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. 2022 Jul 26;119(30):e2201067119.
doi: 10.1073/pnas.2201067119. Epub 2022 Jul 18.

A long-acting C-natriuretic peptide for achondroplasia

Affiliations

A long-acting C-natriuretic peptide for achondroplasia

Eric L Schneider et al. Proc Natl Acad Sci U S A. .

Abstract

The C-natriuretic peptide (CNP) analog vosoritide has recently been approved for treatment of achondroplasia in children. However, the regimen requires daily subcutaneous injections in pediatric patients over multiple years. The present work sought to develop a long-acting CNP that would provide efficacy equal to or greater than that of vosoritide but require less frequent injections. We used a technology for half-life extension, whereby a drug is attached to tetra-polyethylene glycol hydrogels (tetra-PEG) by β-eliminative linkers that cleave at predetermined rates. These hydrogels-fabricated as uniform ∼60-μm microspheres-are injected subcutaneously, where they serve as a stationary depot to slowly release the drug into the systemic circulation. We prepared a highly active, stable CNP analog-[Gln6,14]CNP-38-composed of the 38 C-terminal amino acids of human CNP-53 containing Asn to Gln substitutions to preclude degradative deamidation. Two microsphere [Gln6,14]CNP-38 conjugates were prepared, with release rates designed to allow once-weekly and once-monthly administration. After subcutaneous injection of the conjugates in mice, [Gln6,14]CNP-38 was slowly released into the systemic circulation and showed biphasic elimination pharmacokinetics with terminal half-lives of ∼200 and ∼600 h. Both preparations increased growth of mice comparable to or exceeding that produced by daily vosoritide. Simulations of the pharmacokinetics in humans indicated that plasma [Gln6,14]CNP-38 levels should be maintained within a therapeutic window over weekly, biweekly, and likely, monthly dosing intervals. Compared with vosoritide, which requires ∼30 injections per month, microsphere [Gln6,14]CNP-38 conjugates-especially the biweekly and monthly dosing-could provide an alternative that would be well accepted by physicians, patients, and patient caregivers.

Keywords: C-natriuretic peptide; achondroplasia; half-life extension; hydrogel microsphere.

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Conflict of interest statement

Competing interest statement: All authors are employees and hold options or stock in ProLynx.

Figures

Scheme 1.
Scheme 1.
β-eliminative drug release mechanism. Mod, modulator.
Fig. 1.
Fig. 1.
Sequences of CNP-38 (the natural sequence in Transcon CNP), vosoritide, and stabilized [Gln6,14]CNP-38. The cysteine residues in all sequences form a 17–amino acid intramolecular disulfide bond. Shaded areas show amino acids in natural CNP.
Fig. 2.
Fig. 2.
Potency of [Gln6,14]CNP-38 in cell-based and growth assays. (A) Stimulation of 3T3 cell guanylate cyclase by [Gln6,14]CNP-38 (formula image) and vosoritide (•). (B) Effects of [Gln6,14]CNP-38 and vosoritide on TBL (nasoanal + tail length) growth of 3-wk-old FVB/nJ male mice. Groups of 3-wk-old wild-type mice (n = 6) were given daily subcutaneous administrations of 70 nmol/kg CNP variants or vehicle for 5 wk. cGMP, cyclic guanosine monophosphate. ns, not significant.
Scheme 2.
Scheme 2.
Synthesis of MS∼[Gln6,14]CNP-38.
Fig. 3.
Fig. 3.
C versus t plots of [Gln6,14]CNP-38 released from MS∼[Gln6,14]CNP-38 in CD1 mice. (A) Single dose of MS∼[Gln6,14]CNP-38 4A containing 220 nmol [Gln6,14]CNP-38/mouse (formula image), and assuming dose linearity the simulated dose adjustment to 20 nmol to keep the peptide ∼40 pM (formula image) for 1 wk. (B) Single dose of 4B containing 700 nmol [Gln6,14]CNP-38/mouse (formula image) and simulated dose-adjustment to 85 nmol to maintain the released peptide ≥40 pM (formula image) for 1 mo. Data points are mean ± SD.
Fig. 4.
Fig. 4.
Growth of mice treated with [Gln6,14]CNP-38 and MS∼[Gln6,14]CNP-38 conjugates 4A and 4B at constant amounts per mouse each dosing interval. From left to right are vehicle control (black), QD [Gln6,14]CNP-38 (brown), QWk 4A 20 nmol/mouse (blue), QWk 4A 50 nmol/mouse (red), and single-dose 4B 85 nmol/mouse (green). They are plotted as the percentage of initial TBL versus time; values are displayed as the mean ± SD.
Fig. 5.
Fig. 5.
Growth of mice treated with [Gln6,14]CNP-38 and MS∼[Gln6,14]CNP-38 conjugates 4A and 4B at body weight–determined dosing (micromoles per kilogram). From left to right are vehicle control (black), QD [Gln6,14]CNP-38 (brown), QWk 4A 1.5 μmol/kg (blue), QWk 4A 2.2 μmol/kg (red), Q2Wk 2.2 μmol/kg (green), single-dose 4B 6.1 μmol/kg (purple), and single-dose 4B 40 μmol/kg (orange). They are plotted as the percentage of initial TBL versus time; values are displayed as the mean ± SD.
Fig. 6.
Fig. 6.
Representative mice treated with [Gln6,14]CNP-38 or 4A for 5 wk. (A) Vehicle control. (B) QD [Gln6,14]CNP-38 70 nmol/kg. (C) Q2Wk 2.2 μmol/kg. (D) QWk 2.2 μmol/kg. (E) QWk 1.5 μmol/kg. Anesthetized mice were initially positioned for measurements with their heads extended, noses aligned to the horizontal guideline, and tails straight; here, the distance between the top guideline and the end of the tail best represents TBL.

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