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缺氧诱导因子脯氨酰羟化酶抑制剂罗沙司他的非临床特征:慢性肾脏病贫血的一种新治疗方法。

Nonclinical Characterization of the Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor Roxadustat, a Novel Treatment of Anemia of Chronic Kidney Disease.

机构信息

FibroGen, Inc., San Francisco, California

FibroGen, Inc., San Francisco, California.

出版信息

J Pharmacol Exp Ther. 2020 Aug;374(2):342-353. doi: 10.1124/jpet.120.265181. Epub 2020 Jun 2.


DOI:10.1124/jpet.120.265181
PMID:32487538
Abstract

Anemia of chronic kidney disease (CKD) is a multifactorial disorder caused by impaired erythropoietin (EPO) production and altered iron homeostasis associated with inflammation. Hypoxia-inducible factor (HIF) is a transcription factor that stimulates erythropoiesis via a coordinated response involving increased EPO production and enhanced iron availability for Hb synthesis. HIF degradation is regulated by HIF-prolyl hydroxylase (HIF-PH) enzymes. We hypothesized that roxadustat, an orally available small-molecule inhibitor of HIF-PH, would increase EPO production and promote erythropoiesis in animal models of anemia. In cells, roxadustat increased both HIF-1 and HIF-2 proteins, leading to an increase in EPO production, even in the presence of EPO-suppressing inflammatory cytokines. Roxadustat administered intermittently to healthy rats and cynomolgus monkeys increased circulating EPO levels, reticulocytes, blood Hb, and hematocrit in a dose-dependent manner. Roxadustat corrected anemia in a rat model of CKD after five-sixth nephrectomy and in a rat model of anemia of inflammation with impaired iron metabolism induced by peptidoglycan-polysaccharide (PG-PS). In the PG-PS model, roxadustat significantly decreased hepatic expression of hepcidin, a hormone responsible for iron sequestration and functional iron deficiency, and increased expression of two genes involved in duodenal iron absorption: divalent metal transporter 1 and duodenal cytochrome b. In conclusion, by activating the HIF pathway, roxadustat increased EPO production, elevated Hb, corrected anemia, and improved iron homeostasis. The coordinated erythropoietic response stimulated by roxadustat, involving both EPO production and mobilization of iron stores, makes this compound a promising treatment of anemia of CKD and anemia associated with functional iron deficiency. SIGNIFICANCE STATEMENT: Roxadustat is a novel orally available small-molecule inhibitor of HIF prolyl hydroxylase enzymes that reversibly stabilizes HIF-, thus activating transcription of HIF-dependent genes, including EPO and regulators of iron homeostasis. Activation of the HIF pathway by roxadustat induces erythropoiesis in healthy rats and monkeys and corrects experimentally induced anemia in rats. The coordinated erythropoietic response that increases EPO production and mobilizes iron stores makes roxadustat a promising treatment for anemia of chronic kidney disease and anemia associated with functional iron deficiency.

摘要

慢性肾脏病(CKD)相关贫血是一种由促红细胞生成素(EPO)产生受损和与炎症相关的铁稳态改变引起的多因素疾病。缺氧诱导因子(HIF)是一种转录因子,通过涉及增加 EPO 产生和增强 Hb 合成的铁可用性的协调反应来刺激红细胞生成。HIF 降解受 HIF-脯氨酰羟化酶(HIF-PH)酶的调节。我们假设罗沙司他,一种口服的 HIF-PH 小分子抑制剂,将增加 EPO 的产生,并在贫血的动物模型中促进红细胞生成。在细胞中,罗沙司他增加了 HIF-1 和 HIF-2 蛋白,导致 EPO 的产生增加,即使存在抑制 EPO 的炎症细胞因子也是如此。罗沙司他间歇性给予健康大鼠和食蟹猴,可剂量依赖性地增加循环 EPO 水平、网织红细胞、血液 Hb 和血细胞比容。罗沙司他纠正了 5/6 肾切除大鼠 CKD 模型和肽聚糖-多糖(PG-PS)诱导的铁代谢受损炎症性贫血大鼠模型中的贫血。在 PG-PS 模型中,罗沙司他显著降低了肝脏铁调素的表达,铁调素是一种负责铁隔离和功能性缺铁的激素,并增加了两个涉及十二指肠铁吸收的基因的表达:二价金属转运蛋白 1 和十二指肠细胞色素 b。总之,通过激活 HIF 通路,罗沙司他增加了 EPO 的产生,升高了 Hb,纠正了贫血,并改善了铁稳态。罗沙司他刺激的协调的红细胞生成反应,涉及 EPO 的产生和铁储存的动员,使这种化合物成为治疗 CKD 贫血和与功能性缺铁相关贫血的有前途的药物。意义陈述:罗沙司他是一种新型的、可口服的 HIF 脯氨酰羟化酶酶抑制剂,可可逆地稳定 HIF-,从而激活 HIF 依赖性基因的转录,包括 EPO 和铁稳态调节剂。罗沙司他激活 HIF 通路可诱导健康大鼠和猴子的红细胞生成,并纠正大鼠实验性诱导的贫血。增加 EPO 产生和动员铁储存的协调红细胞生成反应使罗沙司他成为治疗慢性肾脏病贫血和与功能性缺铁相关贫血的有前途的治疗方法。

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[3]
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[4]
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[5]
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[10]
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