, there is a probability of 0.99 that the proportion of unfavourable outcomes in a potential phase III trial would be less than 12 % and a probability of 0.91 that the proportion of unfavourable outcomes would be less than 8 %. With six (7.5 %) unfavourable outcomes, there is a probability of 0.82 that the proportion of unfavourable outcomes in a potential phase III trial would be less than 12 % and a probability of 0.41 that it would be less than 8 %. Simulations using data from the RIFAQUIN trial show that a STEP trial with 80 patients per arm would have correctly shown that the Inferior Regimen should not proceed to phase III and would have had a high chance (0.88) of either showing that the Successful Regimen could proceed to phase III or that it might require further optimisation. CONCLUSIONS: Collection of definitive clinical outcome data in a relatively small number of participants over only 12 months provides valuable information about the likelihood of success in a future phase III trial. We strongly believe that the STEP trial design described herein is an important tool that would allow for more informed decision-making and accelerate regimen development.Item Open Access AI is a viable alternative to high throughput screening: a 318-target study.(Scientific reports, 2024-04) Atomwise AIMS ProgramHigh throughput screening (HTS) is routinely used to identify bioactive small molecules. This requires physical compounds, which limits coverage of accessible chemical space. Computational approaches combined with vast on-demand chemical libraries can access far greater chemical space, provided that the predictive accuracy is sufficient to identify useful molecules. Through the largest and most diverse virtual HTS campaign reported to date, comprising 318 individual projects, we demonstrate that our AtomNet® convolutional neural network successfully finds novel hits across every major therapeutic area and protein class. We address historical limitations of computational screening by demonstrating success for target proteins without known binders, high-quality X-ray crystal structures, or manual cherry-picking of compounds. We show that the molecules selected by the AtomNet® model are novel drug-like scaffolds rather than minor modifications to known bioactive compounds. Our empirical results suggest that computational methods can substantially replace HTS as the first step of small-molecule drug discovery.Item Open Access Harnessing calcineurin-FK506-FKBP12 crystal structures from invasive fungal pathogens to develop antifungal agents.(Nature communications, 2019-09) Juvvadi, Praveen R; Fox, David; Bobay, Benjamin G; Hoy, Michael J; Gobeil, Sophie MC; Venters, Ronald A; Chang, Zanetta; Lin, Jackie J; Averette, Anna Floyd; Cole, D Christopher; Barrington, Blake C; Wheaton, Joshua D; Ciofani, Maria; Trzoss, Michael; Li, Xiaoming; Lee, Soo Chan; Chen, Ying-Lien; Mutz, Mitchell; Spicer, Leonard D; Schumacher, Maria A; Heitman, Joseph; Steinbach, William JCalcineurin is important for fungal virulence and a potential antifungal target, but compounds targeting calcineurin, such as FK506, are immunosuppressive. Here we report the crystal structures of calcineurin catalytic (CnA) and regulatory (CnB) subunits complexed with FK506 and the FK506-binding protein (FKBP12) from human fungal pathogens (Aspergillus fumigatus, Candida albicans, Cryptococcus neoformans and Coccidioides immitis). Fungal calcineurin complexes are similar to the mammalian complex, but comparison of fungal and human FKBP12 (hFKBP12) reveals conformational differences in the 40s and 80s loops. NMR analysis, molecular dynamic simulations, and mutations of the A. fumigatus CnA/CnB-FK506-FKBP12-complex identify a Phe88 residue, not conserved in hFKBP12, as critical for binding and inhibition of fungal calcineurin. These differences enable us to develop a less immunosuppressive FK506 analog, APX879, with an acetohydrazine substitution of the C22-carbonyl of FK506. APX879 exhibits reduced immunosuppressive activity and retains broad-spectrum antifungal activity and efficacy in a murine model of invasive fungal infection.Item Open Access HIV-1 envelope gp41 broadly neutralizing antibodies: hurdles for vaccine development.(PLoS Pathog, 2014-05) Verkoczy, Laurent; Kelsoe, Garnett; Haynes, Barton FItem Open Access Human endotoxin administration as an experimental model in drug development.(Clin Pharmacol Ther, 2014-10) Suffredini, AF; Noveck, RJLinking human physiology to inflammatory mechanisms discovered in vitro or in animal models is essential to determine their importance. Innate immunity underlies many of these inflammatory responses in health and disease. Bacterial endotoxin is the quintessential trigger of innate immune responses. When administered to humans, endotoxin has been an important means of demonstrating key inflammatory mechanisms in vivo. Furthermore, endotoxin challenges have provided opportunities to test the effects of novel inflammation-modifying agents in humans.Item Open Access Impact of economic, regulatory, and patent policies on innovation in cancer chemoprevention.(Cancer Prev Res (Phila), 2008-07) Moe, Jeffrey LChemoprevention agents are an emerging new scientific area that holds out the promise of delaying or avoiding a number of common cancers. These new agents face significant scientific, regulatory, and economic barriers, however, which have limited investment in their research and development (R&D). These barriers include above-average clinical trial scales, lengthy time frames between discovery and Food and Drug Administration approval, liability risks (because they are given to healthy individuals), and a growing funding gap for early-stage candidates. The longer time frames and risks associated with chemoprevention also cause exclusivity time on core patents to be limited or subject to significant uncertainties. We conclude that chemoprevention uniquely challenges the structure of incentives embodied in the economic, regulatory, and patent policies for the biopharmaceutical industry. Many of these policy issues are illustrated by the recently Food and Drug Administration-approved preventive agents Gardasil and raloxifene. Our recommendations to increase R&D investment in chemoprevention agents include (a) increased data exclusivity times on new biological and chemical drugs to compensate for longer gestation periods and increasing R&D costs; chemoprevention is at the far end of the distribution in this regard; (b) policies such as early-stage research grants and clinical development tax credits targeted specifically to chemoprevention agents (these are policies that have been very successful in increasing R&D investment for orphan drugs); and (c) a no-fault liability insurance program like that currently in place for children's vaccines.Item Embargo Investigation of Heat Shock Protein 90 in Plasmodium Parasites(2024) Mansfield, Christopher RockyMalaria is an infectious disease caused by apicomplexan Plasmodium species. These protozoan parasites are transmitted by a mosquito vector to a human host, wherein they undergo an asymptomatic liver stage followed by a symptomatic blood stage of infection. Despite eradication efforts, Plasmodium remain accountable for hundreds of thousands of mortalities per year, mostly caused by P. falciparum. The spreading resistance to the front-line antimalarials that broadly disrupt parasite proteostasis demands further characterization of their adaptive stress responses and novel multi-stage drug targets. This work focuses on the essential P. falciparum molecular chaperone heat shock protein 90 (PfHsp90). Specifically, PfHsp90 is expected to directly interact with a subset of parasite proteins to facilitate their ATP-dependent maturation, stabilization, and regulation. Despite this critical function, the scope of its chaperoning interactions—as well as its consequent contributions to mitigate cellular stress and maintain parasite proteome integrity throughout development—remains largely unresolved. To enable its functional interrogation, we first aimed to establish chemical inhibitors of PfHsp90 with greater affinity to the parasite compared to the conserved human homolog (HsHsp90). In general, our testing supports the particular utility of compounds that bind at the chaperone’s nucleotide-binding domain, as opposed to a putative C-terminal allosteric site, based on their high affinity and resolved mode of ATP-competitive inhibition. From this class of competitive inhibitors, we identified XL888 as exhibiting moderate selectivity to PfHsp90, despite that it was initially developed as a HsHsp90 inhibitor. Subsequent structural evaluation indicated that the PfHsp90 lid subdomain contributes to the parasite chaperone’s higher affinity interaction with XL888’s tropane scaffold. Considering this molecular basis, we were able to develop Tropane 1 as a novel XL888 analog with nanomolar affinity and approximately 10-fold selectivity to PfHsp90, which further demonstrated dual-stage, anti-Plasmodium activity. We next surveyed the PfHsp90-dependent proteome using innovative chemical biology strategies. Based on their thermal stability after chaperone inhibition, we identified 50 candidates as putative PfHsp90 interactors. A significant enrichment of proteasome regulatory particle components was represented in this analysis, from which we subsequently validated that PfHsp90 chaperones the 26S proteasome to support the controlled recycling of cellular proteins. Additionally, we adopted bio-orthogonal labeling with unnatural amino acids to track proteome dynamics in Plasmodium parasites. To date, we have implemented this approach to support that compromised PfHsp90 activity coordinates translation attenuation as a stress response. However, this work sets the foundation to employ such labeling to quantify PfHsp90-coordinated proteome dynamics across multiple parasite life stages. Collectively, these findings broaden our understanding of PfHsp90’s regulation of Plasmodium parasite proteostasis and further establish the potential of this molecular chaperone as a novel, multi-stage antimalarial drug target.
Item Open Access Priorities for the Priority Review Voucher.(Am J Trop Med Hyg, 2017-01-11) Ridley, David BThe U.S. Congress created the priority review voucher program in 2007 to encourage development of drugs for neglected diseases. Under the voucher program, the developer of a drug for a neglected or rare pediatric disease that is approved by the U.S. Food and Drug Administration receives a bonus priority review voucher for another drug. As of 2016, four vouchers have sold for an average price of $200 million. Recent experience with the voucher program indicates strengths and weaknesses of the program, as well as a need for legislative changes.Item Unknown Targeting the SUMO pathway for neuroprotection in brain ischaemia.(Stroke and vascular neurology, 2016-09) Yang, Wei; Sheng, Huaxin; Wang, HaichenSmall ubiquitin-like modifier (SUMO) conjugation (SUMOylation) is a post-translational protein modification that modulates almost all major cellular processes, and has been implicated in many human diseases. A growing body of evidence from in vitro and in vivo studies demonstrates that increasing global levels of SUMO conjugated proteins (global SUMOylation) protects cells against ischaemia-induced damage, while suppressing global SUMOylation promotes cell injury after ischaemia. Indeed, SUMOylation has emerged as a potential therapeutic target for neuroprotection in brain ischaemia, including global brain ischaemia and focal brain ischaemia (ischaemic stroke). Here, we summarise findings on the role of SUMOylation in human diseases, brain ischaemia in particular, and review recent developments in drug discovery targeting SUMOylation with a major focus on its neuroprotective applications.Item Unknown The cost of drug development.(N Engl J Med, 2015-05-14) DiMasi, Joseph A; Grabowski, Henry G; Hansen, Ronald WItem Unknown Therapeutic Development of Apolipoprotein E Mimetics for Acute Brain Injury: Augmenting Endogenous Responses to Reduce Secondary Injury.(Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, 2020-04) James, Michael L; Komisarow, Jordan M; Wang, Haichen; Laskowitz, Daniel TOver the last few decades, increasing evidence demonstrates that the neuroinflammatory response is a double-edged sword. Although overly robust inflammatory responses may exacerbate secondary tissue injury, inflammatory processes are ultimately necessary for recovery. Traditional drug discovery often relies on reductionist approaches to isolate and modulate specific intracellular pathways believed to be involved in disease pathology. However, endogenous brain proteins are often pleiotropic in order to regulate neuroinflammation and recovery mechanisms. Thus, a process of "backward translation" aims to harness the adaptive properties of endogenous proteins to promote earlier and greater recovery after acute brain injury. One such endogenous protein is apolipoprotein E (apoE), the primary apolipoprotein produced in the brain. Robust preclinical and clinical evidence demonstrates that endogenous apoE produced within the brain modulates the neuroinflammatory response of the acutely injured brain. Thus, one innovative approach to improve outcomes following acute brain injury is administration of exogenous apoE-mimetic drugs optimized to cross the blood-brain barrier. In particular, one promising apoE mimetic peptide, CN-105, has demonstrated efficacy across a wide variety of preclinical models of brain injury and safety and feasibility in early-phase clinical trials. Preclinical and clinical evidence for apoE's neuroprotective effects and downregulation of neuroinflammatory and the resulting translational therapeutic development strategy for an apoE-based therapeutic are reviewed.Item Open Access Vaccines in 2017: Closing in on a Zika virus vaccine.(Nature reviews. Immunology, 2018-02) Diamond, Michael S; Coyne, Carolyn B