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Medical Forum / Diseases and Disorders / AIDS / September 2004

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goat plasma antibodies now in clinical trial

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Ren Stimpy - 03 Sep 2004 17:12 GMT
This is an interesting approach and I remember reading about something
similiar being done in the U.S. a few years ago.
From NATAP (http://www.natap.org/2004/Bangkok/bangkok_53.htm):

Passive Immunotherapy Drug: HRG214
     
 Here is a press release from the manufacturer, which is followed by
the poster abstract reported at the XV Intl AIDS Conference.

Virionyx Corporation Ltd, the New Zealand biopharmaceutical firm
presented a poster at the XV International AIDS Conference in Bangkok,
Thailand (July 2004) on this potential therapy for HIV.

As the conference delegates grappled with the announcement that a
preventative AIDS vaccine is still years away and with the United
Nations report that 14,000 people are infected with human
immunodeficiency virus (HIV) every day, the Auckland based company had
some good news for them.

Virionyx told the doctors, researchers, scientists, medical
professionals and media attending the conference that AIDS and HIV
infected patients participating in the pre-Phase II multi dose
clinical trials of its biotherapeutic, PEHRG214, at Harvard Medical
School are responding favourably to treatment.

The international AIDS and cancer specialist, Associate Professor
Bruce Dezube, who is conducting the trials, reported early signs of
efficacy in the patients and that they generally tolerated the
treatment well, in contrast to the existing AIDS drugs which have
significant adverse side effects.

"The only adverse event was a rash -- a mild allergic reaction -- to
the treatment in some of the patients. This was successfully prevented
with Benadryl, Tylenol and Allegra on the days they were infused," he
said.

Despite the low dosage levels of PEHRG214 used in the trials, Dr
Dezube said many patients showed significant improvement in three
vital areas -- a reduced amount of virus overall, an increase in the
number of healthy CD4 white cells and a reduced number of infected
white cells, which are the source of continuing infection in an HIV
infected patient.

In his written summary of the trials for the conference, Dr Dezube
said immune-based therapies, such as PEHRG214, may work to enhance
conventional AIDS drug regimens or even play a key role in maintenance
strategies that may eventually allow patients to stop taking drugs.

Back in New Zealand at the Virionyx Corporation laboratories Dr Frank
Gelder, the company's Scientific Director who discovered the
proprietary antibody therapy preparation, said he was pleased that the
United States Food and Drug Administration (FDA) approved trials on
over 40 patients at Harvard and elsewhere were reinforcing and
extending the results previously observed with the drug in the
compassionate release treatment of 77 patients, some of them in New
Zealand, in the late 1990s prior to it entering the formal FDA trial
process.

Dr Gelder explained that PEHRG214 is a new approach to AIDS treatment,
using antibodies purified from immunised goat plasma to target
specific parts of the HIV not recognised by the human immune system.

He said Virionyx maintains two special herds of goats that it uses to
produce antibodies against HIV. These antibodies are then formulated
by Virionyx's team of scientists for use in humans.

"Goats have immune systems that can recognise specific parts of HIV
not recognised by the human immune system and mount an antibody
response to these previously unidentified targets," Dr Gelder said. "I
developed the science for this in the US and brought it to New Zealand
because of the unique environment in this country where livestock
herds carry a very low incidence of chronic endemic diseases,
especially those with potential to transfer to man, and can therefore
be utilised to develop antibodies."

Dr Gelder said under laboratory conditions PEHRG214 demonstrates the
ability to destroy cell-free viruses.

"While currently available anti-HIV drugs taken in careful combination
are very effective in controlling the ability of the virus to
replicate and infect healthy CD4 white cells, sooner or later the
virus mutates and escapes these treatment regimens. Trial data to date
suggests PEHRG214 is effective even in patients who are failing the
highly active anti-retroviral treatments known as HAART," he said.

Based on advice from Dr Dezube and other international consultants
assisting with the trial of PEHRG214, the drug will now immediately
proceed to a full US FDA compliant Phase II efficacy trial in 40
patients.

CONFERENCE ABSTRACT

"A Passive Immunotherapy, HRG214, in HIV-1 Infected Patients: a
multidose study"

Bruce Dezebue, from Beth Israel Deaconess Medical Center/Harvard
Medical School, reported these study results at the XV IAC.

HRG214 is a novel ployclonal antibody (Ab) preparation produced by
immunization of goats with purified HIV proteins followed by booster
immunizations with synthetic peptides to HIV epitode regions. The
resultant agent has high titers and affinity to multiple HIV epitopes
and inhibits abroad spectrum of primary HIV isolates. As previously
reported (Jnl Infect Dis 2003) HRG, when administered intravenously as
a single dose up to 16 mg/kg, is reasonably well tolerated, achieves
plasma concentrations exceeding those values which neutralize HIV in
vitro, and demonstrates antiviral activity.

Dezube said in his abstract that immune-based therapies may enhance
the activity of conventional regimens or be part of innovative
induction/maintenance strategies that may eventually allow the
discontinuation of treatment while maintaining good virologic control
and immune function. I say this is quite a leap by Dezube & prove it
first.

A multi-dose study to assess the pharmacokinetics and safety of HRG
was conducted in HIV-1 infected patients with entry CD4 counts >50
cells/ul and viral load >500 copies/ml; concomitant antiretroviral
therapy was permitted provided the regimen was stable. HRG was
administered at a dose of 4 mg/kg twice a week for a total of 9 doses
over one month. Serial blood samples were obtained for HRG plasma
levels, HIV viral load, and the presence of anticaprine Abs.

Eleven patients received HRG. Before receiving study drug patients had
median 185 CD4s, HIV RNA 55,000 copies/ml, and 7 of 11 were taking
HAART. The only adverse event judged probably related to study drug
was a transient rash/allergy in 3 patients. The protocol was amended
so that patients received pre-treatment prophylaxis with Benadryl,
Tylenol, and Allegra; such pre-treatment decreased the incidence of
rash. Median serum HRG half-life was 70 hours. In one patient, an
increase in anti-caprine antibody levels was observed, accompanied by
accelerated HRG clearance. Median decrease in VL was 0.20 log; maximal
decrease >2.0 log was seen in a patient resistant to all drug classes.
Two of eight patients had a decrease in HIV RNA levels of >0.50 log
even though they were on HAART and failing virologically. Median
(maximum) increase in CD4 cells were 27 (136) cells.

Dezube concluded HRG214, when administered twice weekly over the
course of a month, is reasonably well-tolerated, achieves plasma
concentrations approaching those values which neutralize HIV in
laboratory experiments, and demonstrates early evidence of antiviral
activity even in anti-retroviral experienced patients. Dose escalation
study is ongoing. Dezube concluded further trails are warranted to
explore dosing both at higher levels & for longer periods of time.
Alex - 03 Sep 2004 23:08 GMT
Great, now we can all get goat herpes. I'ts baaaad.

Alex

> This is an interesting approach and I remember reading about something
> similiar being done in the U.S. a few years ago.
[quoted text clipped - 20 lines]
> clinical trials of its biotherapeutic, PEHRG214, at Harvard Medical
> School are responding favourably to treatment.
 
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