Targeting the hepcidin-ferroportin pathway in anaemia of chronic kidney disease
Matthew Sheetz, Philip Barrington, Sophie Callies, Paul H Berg, Juliet McColm, Thomas Marbury, Brian Decker, Gregory L Dyas, Stephanie M E Truhlar, Robert Benschop, Donmienne Leung, Jolene Berg, Derrick R Witcher, Matthew Sheetz, Philip Barrington, Sophie Callies, Paul H Berg, Juliet McColm, Thomas Marbury, Brian Decker, Gregory L Dyas, Stephanie M E Truhlar, Robert Benschop, Donmienne Leung, Jolene Berg, Derrick R Witcher
Abstract
Aims: Erythropoiesis-stimulating agents used to treat anaemia in patients with chronic kidney disease (CKD) have been associated with cardiovascular adverse events. Hepcidin production, controlled by bone morphogenic protein 6 (BMP6), regulates iron homeostasis via interactions with the iron transporter, ferroportin. High hepcidin levels are thought to contribute to increased iron sequestration and subsequent anaemia in CKD patients. To investigate alternative therapies to erythropoiesis-stimulating agents for CKD patients, monoclonal antibodies, LY3113593 and LY2928057, targeting BMP6 and ferroportin respectively, were tested in CKD patients.
Methods: Preclinical in vitro/vivo data and clinical data in healthy subjects and CKD patients were used to illustrate the translation of pharmacological properties of LY3113593 and LY2928057, highlighting the novelty of targeting these nodes within the hepcidin-ferroportin pathway.
Results: LY2928057 bound ferroportin and blocked interactions with hepcidin, allowing iron efflux, leading to increased serum iron and transferrin saturation levels and increased hepcidin in monkeys and humans. In CKD patients, LY2928057 led to slower haemoglobin decline and reduction in ferritin (compared to placebo). Serum iron increase was (mean [90% confidence interval]) 1.98 [1.46-2.68] and 1.36 [1.22-1.51] fold-relative to baseline following LY2928057 600 mg and LY311593 150 mg respectively in CKD patients. LY3113593 specifically blocked BMP6 binding to its receptor and produced increases in iron and transferrin saturation and decreases in hepcidin preclinically and clinically. In CKD patients, LY3113593 produced an increase in haemoglobin and reduction in ferritin (compared to placebo).
Conclusion: LY3113593 and LY2928057 pharmacological effects (serum iron and ferritin) were translated from preclinical-to-clinical development. Such interventions may lead to new CKD anaemia treatments.
Trial registration: ClinicalTrials.gov NCT01330953 NCT01991483 NCT02144285 NCT02604160.
Keywords: chronic kidney disease; immunoglobulins; transport.
Conflict of interest statement
D.R.W. is an employee and shareholder of Eli Lilly and Company and is the holder of the issued patent US 8183346, Anti‐Ferroportin 1 Monoclonal Antibodies and Uses Thereof. M.S. is a shareholder of Eli Lilly and Company and at the time this work was performed, was an employee of Eli Lilly and Company. P.B. is an employee and shareholder of Eli Lilly and Company. S.C. is an employee and shareholder of Eli Lilly and Company. P.H.B. is an employee and shareholder of Eli Lilly and Company. J.M. was a shareholder and employee of Eli Lilly and Company at the time this work was performed. T.M. is an employee and equity owner of Orlando Clinical Research Center that received a grant from Eli Lilly and Company and contracted to conduct the study protocol. B.D. has declared that no conflict of interest exists. G.L.D. is an employee and shareholder of Eli Lilly and Company, a shareholder of Amgen Inc. and is the holder of the issued patent WO 2009094551 A1 – Ferroportin Antibodies and Methods of Use licensed with Amgen Inc. with no knowing licensing or royalties. S.M.E.T. is an employee and shareholder of Eli Lilly and Company and holds the issued patents for US 8795665 and US 8980582. R.B. is an employee and shareholder of Eli Lilly and Company. D.L. is an employee and shareholder of Eli Lilly and Company and holds the issued patents for US 8183346 and US 8679497. J.B. is an employee of DaVita Clinical Research that received a grant from Eli Lilly and Company and Lilly contracted with DaVita Clinical Research to conduct the study protocol. Related specialties: Hematology, nephrology.
© 2019 The British Pharmacological Society.
Figures
Source: PubMed