Fecal microbiota, live-jslm(University of Alberta)

关注并星标CPHI制药在线 微生态药物（live biotherapeutic products, LBP）又称活体菌药物，是指利用正常微生物或影响微生物生长代谢的物质制成的药物制剂，是继小分子、大分子、细胞治疗和基因治疗之后的另一种新型的药物形式，通过干预人体微生物群落来发挥治疗作用，目前以活体生物药为主。 2016年，美国食品药品监督管理局生物制品评价与研究中心(Food and Drug Administration Center for Biologics Evaluation and Research,FDA/CBER)发布了全球第一部明确将活体生物药作为药物使用的指南，该指南侧重的是活体生物药早期临床阶段化学制造和控制(chemical manufacturing and control, CMC)相关技术要求，明确了活体生物药的定义。活体生物药是一种生物活性药物，具有以下的特点：(1) 含有活的生物体，如细菌；(2) 具有预防、治疗人类疾病或适应证的功能；(3) 不是疫苗。其核心要素是要按新药的标准开发，明确适应症并进行系统的菌株安全性、药效、CMC以及临床评价。除了生物制品的一些共同特征以外，食品药品监督管理局(Food and Drug Administration, FDA)指南突出了活菌药物特有的研究重点，如鉴定菌株的稳定性、抗生素敏感性、耐药性、是否转移以及存在移位的可能，还有产品的生产控制与稳定性等。 天然菌株 LBP 研发现状 近年来，随着测序与分离技术的发展，人们不断发现了更多与疾病密切相关、但尚无人体应用历史的天然新菌种，并将其按照药物进行开发，成为天然菌株LBP，其包含单菌LBP和复合菌 LBP，这2种类型的LBP 已在多种疾病治疗的临床试验中有所报道。 01 单菌 LBP 的开发 单菌LBP已在癌症、消化道疾病等多种疾病的研究领域中有所报道。在癌症治疗方面，英国4D pharma plc公司基于鸡肠球菌(Enterococcus gallinarum)开发了活体生物药MRx0518，该药物可以与pembrolizumab单抗联合治疗实体瘤，其机理是 MRx0518 的鞭毛蛋白可以激活细胞受体TLR5 和核因子(nuclear factor kappa-B, NF-κB)并诱导HT29-MTX细胞产生 IL-8，引发强烈的促炎反应，从而抑制肿瘤细胞的生长。此外，还有研究报道MRx0518可以与放射疗法联合治疗胰腺癌，受试者将在放射治疗开始前一周时每天服用MRx0518，且在整个放射治疗期间一直服用直至患者进行肿瘤切除手术。 在消化道疾病方面，广州知易生物科技有限公司基于脆弱拟杆菌(Bacteroides fragilis)开发了SK08 药物，该药物可有效治疗肠应激综合征(irritable bowel syndrome, IBS)和溃疡性结肠炎(ulcerative colitis, UC)，并在临床前研究中展现出了良好的药效与安全性，多项研究表明，脆弱拟杆菌产生的多聚糖可调节辅助性 T 细胞 1(Th1)/(Th2)比例的平衡，增强机体 T 细胞的功能，同时可以诱导 Treg 细胞分化并产生 IL-10，抑制炎症因子 IL-17，从而达到调节机体的免疫功能的效果。4D pharma plc 公司开发了一种治疗克罗恩病(Crohn’s disease, CD)的LBP 药物—thetanix，该药物由一株多形拟杆菌(Bacteroides thetaiotaomicron)构成，其作用机理是抑制与多种炎症性疾病相关的NF-κB 活化，产生的 pirin-like 蛋白已成为候选效应分子，该药物在Ⅰb期临床试验中展现出良好的安全性，达到了预期结果。 此外，单菌 LBP 在呼吸系统疾病、妇科疾病以及神经系统疾病的治疗中也有所报道，由短双歧杆菌(Bifidobacterium breve)制成的单菌药物 MRx-4DP0004 可治疗哮喘。OSel 公司基于干酪乳杆菌(Lactobacillus crispatus)开发了一种活体生物药 Lactin-V，该药物可以治疗复发性阴道炎。由马赛巨型球菌(Megasphaera massiliensis)构成的 MRx-0029 以及由狄氏副拟杆菌(Parabacteroides distasonis)构成的 MRx-0005在临床前均表现出治疗帕金森症的潜力，这2种菌株可以降低神经系统炎症反应，保护神经元免受氧化应激损伤并且恢复肠壁屏障完整性，目前这2款 LBP 的在研新药(investigational new drug, IND)申报已获得了FDA 批准，已进入临床试验阶段。 02 复合菌 LBP 的开发 21世纪初以来，艰难梭菌感染（CDI）一直是全球主要的公共卫生问题之一，基于粪菌移植 (fecal microbiota transplantation, FMT)的微生物组疗法在临床试验中对CDI疗效显著。Seres Therapeutics公司研发的复合菌药物SER-109是一种由纯化的厚壁菌门孢子组成的微生物组治疗剂，可以有效治疗 CDI，其核心逻辑是厚壁菌孢子有机体与艰难梭菌竞争性代谢生长所必需的营养素和胆汁酸，从而抑制艰难梭菌的繁殖。类似地，Rebiotix公司研发的复合菌药物RBX2660 是一种广谱微生物群混悬液，也可以治疗 CDI，该复合菌药物中的克劳氏芽孢杆菌和罗伊氏乳杆菌所分泌的化合物能抑制艰难梭菌的生长，此外该复合菌药物中的梭状芽孢杆菌代谢产生的次级胆汁酸能够增强艰难梭菌定殖抗性，同时提供营养生态位竞争的无毒艰难梭菌也会抑制艰难梭菌感染。此外，FinchTherapeutics 公司正在研发的CP-101 是一种胶囊给药的微生物组疗法，基于冻干保存的粪便，也用来防止CDI 复发。 还有许多复合菌 LBP 是从唾液或粪便等生物样本中分离出来的微生物组治疗剂，这些细菌被分离以后可以在克隆细胞库中繁殖。VEDANTA公司研发的VE303包含8 种共生梭状芽孢杆菌菌株，可以治疗CDI。该公司的另一款药物VE800 是从健康人类供体粪便中分离出的由11种细菌菌株组成的联合体，这些菌株可以诱导CD8+ T 细胞的激活、增强免疫系统对肿瘤细胞的攻击能力并显著增强抗 PD-1治疗的效果，该药物与Nivolumab 联合治疗多种肿瘤已经取得了一定进展。VE202含有经试验鉴定后的11株粪便来源的菌株，该药物可以通过调节肠道菌群诱导免疫耐受进而治疗自身免疫性疾病，例如炎症性肠病(IBD)。 此外，Biomica公司研发的复合菌药BMC128 含有4种来自人类肠道的天然菌株，它能够通过多种生物学过程增强免疫治疗效果并促进机体抗肿瘤免疫活性，从而抑制肿瘤的生长。MRM Health公司基于CORAL 平台开发了一种复合菌 LBP，该药物包含了经过合理搭配的9株肠道共生菌，在动物模型中，它能够改善门静脉高压、胰岛素信号传导、非酒精性脂肪肝活动指数以及预防肝纤维化的发展，还可以改善血管内皮功能、重塑肠道菌群。 虽然FMT 疗法已经有诸多临床试验，但科学家始终无法掌握其明确的作用机制，因此具有一定的风险，包括不可预料的副作用、疗效不稳定和监管困难等。相比之下，成分明确的细菌组合体构成的复合菌 LBP 更加安全、可控，作用机制更加明确，人们更容易接受。 基因工程菌株 工程菌是采用现代生物工程技术加工出来的新型微生物，具有多功能、高效和适应性强等特点。近年来，微生物药物领域有较多工程菌已经进入临床研究阶段。研究表明，特定的酶或包含特定途径的工程益生菌能够缓解生物体的代谢紊乱，工程菌可以合成代谢所必需的酶从而恢复代谢，并且可以抑制有毒产物的合成或将其代谢成无毒产物，进而治疗此类代谢疾病。Synlogic 通过将编码苯丙氨酸解氨酶和 L-氨基酸脱氨酶的基因插入到大肠杆菌(Escherichia coli) Nissle 1917(缩写为“ECN”)的基因组中，得到苯丙酮尿症治疗药物 SYNB1934，在动物试验中，SYNB1618 可显著降低 Pahenu2/enu2小鼠的血浆苯丙氨酸浓度且防止健康的非人类灵长类动物(NHPs)食蟹猴血浆中苯丙氨酸浓度的激增。高尿酸治疗的菌株SYNB1353可消耗蛋氨酸，从而用于治疗高胱氨酸尿症。Advaxis的ADXS-503 (减毒活单核细胞增生李斯特菌)，单用和联合派姆单抗可用于治疗非小细胞肺癌 (NSCLC)。此外，还有多种工程菌用于治疗酶缺乏引起的代谢紊乱疾病、细菌感染、炎症性肠病和癌症等。 随着人们对基因工程编辑药物的认识更加全面和客观，工程菌药物将会越来越受到人们的青睐，虽然人们对于转基因的安全性一直心存疑虑，但面对一些严重疾病的治疗剂选择，例如肿瘤治疗上，病人的抗风险能力更高，依从性和接受度更好。且工程菌药物拥有独特的优势，例如靶向性更好，可以增加目标部位的药物积累并最大限度地减少脱靶效应；给药的剂量低，产生的毒副作用也很小，最重要的是它可以通过人为改造，使其具有人们想要的特定功能，能够“因病制宜”，因此它的应用范围更广泛。 小分子微生态调节剂 小分子微生态调节剂 (small molecule microbiome modulator, SMMM) 是指能选择性地促进宿主肠道内的有益细菌生长繁殖的物质，通过促进有益菌的繁殖，抑制有害细菌的生长，达到调整肠道菌群，促进机体健康的目的。Second Genome的SGM-1019 可用于治疗非酒精性脂肪性肝炎 (NASH)；Enterome的 EB8018 可用于治疗炎症性肠病（IBD）；绿谷制药于2019 年 11 月在我国上市了甘露特钠胶囊(GV-971)，GV-971 可以调节肠道菌群失衡，抑制 α-突触核蛋白的聚集，减少肠道与脑内 α- 突触核蛋白的沉积，减轻神经炎症并保护多巴胺能神经元，改善运动和非运动症状。Intrinsic Medicine使用人乳寡糖小分子微生态调节剂治疗疼痛、调节肿瘤免疫、抗病毒和呼吸道感染等。 参考资料：        [1]朱永亮.活体菌药物产业化[J].生命科学,2023,35(03):340-346.        [2]邹丹阳, 董雨萌, 陈晶瑜. 活体生物药：生物技术推动的创新药研发前沿[J].生物工程学报, 2023, 39(4): 1275-1289. 作者简介：小泥沙，食品科技工作者，现就职于国内某大型药物研发公司，从事营养食品及功能性食品的开发与研究。 END 【智药研习社直播预告】 来源：CPHI制药在线 声明：本文仅代表作者观点，并不代表制药在线立场。本网站内容仅出于传递更多信息之目的。如需转载，请务必注明文章来源和作者。 投稿邮箱：Kelly.Xiao@imsinoexpo.com ▼更多制药资讯，请关注CPHI制药在线▼ 点击阅读原文，进入智药研习社~

First real-world outcomes analysis evaluated efficacy of REBYOTA in patients with recurrent C. diff infection Ad-hoc analysis evaluated efficacy and safety of REBYOTA in participants taking common non-antibiotic medications associated with microbiome imbalance and recurrent C. diff infection Post-hoc analysis looked at gut microbiome composition and diversity in patients following REBYOTA administration PARSIPPANY, N.J.--(BUSINESS WIRE)-- Ferring Pharmaceuticals today announced three poster presentations at Digestive Disease Week® (DDW 2024) that add to the robust clinical evidence for REBYOTA® (fecal microbiota, live – jslm), including the first real-world outcomes data assessing the use of this therapy in patients with recurrent C. difficile (C. diff) infection. REBYOTA is the first and only single-dose microbiome-based therapy approved by the U.S. Food and Drug Administration (FDA) for the prevention of recurrent C. diff infection in individuals 18 years of age and older, following antibiotic treatment for C. diff infection. This press release features multimedia. View the full release here: In the real-world experience analysis (poster number Sa1916), medical records were reviewed for patients with recurrent C. diff infection who received REBYOTA in outpatient clinics from February 2023 through November 2023 (n=46). Those with 8-week follow-up were further evaluated and the efficacy of REBYOTA was assessed as the absence of recurrence at 8 weeks after administration. Nearly 74% of these patients (25/34) maintained the effectiveness of REBYOTA at eight weeks, despite having a higher risk of further recurrence. An ad-hoc subgroup analysis (poster number Sa1901) of the PUNCH CD3-Open-Label Study (OLS) – an ongoing Phase 3 REBYOTA trial – evaluated the efficacy and safety of REBYOTA in participants taking certain medications that may cause an imbalance in the gut microbiome (dysbiosis) and can increase the risk of recurrent C. diff infection. Of 469 adult participants with documented recurrent C. diff infection in the modified intent to treat (mITT) efficacy population, outcomes were assessed in 290 patients who were taking proton pump inhibitors (PPI) (42.1%), statins (48.6%) and/or psychotropic medications, such as antidepressants and antianxiety medicines (55.2%), for a period of two weeks prior and two or more weeks after REBYOTA administration. Treatment success was defined as the absence of CDI recurrence within 8 weeks of REBYOTA administration and participants were monitored for treatment-emergent adverse events (TEAEs) for up to 6 months after administration. Treatment success rates at 8 weeks were 78.7% of participants taking PPIs, 75.2% of statin users and 75.2% of those receiving psychotropic medications. Participants had comparable treatment success rates whether they were receiving one of these medications or multiple medications concurrently. “Prospective clinical trials often exclude the types of patients we commonly see in clinical practice including those who are taking additional medication for other conditions that may increase their risk for recurrent C. difficile infection," said Paul Feuerstadt, MD, FACG, AGAF, Yale University School of Medicine. "This analysis provides data on this patient population who clinicians see every day." In the analysis, most TEAEs were mild or moderate gastrointestinal disorders and related to preexisting conditions or C. diff infection. Serious TEAEs occurred in 15.9% of participants receiving PPIs, 15.9% of participants receiving statins and 15.5% of participants receiving psychotropic medications. All serious TEAEs were assessed as unrelated to REBYOTA administration. A post-hoc analysis from the PUNCH CD3 Phase 3 clinical trial (poster number Sa1910) examined the gut microbiota composition and diversity among participants who received REBYOTA and had treatment success at eight weeks — defined as remaining free of C. diff infection recurrence. Patients provided stool samples at baseline (before study treatment) and at 1 week, 4 weeks, 8 weeks, 3 months and 6 months after study treatment. The analysis evaluated whether the species of bacteria present after treatment were those present in the REBYOTA dose they received and the durability of those changes. The composition and diversity of the gut microbiota of participants who received REBYOTA shifted toward the REBYOTA pro early as one week after administration. By week 1, a median of 10 species (range 0 to 78) clonally engrafted from REBYOTA to participants administered therapy, with significantly greater engraftment in those who were therapy responders versus non-responders. Participants who received placebo had no significant clonal engraftment. For at least six months, the number of REBYOTA responders with engraftment continued to rise and persist. Bacteroidia species showed the highest median engraftment effectiveness. DDW 2024 has abstracts available on its website. About C. diff infection C. diff infection is a serious and potentially deadly infection that impacts people across the globe. The C. diff bacterium causes debilitating symptoms, such as severe diarrhea, fever, stomach tenderness or pain, loss of appetite, nausea and colitis (an inflammation of the colon).1 C. diff infection can be the start of a vicious cycle of recurrence, causing a significant burden for patients and the healthcare system.2,3 It has been estimated that up to 35% of C. diff infection cases recur after initial diagnosis and people who have had a recurrence are at significantly higher risk of further infections.4,5,6,7 After the first recurrence, it has been estimated that up to 65% of patients may develop a subsequent recurrence.6,7 Antibiotics – the current standard of care for treatment of C. diff infection – treat the disease but can also be a contributing factor to the cycle of recurrence.1 About REBYOTA REBYOTA is a pre-packaged, single-dose 150 mL microbiota suspension for rectal administration consisting of a liquid mix of up to trillions of live microbes – including Bacteroides. REBYOTA is delivered directly to the gut microbiome and is administered by a healthcare professional in one visit. INDICATION REBYOTA (fecal microbiota, live – jslm) is indicated for the prevention of recurrence of Clostridioides difficile (C. diff) infection in individuals 18 years of age and older, following antibiotic treatment for recurrent C. diff infection. Limitation of Use REBYOTA is not indicated for the treatment of C. diff infection. IMPORTANT SAFETY INFORMATION You should not receive REBYOTA if you have a history of a severe allergic reaction (e.g., anaphylaxis) to REBYOTA or any of its components. You should report to your doctor any infection you think you may have acquired after administration. REBYOTA may contain food allergens. Most common side effects may include stomach pain (8.9%), diarrhea (7.2%), bloating (3.9%), gas (3.3%), and nausea (3.3%). REBYOTA has not been studied in patients below 18 years of age. Clinical studies did not determine if adults 65 years of age and older responded differently than younger adults. You are encouraged to report negative side effects of prescription drugs to FDA. Visit or call 1-800-332-1088. Please click to see the full Prescribing Information. About Ferring Pharmaceuticals Ferring Pharmaceuticals is a privately-owned, research-driven, specialty biopharmaceutical group committed to building families and helping people live better lives. In the United States, Ferring is a leader in reproductive medicine and maternal health, and in areas of gastroenterology and orthopaedics. We are at the forefront of innovation in microbiome-based therapeutics and uro-oncology intravesical gene therapy. Our company was founded in 1950 and is headquartered in Saint-Prex, Switzerland. Ferring employs more than 7,000 people worldwide and markets its medicines in over 100 countries. Ferring USA is based in Parsippany, New Jersey, and employs more than 900 employees. For more information, please visit , call 1-888-FERRING (1-888-337-7464), or connect with us on LinkedIn, and X (Twitter). About DDW Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW is an in-person and online meeting from May 18-21, 2024. The meeting showcases more than 4,400 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. More information can be found at . References: Centers for Disease Control and Prevention. What is C. diff? 7 Sep. 2022. Available at: . Centers for Disease Control and Prevention. 2019 Antibiotic Resistance Threats Report: Clostridioides difficile. 23 Nov. 2021. Available at: . Feuerstadt P, et al. Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis. J Med Econ. 2020;23(6):603-609. Riddle DJ, Dubberke ER. Clostridium difficile infection in the intensive care unit. Infect Dis Clin North Am. 2009;23(3):727-743. Nelson WW, et al. Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis. J Manag Care Spec Pharm. 2021 Jul;27(7):828-838. doi: 10.18553/jmcp.2021.20395. Epub 2021 Mar 11. Kelly, CP. Can we identify patients at high risk of recurrent Clostridium difficile infection? Clin Microbiol Infect. 2012; 18 (Suppl. 6): 21–27. Smits WK, et al. Clostridium difficile infection. Nat Rev Dis Primers. 2016;2:16020. doi: 10.1038/nrdp.2016.20.