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Protein replacement therapies

Manifestation of Novel Social Challenges of the European Union in the Teaching Material of Medical Biotechnology Master’s P rogrammes at the University of Pécs and at the University of Debrecen Identification number : TÁMOP-4.1.2-08/1/A-2009-0011.

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Protein replacement therapies

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  1. Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat theUniversity of Pécs and at the University of Debrecen Identificationnumber: TÁMOP-4.1.2-08/1/A-2009-0011

  2. Manifestation of Novel Social Challenges of the European Unionin the Teaching Material ofMedical Biotechnology Master’s Programmesat theUniversity of Pécs and at the University of Debrecen Identificationnumber: TÁMOP-4.1.2-08/1/A-2009-0011 József Tőzsér MolecularTherapies-Lectures 5-6 Protein replacementtherapies

  3. Protein-basedtherapies • Replacement of missingorabnormalproteins (e.g. Insulin) • Influencingsignaltransductionpathways (e.g. interferons) • Supplementation of growthhormones (e.g. PDGF) • Influencingthehaemostaticsystem (e.g. tPA) • Degradation of moleculeswithenzymes (e.g. Asparaginase • Use of protein vaccines (e.g. recombinant HPV vaccine)

  4. Examples of proteinsreplacedintherapy • Insulin (diabetes) • Albumin (hypoalbuminaemia) • Lactate (lactoseintolerance) • Factor VIII. (haemophilia) • Factor IX. (haemophilia) • Protein C (protein C deficiency) • Beta-glucocerebrosidase (Gaucher’sdisease)

  5. Examples of protein therapeuticproducts • Humulin (insulin) • Novolin (insulin) • Flexbumin 25% (albumin) • Lactaid (lactose) • ReFacto (F VIII) • BeneFix (F IX) • Ceprotin (aktivált protein C)

  6. Therapeuticproteins • The firsttherapeutic protein usewastheutilization of cowpox „protein vaccine" againstsmallpoxby Jenner (1796) • The firsttherapeutic protein usedwasinsulinbyBantingand Best (1922) • More than 200 peptideor protein has beenapprovedin USA foruseintherapy • Therapeuticproteinsmaycomefromdifferentsources

  7. Therapeuticproteins – sources ProteinOriginalsource • Albumin Human blood • InsulinPig, bovinepancreas • Factor VIII Human blood • Factor IX Human blood • KalcitoninSalmon • Anti-venom Horse, dunkeyblood • β-glucorerebrosidase Human placenta

  8. Therapeuticproteins – sources • Naturalsourse is usuallysparse and expensive • It is difficulttosatisfydemands • Hardtoisolatetheproduct • May lead toimmuneintolerance (e.g. incase of animanproteins) • Potentialviral and pathogencontaminations • Nowadays most of the protein drugsare made byrecombinanttechniques • Cheaper, safer, unlimitedsource

  9. Insulin, thefirst protein replacementdrug • InJanuary1922, Bantingand Bestusedfirstinsulintotreat a 14-years-old patientnamed Leonard Thomson • He became more illastheconsequence of theinjection, buthisbloodglucoseleveldecreased, thereforetheimprovement of thepreparationtechniquewasdecided • 6 weekslater a betterextractwasabletodecreasethebloodglucoselevelfrom520 mg/dLto120 mg/dL within 24 hours. • Leonard livedforadditional 13 years, he died of pneumonisaattheage 27

  10. Structure of insulin Twopolypeptidchains, A.chain: 21 aminoacidresidues B-chain: 30 aminoacidresidues Chainsareheldtogetherby a disulfidebridge Insulingene is locatedat chromosome 11

  11. Protein therapeutics – fromblood • The human body containsapprox. 6 liters of blood • 60-70% of blood is plasma, 8-9%- proteins. Therefore • it is an important protein source • Human plasmacontainsabout10,000 different • proteins • About 20 proteinsmakeupthe99% of thetotal protein • content of plasma • Annuallyseveralmillionliters of outdated • transfusionplasma is genereated, thereforeit is an • excellent and relativelyabundant protein source

  12. Examples of blood protein products • Factor VIII (correction of haemophilia) • Factor IX (correction of haemophilia) • Albumin (correction of hypoalbuminaemia) • IntravenousIgG(ininfections) • Antithrombin III (correction of coagulationdisorder) • Alpha I-PI (correction of emphysema)

  13. Cohnfractionation • Cohnfractionationwasoriginallydevelopedin 1946. • InCohnfractionationplasmaproteinsareselectivelyprecipitatedbyusingethanol, salt, temperaturechange. • Separation of thefractions is achievedbycentrifugation.

  14. Recombinanttechnologies • Theyweredevelopedinthe 1970s and 1980s • Paul Berg (1973): discovery of restrictionenzymes • Herbert Boyer (1978): cloning of the human insulingeneinto E. coli - Genentech • Fundamentallytwo major approaches • Expressin inisolatedcells • Expressionintransgenicplantsoranimals

  15. Hemostaticcascade XII XIIa XIa Ca2+ XI Extrinsic pathway IX IXa, VIII PL Ca2+ Intrinsic pathway VII + TF, Ca2+ VIIa TF, Ca2+ X Xa V PL Ca2+ Common pathway XIII prothrombin thrombin fibrinogen fibrin XIIIa + Ca2+ Allcomponents of theintrinsicpathwayareinthebloodstream. Extrinsicpathway is initiatedbythe TF that is normallyexclodedfromthe Bloodstream. Cascade (avalange) model. crosslinked fibrin

  16. Haemophilias A and B • Hemophilias A and B are caused by deficiencies in factors VIII or IX, respectively • Affect ~1 in 5,000 males in Hemophilia A, • ~1 in 30,000 males in Hemophilia B • Inherited as a recessive X-linked trait in both cases (Mother would be an unaffected carrier) • Treated by administration of factor VIII or factor IX concentrates • Recombinant factor VIII or IX • Gene therapy trials

  17. Haemophilia A – genetherapy • Only FVIII level is  1 % of normalcausesseveresymptoms (spontaneousbleedingintojoints, vital • organs), thereforeevenlowlevels of proteinsare • beneficial • Tightcontrol of FVIII production is notrequired • Broadtherapeutic index minimizestherisk of • overdose • Deliverytobloodstreamdoesnotrequireexpression • intheliver • Domain B is notrequiredforfunction, initsabsencetheexpressionlevelsarehigher

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