VEGFR3

深度聚焦多肽、多肽偶联药物研发、质控、工艺开发，7月相约苏州，联系电话18116036798目前，治疗肿瘤的主要手段有手术切除、放射治疗和化学药物治疗。化疗药物不仅杀伤肿瘤细胞，同时也作用于广泛的正常细胞，产生各种各样的毒副作用。而化疗药物的耐药性也是其不能有效治疗肿瘤的原因。因此，研制高效、低毒副作用的抗肿瘤药物显得尤为重要。与传统化疗药物相比，多肽类药物具有分子量小、对肿瘤敏感、不易耐药、成本低等特点，这使得多肽类药物受到了国内外的积极研究与开发，此外，多肽也是肿瘤抗原中起作用的主要成分，多肽疫苗的研发也将为肿瘤患者带来希望。本文就多肽药物抗肿瘤的作用机制及多肽作为免疫检查点阻断剂的最新研究进展进行总结，一起来看看吧！一、多肽药物的抗肿瘤机制多肽是以氨基酸为基本单位组成的分子，分子量一般在10 KDa以下，介于化学小分子与生物制品之间，其主要特点是选择性高、作用浓度低。1、调节免疫功能 肿瘤免疫治疗是通过人体自身免疫系统对肿瘤做出反应，从而达到治疗癌症的目的。作为一种生物疗法，免疫治疗已成为除了手术治疗和放化疗之外的第4种重要的肿瘤治疗手段。免疫应答可以分为特异性免疫应答和非特异性免疫应答。非特异性免疫又称固有免疫，固有免疫细胞包括巨噬细胞、树突状细胞、NK细胞等，通过模式识别受体或有限多样性抗原识别受体对病原体等识别结合产生非特异性抗肿瘤等作用。Sun 等[18] 研究表明不同浓度的杏鲍菇菌丝体（PEMP）多肽能够刺激巨噬细胞释放NO、H2O2和TNF-α等抑制癌细胞的增殖，增强巨噬细胞的吞噬能力从而发挥抗肿瘤的作用。 特异性免疫应答可以分为T淋巴细胞介导的适应性免疫即细胞免疫和B淋巴细胞介导的体液免疫2种。T细胞可以分为CD4+T细胞和CD8+T细胞，在 特异性抗原部位发挥效应功能的主要是细胞毒性T 淋巴细胞（CTL）。CTL 是细胞免疫的主要效应细胞，特异性地杀伤胞内病原体感染细胞和肿瘤细胞等。Sun等研究开发人类磷脂酰乙醇胺结合蛋白4（hPEBP4）衍生的免疫原性肽来诱导针对乳腺癌的抗原特异性CTL，并鉴定了一种新的免疫原性肽 P40-48（TLFCQGLEV），其能够在 HLA-A2.1/Kb 转基因小鼠以及来自乳腺癌患者的外周血淋巴细胞中引发特异性CTL应答。用2种类似物接种诱导的CTL的继承性转移比天然肽更有效地抑制肿瘤生长。Xie等通过HLA结合预测算法搜索来自Eps8蛋白的新型人类白细胞抗原（HLA）-A*2402 限制性表位，来自 Eps8 的新的 HLA-A*2402 限制性表 的肽327（EFLDCFQKF）、534（KYAKSKYDF）和755（LFSLNKDEL）诱导肽特异性CTL分泌更高水平的IFN-γ并显示出增强的抗恶性癌细胞的细胞毒活性，通过抑制Eps8/EGFR相互作用，肽327和TAT327可以作为新的肽抑制剂，这可以提供治疗各种癌症的创新方法。B细胞作为体液免疫的主要细胞，其对肿瘤具有双重作用，即促进抗肿瘤反应和诱导免疫耐受。根据功能的不同，B细胞可分为效应性B细胞和调节性B细胞。其中调节性B细胞（Bregs）与肿瘤的关系十分密切，其肿瘤免疫中的作用机制主要有以下几个方面：一方面，Bregs可以通过分泌IL-10，减少Th1细胞和Th17等T细胞的分化，减少肿瘤抑制性细胞因子的表达从而促进肿瘤的生长；另一方面，Bregs可以通过分泌TGF-β、协同共刺激分子和IL-10一同诱导 Tregs的产生，从而通过Tregs抑制免疫效应细胞的功能以此保护肿瘤细胞。效应性B细胞分又1型和2型2种亚型。其中1型效应性B细胞（Be1）主要产生TNF-α、IFN-γ和IL-12等促炎细胞因子发挥抗肿瘤的作用；而2型效应性B细胞（Be2）主要产生IL-4、IL-13等细胞因子，Th2细胞反应有关。Huang等研究表明单独CpG足以抑制BRAF抑制剂诱导的抗肿瘤反应，表明在接受基于CpG的肽疫苗的小鼠中观察到的BRAF抑制剂的抗肿瘤活性受损主要取决于使用CpG。CpG增加了循环B细胞的数量，这产生了增加量的TNF-α，这有助于BRAF抑制剂对肿瘤的抗性增加。常旭、欧红利对美洲大蠊的抗肿瘤作用及对荷瘤小鼠免疫功能的影响等方面进行了研究，表明了美洲大蠊多肽是通过提高荷瘤小鼠免疫功能来实现抗 肿瘤作用的机制。图片来源：摄图网2、抑制肿瘤新生血管形成 新生血管是肿瘤获取营养保证自身发展的重要途径，肿瘤血管生成是肿瘤诱导体内多种因子共同作用的结果，其中主要是促进因子和抑制因子共同作用的结果，正常情况下两者处于平衡状态。在多种的促进因子中血管内皮生成因子（VEGF）是血管生成的重要调节物，其受体（VEGFR）主要有VEGFR-1、VEGFR-2、VEGFR-3 3种。目前研究的抗肿瘤肽类药物在抑制血管生成方面的机制是多数学者研究的热点。例如，Qi等研究发现金属蛋白酶-3（TIMP-3）的组织抑制剂通过其阻断VEGF与其受体VEGFR-2的结合的能力，是VEGF介导的血管生成和新血管形成的有效抑制剂。Bracci 等研究的支链肽NT4结合HSPG并选择性靶向癌细胞和组织。NT4证明对内皮细胞增殖、迁移和管形成具有重要影响，特别是当由FGF2和凝血酶诱导时。此外，NT4对侵袭性肿瘤细胞迁移和侵袭具有重要作用。因此，抗肿瘤多肽类药物的抗血管生成机制为其成为肿瘤靶向药物的发展提供了线索。3、促进细胞凋亡 细胞凋亡又称细胞程序性死亡，是细胞正常死亡的主要方式，在清除细胞过程中起着重要的作用。当凋亡信号通路异常时就会出现多种疾病，其中就包括细胞癌变，细胞凋亡的抗性与肿瘤发生密切相关。在机体内，细胞凋亡有主要的2种途径：外源性通路，其主要是通过细胞表面的凋亡受体刺激激活的；内源性通路，除受凋亡信号激活外还有破坏线粒体膜完整性。与细胞凋亡密切相关的信号通路还有很多，比如Bcl-2家族和Fas/FasL途径。Bcl-2家族主要有2大类蛋白，一类为抗凋亡蛋白（Bcl-2），另一类为促凋亡蛋白（Bax），在肿瘤细胞中，抗凋亡蛋白（Bcl-2）过度表达导致细胞抗凋亡能力提高，肿瘤细胞的生长无法受到调控。多肽类药物诱导细胞凋亡可以通过影响Bcl-2家族蛋白。张丹等研究表明，美洲大蠊多肽可以通过上调Bax蛋白表达，下调Bcl-2蛋白表达，诱导人肝癌细胞SMMC-7721发生凋亡，从而抑制肿瘤细胞的增殖。因此，靶向调节Bcl-2家族成为治疗肿瘤的有效途径。另一个为 Fas/FasL 信号通路，是调节细胞凋亡的主要途径之一，Fas/FasL 信号通路的激活诱导细胞的凋亡。Kuo等研究表明从尼罗河罗非鱼中提取的低浓度海洋抗菌肽（AMP）MSP-4通过激活Fas/FasL信号通路诱导骨髓瘤MG63发生细胞凋亡从而发挥抗肿瘤作用。二、多肽作为免疫检查点抑制剂（一）单靶点多肽1、PD-1/PD-L1 多肽 高通量展示筛选技术在免疫检查点阻断肽的筛选中发挥着非常重要的作用。Tao等利用噬菌体展示技术筛选获得了靶向PD-1的多肽P-F4；Liu等利用同样的方法获得了靶向PD-L1的多肽CLP002；Li等首次利用细菌表面展示技术筛选获得了针对PD-L1的多肽TPP-1；Kamalinia等利用mRNA展示技术获得了PD-L1多肽SPAM。 然而，上述多肽均为L构型氨基酸组成的线性多肽，构象和抗酶解稳定性较差。为了获得构象更为稳定的多肽，环肽是一种较好的选择。2015 年，Maute 等利用酵母展示技术获得高亲和 PD-L1 的 PD-1 蛋白突变体，其亲和力是野生型 PD-1 的74000倍，该 PD-1 高亲和突变体已经被应用于靶向 PD-L1 多肽的设计。Jeong 等通过从上述 PD-1 蛋白突变体截取多肽片段，并利用树枝状大分子形成了多价的 PD-L1 多肽偶联物。无独有偶，Yin 等基于 PD-1 高亲和突变体，提出了 “多肽模拟设计”的概念，并设计了具有高亲和力和较 好抗肿瘤效果的 PD-L1 的大环肽 MOPD-1。PD-1/PD-L1 受配体相互作用是介导肿瘤免疫逃逸的关键因素之一，抑制其介导的负性信号通路能够打破机体已经建立的免疫耐受，并能使 PD-1 免疫细胞的功能耗竭得以改善。国内外已有多个课题组和公司也在研发 PD-1/PD-L1 的小分子药物，大多数小分子药物可以无障碍地进入细胞内部。与传统的放化疗相比，PD-1/PD-L1 的多肽阻断剂通常不会直接影响肿瘤细胞的增殖或迁移，而是通过调动免疫系统的功能而杀伤肿瘤细胞。此外，PD-1 主要在免疫耐受的维持阶段发挥作用，这意味着 PD-1/PD-L1 的阻断不会带来严重的不良反应。总之，PD-1/PDL1 的多肽阻断剂有望为肿瘤免疫治疗提供极具潜力的候选药物。2、其他免疫检查点多肽 以 PD-1/PD-L1 抗体为代表的基于免疫检查点阻断的肿瘤免疫治疗已经在临床治疗中取得了显著的效果。然而，在 PD-1 抗体治疗过程中，其他免疫检查点分子如 TIM-3 和 TIGIT 表达上调，会引起 PD-1 抗体治疗的适应性耐药。在黑色素瘤患者中，即便部分患者有较高的肿瘤突变负荷和炎性肿瘤微环境，TIGIT/PVR 通路仍会介导 PD-1 抗体治疗的耐药性。考虑到免疫反应的动态变化以及免疫检查点表达调控的复杂性，难以依靠任何单一的靶点实现最佳的治疗效果，针对其他免疫检查点通路的单抗药物研究也在进行中，而相关的多肽阻断剂研究也逐渐受到关注。 TIGIT/PVR 通路在肿瘤免疫抑制中发挥着重要的作用，阻断 TIGIT/PVR 能够增强 PD-1/PD-L1 阻断的治疗效果，并有望克服 PD-1/PD-L1 抗体治疗耐药。免疫检查点多肽阻断剂图片来源：参考文献[1]（二）双功能多肽 双特异性抗体是当前抗体药物研发的热点，已有多个双特异性抗体获得FDA批准用于临床研究。与双特异性抗体的作用相同，双功能多肽是将针对两个功能相关或互补的靶点的多肽分子进行偶联，偶联后的多肽不仅能够保留单靶点多肽的功能活性，还可以增加多肽的稳定性和半衰期。与单靶点多肽相比，双功能多肽可以同时针对生物体内不同的信号传导发挥功能，将不同靶点多肽进行合理设计还能够起到 1+1>2 的效果。相较于 双特异性抗体，双功能多肽的设计和合成更为简便。 （三）自组装多肽 通过合理的设计，特定序列的多肽自身也能够自组装构建药物递送系统。Wang 等利用具有自组装功能的 G7 肽（GNNQQNY）将靶向 CD3 的多肽与靶向整合素 αvβ3 的RGD肽连接形成双功能多肽 anti-CD3-G7-RGD，该多肽在靶向 T 细胞的 CD3 受体的同时，利用 G7 肽原位自主装形成纳米寡聚物的特性，诱导 CD3 受体寡聚化进而激活 T 细胞。不仅如此， 双功能肽的 RGD 序列能够引导 T 细胞精准地识别并杀伤肿瘤细胞。Lv 等使 pep-20 在肿瘤组织中原位组装形成纳米纤维，打破肿瘤细胞高表达的 CD47 所介导的“不要吃我”信号，增强巨噬细胞对肿瘤细胞的吞噬效应，有效抑制了肿瘤生长。另外，也可以利用纳米载体将其他药物与免疫检查点阻断肽进行一体化设计，起到协同作用。Zhu 等将D PPA-1 肽用于与化疗药物阿霉素（DOX）通过基质金属蛋白酶 2（MMP2）的特异性底物序列进行偶联，自组装形成酶响应性的纳米颗 粒，通过胞吞作用促进药物在肿瘤的累积和渗透， D PPA-1 肽和 DOX 通过 MMP2 响应性的释放，不仅可以充分发挥化疗药物对肿瘤的杀伤作用，而且D PPA-1 肽能够增强 T 细胞功能。Cheng 等设计了由 3-二乙基氨基丙基异硫氰酸（DEAP）、MMP2 底物序列 和D PPA-1 组成的两亲性肽，该多肽与吲哚胺 2，3-双加氧酶 1（IDO1）的抑制剂 NLG919 通过疏水作用组装成纳米颗粒。该纳米颗粒在肿瘤微环境中具有双重刺激依次响应的优点：首先，通过 EPR 效应在肿瘤部位富集，DEAP 序列在弱酸环境下发生质子化使得纳米 结构膨胀；进而，高表达的 MMP2 识别底物序列并彻底崩解纳米颗粒，释放D PPA-1 肽和 NLG919。该设计充分结合多肽及小分子药物的性质和肿瘤微环境的特点，联合 PD-1/PD-L1 阻断和 IDO1 抑制剂，协同增强肿瘤组织 T 细胞的功能，诱导强大的抗肿瘤免疫反应。（四）核素标记多肽 阻断免疫检查点的肿瘤免疫治疗效果与免疫检查点的表达情况密切相关。通过检测免疫检查点的表达水平对患者进行筛选能够促进精准治疗。免疫组织 化学是目前检测免疫检查点表达的金标准。然而，该方法无法实时量化全身的表达水平。而在肿瘤发生、进展以及治疗过程中，检查点分子的表达是高度动态变化的。在特定的肿瘤类型或转移灶中，免疫检查点的表达也具有高度异质性。在患者选择和疗效监测方面，以高灵敏度和分辨率进行全身非侵入性免疫检查点表达检测非常重要。正电子发射断层扫描（PET）作为一种无创水平成像技术，可用于实时、重复和所有病灶的动态检测。极大方便了临床上筛选可能受益的患者、对免疫治疗进行疗效评价以及及时地进行治疗策略的调整。PET 成像已广泛用于多种免疫检查点的示踪，包括多种与放射性核素标记的 PD-1/PD-L1、TIGIT、LAG-3 和 TIM-3 抗体等。放射性核素标记的免疫检查点抗体组织渗透能力不足，而且由于抗体本身的半衰期较长，往往需要较长的时间才能实现较强的组织富集。低分子量的多肽因具有适当的半衰期和较强的实体瘤渗透能力成为 PET 成像探针的理想候选。靶向 PD-1 或 PD-L1 的高亲和力多肽，尤其是 TPP-1 和 WL12 已被用于各种放射性核素标记的 PET 成像。目前，放射性标记的免疫检查点抗体或多肽在 PET 成像和光学成像中的应用已经进行了广泛的临床前和初步临床研究，显示出其作为患者分层、疗效 的动态监测和预后工具的潜力。其中，低分子量多肽作为诊断探针具有实体瘤渗透能力强、不良反应小、半衰期适宜的良好特性，在 PET 成像中的应用已经崭露头角，也将为肿瘤患者的临床诊断和辅助治疗提供有力的工具。写在最后：近年来，全球多肽药物的市场销售额保持快速增长趋势，多肽药物成为中国“十四五”期间生物医药研究的重点方向之一。但多肽药物目前面临的困难依旧存在，仍需要致力于设计更为简便、有效的修饰策略来提高多肽的结构稳定性。另外，目前虽然在多肽药物口服方面取得了一些进展，但是在临床应用和递送技术方面仍未取得显著突破，这些问题亟需研究者们 设计更为巧妙的方法来解决，从而进一步推动多肽药物的临床应用。END参考文献：[1]牛潇爽, 胡争, 周秀曼, 高艳锋. 多肽药物在肿瘤免疫治疗中的研究进展[J]. 中国肿瘤临床, 2023, 50(6)：271-277. doi:10.12354/j.issn.1000-8179.2023.20221128[2]陈泽锋,白丽.抗肿瘤多肽类药物的来源及其机制的研究进展[J].免疫学杂志,2018,34(12):1099-1104.DOI:10.13431/j.cnki.immunol.j.20180171.[3]刘光照,张婕,殷润婷.抗肿瘤多肽的研究新进展[J].药学进展,2015,39(09):671-675.声明：本文出自医会宝编辑部，旨在为医疗专业人士传递更多医学信息。本文并不能取代医生的专业诊疗意见，如有罹患，需前往专业医院检查诊断。END深度聚焦多肽、多肽偶联药物研发、质控、工艺开发，7月相约苏州，联系电话18116036798戳“阅读原文”立即报名多肽药物论坛吧!

Former CymaBay Therapeutics CEO brings extensive leadership experience to his role as a Non-Executive Director and Audit and Risk Committee ChairMELBOURNE, Australia and PRINCETON, N.J., April 03, 2024 (GLOBE NEWSWIRE) -- Opthea Limited (ASX/NASDAQ: OPT “Opthea”, the “Company”), a clinical-stage biopharmaceutical company developing novel therapies to treat highly prevalent and progressive retinal diseases, including wet age-related macular degeneration (wet AMD), today announced the appointment of Sujal Shah to the Company’s Board of Directors (the “Board”), effective April 4, 2024. Concurrent with his appointment as non-Executive Director, Mr. Shah will also become Chairman of the Audit and Risk Committee. In conjunction with Mr. Shah’s appointment, the Company also announced that Daniel Spiegelman has resigned from the Board in his role as Non-Executive Director and as Chairman of the Audit and Risk Committee. Mr. Shah is an accomplished biopharmaceutical executive with extensive leadership and product development experience and a track record in capital formation that complements the deep expertise in retinal disease, especially wet AMD, of the Opthea Board. Most recently, Mr. Shah served as President and Chief Executive Officer of CymaBay Therapeutics which was acquired by Gilead Sciences for approximately $4.3 billion in total equity value in March 2024. “We are delighted to welcome Sujal to our Board of Directors as we rapidly advance the registrational program for sozinibercept in wet AMD and prepare for key upcoming clinical, regulatory and commercial milestones,” said Jeremy Levin, D.Phil, MB BChir, Chairman of the Opthea Board of Directors. “Sujal’s significant experience driving value for biotech companies through successful product and commercial development will be an invaluable resource to the Opthea team as we enter this pivotal growth phase of the company.” “It’s a privilege to join the Board of Opthea at such a transformative time,” said Sujal Shah. “I look forward to partnering with the executive leadership team and the Board as we continue to drive sozinibercept forward, with the goal of enhancing vision outcomes for patients worldwide.” Dr. Levin concluded by sharing, “On behalf of the Opthea organization, I want to express our gratitude and appreciation to Dan Spiegelman, who will now transition from our Board, for his work as a non-Executive Director and Audit and Risk Committee Chairman. We are very grateful for Dan’s contribution to the Company.” About Sujal Shah Mr. Shah brings two decades of experience as a biopharmaceutical executive and strategic advisor to the Opthea Board. Most recently, Mr. Shah served as President and Chief Executive Officer at CymaBay Therapeutics, a clinical-stage biopharmaceutical company developing innovative therapies for patients with liver and other chronic diseases. Mr. Shah joined CymaBay as Chief Financial Officer, taking the company public in 2013. Prior to CymaBay, Mr. Shah was a healthcare investment banker for Citigroup Inc. as well as Credit Suisse, where he was responsible for managing client relationships and executing strategic and financing related transactions for clients focused on life sciences. Mr. Shah currently serves as Chairman of the Board of Tvardi Therapeutics and as a Director on the Board of Stratus Therapeutics. He received an M.B.A. from the Carnegie Mellon University Tepper School of Business and M.S. and B.S. degrees in Biomedical Engineering from Northwestern University. About Sozinibercept Sozinibercept (OPT-302) is a soluble form of vascular endothelial growth factor receptor 3 (VEGFR-3) expressed as an immunoglobulin G1 (IgG1) Fc-fusion protein. It binds and neutralizes the activity of VEGF-C and VEGF-D on their endogenous receptors, VEGFR-2 and VEGFR-3. Research indicates that targeted inhibition of VEGF-C and VEGF-D can prevent blood vessel growth and vascular leakage, which contribute to the pathophysiology of retinal diseases including wet AMD. Sozinibercept has received Fast Track Designation from the U.S. FDA for the treatment of wet AMD. Positive results from the Phase 2b study of sozinibercept, administered in combination with standard of care, LUCENTIS® (ranibizumab), for the treatment of wet AMD, published in Ophthalmology, met the pre-specified primary efficacy endpoint of a statistically superior gain in visual acuity at 24 weeks, compared to ranibizumab alone. In addition, secondary outcomes were positive for the combination therapy with sozinibercept, including more participants with gains in vision of 10 or more letters and improved anatomy, with a reduction in swelling and vascular leakage, with a favorable safety profile. About Opthea Opthea (ASX/NASDAQ:OPT) is a biopharmaceutical company developing novel therapies to address the unmet need in the treatment of highly prevalent and progressive retinal diseases, including wet age-related macular degeneration (wet AMD) and diabetic macular edema (DME). Opthea’s lead product candidate, sozinibercept, is being evaluated in two pivotal Phase 3 clinical trials (COAST, NCT04757636, and ShORe, NCT04757610,) for use in combination with standard-of-care anti-VEGF-A monotherapies to improve overall efficacy and deliver superior vision gains compared to the standard-of-care anti-VEGF-A agents. To learn more, visit our website and follow us on X and LinkedIn. LUCENTIS® is a registered trademark of Genentech USA, Inc. A member of the Roche Group. Inherent risks of Investment in Biotechnology Companies There are a number of inherent risks associated with the development of pharmaceutical products to a marketable stage. The lengthy clinical trial process is designed to assess the safety and efficacy of a drug prior to commercialization and a significant proportion of drugs fail one or both of these criteria. Other risks include uncertainty of patent protection and proprietary rights, whether patent applications and issued patents will offer adequate protection to enable product development, the obtaining of necessary drug regulatory authority approvals and difficulties caused by the rapid advancements in technology. Companies such as Opthea are dependent on the success of their research and development projects and on the ability to attract funding to support these activities. Investment in research and development projects cannot be assessed on the same fundamentals as trading and manufacturing enterprises. Therefore, investment in companies specializing in drug development must be regarded as highly speculative. Opthea strongly recommends that professional investment advice be sought prior to such investments. Forward-looking Statements This ASX announcement contains certain forward-looking statements, including within the meaning of the U.S. Private Securities Litigation Reform Act of 1995. The words “expect”, “believe,” “should”, “could”, “may”, “will”, “plan” and other similar expressions are intended to identify forward-looking statements. Forward-looking statements in this ASX announcement include statements regarding rapidly advancing the registrational program for sozinibercept in wet AMD, expectations regarding the pivotal growth phase of Opthea, and the ability of sozinibercept to enhance vision outcomes for patients worldwide. Forward-looking statements, opinions and estimates provided in this ASX announcement are based on assumptions and contingencies which are subject to change without notice, as are statements about market and industry trends, which are based on interpretations of current conditions. Forward-looking statements are provided as a general guide only and should not be relied upon as an indication or guarantee of future performance. They involve known and unknown risks and uncertainties and other factors, many of which are beyond the control of Opthea and its directors and management and may involve significant elements of subjective judgment and assumptions as to future events that may or may not be correct. These statements may be affected by a range of variables which could cause actual results or trends to differ materially, including but not limited to future capital requirements, the development, testing, production, marketing and sale of drug treatments, regulatory risk and potential loss of regulatory approvals, ongoing clinical studies to demonstrate sozinibercept safety, tolerability and therapeutic efficacy, additional analysis of data from Opthea’s Phase 3 clinical trials, timing of completion of the ShORe clinical trial patient enrollment and clinical research organization and labor costs, intellectual property protections, and other factors that are of a general nature which may affect the future operating and financial performance of the Company including risk factors set forth in Opthea’s Annual Report on Form 20-F filed with the U.S. Securities and Exchange Commission (the “SEC”) on September 28, 2023, Opthea’s 2024 Half Year Report included as an exhibit to the Form 6-K filed with the SEC on February 29, 2024, and other future filings with the SEC. Actual results, performance or achievement may vary materially from any projections and forward-looking statements and the assumptions on which those statements are based. Subject to any continuing obligations under applicable law or any relevant ASX listing rules, Opthea disclaims any obligation or undertaking to provide any updates or revisions to any forward-looking statements in this ASX announcement to reflect any change in expectations in relation to any forward-looking statements or any change in events, conditions or circumstances on which any such statement is based, except as otherwise required by applicable law. Authorized for release to ASX by Fred Guerard, CEO Investor Enquiries PJ KelleherLifeSci Advisors, LLCEmail: pkelleher@lifesciadvisors.com Phone: 617-430-7579 Media Silvana Guerci-LenaNorthStream Global PartnersEmail: silvana@nsgpllc.com Join our email database to receive program updates:Tel: +61 (0) 3 9826 0399Email: info@opthea.com Source: Opthea Limited

SYDNEY, March 21, 2024 /PRNewswire/ -- Kazia Therapeutics Limited (NASDAQ: KZIA), a biotechnology company specialising in oncology, is pleased to announce that it has entered into an exclusive licensing agreement with Sovargen Co., Ltd, a biotechnology company specializing in central nervous system (CNS) diseases, to develop, manufacture and commercialise paxalisib as a potential treatment of intractable epilepsy in focal cortical dysplasia type 2 (FCD T2) and tuberous sclerosis complex (TSC) disease. The underlying cause of FCD T2 and TSC can be traced back to somatic mutations in the PI3K/Akt/mTOR pathway or mutations in the TSC1 or TSC2 genes, which lead to the overactivation of the mTOR pathway. Paxalisib is an oral dual inhibitor targeting both PI3K and mTOR within this pathway, and it is distinguished by its ability to penetrate the brain. Although FCD T2 and TSC are rare orphan diseases, they represent a high medical unmet need with significant market opportunity. There are currently no approved drugs for patients with FCD T2. Under the agreement, Kazia will receive an upfront payment of US$1.5 million, potential milestone payments of up to US$19 million upon the achievement of development and regulatory milestones, and a percentage of sub-licensing revenues and royalties on net sales of products incorporating paxalisib. The licensing agreement includes all countries worldwide, excluding mainland China, Hong Kong, Macao and Taiwan, which Kazia retains. Kazia CEO Dr. John Friend said: "We are pleased to announce we have exclusively licensed the development, manufacture and commercialization of paxalisib to Sovargen for its potential use in select CNS diseases that are associated with mTORopathy. Kazia's primary focus of paxalisib continues to be oncology, with multiple studies ongoing. Our license with Sovargen provides us the ability to explore the impact of paxalisib outside of our area of expertise where there is substantial patient need and market opportunity. We are enthusiastic about seeing paxalisib's potential explored in these patient populations." Sovargen CEO Cheolwon Park shared his excitement about the collaboration: "The dual inhibition mechanism of paxalisib, coupled with its observed safety pro previous oncology studies, positions us to anticipate initiation of a Phase 2 clinical trial for patients with FCD T2 and TSC in the latter half of 2024. Sovargen has played a pioneering role in identifying the critical link between mTOR hyperactivation due to mTORopathy somatic mutations and epileptic seizures in FCD T2 patients and we have an unwavering dedication to developing effective treatments for these patients." About Kazia Therapeutics Limited Kazia Therapeutics Limited (NASDAQ: KZIA) is an oncology-focused drug development company, based in Sydney, Australia. Our lead program is paxalisib, an investigational brain-penetrant inhibitor of the PI3K / Akt / mTOR pathway, which is being developed to treat multiple forms of brain cancer. Licensed from Genentech in late 2016, paxalisib is or has been the subject of ten clinical trials in this disease. A completed Phase 2 study in glioblastoma reported early signals of clinical activity in 2021, and a pivotal study in glioblastoma, GBM AGILE, is ongoing, with final data expected in 1H2024. Other clinical trials are ongoing in brain metastases, diffuse midline gliomas, and primary CNS lymphoma, with several of these having reported encouraging interim data. Paxalisib was granted Orphan Drug Designation for glioblastoma by the FDA in February 2018, and FTD for glioblastoma by the FDA in August 2020. Paxalisib was also granted FTD in July 2023 for the treatment of solid tumour brain metastases harboring PI3K pathway mutations in combination with radiation therapy. In addition, paxalisib was granted Rare Pediatric Disease Designation and Orphan Drug Designation by the FDA for diffuse intrinsic pontine glioma in August 2020, and for atypical teratoid / rhabdoid tumours in June 2022 and July 2022, respectively. Kazia is also developing EVT801, a small-molecule inhibitor of VEGFR3, which was licensed from Evotec SE in April 2021. Preclinical data has shown EVT801 to be active against a broad range of tumour types and has provided evidence of synergy with immuno-oncology agents. A Phase I study is ongoing and preliminary data is anticipated in CY2024. For more information, please visit or follow us on Twitter @KaziaTx. About Sovargen Sovargen Co., Ltd. is a biotechnology company focused on the discovery and development of drugs to treat rare and incurable neurological disorders that are caused by brain somatic mosaicism. Sovargen's platform technology is associated with ASO (Antisense Oligonucleotide) development for undruggable targets in CNS disease including technology for target discovery (SovarIN™), ASO drug discovery & optimization (SovarON™), and target validation & efficacy evaluation platform using disease-specific animal model and human organoid system (SovarUP™). For more information, please visit Forward-Looking Statements This announcement may contain forward-looking statements, which can generally be identified as such by the use of words such as "may," "will," "estimate," "future," "forward," "anticipate," or other similar words. Any statement describing Kazia's future plans, strategies, intentions, expectations, objectives, goals or prospects, and other statements that are not historical facts, are also forward-looking statements, including, but not limited to, statements regarding: expansion of paxalisib into other indications including intractable epilepsy in focal cortical dysplasia type 2 (FCD T2) and tuberous sclerosis complex (TSC) disease, expectations regarding whether milestones will be met, expectations on market opportunities for paxalisib in FCD T2 and TSC, plans to initiate clinical trials for paxalisib in FCD T2 and TSC, the timing for results and data related to Kazia's clinical and preclinical trials and investigator-initiated trials of Kazia's product candidates, and Kazia's strategy and plans with respect to its programs, including paxalisib and EVT801. Such statements are based on Kazia's current expectations and projections about future events and future trends affecting its business and are subject to certain risks and uncertainties that could cause actual results to differ materially from those anticipated in the forward-looking statements, including risks and uncertainties: associated with clinical and preclinical trials and product development, related to regulatory approvals, and related to the impact of global economic conditions. These and other risks and uncertainties are described more fully in Kazia's Annual Report, filed on form 20-F with the United States Securities and Exchange Commission (SEC), and in subsequent filings with the SEC. Kazia undertakes no obligation to publicly update any forward-looking statement, whether as a result of new information, future events, or otherwise, except as required under applicable law. You should not place undue reliance on these forward-looking statements, which apply only as of the date of this announcement. This announcement was authorized for release by Dr John Friend, CEO. Company Codes: NASDAQ-SMALL:KZIA