Remyelination Drug is Safe in Humans

Tran JQ, Rana J, Barkhof F, Melamed I, Gevorkyan H, Wattjes MP, de Jong R, Brosofsky K, Ray S, Xu L, Zhao J, Parr E, Cadavid D.
Randomized phase I trials of the safety/tolerability of anti-LINGO-1 monoclonal antibody BIIB033. Neurol Neuroimmunol Neuroinflamm. 2014;1(2):e18. doi: 10.1212/NXI.0000000000000018. eCollection 2014 Aug.

OBJECTIVE:  To evaluate the safety, tolerability, and pharmacokinetics (PK) of BIIB033 (anti-LINGO-1 monoclonal antibody) in healthy volunteers and participants with multiple sclerosis (MS).
METHODS: In 2 separate randomized, placebo-controlled studies, single ascending doses (SAD; 0.1-100 mg/kg) of BIIB033 or placebo were administered via IV infusion or subcutaneous injection to 72 healthy volunteers, and multiple ascending doses (MAD; 0.3-100 mg/kg; 2 doses separated by 14 days) of BIIB033 or placebo were administered via IV infusion to 47 participants with relapsing-remitting or secondary progressive MS. Safety assessments included adverse event (AE) monitoring, neurologic examinations, conventional and nonconventional MRI, EEG, optical coherence tomography, retinal examinations, and evoked potentials. Serum and CSF PK as well as the immunogenicity of BIIB033 were also evaluated.
RESULTS: All 72 healthy volunteers and 47 participants with MS were included in the safety analyses. BIIB033 infusions were well tolerated. The frequency of AEs was similar between BIIB033 and placebo. There were no serious AEs or deaths. No clinically significant changes in any of the safety measures were observed. BIIB033 PK was similar between healthy volunteers and participants with MS. Doses of ≥10 mg/kg resulted in BIIB033 concentrations similar to or higher than the concentration associated with 90% of the maximum remyelination effect in rat remyelination studies. The incidence of anti-drug antibody production was low.
CONCLUSIONS: The emerging safety, tolerability, and PK of BIIB033 support advancing BIIB033 into phase II clinical development as a potential treatment for CNS demyelination disorders.
CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that BIIB033 is well tolerated and safe (serious adverse event rate 0%, 95% confidence interval 0-7.6%).

Anti-LINGO-1 is antibody that targets LINGO-1 and this has been associated with promoting remyelination and possibly it cause also promote nerve plasticity (regrowth of nerve pathways to maintian nerve function in damaged nerve pathways). This is the safety study showing that the treatment is safe. The question is will enough antibody reach the CNS to cause remyelination. The trials in MS are underway.

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  • "The question is will enough antibody reach the CNS to cause remyelination. The trials in MS are underway."
    "Although CNS penetration of anti-LINGO-1 mAbs is limited, the CNS-specific expression of LINGO-1 created an opportunity to deliver efficacious concentrations of BIIB033 by giving high doses systemically. " Increasing doses up to 100mg/mL to allow 0.1% CNS/serum ratio into CNS. High doses of anti-LINGO used to achieve pharmacologic activity. I assume it is not feasible to inject lower doses directly into the CNS?

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