Clinical trials, Fialuridine, TGN This page was last edited on 20 May , at In addition, no signs of toxicity were observed in any of the physiological systems including cardiovascular system, respiratory system, or central nervous system. However, in vitro and in vivo data from animal studies later suggested that administration would lead to preferential activation of regulatory T cells , leading to a net effect of T-cell downregulation. National Center for Biotechnology Information , U. Activation of T cells normally requires both engagement of the antigen receptor signal 1 and co-stimulation signal 2. While the drug had appeared to be safe in animal models, researchers noted that there were reasons why these may not be indicative of the response in humans, particularly with respect to this type of drug.

Views Read Edit View history. A volunteer also lost his fingers and toes as a result of being injected with the drug. On its website, the company wrote: Shortly after, the remaining participants who received the actual drug also became ill, vomiting and complaining of severe pain. These studies demonstrated that doses hundred times higher than that administered to humans did not induce any toxic reactions. In preclinical studies, well-tolerated expansion of T cells was observed without any measurable proinflammatory reaction. Thus, depending upon the condition of the immune system TGN was thought to be useful for disease related to low numbers of activated T such as B-cell lymphoma or for treatment of autoimmune diseases such as rhematoid arthritis.

In an another clinical trial conducted by National Institute of Health for the drug Fialuridine, a thymidine analog having antiviral activity against Hepatitis B virus showed adverse reactions in phase 2 clinical trials leading to death of five human volunteers due to severe hepatic toxicity and lactic acidosis. Thus, depending upon the condition of the immune system TGN was thought to be useful for disease related to low numbers of activated T such as B-cell lymphoma or for treatment of autoimmune diseases such as rhematoid arthritis.

On the contrary, a low dose of 0.

Theralizumab – Wikipedia

Expert Scientific Group on phase one clinical trials: First in man, caae trials of potent biological molecules should include initial testing on very less number of human volunteers before administration of drug to a greater number of human volunteers. Open in a separate window. These assays showed specificity of TGN for CD28 receptor and that TGN did not cross react with other closely related molecular targets such as Cytotoxic T-lymphocyte-antigen-4 and inducible co-stimulator.


An investigation by the UK drug regulator reported that the reaction was not due to contamination of the dose, or an incorrect dose being administered, but suggested that the problem was due to “on target” effects of the drug.

tgn1412 case study

These encouraging results demonstrated high possibility for the use of this superagonist for the treatment of different T-cell deficiency syndromes like auto-immune diseases and B-cell lymphoma.

Drugs showing safety and efficacy in preclinical animal models may show very different pharmacological properties when administered to humans.

Studies of monoclonal antibodies specific for mouse, rat, or human CD28 identified so-called “superagonistic” antibodies that could rgn1412 T cells without concurrent antigen-receptor stimulation signal 1.

All of the men were reported to have experienced severe cytokine release syndrome resulting in angioedematgn142 of skin and mucous membranesakin to the effects of the complement cascade in severe allergic reaction.

The patients were treated with corticosteroids to reduce inflammation, and plasma-exchange to attempt to remove TGN from their circulation. Anti-TGN antibody titers were observed in all animals, which were thought to be as a consequence of the humanized antibody being used in primate model. To begin with, the preclinical testing must be substantially predictive of wtudy clinical results.

Edmond, OK Mailing address Email: Two antibodies specific for human CD28 were identified. The above-mentioned incidents especially the TeGenero incident was an alarming call for the researchers and also for the trial approving regulatory authorities on toxicity-related unpredictability of new drugs in human subjects especially for biological with a novel mechanism of action like TGN Retrieved 20 March Inclusion of an allergy test in preclinical studies might have predicted the massive cytokine release.

What makes the difference in humans?


TGN From Discovery to Disaster

National Center for Biotechnology InformationU. One conclusion drawn by the ESG report on TGN indicated that the preclinical studies conducted for TGN met regulatory requirements but fell short of predicting a safe dose for human use. These studies revealed a consistent tissue staining in lymphoid tissue as expected demonstrating target-tissue specificity of CD28 superagonist.

For example, Nguyen et al. Humanised variable regions were subsequently recombined stuyd a human gene coding for the IgG4 gamma chain and with a human gene coding for a human kappa chain, respectively.

tgn1412 case study

A phase-1, single-centre, double-blind, randomised, placebo-controlled, single escalating dose study, to assess the safety, pharmacokinetics, pharmacodynamics and immunogenicity of TGN administered intravenously to tg1n412 volunteers. After identification of CD28 antibodies capable of activating T cells along with signal from T-cell receptors, studies were conducted to evaluate T-cell activation potential of these CD28 antibodies.

The company claims that these did cade indicate any safety issues. The TeGenero incident and the Duff report conclusions: They suggested that the predictive value of pre-clinical animal models required reevaluation, dose fixing needed refinement or redesign, and criteria for high-risk antibodies needed to be established. The drug, which was designated as an orphan medical product by the European Medicines Agency in Marchwas developed by TeGenero Immuno Therapeutics, tested by Parexel and manufactured by Boehringer Ingelheim.

Retrieved 18 March He took his shirt off, complaining that he felt like he was burning.

TGN1412: From Discovery to Disaster

A repeat dose study for toxicokinetic evaluation of TGN was conducted. The main aim was to establish safe human dose which tg1412 be further be used for subsequent drug trials. This unprecedented outcome of the TGN trial, raised many questions regarding safety processes implemented during clinical trials.