TIM3

点击上方的 行舟Drug ▲ 添加关注前言迄今为止，与传统的抗癌治疗策略相比，免疫治疗被认为是最有前景的全身性肿瘤治疗方法，其中，单克隆抗体因其特异性靶向分子的能力，已成为癌症治疗中一种关键而有效的治疗方式。然而，由于肿瘤复杂的疾病发病机制，针对单一靶点的单克隆抗体往往不足以表现出足够的治疗效果。因此，针对多个靶点的双特异性抗体（bsAbs）应运而生，它的发展改变了肿瘤免疫治疗的领域。目前，人们正在研究越来越多的针对癌症治疗的不同类型的bsAbs。这些类型包括双靶向抑制剂，其作用于不同水平的肿瘤增殖、血管形成和转移；以及双特异性抗体偶联药物、T细胞结合器、双特异性自然杀伤细胞接合器（NKCE）和先天免疫细胞接合器。其他类型还包括双特异性免疫检查点抑制剂（CPI）、共刺激bsAbs和融合蛋白、具有联合检查点抑制和共刺激特征的bsAbs、在肿瘤微环境（TME）中特异性激活的bsAb，以及将过继T细胞治疗和治疗性抗体相结合的新方法。目前，有300多项临床试验涉及200多种不同的双特异性抗体分子，其中约75%用于治疗实体瘤，25%用于治疗血液系统恶性肿瘤。有10种bsAb药物已被批准用于癌症治疗，其中9种在美国和/或欧洲获得批准，cadonilimab在中国获得批准。到目前为止，临床中开发的很大一部分bsAbs已经处于后期阶段（II期和III期）。另外，可以发现，治疗实体瘤的bsAbs主要由免疫调节剂主导，包括双CPI（约45%）和TCE（约33%），其次是靶向双途径、ICEs和ADC的bsAb。bsAb的发展史BsAbs最初的概念是由AlfredNisonof在20世纪60年代首次提出的。他将两个不同的抗原结合位点结合在一个分子中，并从抗牛γ球蛋白和抗卵清蛋白单价片段的混合物中获得了一个具有双重特异性的F(ab’)2分子。1975年，Köhler和Milstein发明了杂交瘤技术，最终解决了生产单克隆抗体的问题，开启了单克隆抗体治疗的新时代。1983年，Milstein和Cuello开创了quadroma技术，该技术基于分泌Abs混合物的两种不同杂交瘤细胞系的体细胞融合，包括具有双重特异性的鼠IgG形式的bsAb。然而，bsAb的低产率以及难以从密切相关的错配副产物中纯化所需的Ab是一个重大问题。1988年，James Huston和他的同事发明了单链抗体片段（scFv），它最大限度地减少了复性问题，例如不正确的结构域配对或聚集。1996年，Genentech的科学家们利用重组DNA技术发明了knob-into-hole技术，克服了Quadrome技术的局限性。通过在人类IgG的CH3结构域之间的界面突变选定的氨基酸，可以减少IgG重链的错配。这种技术利用更有利的蛋白质相互作用，最终可以形成高达90%的正确双特异性重链配对。随后，随着抗体工程和生物学的进展，bsAb的不同概念和结构正在不断演变。靶向双受体抑制的bsAb许多参与细胞信号传导的细胞表面蛋白，如RTK和相关受体，是基于抗体治疗的有效靶点。尽管靶向一个确定的信号受体的抗体治疗是非常有效的，但疾病相关表型通常由不止一种途径触发。这种冗余允许细胞通过使用其他补偿信号通路，从而耐受药物的生长抑制或细胞毒性诱导。同时调节不同疾病相关信号受体或通路的bsAbs可以减少或克服这一限制。Amivantamab（JNJ-61186372）靶向EGFR和肝细胞生长因子受体（MET），两种受体都能触发非小细胞肺癌（NSCLC）的增殖。因此，阻断两种受体比仅阻断一种途径能够更有效地抑制NSCLC的生长。Amivantamab已被FDA批准用于治疗携带EGFR外显子20插入突变的NSCLC亚型。一项随机III期研究的数据显示，在这部分患者中，与单独化疗相比，Amivantamab联合化疗具有显著优越性。另外一些针对肿瘤不同第二靶点的EGFR的bsAbs也正在临床开发中。例如，petosemtamab（MCLA-158）靶向EGFR和LGR5，LGR5是一种癌症干细胞相关的细胞表面受体。Petosemtamab目前正在包括晚期头颈部鳞状细胞癌在内的实体瘤患者的I/II期试验中进行评估（NCT03526835）。靶向配体受体抑制的bsAbbsAbs可以同时阻断两种不同的配体，或者是配体和受体的组合。VEGF和血管生成素2（ANG2）的双重靶向作用分别阻断VEGFR和血管生成因子1受体（TIE2）的激活，这两种途径涉及血管生成。vanucizumab，一种靶向VEGFA和ANG2的bsAb，在临床前模型中与化疗联合显示出抗肿瘤、抗血管生成和抗转移作用。BI836880是一种三特异性纳米抗体融合蛋白，由三个靶向VEGFA、ANG2和HSA的纳米抗体组成，后者可延长其血清半衰期。目前正在头颈部鳞状细胞癌、NSCLC和其他实体瘤患者的I期研究中进行评估。此外，靶向VEGF可以进一步设计成联合靶向肿瘤细胞上的PD-L1或T细胞上的PD-1，从而将抗血管生成与肿瘤免疫学方法联系起来。例如靶向PD1和VEGF的ivonescimab（AK112），其目前已在中国获批用于。其他bsAbs靶向PDL1和VEGF，包括PM8002，该药物正在NSCLC患者的II/III期研究（NCT05756972）中进行评估。靶向受体激活的bsAb许多抗肿瘤反应是通过激活细胞表面受体介导的，包括通过诱导细胞凋亡的免疫反应或细胞死亡。其中一种方法是靶向递送受体激活配体，如生长因子、细胞因子和（共）免疫刺激配体，将其融合到抗体或抗体片段中，以诱导局部或组织特异性激动活性，从而诱导细胞反应。越来越多的这种抗体-配体融合蛋白正在进入临床试验。受体激活也可以使用激动性抗体来实现。针对靶抗原和肿瘤坏死因子超家族（TNFRSF）成员的bsAbs已被证明是具有强大活性和肿瘤选择性的激动分子。RG7386（RO6874813）是一种四价bsAb，靶向癌症相关成纤维细胞上的FAPα和DR5，在具有FAPα间质表达的小鼠模型中具有效和选择性的肿瘤细胞杀伤，并已进入临床测试。此外，BI905711，一种靶向DR5和CDH17的四价双特异性IgG-scFv融合蛋白，目前处于I期临床研究中。靶向递送有效载荷的bsAb存在两种概念上不同的方法来利用bsAbs靶向递送有效载荷，如细胞毒性药物或放射性药物。第一种方法，预靶向治疗，使用bsAb的一个臂特异性靶向肿瘤细胞，另一个臂随后捕获有效载荷到肿瘤细胞。GD2 x DOTA是一种识别GD2的bsAb，并捕获放射性有效载荷177Lu-DOTA，其在TME中组装。在没有四聚化的情况下，由于半衰期，它会被迅速从外围清除。然而，到目前为止，临床试验中很少有bsAbs利用这种MoA，这可能是因为放射性预靶向涉及复杂的导流，限制了其普遍适用性。第二种方法通过递送偶联到双特异性抗体上的细胞毒性有效载荷，实现肿瘤细胞的特异性靶向。目前，bsADC已成为肿瘤药物开发的热点，已有多款bsADC进入临床开发，如ZW49、REGN5093、BL-B01D1等。靶向癌症免疫治疗的bsAb癌症免疫疗法中使用的大多数bsAbs通过T细胞驱动的天然或内源性免疫发挥作用，包括免疫检查点抑制（CPIs）效应细胞接合器（包括TCE和ICEs）以及共刺激性bsAb。双免疫检查点抑制许多抑制免疫检查点的单特异性抗体，如CTLA4或PD-1/PDL-1，已被批准用于癌症免疫疗法。将检查点抑制性抗体疗法扩展到bsAbs可以减少不期望的副作用，并增强疗效。大多数双免疫检查点抑制剂靶向PD-1/PD-L1轴和其他免疫抑制分子，如CTLA-4、TIM-3、LAG-3或TIGIT。MEDI5752（PD-1×CTLA-4）抑制PD-1+激活的T细胞中CTLA-4的功能，诱导PD-1的快速内化和降解。与PD-1和CTLA-4单抗联合治疗相比，MEDI5752的活性显著增强。针对其他检查点分子的双功能性抑制剂，包括LAG-3和TIGIT，也正在开发中。效应细胞接合器细胞接合器连接两种不同类型的细胞，主要是肿瘤细胞和T/NK细胞，以诱导肿瘤细胞溶解。细胞接合器由TAA靶向部分和效应细胞识别部分组成，并进一步分为T细胞接受器和NK细胞接受器。T细胞接合器利用TAA和TCR成分（主要是CD3），它们连接肿瘤细胞和T细胞，绕过TCR-MHC-I相互作用。因此，无论抗原特异性如何，T细胞结合器都会触发T细胞活化，产生包括穿孔素和颗粒酶在内的细胞毒性分子，以杀伤肿瘤细胞。BiTE是T细胞结合器的一种形式，通过靶向TAA和CD3的单链抗体将肿瘤细胞和T细胞结合，用于T细胞介导的肿瘤细胞杀伤。靶向CD19和CD3的blinatumomab是临床上典型的BiTE，2014年，blinatumomab成为第一个被FDA批准的BsAb，用于治疗ALL患者，在随后的几年里，blinatumomab的治疗范围进一步拓宽，2018年，FDA批准其用于首次或第二次完全缓解后MRD≥0.1%的pre-B ALL患者群体的治疗。目前，超过60例BiTE形式的双抗正在进行I/II期临床试验。NK细胞接合器将CD16A+NK细胞重定向至肿瘤细胞，诱导NK细胞活化。与BiTE相比，NK细胞接受者表现出较少的不良反应，如细胞因子释放综合征（CRS）和神经毒性。多种细胞毒性受体可激活NK细胞：CD16（FcγRIII）、天然细胞毒性受体（NCR；NKp30、NKp44、NKp46）、C型凝集素样受体NKG2D（CD314）和CD94/NKG2C。最近，抗CD30×CD16A的NK细胞接合器（AFM13）在AACR 2022的报告中展示了不俗的抗肿瘤效果。共刺激bsAbs高效、持久和局部受限的抗肿瘤免疫反应需要共刺激和共抑制信号来严格调节细胞毒性T细胞、自然杀伤细胞和巨噬细胞的激活、分化和维持。TNFRSF家族的成员（如4-1BB、CD40、OX40、GITR、CD27或CD30）以及CD28免疫球蛋白超家族（如CD28、CTLA4、PD-1、ICOS、BTLA)及其相应的配体在介导免疫调节信号中发挥着重要作用。靶向这些免疫调节途径可以增强免疫治疗。PRS-343（cinrebafusp），是一种针对HER2和4-1BB的四价bsAb，在IND研究中其耐受性良好，没有明显和相关的药物相关毒性；在接受有效剂量治疗的患者中（n=33），12%的患者达到ORR，包括1个CR，疾病控制率（DCR）为52%。bsAbs中通过4-1BB进行肿瘤选择性共刺激的其他靶点还包括EGFR、PSMA、CLDN18.2、B7H4、CEACAM5、HER2、PD-L1和FAP。此外，十多种针对PD-L1和4-1BB的不同bsAbs处于I期或II期试验中。bsAb的新概念bsAbs的领域仍在进一步探索和扩展技术和应用，可能提供目前正在开发的bsAb尚未解决的治疗概念。三特异性TCE共刺激信号可以与双特异性TCE组合以促进更加有效的T细胞活化。这样的三特异性TCE目前正在针对TAA和CD3的临床试验中，并且进一步包含抗CD28结合位点。SAR443216是一种针对HER2×CD3×CD28的三特异性抗体，能够强力激活CD4+和CD8+T细胞，诱导T细胞增殖、细胞因子和颗粒酶B的释放，以及T细胞介导的对表达HER2的肿瘤细胞的杀伤，其目前处于I期临床研究中。在类似的方法中，SAR442257是另一种CD38×CD3×CD28的三特异性抗体。前药方法一种新兴的方法是在肿瘤处选择性激活的前药，产生具有高度肿瘤特异性功能的bsAbs。前药转化为功能性bsAbs可以通过环境触发因素如肿瘤相关蛋白酶来实现。双重肿瘤靶向的另一种前药方法依赖于来自两个具有分裂CD3ε结合部分的肿瘤特异性组装。这些分子需要被设计为非活性的独立实体并在循环中，使得它们仅在肿瘤抗原结合和随后的原位组装时被激活。PROTAC bsAbs另一个新兴概念和新的MoA利用bsAbs通过靶向降解来抑制增殖相关过程。类似于双特异性或多特异性小分子蛋白水解靶向嵌合体（PROTACs），bsAbs可被设计为触发参与癌症发展或进展的表面蛋白的内化和随后的降解。这样的bsAbs同时与靶向降解的蛋白质和降解的因子结合，并触发内化，如膜上的E3泛素连接酶或转铁蛋白受体。目前，抗体-PROTAC概念仍处于早期开发阶段，迄今为止还没有进入临床研究。bsAb递送bsAb开发中另一个重要的新兴概念是bsAb的局部产生和随后的局部递送，如通过脂质纳米颗粒介导的mRNA递送的CLDN6 TCE、溶瘤病毒或包括CAR-T细胞在内的基因治疗方法。细胞因子模拟抗体最后，bsAbs也可以作为细胞因子模拟物或所谓的合成细胞因子激动剂。scFvs或基于单域抗体VHH的方法可以通过模拟IL-2或IL-15、IL-18、I型干扰素和IL-10来有效地触发细胞因子信号传导。这种基于抗体的细胞因子模拟物可能在癌症免疫疗法中具有各种应用。小结bsAbs领域最近取得了实质性进展，到2023年底，已有十几种bsAbs获得批准，许多不同的方法正在临床上进行测试。尽管如此，由于癌症的异质性和适应性，这些方法中的任何一种都不太可能成为普遍的癌症免疫疗法。相反，抗体需要针对某些应用量身定制，并将依赖于与其他方法的结合，以最大限度地提高其疗效和安全性。在不久的将来，多特异性抗体疗法的发展可能会在以下四个领域出现增长：针对具有明确依赖性的肿瘤相关RTK的bsAbs；用于以增加的选择性靶向肿瘤的bsADC；用于靶向降解适用于各种途径的细胞表面蛋白的双特异性PROTAC；以及用于癌症免疫疗法的多特异性抗体。与其他治疗癌症的药物一样，通过改进的诊断方法和新的开发模式，将bsAbs和多特异性抗体疗法应用于早期患者，对于实现治愈癌症患者的目标至关重要。参考文献：1. The present and future of bispecific antibodies for cancer therapy. Nat Rev Drug Discov.2024 Mar 6.2. Development of Bispecific Antibody for CancerImmunotherapy: Focus on T Cell Engaging Antibody. Immune Netw. 2022 Feb; 22(1): e4.文章信息源于公众号小药说药，登载该文章目的为更广泛的传递行业信息，不代表赞同其观点或对其真实性负责。文章版权归原作者及原出处所有，文章内容仅供参考。本网拥有对此声明的最终解释权，若无意侵犯版权，请联系小编删除。学如逆水行舟，不进则退；心似平原走马，易放难收。行舟Drug每日更新 欢迎订阅+医药大数据|行业动态|政策解读

这项研究填补了实体瘤浸润T细胞无法产生足够能量的知识空白，并首次提出ACC是阻碍T细胞在营养应激条件下持续发挥功能的分子开关。 近日，一篇发表在《细胞代谢》期刊上的论文揭示[1]，深陷肿瘤当中的T细胞产不出能量，是因为自身的代谢“开关”被肿瘤改动，用于产能的脂肪囤成“肥肉”了！ 美国北卡罗来纳大学教堂山分校的Jessica E. Thaxton团队发现，肿瘤微环境中的代谢应激会导致T细胞中的乙酰辅酶A羧化酶（ACC）活性升高，这促使T细胞倾向于储存而非分解脂质，脂滴在T细胞中积累，脂肪酸氧化产生能量的代谢途径被抑制，阻碍了T细胞的有效功能。 使用ACC抑制剂可以挽救T细胞的代谢，使其对脂肪的处理偏好于用来脂肪酸氧化而不是脂质储存，并增强T细胞的抗肿瘤效应、改善T细胞线粒体结构。 这项研究填补了实体瘤浸润T细胞无法产生足够能量的知识空白，并首次提出ACC是阻碍T细胞在营养应激条件下持续发挥功能的分子开关。 论文首页截图 在这项研究中，Jessica E. Thaxton团队利用纤维肉瘤小鼠模型（MCA-205）、结直肠癌小鼠模型（MC-38）和黑色素瘤小鼠模型（B16）发现，相对于脾脏或淋巴结来源的CD8+T细胞，肿瘤浸润CD8+T细胞中与脂质代谢紊乱相关的基因富集，脂质积累增加大约1.5倍，大多数类别的脂质丰度都有提高。使用共聚焦显微镜可观察到，肿瘤浸润CD8+T细胞积累有相对更多的脂滴。 随后的一系列结果表明，进入实体瘤肿瘤微环境是T细胞脂质积累的驱动因素。由于快速增殖的需求，肿瘤细胞大量消耗抢夺微环境中的葡萄糖、氧气等各种生存资源，这些压力、应激诱导了肿瘤浸润T细胞中脂滴的积累。 更重要的是，他们发现，随着肿瘤发展，脂滴积累增加，脂滴浓度升高与肿瘤浸润CD8+T细胞功能障碍标志物PD-1、Tim-3、TOX、CTLA-4、LAG-3的表达上调相关。 这些结果表明，肿瘤浸润CD8+T细胞中异常的脂质积累与起功能受损相关。 肿瘤微环境驱动T细胞脂滴形成，且脂滴形成与T细胞功能受损相关 ACC是参与脂肪酸生物合成过程的关键代谢酶。ACC活性会导致脂肪酸合成增加，同时间接阻止线粒体将其利用进行脂肪酸氧化（FAO）来产生ATP。ACC可以说是细胞中的代谢开关，调节着脂质储存与脂质分解以获取能量之间的平衡，“如果ACC被‘打开’，细胞通常会储存脂质；如果 ACC‘关闭’，细胞则倾向于使用线粒体中的脂质来制造ATP，”Thaxton说[2]。 肿瘤正是借着ACC给T细胞养起了膘。 研究者们发现，CD8+T细胞在肿瘤微环境下被诱导ACC过度表达，这导致脂滴积累并限制脂肪酸水解，而脂肪酸水解是细胞在肿瘤微环境这样的营养限制条件下的重要能量产生途径。 使用ACC抑制剂（ND-646）限制T细胞中ACC的活性，会显著改变T细胞代谢特征，导致T细胞的脂质合成减少、脂滴减少，促进T细胞将脂肪酸用于氧化分解并产生更多ATP。 ACC抑制剂对T细胞代谢大改造 从功能上来看，ACC抑制剂处理后，CD8+T细胞表型重塑，被激活并扩增，与T细胞记忆性状相关的基因集富集而耗竭特征减弱，CD62L、TCF-1、BCL-2等干性生物标记物上调。此外，T细胞的线粒体结构得到改善，线粒体数量更多、体积更大，线粒体嵴以及线粒体与内质网接触点的数量也更多。 将经过ACC抑制剂一番打造的T细胞输注给黑色素瘤小鼠，可以观察到小鼠T细胞在肿瘤微环境中持续发挥抗肿瘤功能，输注第七天时，肿瘤微环境中具有活性的CD8+T细胞占比相较于对照组增加3倍，干性相关的转录因子表达上调；与对照组相比，小鼠肿瘤进展得到更有效控制。 不仅如此，研究者们获取7名健康捐献者的外周T细胞进行评估和体外培养发现，ACC抑制剂处理可以促进记忆T细胞的形成。 ACC抑制剂增加T细胞抗肿瘤功能和干性表型 也就是说，ACC抑制剂能够改善了T细胞在肿瘤微环境中的代谢状态和抗肿瘤功能，这项研究成果可能有助于增强CAR-T细胞疗法，从患者体内取出T细胞经体外修饰和ACC抑制剂处理后，重新输注患者体内以对抗癌症。 对于研究结果，Jessica E. Thaxton猜想，T细胞可能是需要脂质的“微妙平衡”才能在实体瘤中持续存在，不仅得有足够的脂质以提供能量来对抗癌细胞，还要控制脂质的积累，以避免过多的脂质储存对其功能产生负面影响。 未来的工作中，Jessica E. Thaxton团队将进一步尝试CAR-T细胞疗法以外的应用，即能否绕开取出T细胞再输注这一过程，直接在患者肿瘤翻转T细胞的ACC代谢开关。但是在这之前，还得确定调节ACC开关对其它免疫细胞有何影响。 参考文献： [1] Hunt, E. G., Hurst, K. E., Riesenberg, B. P., Kennedy, A. S., Gandy, E. J., Andrews, A. M., Del Mar Alicea Pauneto, C., Ball, L. E., Wallace, E. D., Gao, P., Meier, J., Serody, J. J., Coleman, M. F., & Thaxton, J. E. (2024). Acetyl-CoA carboxylase obstructs CD8+ T cell lipid utilization in the tumor microenvironment. Cell metabolism, S1550-4131(24)00055-X. Advance online publication. https://doi.org/10.1016/j.cmet.2024.02.009 [2]https://news.unchealthcare.org/2024/03/researchers-gain-insight-into-why-t-cells-lose-energy-in-solid-tumors/

Full-year 2023 net revenue reaches 135 billion KRW, driven by strong sales growth. R&D momentum persisted with promising developments in anti-FcRn antibodies HL161ANS and batoclimab, positioning them as potentially best-in-class treatments for lgG-mediated autoimmune diseases. Anticipates the initiation of tanfanercept Phase 3 VELOS-4 study in dry eye disease in the first half of 2024 and top-line data results from HL192 Phase 1 study for Parkinson's Disease in the second half of 2024. ROCKVILLE, Md. and SEOUL, South Korea, March 21, 2024 /PRNewswire/ -- HanAll Biopharma Co., Ltd. (KRX: 009420.KS), a global biopharmaceutical company committed to discovering and developing innovative medicines for patients, reported financial results for 2023 and provided business updates. HanAll delivered a strong full-year performance, with a 23 percent increase in sales compared to 2022, demonstrating continued innovation momentum through multiple meaningful data readouts for anti-FcRn assets and the dry eye disease program. Total revenues for 2023 were 135 billion Korean won (KRW), mainly driven by strong sales growth from key products. Operating income for the year recorded 2.2 billion KRW. "2023 marked a significant milestone as we celebrated our 50th anniversary. We have delivered record-high sales performance, with continued advancements in our R&D programs by adding the Parkinson's disease program, completing the VELOS-3 study in dry eye, and securing meaningful outcomes from the Phase 1 study of HL161ANS, our second anti-FcRn asset," said Sean Jeong, M.D., MBA, CEO of HanAll Biopharma. "As we anticipate further advancements in 2024, including the VELOS-4 study in dry eye and additional data readouts from the anti-FcRn assets and Parkinson's program, we will continue to focus our efforts to serve patients," he added. Full-Year 2023 BUSINESS UPDATE Pipeline Development Highlights A comprehensive update of HanAll's pipeline development below includes an overview of research along with lists of compounds, targeted indications, and developmental phases. AUTOIMMUNE DISEASES PROGRAMS Batoclimab (HL161BKN) A novel, fully human, subcutaneously administered antibody targeting FcRn with the potential to address multiple IgG-mediated autoimmune diseases. Batoclimab is designed to selectively bind to FcRn, which plays a role in recycling IgG, thereby reducing levels of harmful IgG antibodies. Immunovant, HanAll's licensed partner in the United States and Europe, has reported positive initial results from a Phase 2 proof-of-concept trial evaluating the safety and efficacy of batoclimab in patients with Graves' disease. The study demonstrated that batoclimab achieved response rates exceeding 50% in patients who are hyperthyroid despite treatment with an anti-thyroid medication (ATD) for more than 12 weeks. Treatment response is defined as normalization of T3 and T4 hormone levels without increasing ATD dose. Consistent with studies of batoclimab in other indications, the subcutaneous administration of 680 mg batoclimab showed an impressive reduction of up to 87% in IgG levels, with a mean IgG reduction of 81% after 12 weeks of treatment. Batoclimab was generally well tolerated with no new safety signals identified from the initial data set. Immunovant plans to assess the development of the second anti-FcRn, 'HL161ANS (IMVT-1402)', for Graves' disease, with details expected to be unveiled later in 2024. Harbour BioMed, a licensed partner in China, provided updates on the progress of the Biologics License Application (BLA) submission for batoclimab, intended for the treatment of generalized myasthenia gravis (gMG). In line with the clinical study protocol, the company is currently in the extension period of the Phase 3 clinical trial to gather additional long-term safety data. Harbour BioMed plans to include the supplementary long-term safety data and aims to re-submit the BLA for batoclimab to the National Medical Products Administration (NMPA) in the first half of 2024. BLA submission for batoclimab for the treatment of gMG was made in June 2023, prompted by a positive topline result obtained from the Phase 3 clinical trial. HanAll and Immunovant are progressing a Phase 3 clinical study of batoclimab in generalized myasthenia gravis (gMG) in Japan. Clinical trial notification (CTN) was approved to initiate a Phase 3 clinical study of batoclimab in thyroid eye disease (TED) in Japan. HL161ANS Another novel, fully human, subcutaneous antibody molecule that inhibits FcRn-mediated recycling of IgG is designed to deliver maximum lgG reductions while minimizing interference with albumin recycling. Immunovant announced positive initial Phase 1 600 mg MAD results for HL161ANS (IMVT-1402) in November 2023. In the study, four once-weekly subcutaneous injections of 600 mg HL161ANS reduced total IgG level by a mean of 74%, demonstrating comparable potency to batoclimab 680 mg, which reduced IgG by 76% after four weekly doses. Overall, HL161ANS consistently demonstrated a significant reduction in IgG levels with potency similar to or greater than that of batoclimab, with no significant decrease in serum albumin or significant increase in LDL-cholesterol levels at day 29 (peak pharmacodynamics impact) from baseline (p-values > 0.05). OPHTHALMIC DISEASE PROGRAM Tanfanercept (HL036) A novel topical protein therapy for ophthalmic diseases, including dry eye disease (DED), which inhibits TNF, a key mediator of ocular inflammation HanAll Biopharma and Daewoong Pharmaceutical successfully concluded discussions with the FDA in the second half of 2023, finalizing the Phase 3 VELOS-4 study design and development plan. The anticipated initiation of the VELOS-4 study is set for the first half of 2024. The concluded Phase 3 VELOS-3 study revealed a significant improvement in the unanesthetized Schirmer test, a secondary efficacy endpoint measuring changes in tear volume from baseline in individuals treated with tanfanercept 0.25% compared to the vehicle. This improvement, assessed at week 8, demonstrated a highly statistically significant outcome (p=0.002). Furthermore, a noteworthy proportion of participants in the tanfanercept group (13%) exhibited a Schirmer test improvement of at least 10 mm from baseline at week 8, which was statistically significant (p=0.011) compared to the vehicle group (4%). It is worth mentioning that, according to the FDA's 2020 Draft Guidance on Dry Eye Drug Development, achieving a statistically significant difference in the percentage of patients with a minimum 10 mm increase in the Schirmer test is considered an acceptable primary efficacy endpoint. The FDA has also outlined an alternative approval pathway, requiring the demonstration of a statistically significant difference in an objective predefined sign of dry eye and, additionally, at least one subjective predefined symptom of dry eye. However, this second pathway often involves increased complexity, necessitating additional studies. NEUROLOGY PROGRAM HL192 (ATH-399A) A pipeline candidate originated from NurrOn Pharmaceuticals that targets Nurr1, a master regulator in dopaminergic neuron development and maintenance, is being developed to treat neurodegenerative diseases, including Parkinson's disease (PD). HanAll Biopharma, Daewoong Pharmaceutical, and NurrOn Pharmaceuticals are progressing with the Phase 1 clinical trial of HL192 in healthy participants. The results from the Phase 1 clinical trial of HL192 are expected in the second half of 2024. ONCOLOGY PROGRAMS HL187/ HL186 HL187 is a monoclonal antibody that targets TIGIT (T cell immunoreceptors with Ig and ITIM domains {Immunoreceptor tyrosine-based inhibitory motif domains}). HL186 is a monoclonal antibody that targets TIM-3 (T cell Ig and mucin domain-3). These antibodies are being developed in collaboration with Daewoong Pharmaceutical as potential oncology treatments. HanAll is currently advancing the pre-clinical examination of HL187 (anti-TIGIT) and concurrently evaluating the prospects of HL186 (anti-TIM-3) as part of the ongoing strategic portfolio review. FINANCIAL HIGHLIGHTS (CONSOLIDATED) Key Highlights Sales generated 135 billion KRW in 2023, a 22.7% increase compared to 2022. Sales remained strong with its major products including Normix, Eligard, and Biotop. R&D expenses, reported as 24 billion KRW, a 45.1% increase compared to 2022. Operating income was 2.2 billion KRW, a 46.9% increase compared to the same period in 2022. Net income was 3.5 billion KRW, compared to 300 million KRW in 2022. About HanAll Biopharma HanAll Biopharma (KRX: 009420.KS) is a global biopharmaceutical company with a presence in Korea, the USA, Japan, and Indonesia with a mission of making meaningful contributions to patients' lives by introducing innovative, impactful medicines to address severe unmet medical needs. HanAll has been operating a portfolio of pharmaceutical products in the areas of endocrine, circulatory, and urologic diseases for over 50 years. HanAll has also expanded its focus to immunology, oncology, neurology, and ophthalmology to discover and develop innovative medicines for patients with diseases for which there are no effective treatments. Its lead pipeline asset, HL161 (INN: batoclimab), an anti-FcRn antibody, is being developed in Phase 3 and Phase 2 trials across the world for the treatment of autoimmune diseases including myasthenia gravis (MG), thyroid eye disease (TED), chronic inflammatory demyelinating polyneuropathy (CIDP), and Graves' disease (GD). Another main asset, HL036 (INN: tanfanercept), a TNF inhibitor protein, is being evaluated in Phase 3 clinical studies in the US and China for the treatment of dry eye disease. For further information, visit our website and connect with us on LinkedIn. For any media inquiries, please contact HanAll PR/IR ([email protected], [email protected]). Disclaimer Statement The contents of this announcement include statements that are, or may be deemed to be, "forward-looking statements." These forward-looking statements can be identified by the use of forward-looking terminology, including the terms "believes," "estimates," "anticipates," "expects," "intends," "may," "will," or "should," and include statements HANALL (the company, we) makes concerning its 2024 business and financial outlook and related plans; the therapeutic potential of its product candidates; the intended results of its strategy and the company, and its collaboration partners', advancement of, and anticipated clinical development, data readouts and regulatory milestones and plans, including the timing of planned clinical trials and expected data readouts; the design of future clinical trials and the timing and outcome of regulatory filings and regulatory approvals. By their nature, forward-looking statements involve risks and uncertainties, and readers are cautioned that any such forward-looking statements are not guarantees of future performance. The company's actual results may differ materially from those predicted by the forward-looking statements. These may include various significant factors, such as our expectations regarding the inherent uncertainties associated with competitive developments, preclinical and clinical trial and product development activities, and regulatory approval requirements. In addition, performance may be affected by our reliance on collaborations with third parties, estimating the commercial potential of our product candidates, our ability to obtain and maintain protection of intellectual property of technologies and drugs, our limited operating history, and our ability to obtain additional funding for operations and to complete the development and commercialization of product candidates. A further list and description of these risks, uncertainties, and other risks can be found in Korea Stock Exchange (KRX) filings and reports, including in our most recent annual report as well as subsequent filings and reports filed by the company with the KRX. Given these uncertainties, the reader is advised not to place any undue reliance on such forward-looking statements. These forward-looking statements speak only as of the date of publication of this document. We undertake no obligation to publicly update or revise the information in this press release, including any forward-looking statements, except as may be required by Korean law and regulations. SOURCE HanAll Biopharma