Hideaki Nagase, Ph.D.
Kennedy Institute of Rheumatology-Centre for Degenerative Diseases, University of Oxford, UK
Osteoarthritis: diagnosis, treatment and challenges
Hideaki Nagase1, Ngee Han Lim1, George Bou-Gharios1, Ernst Meinjohanns2 and Morten Meldal3
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, London, W6 8LH UK
- Carlsberg Laboratory, Copenhagen, Denmark,
- Nano-Science Center, Department of Chemistry, University of Copenhagen, Denmark
Osteoarthritis (OA) is the most prevalent age-related degenerative joint disease. With the expanding ageing population, it imposes a major socio-economic burden on society. A key feature of OA is a gradual loss of articular cartilage and deformation of bone, resulting in the impairment of joint function. Currently, there is no effective disease-modifying treatment except joint replacement surgery. There are many possible causes of cartilage loss (e.g. mechanical load, injury, reactive oxygen species, aging, etc.) and etiological factors (obesity, genetics), but the degradation of cartilage is primarily caused by elevated levels of active metalloproteinases. It is therefore attractive to consider proteinase inhibitors as potential therapeutics. However, there are several hurdles to overcome, namely early diagnosis and continuous monitoring of the efficacy of inhibitor therapeutics. We are therefore aiming at developing non-invasive probes to detect cartilage degrading metalloproteinase activities.
We have designed in vivo imaging probes to detect MMP-13 (collagenase 3) activity that participates in OA by degrade cartilage collagen II and MMP-12 (macrophage elastase) activity involved in inflammatory arthritis. These activity-based probes consist of a peptide that is selectively cleaved by the target proteinase, a near-infrared fluorophore and a quencher. The probe’s signal multiplies upon proteolysis. They were first used to follow the respective enzyme activity in vivo in the mouse model of collagen-induced arthritis and we found MMP-12 activity probe (MMP12AP) activation peaked at 5 days after onset of the disease, whereas MMP13AP activation was observed at 10-15 days. The in vivo activation of these probes was inhibited by specific low molecule inhibitors. We proceeded to test both probes in the mouse model of OA induced by the surgical destabilization of medial meniscus of the knee joints. In this model, degradation of knee cartilage is first detected histologically 6 weeks after surgery with significant erosion detectable at 8 weeks. Little activation of MMP12AP was detected, which was expected, as macrophage migration is not obvious in OA. MMP13AP, on the other hand, was significantly activated in the operated knee at 6 weeks compared with the non-operated contralateral knee, but there were no significant differences between the operated and sham-operated knees. At 8 weeks, however, the signals in the operated knees were significantly higher than both the contralateral and sham-operated controls. Activation of aggrecanases and MMP-13 are observed before structural changes of cartilage. We are therefore currently improving the MMP-13 probe for earlier detection by attaching it to polymers that are retained in cartilage.
Pradip K. Bhatnagar, Ph.D.
Former President & Head, Daiichi Sankyo Life Science Research Centre, India
Strategies for Diseases/Target Selection for Drug Discovery and a Multi-Targeted Approach to Metabolic Disorder
Drug discovery and development is a high risk and expensive undertaking. Although, technologies, such as, bioinformatics, genomics, high throughput screening and computer-aided design have helped identify targets, biomarkers, lead candidates and reduced the time required for advancing an idea from bench to clinic, but it still takes 10-12 years and costs approximately one billion dollars to bring a drug to market globally. Therefore, it is imperative that the strategies to reduce the risk and increase efficiency are carefully selected. In this presentation I would discuss strategies for selecting potential diseases, targets and provide an example of multi-targeted approach to metabolic disorder.
Suryaprakash Sambhara, DVM, Ph.D
Chief, Immunology Section, Influenza Division, CDC, Atlanta, USA
Making sense of pathogen sensors of Innate Immunity: Utility of their ligands as antiviral agents and adjuvants for vaccines.
Currently used antiviral agents act by inhibiting viral entry, replication, or release of viral progeny. However, recent emergence of drug-resistant viruses has become a major public health concern as it is limiting our ability to prevent and treat viral diseases. Furthermore, very few antiviral agents with novel modes of action are currently in development. It is well established that the innate immune system is the first line of defense against invading pathogens. The recognition of diverse pathogen-associated molecular patterns (PAMPs) is accomplished by several classes of pattern recognition receptors (PRRs) and the ligand/receptor interactions trigger an effective innate antiviral response. In the past several years, remarkable progress has been made towards understanding both the structural and functional nature of PAMPs and PRRs. As a result of their indispensable role in virus infection, these ligands have become potential pharmacological agents against viral infections. Since their pathways of action are evolutionarily conserved, the likelihood of viruses developing resistance to PRR activation is diminished. I will discuss the recent developments investigating the potential utility of the ligands of innate immune receptors as antiviral agents and molecular adjuvants for vaccines.
Kal Ramnarayan, Ph.D.
Co-founder President & Chief Scientific Officer, Sapient Discovery, San Diego, CA, USA
A cost-effective approach to Protein Structure-guided Drug Discovery: Aided by Bioinformatics, Chemoinformatics and computational chemistry
With the mapping of the human genome completed almost a decade ago, efforts are still underway to understand the gene products (i.e., proteins) in the human biological and disease pathways. Deciphering such information is very important for the discovery and development of small molecule drugs as well as protein therapeutics for various human diseases for which no cure exists. As an example, with more than 500 members, the kinase family of protein targets continues to be an important and attractive class for drug discovery. While how many of the members in this family are actually druggable is still to be established, there are several ongoing efforts on this class of proteins across a broad spectrum of disease categories. Even though in general the protein structural topology might looks similar, there are issues with respect selectivity of identified small molecule inhibitors when, the lead molecule discovery is carried out at the ATP binding site. As an added complexity, allosteric modulators are needed for some of the members, but the actual site for such modulation on the protein target can not resolved with uncertainty. In this presentation we will describe a bioinformatics and computational based platform for small molecule discovery for protein targets that are involved in protein-protein interactions as well as targets like kinases and phosphatases. We will describe a computational approach in which we have used an informatics based platform with several hundred kinases to sort through in silico and identify inhibitors that are likely to be highly selective in the lead generation phase. We will discuss the implication of this approach on the drug discovery of the kinase and phosphatase classes in general and independent of the disease category.
![Delegate Talk: A Mobile Phone Application for Daily Physical Activity Monitoring in Chronic Obstructive Pulmonary Disease @ Amriteshwari Hall | Vallikavu | Kerala | India](http://www.amritabioquest.org/conference/2013/wp-content/uploads/sites/2/2015/02/biomed.jpg)
H S M Kort, J-W J Lammers, S N W Vorrink, T Troosters
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a disabling airway disease with variable extrapulmonary effects that may contribute to disease severity in individual patients (Rabe et al. 2007). The world health organization predicts that COPD will become the third leading cause of death worldwide by 2030. Patients with COPD demonstrate reduced levels of spontaneous daily physical activity (DPA) compared with healthy controls (Pitta et al. 2005). This results in a higher risk of hospital admission and shorter survival (Pitta et al. 2006). Pulmonary rehabilitation can help to improve the DPA level, however, obtained benefits decline after 1–2 years (Foglio et al. 2007).
Purpose
In order to maintain DPA in COPD patients after rehabilitation, we developed a mobile phone application. This application measures DPA as steps per day, measured by the accelerometer of the smartphone, and shows the information to the patient via the display of the mobile phone. A physiotherapist can monitor the patient via a secure website where DPA measurements are visible for all patients. Here, DPA goals can be adjusted and text messages sent.
Method
Three pilot studies were performed with healthy students and COPD patients to test the application for usability, user friendliness and reliability with questionnaires and focus groups. Subjects also wore a validated accelerometer. For the Randomized Controlled Trial (RCT) 140 COPD patients will be recruited in Dutch physiotherapy practises. They will be randomised in an intervention group that receives the smartphone for 6 months and a control group. Measurements include lungfunction, dyspnea, and exercise capacity and are held at 0, 3, 6 and 12 months.
Results and Discussion
The application was found to be useful, easy to learn and use. Subjects had no problems with health care professionals seeing information on their physical activity performance. They do find it important to be able to determine who can see the information. Correlations between the accelerometer and the measurements on DPA of the smartphone for steps per hour were 0.69 and 0.70 for pilot studies 1 (students) and 2 (COPD patients) respectively. The version of the application in pilot study 3 contained an error, which made correlations with the accelerometer unusable. The RCT study is now being executed.
Gokul Das, Ph.D.
Co-Director, Breast Disease Site Research Group, Roswell Park Cancer Institute, Buffalo, NY
Probing Estrogen Receptor−Tumor Suppressor p53 Interaction in Cancer: From Basic Research to Clinical Trial
Tumor suppressor p53 and estrogen receptor have opposite roles in the onset and progression of breast cancer. p53 responds to a variety of cellular of stresses by restricting the proliferation and survival of abnormal cells. Estrogen receptor plays an important role in normal mammary gland development and the preservation of adult mammary gland function; however, when deregulated it becomes abnormally pro-proliferative and greatly contributes to breast tumorigenesis. The biological actions of estrogens are mediated by two genetically distinct estrogen receptors (ERs): ER alpha and ER beta. In addition to its expression in several ER alpha-positive breast cancers and normal mammary cells, ER beta is usually present in ER alpha-negative cancers including triple-negative breast cancer. In spite of genetically being wild type, why p53 is functionally debilitated in breast cancer has remained unclear. Our recent finding that ER alpha binds directly to p53 and inhibits its function has provided a novel mechanism for inactivating genetically wild type p53 in human cancer. Using a combination of proliferation and apoptosis assays, RNAi technology, quantitative chromatin immunoprecipitation (qChIP), and quantitative real-time PCR (qRT-PCR), in situ proximity ligation assay (PLA), and protein expression analysis in patient tissue micro array (TMA), we have demonstrated binding of ER alpha to p53 and have delineated the domains on both the proteins necessary for the interaction. Importantly, ionizing radiation inhibits the ER-p53 interaction in vivo both in human cancer cells and human breast tumor xenografts in mice. In addition, antiestrogenstamoxifen and faslodex/fulvestrant (ICI 182780) disrupt the ER-p53 interaction and counteract the repressive effect of ER alpha on p53, whereas 17β-estradiol (E2) enhances the interaction. Intriguingly, E2 has diametrically opposite effects on corepressor recruitment to a p53-target gene promoter versus a prototypic ERE-containing promoter. Thus, we have uncovered a novel mechanism by which estrogen could be providing a strong proliferative advantage to cells by dual mechanisms: enhancing expression of ERE-containing pro-proliferative genes while at the same time inhibiting transcription of p53-dependent anti-proliferative genes. Consistently, ER alpha enhances cell cycle progression and inhibits apoptosis of breast cancer cells. Correlating with these observations, our retrospective clinical study shows that presence of wild type p53 in ER-positive breast tumors is associated with better response to tamoxifen therapy. These data suggest ER alpha-p53 interaction could be one of the mechanisms underlying resistance to tamoxifen therapy, a major clinical challenge encountered in breast cancer patients. We have launched a prospective clinical trial to analyze ER-p53 interaction in breast cancer patient tumors at Roswell Park Cancer Institute. Our more recent finding that ER beta has opposite functions depending on the mutational status of p53 in breast cancer cells is significant in understanding the hard-to-treat triple-negative breast cancer and in developing novel therapeutic strategies against it. Our integrated approach to analyze ER-p53 interaction at the basic, translational, and clinical research levels has major implications in the diagnosis, prognosis, and treatment of breast cancer.
The global healthcare scene of which the pharmaceutical industry and its products are integral components is today at the cross roads. The high and unaffordable costs of drug research with estimates of over 1 billion dollars for every new drug discovered and developed, the very low success rates, the high degree of obsolescence due to undesirable adverse drug reactions, the decline in the development pipeline of new drugs, patent expiries leading to generic competition and the public’s disillusionment with use of chemicals for human consumption as drugs have all significantly contributed to the problems of this lifeline industry. The strategy adopted by the large R&D based Corporations to get bigger and bigger through mergers and acquisitions to improve cost-effectiveness and productivity of R&D has so far not worked effectively. Consequently, one of the recent trends in healthcare, articulated by many experts is to look for alternate or even complementary approaches to reduce the impact of rising costs of drugs on healthcare. Various new strategies for drug discovery such as the use of Natural Products especially medicinal plants are being actively pursued by healthcare planners and providers. Side by side, traditional systems of medicine whether from the oriental countries or the western nations are also having a serious relook to understand their usefulness in healthcare. To achieve its legitimate position in the healthcare scenario, it is essential to scientifically validate their claimed utility through appropriate and systematic research efforts including pre-clinical and clinical studies. In addition to their own use as medicines, knowledge on the Indian Traditional Medicines can be used as a platform for new drug discovery. The huge potential for carrying out systematic R&D programs for new Drug Discovery based on natural products and possible strategies to realise them in the coming decades will be explained in this presentation.
Ramani A. Aiyer, Ph.D., MBA
Principal, Shasta BioVentures, San Jose, CA, USA
New Drug R&D in India: Challenges & Opportunities
New drug discovery and development has become a global endeavor, with Western big pharmaceutical companies farming out more and more chemistry and biology research to Asia, particularly India and China. During the last decade, several Indian pharmaceutical companies have embarked on ambitious R&D programs, with slow but steady progress in developing new chemical / molecular entities. The Indian government has also made a strong commitment to promote innovation and entrepreneurship in the biotechnology sector. The first part of the talk will focus on a case study showing the entire process of discovery and development of a new drug recently launched for Rheumatoid Arthritis. We will then address the challenges of conducting innovative R&D in India and actions necessary to overcome them. The second part of the talk will make the case for developing Ayurvedic drug formulations for the Western / Global markets, again using the example of Rheumatoid Arthritis (Aamavaata). Ayurveda takes a holistic approach to disease diagnosis and therapy based on interactions among body type (prakriti), tri-doshas (three body humors), sapta-dhatus (seven tissues) and malas (excretions). The drugs prescribed are usually herbo-mineral formulations comprising multiple medicinal plants and / or metals. The manufacturing processes date back to Ayurvedic texts several thousand years old, and are compiled in the Ayurvedic Pharmacopeia. Also, the treatment modalities and drug formulations are “personalized” to fit different patient types, based on the holistic diagnoses mentioned earlier. There is a tremendous need to establish a sound basis for Ayurvedic drug discovery R&D for the modern world. We must find a scientific and ethical way to leverage the vast body of anecdotal and possibly retrospective data on patients undergoing Ayurvedic treatment. Combined with in vitro and in vivo biological data on Ayurvedic herbo-mineral formulations, the adoption of stringent manufacturing practices, and designing sound clinical trials to establish the safety and efficacy, India has a golden opportunity to expand the reach of Ayurvedic drugs into Western / Global medical practice.