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Title: A pilot study evaluating GSK1070806 inhibition of interleukin-18 in renal transplant delayed graft function
Author: Wlodek, E.
Kirkpatrick, R. B.
Andrews, Susan
Noble, R.
Schroyer, R.
Scott, J.
Watson, C. J. E.
Clatworthy, M.
Harrison, E. M.
Wigmore, S. J.
Stevenson, K.
Kingsmore, D.
Sheerin, N. S.
Bestard Matamoros, Oriol
Stirnadel-Farrant, H. A.
Abberley, L.
Busz, M.
Dewall, S.
Birchler, M.
Krull, D.
Thorneloe, K. S.
Weber, A.
Devey, L.
Keywords: Trasplantament renal
Kidney transplantation
Issue Date: 8-Mar-2021
Publisher: Public Library of Science (PLoS)
Abstract: Introduction: Delayed graft function (DGF) following renal transplantation is a manifestation of acute kidney injury (AKI) leading to poor long-term outcome. Current treatments have limited effectiveness in preventing DGF. Interleukin-18 (IL18), a biomarker of AKI, induces interferon-γ expression and immune activation. GSK1070806, an anti-IL18 monoclonal antibody, neutralizes activated (mature) IL18 released from damaged cells following inflammasome activation. This phase IIa, single-arm trial assessed the effect of a single dose of GSK1070806 on DGF occurrence post donation after circulatory death (DCD) kidney transplantation. Methods: The 3 mg/kg intravenous dose was selected based on prior studies and physiologically based pharmacokinetic (PBPK) modeling, indicating the high likelihood of a rapid and high level of IL18 target engagement when administered prior to kidney allograft reperfusion. Utilization of a Bayesian sequential design with a background standard-of-care DGF rate of 50% based on literature, and confirmed via extensive registry data analyses, enabled a statistical efficacy assessment with a minimal sample size. The primary endpoint was DGF frequency, defined as dialysis requirement ≤7 days post transplantation (except for hyperkalemia). Secondary endpoints included safety, pharmacokinetics and pharmacodynamic biomarkers. Results: GSK1070806 administration was associated with IL18-GSK1070806 complex detection and increased total serum IL18 levels due to IL18 half-life prolongation induced by GSK1070806 binding. Interferon-γ-induced chemokine levels declined or remained unchanged in most patients. Although the study was concluded prior to the Bayesian-defined stopping point, 4/7 enrolled patients (57%) had DGF, exceeding the 50% standard-of-care rate, and an additional two patients, although not reaching the protocol-defined DGF definition, demonstrated poor graft function. Six of seven patients experienced serious adverse events (SAEs), including two treatment-related SAEs. Conclusion: Overall, using a Bayesian design and extensive PBPK dose modeling with only a small sample size, it was deemed unlikely that GSK1070806 would be efficacious in preventing DGF in the enrolled DCD transplant population.
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It is part of: PLoS One, 2021, vol. 16, num. 3, p. e0247972
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Appears in Collections:Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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