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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalBritish Journal of Clinical Pharmacology
DOIs
StatePublished - Jan 1 2019

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Chronic Renal Insufficiency
Anemia
Hepcidins
Iron
Ferritins
Hematinics
Transferrin
Bone and Bones
Serum
Placebos
Pharmacology
Complementary Therapies
Protein Binding
Haplorhini
Healthy Volunteers
Hemoglobins
Proteins
Homeostasis
Monoclonal Antibodies
Confidence Intervals

Keywords

  • chronic kidney disease
  • immunoglobulins
  • transport

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Sheetz, M., Barrington, P., Callies, S., Berg, P. H., McColm, J., Marbury, T., ... Witcher, D. R. (2019). Targeting the hepcidin–ferroportin pathway in anaemia of chronic kidney disease. British Journal of Clinical Pharmacology. https://doi.org/10.1111/bcp.13877

Targeting the hepcidin–ferroportin pathway in anaemia of chronic kidney disease. / Sheetz, Matthew; Barrington, Philip; Callies, Sophie; Berg, Paul H.; McColm, Juliet; Marbury, Thomas; Decker, Brian; Dyas, Gregory L.; Truhlar, Stephanie M.E.; Benschop, Robert; Leung, Donmienne; Berg, Jolene; Witcher, Derrick R.

In: British Journal of Clinical Pharmacology, 01.01.2019.

Research output: Contribution to journalArticle

Sheetz, M, Barrington, P, Callies, S, Berg, PH, McColm, J, Marbury, T, Decker, B, Dyas, GL, Truhlar, SME, Benschop, R, Leung, D, Berg, J & Witcher, DR 2019, 'Targeting the hepcidin–ferroportin pathway in anaemia of chronic kidney disease', British Journal of Clinical Pharmacology. https://doi.org/10.1111/bcp.13877
Sheetz, Matthew ; Barrington, Philip ; Callies, Sophie ; Berg, Paul H. ; McColm, Juliet ; Marbury, Thomas ; Decker, Brian ; Dyas, Gregory L. ; Truhlar, Stephanie M.E. ; Benschop, Robert ; Leung, Donmienne ; Berg, Jolene ; Witcher, Derrick R. / Targeting the hepcidin–ferroportin pathway in anaemia of chronic kidney disease. In: British Journal of Clinical Pharmacology. 2019.
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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.",
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AU - Barrington, Philip

AU - Callies, Sophie

AU - Berg, Paul H.

AU - McColm, Juliet

AU - Marbury, Thomas

AU - Decker, Brian

AU - Dyas, Gregory L.

AU - Truhlar, Stephanie M.E.

AU - Benschop, Robert

AU - Leung, Donmienne

AU - Berg, Jolene

AU - Witcher, Derrick R.

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N2 - 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.

AB - 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.

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