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COVID-19 symptoms can cause substantial disability, yet no therapy can currently reduce their frequency or duration. We conducted a double-blind placebo-controlled trial of hesperidin 1000 mg once-daily for 14 days in 216 symptomatic non-vaccinated COVID-19 subjects. Thirteen symptoms were recorded after 3, 7, 10 and 14 days. The primary endpoint was the proportion of subjects with any of four cardinal (group A) symptoms: fever, cough, shortness of breath or anosmia. At baseline, symptoms in decreasing frequency were: cough (53.2%), weakness (44.9%), headache (42.6%), pain (35.2%), sore throat (28.7%), runny nose (26.9%), chills (22.7%), shortness of breath (22.2%), anosmia (18.5%), fever (16.2%), diarrhea (6.9%), nausea/vomiting (6.5%) and irritability/confusion (3.2%). Group A symptoms in the placebo vs hesperidin group was 88.8% vs 88.5% (day 1) and reduced to 58.5 vs 49.4 % at day 14 (OR 0.69, 95% CI 0.38–1.27, p = 0.23). At day 14, 15 subjects in the placebo group and 28 in the hesperidin group failed to report their symptoms. In an attrition bias analysis imputing “no symptoms” to missing values, the hesperidin group shows reduction of 14.5 % of group A symptoms from 50.9% to 36.4% (OR: 0.55, 0.32–0.96, p = 0.03). Anosmia, the most frequent persisting symptom (29.3%), was lowered by 7.3% at 25.3 % in the hesperidin group vs 32.6% in the placebo group (p = 0.29). Mean number of symptoms in placebo and hesperidin was 5.10 ± 2.26 vs 5.48 ± 2.35 (day 1) and 1.40 ± 1.65 vs 1.38 ± 1.76 (day 14) (p = 0.92). In conclusion, most non-vaccinated COVID-19 infected subjects remain symptomatic after 14 days with anosmia being the most frequently persisting symptom. Hesperidin 1g daily may help reduce group A symptoms. Earlier treatment of longer duration and/or higher dosage should be tested.

Non-alcoholic Fatty Liver Disease (NAFLD) is the most common form of liver disease and is associated with metabolic dysregulation. Although G protein-coupled receptor 84 (GPR84) has been associated with inflammation, its role in metabolic regulation remains elusive. The aim of our study was to evaluate the potential of PBI-4547 for the treatment of NAFLD and to validate the role of its main target receptor, GPR84. We report that PBI-4547 is a fatty acid mimetic, acting concomitantly as a GPR84 antagonist and GPR40/GPR120 agonist. In a mouse model of diet-induced obesity, PBI-4547 treatment improved metabolic dysregulation, reduced hepatic steatosis, ballooning and NAFLD score. PBI-4547 stimulated fatty acid oxidation and induced gene expression of mitochondrial uncoupling proteins in the liver. Liver metabolomics revealed that PBI-4547 improved metabolic dysregulation induced by a high-fat diet regimen. In Gpr84−/− mice, PBI-4547 treatment failed to improve various key NAFLD-associated parameters, as was observed in wildtype littermates. Taken together, these results highlight a detrimental role for the GPR84 receptor in the context of meta-inflammation and suggest that GPR84 antagonism via PBI-4547 may reflect a novel treatment approach for NAFLD and its related complications.

Numerous clinical conditions can lead to organ fibrosis and functional failure. There is a great need for therapies that could effectively target pathophysiological pathways involved in fibrosis. GPR40 and GPR84 are G protein–coupled receptors with free fatty acid ligands and are associated with metabolic and inflammatory disorders. Although GPR40 and GPR84 are involved in diverse physiological processes, no evidence has demonstrated the relevance of GPR40 and GPR84 in fibrosis pathways. Using PBI-4050 (3-pentylbenzeneacetic acid sodium salt), a synthetic analog of a medium-chain fatty acid that displays agonist and antagonist ligand affinity toward GPR40 and GPR84, respectively, we uncovered an antifibrotic pathway involving these receptors. In experiments using Gpr40 - and Gpr84 -knockout mice in models of kidney fibrosis (unilateral ureteral obstruction, long-term post-acute ischemic injury, and adenine-induced chronic kidney disease), we found that GPR40 is protective and GPR84 is deleterious in these diseases. Moreover, through binding to GPR40 and GPR84, PBI-4050 significantly attenuated fibrosis in many injury contexts, as evidenced by the antifibrotic activity observed in kidney, liver, heart, lung, pancreas, and skin fibrosis models. Therefore, GPR40 and GPR84 may represent promising molecular targets in fibrosis pathways. We conclude that PBI-4050 is a first-in-class compound that may be effective for managing inflammatory and fibrosis-related diseases.

Introduction: Nonalcoholic Fatty Liver Diseases (NAFLD), characterized by fatty acid and glucose metabolism dysregulation, is highly prevalent in all regions of the world. PBI-4547 is an orally active compound which displays pleiotropic activities and has been shown to reduce NASH, diabetes and fibrosis in different rodent models. The goal of the current study was to investigate the effects of PBI-4547 in a mouse model of high-fat diet-induced obesity and metabolic syndrome. Methods: C57BL/6 mice were fed with either a standard or a high-fat diet (HFD, Harlan, TD.06414) for 14 weeks. Mice fed with the HFD were then treated or not with PBI-4547 (10 mg/kg, oral once a day) for 6 weeks. Liver/WAT histology and mRNA gene profile were examined. HepG2 hepatocytes were also used for in vitro experiments. Blood glucose, serum insulin level, serum triglyceride and adiponectin were followed over the 6 weeks of treatment. Results: PBI-4547 treatment led to a significant reduction of hepatic steatosis, ballooning and total NAFLD score. Inflammation and fibrosis in white adipose tissues were also significantly reduced by PBI-4547. Adiponectin levels were also increased by PBI-4547. Metabolomic study from liver extracts revealed that PBI-4547 restored back to normal the levels of amino acids, Krebs cycle and energy-related intermediates. Uncoupling Proteins (Ucp2/3 in liver and Ucp1 in WAT) were also increased by PBI-4547 suggesting that PBI-4547 could affect mitochondria and increase energy expenditure. Oxygen consumption rate analyses confirmed that PBI-4547 reduces Oxphos-related ATP production and increased proton leak in HepG2 hepatocytes. In such way, PBI-4547 increased glucose and fatty acid metabolism improving insulin resistance and β-cell function. Conclusions: These results indicate that PBI-4547 offers the potential as a novel therapy for NAFLD, diabetes and associated metabolic syndrome. Disclosure J. Simard: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. J. Thibodeau: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Leduc: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Tremblay: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Laverdure: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. R. Corpuz: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. F.A. Leblond: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. B. Grouix: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc. L. Gagnon: Employee; Self; Prometic Life Sciences Inc. Stock/Shareholder; Self; Prometic Life Sciences Inc.

PBI-4050 (3-pentylbenzenacetic acid sodium salt), a novel first-in-class orally active compound that has completed clinical Phases Ib and II in subjects with chronic kidney disease (CKD) and metabolic syndrome respectively, exerts antifibrotic effects in several organs via a novel mechanism of action, partly through activation of the G protein receptor 40 (GPR40) receptor. Here we evaluate the effects of PBI-4050 in both WT and Gpr40−/− mice on adenine-induced tubulointerstitial injury, anemia and activation of the unfolded protein response (UPR) pathway. Adenine-induced CKD was achieved in 8-week-old C57BL/6 mice fed a diet supplemented with 0.25% adenine. After 1 week, PBI-4050 or vehicle was administered daily by oral-gavage for 3 weeks. Gpr40−/− mice were also subjected to adenine-feeding, with or without PBI-4050 treatment. PBI-4050 improved renal function and urine concentrating ability. Anemia was present in adenine-fed mice, while PBI-4050 blunted these effects and led to significantly higher plasma erythropoietin (EPO) levels. Adenine-induced renal fibrosis, endoplasmic reticulum (ER) stress and apoptosis were significantly decreased by PBI-4050. In parallel, Gpr40−/− mice were more susceptible to adenine-induced fibrosis, renal function impairment, anemia and ER stress compared with WT mice. Importantly, PBI-4050 treatment in Gpr40−/− mice failed to reduce renal injury in this model. Taken together, PBI-4050 prevented adenine-induced renal injury while these beneficial effects were lost upon Gpr40 deletion. These data reinforce PBI-4050’s use as a renoprotective therapy and identify GPR40 as a crucial mediator of its beneficial effects.

PBI-4050 is a novel orally active small-molecule compound with demonstrated anti-fibrotic activity in several models of fibrosis, including lung fibrosis. We present results from our first clinical study of PBI-4050 in patients with idiopathic pulmonary fibrosis (IPF). This 12-week open-label study explored the safety, efficacy and pharmacokinetics of daily oral doses of 800 mg PBI-4050 alone and in combination with nintedanib or pirfenidone in patients with predominantly mild or moderate IPF. Nine patients received PBI-4050 alone, 16 patients received PBI-4050 with nintedanib and 16 patients received PBI-4050 with pirfenidone. PBI-4050 alone or in combination with nintedanib or pirfenidone was well tolerated. Pharmacokinetic profiles for PBI-4050 were similar in the PBI-4050 alone and PBI-4050+nintedanib groups but reduced in the PBI-4050+pirfenidone group, suggesting a drug–drug interaction. There were no significant changes in forced vital capacity (FVC), either in % predicted or mL, from baseline to week 12 for PBI-4050 alone or PBI-4050+nintedanib. In contrast, a statistically significant reduction (p, PBI-4050 alone and in combination with nintedanib demonstrated no safety concerns and showed encouraging results for lung function in IPF patients http://ow.ly/olQD30myD0E

AIMS Heart failure with reduced ejection fraction (HFrEF) causes lung remodelling with myofibroblasts proliferation and fibrosis leading to a restrictive lung syndrome with pulmonary hypertension (PH) and right ventricular (RV) dysfunction. PBI-4050 is a first-in-class anti-fibrotic, anti-inflammatory, and anti-proliferative compound. The present study evaluated the therapeutic impact of PBI-4050 on PH in an HFrEF model. METHODS AND RESULTS HFrEF was induced after myocardial infarction (MI) in rats. Two weeks later, sham-operated and MI groups received PBI-4050 (200 mg/kg/day by gavage) or saline for 3 weeks. Animals were analysed according to infarct size as large (≥30% left ventricle) or medium MI (

Introduction and Aims: Given the expected rise in the prevalence of obesity and type 2 diabetes, hepatic steatosis will, if not already, become an epidemic. The aim of this study was to determine the mechanism of action of PBI-4547 on diabetic complications. Methods: ob/ob mice (6 weeks old) were treated with vehicle or PBI-4547 (10, 25 and 50 mg/kg, oral once a day) from day 1 through 105. Liver and white adipose tissue (WAT) histology, blood glucose, serum triglyceride and adiponectin levels were examined. Gene expression of pro-inflammatory/fibrotic markers, metabolic and mitochondrial fatty acid transport and oxidation (FAO) regulators, and PPAR gene expression were determined in liver and WAT. Results: Blood glucose, cholesterol and triglyceride levels were strongly reduced by PBI-4547. ob/ob mice displayed severe liver steatosis which was completely reversed with PBI-4547. PBI-4547 significantly reduced fibrosis, inflammatory cell infiltration, and adipocyte size in WAT. Serum level of adiponectin was reduced in ob/ob mice and increased with PBI-4547. In liver, PBI-4547 reduced TNF-α, collagen I, III and IV, α-SMA, fibronectin, MMP-2, TIMP1, ICAM, PDGFα, TGFβ1, PPARδ and PPARγ, FASN, but increased mitochondrial FA transport and oxidation (ACOX-1, CD36, FABP4, CPT1β, PDK4). In WAT, PBI-4547 reduced TNF-α, collagen types I, IV and VI, MMP-2, MCP-1, F4/80, increased PPARα and PPARγ, and also increased ACOX-1, CD36, FASN, FABP4, COX4I1, SREBF1, PGC1-α, UCP-1 (by 160X, suggesting browning of adipose tissue), CPT1α, CPT1β and PDK4. Furthermore, PBI-4547 increased adiponectin and its receptors, and abolished vaspin gene expression. Conclusions: PBI-4547 is a potential novel therapy for diabetes and hepatic steatosis through its pleiotropic activities on glucose and lipid metabolism, by improving mitochondrial dysfunction, by inducing browning of adipose tissue, and by regulating adipokines. Disclosure L. Gagnon: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Laverdure: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. F. Sarra-Bournet: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Cloutier: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Felton: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Tremblay: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. J. Richard: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. L. Gervais: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. P. Laurin: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc.. Board Member; Self; Prometic Life Sciences Inc. F.A. Leblond: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. B. Grouix: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc..

Introduction and Aims: Obesity and its resulting metabolic disturbances are major health threats and are the main cause of a host of diseases, including nonalcoholic fatty liver disease (NAFLD). PBI-4547 is a novel first-in-class orally active antidiabetic compound which displays pleiotropic activities and has been shown to reduce NASH, diabetes, and renal fibrosis in different animal models. The aim of this study was to investigate the effects of PBI-4547 in a mouse model of high-fat diet-induced obesity and metabolic syndrome. Methods: C57BL/6 mice were fed with either a standard or a high-fat diet (HFD, Harlan, TD.06414) for 14 weeks. These mice were divided in three groups [normal chow, HFD + vehicle, and HFD + PBI-4547 (10 mg/kg, oral once a day)] and treated for an additional 6 weeks. Blood glucose, serum insulin level, serum triglyceride and adiponectin, liver histology, as well as liver and white adipose tissue (WAT) pro-inflammatory/fibrotic gene expression were examined. Results: In an oral glucose tolerance test, PBI-4547 increased glucose metabolism compared to the HFD control group. Insulin resistance (measured by HOMA-IR) and β cell function (HOMA1-β) were improved by PBI-4547. Serum triglyceride level was significantly reduced by PBI-4547 while adiponectin in serum was significantly increased. Histological analysis showed a significant reduction of hepatic steatosis and ballooning by PBI-4547. To further characterize the activity of PBI-4547, quantitative RT-PCR analysis of pro-fibrotic markers was performed, demonstrating that PBI-4547 reduced CTGF and MMP2 gene expression in the liver as well as CTGF, MCP-1, MMP2 and collagen type I gene expression in the WAT. Conclusions: Taken together, these results suggest that PBI-4547 offers the potential as a novel therapy for nonalcoholic fatty liver disease, obesity and associated metabolic syndrome. Disclosure M. Leduc: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. B. Grouix: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Tremblay: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. L. Gervais: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. F. Sarra-Bournet: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Felton: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. J. Simard: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. F.A. Leblond: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. P. Laurin: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc.. Board Member; Self; Prometic Life Sciences Inc. L. Gagnon: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc..

Background: PBI-4050 displays anti-inflammatory/fibrotic properties with metabolic regulation. PBI-4050 has been shown to reduce glycated hemoglobin levels, and different biomarkers related to kidney and heart injury in a phase II open label clinical trial in patients suffering from type 2 diabetes with metabolic syndrome. PBI-4050 has also completed with success an open label phase II clinical trial in patients with idiopathic pulmonary fibrosis (IPF) and in patients with Alström Syndrome. The aim of this study was to investigate the effect of PBI-4050 on diabetic nephropathy in leptin deficient ob/ob mice, a model of type 2 diabetes and metabolic syndrome. Methods: ob/ob mice were treated with vehicle or PBI-4050 (200 mg/kg, oral once a day) from day 1 to 105. OGTT, triglycerides, adiponectin and serum insulin levels, as well as inflammatory cell infiltration and pro-inflammatory/fibrotic gene expression and histology of kidney and white adipose tissue (WAT) were examined. Results: PBI-4050 improved glucose metabolism, reduced serum triglycerides and insulin levels, and increased serum adiponectin levels. In kidneys, PBI-4050 reduced ER stress (p-PERK, ATF-6, CHOP and p-IRE1). Furthermore, PBI-4050 reduced α-SMA, fibronectin and CTGF gene expression. Pro-inflammatory/remodeling markers expression (MRC-1, MCP-1 and MMP-2) were also reduced with PBI-4050 treatment. Moreover, histological analysis revealed that PBI-4050 reduced collagen deposition in glomeruli. Specific immunostaining also showed that PBI-4050 significantly reduced galectin-3 expression in kidney and WAT. Finally, PBI-4050 reduced the expression levels of inflammatory cell infiltration markers (Ly6G and F4/80) in kidney. Conclusions: These results suggest that PBI-4050 is a strong potential candidate for the treatment of metabolic diseases and related diabetic nephropathy. Disclosure J. Simard: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Cloutier: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Laverdure: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. J. Richard: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. L. Gervais: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. A. Felton: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. B. Grouix: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. P. Laurin: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc.. Board Member; Self; Prometic Life Sciences Inc. M. Leduc: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. F.A. Leblond: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. L. Gagnon: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc..

Introduction: PBI-4547 is a novel orally active compound that is being developed for potential clinical use in patients suffering from metabolic and inflammatory/fibrosis-related diseases. This study examined the effect of PBI-4547 in NOD mice, a model of type 1 diabetes. Our objective was to demonstrate the efficacy of PBI-4547 to stop the progression of diabetes in mice exhibiting prediabetic glucose escalation. Methods: NOD/ShiLtJ female mice (8 weeks of age) were followed up to the appearance of the first sign of hyperglycemia (three consecutive weeks of glucose increase (over 7 mmol/l). Once identified as prediabetic, mice were randomly allocated to control (receiving vehicle (water)) or PBI-4547 (25 mg/kg/day) groups for treatment by daily gastric gavage for 8 to 12 weeks. Results: Mice treated with vehicle (n=9) evolved to a moderate to severe diabetic condition (glucose levels 11.7-37 mmol/l). Most of these vehicle-treated mice (6/9) survived only a few weeks after the onset of the prediabetic condition. At the opposite, NOD mice treated with PBI-4547 all showed a reversal of their hyperglycemia and none of the observed animals (n=12) evolved to a chronic hyperglycemia (over 11 mmol/l). Survival was also significantly improved in the group treated with PBI-4547 with 8 of 12 mice surviving more than 10 weeks after the onset of treatment. Analysis of insulinemia showed a significant difference between both groups. Immunohistological analysis of pancreas recovered at euthanasia revealed a significant reduction in islet inflammatory cell infiltration. Moreover, NOD mice treated with PBI-4547 maintained normoglycemia despite a reduced number of islets. In fact, PBI-4547 reduced by 30% the number of severely damaged islets. Conclusions: These data suggest that PBI-4547 could preclude the evolution of diabetes in a type 1 model. Disclosure F.A. Leblond: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. K. Hince: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. F. Sarra-Bournet: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. W. Gagnon: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Tremblay: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Cloutier: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. S. Létourneau: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. J. Simard: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. M. Leduc: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. B. Grouix: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc. P. Laurin: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc.. Board Member; Self; Prometic Life Sciences Inc. L. Gagnon: Employee; Self; Prometic Biosciences Inc.. Stock/Shareholder; Self; Prometic Life Sciences Inc..

Extensive kidney fibrosis occurs in several types of chronic kidney diseases. PBI-4050, a potentially novel first-in-class orally active low–molecular weight compound, has antifibrotic and antiinflammatory properties. We examined whether PBI-4050 affected the progression of diabetic nephropathy (DN) in a mouse model of accelerated type 2 diabetes and in a model of selective tubulointerstitial fibrosis. eNOS–/– db/db mice were treated with PBI-4050 from 8–20 weeks of age (early treatment) or from 16–24 weeks of age (late treatment). PBI-4050 treatment ameliorated the fasting hyperglycemia and abnormal glucose tolerance tests seen in vehicle-treated mice. In addition, PBI-4050 preserved (early treatment) or restored (late treatment) blood insulin levels and increased autophagy in islets. PBI-4050 treatment led to significant improvements in lifespan in the diabetic mice. Both early and late PBI-4050 treatment protected against progression of DN, as indicated by reduced histological glomerular injury and albuminuria, slow decline of glomerular filtration rate, and loss of podocytes. PBI-4050 inhibited kidney macrophage infiltration, oxidative stress, and TGF-β–mediated fibrotic signaling pathways, and it also protected against the development of tubulointerstitial fibrosis. To confirm a direct antiinflammatory/antifibrotic effect in the kidney, further studies with a nondiabetic model of EGFR-mediated proximal tubule activation confirmed that PBI-4050 dramatically decreased the development of the associated tubulointerstitial injury and macrophage infiltration. These studies suggest that PBI-4050 attenuates development of DN in type 2 diabetes through improvement of glycemic control and inhibition of renal TGF-β–mediated fibrotic pathways, in association with decreases in macrophage infiltration and oxidative stress.

PBI-4050 is a novel orally active compound which displays anti-inflammatory/anti-fibrotic activities and is presently in clinical phase II in idiopathic pulmonary fibrosis (IPF), in metabolic syndrome associated with diabetes, and in cystic fibrosis related diabetes. The aim of this study was to determine the effect of PBI-4050 in the BioMAP SAEMyoF primary human cell fibrotic lung disease model. The BioMAP SAEMyoF system is a co-culture of TGF-β/TNF-α-stimulated primary human small airway epithelial cells and lung myofibroblasts that models the biology of fibrotic lung diseases such as IPF. Protein biomarker expression levels relative to vehicle control were determined in cells treated with PBI-4050, and compared to treatments with the anti-fibrotic drug pirfenidone and the tyrosine kinase inhibitor nintedanib. PBI-4050 key activities included a significant decrease of myofibroblast activation (α-SMA and N-cadherin) and of extracellular matrix production (collagen I and III). PBI-4050 also showed tissue remodeling (reduced MMP9 and PAI-1, increased MMP1) and inflammation-related (reduced I-TAC, M-CSF, MCP-1, IP-10) activities. Pirfenidone had a generally similar profile to PBI-4050, with the exception of increases in VCAM-1, MMP9 and TIMP-1 expression that were not obtained with PBI-4050 treatment. Unlike PBI-4050, nintedanib treatment did not result in reduced α-SMA, N-cadherin, and M-CSF expression, nor increased MMP1. Our results demonstrate that PBI-4050 reduces myofibroblast activation, extracellular matrix production and inflammation in a primary human cell system modeling fibrotic lung diseases, and is a potential novel therapy for the treatment of IPF.

PBI-4050 is a first-in-class orally active compound which displays antifibrotic activities in kidney, heart, liver, pancreas and lung models. PBI-4050 was found to be safe and well tolerated in healthy volunteers and in patients with CKD and Type 2 diabetes without any SAEs. Translation of pharmacological efficacy in humans …

Heart failure with reduced ejection fraction (HFrEF) causes lung remodeling characterized by myofibroblasts proliferation and fibrosis leading to a restrictive lung syndrome with pulmonary hypertension (PH) and right ventricular (RV) dysfunction. PBI-4050 is a first-in-class synthetic analog with

N,N-dimethylaminopurine pentoxycarbonyl D-arginine (BCH-1393) is a novel low molecular weight synthetic immunomodulator that has been shown to significantly stimulate cytotoxic T-lymphocyte responses both in vitro and in vivo (Zacharie B, Gagnon L, Attardo G, Connolly TP, St-Denis Y, Penney CL. Synthesis and activity of 6-substituted purine linker amine immunostimulants. J. Med. Chem. 1997;40:2883-94). Prompted by this evidence, we extended evaluation of BCH-1393 for anticancer activity in syngeneic mouse experimental tumor models. Consistent with previous findings, in vitro assessment of BCH-1393 activity demonstrated a significant increase in the CTL responses in the range of 10(-9)-10(-5) M. Treatment of mice with four consecutive daily intraperitoneal injections at 25 and 50 mg/kg resulted in a significant increase of the relative percentage of blood CD4+, CD8+, NK and monocyte subsets without any evidence of toxicity. In vivo anti-tumor activity of BCH-1393 was evaluated, either alone or in combination with subtherapeutic doses of cyclophosphamide (Cy), against weakly immunogenic mouse breast carcinoma DA-3 and strongly immunogenic colon adenocarcinoma MC38. Daily intraperitoneal injection of BCH-1393 at 50 mg/kg alone was well tolerated but produced a relatively weak anti-tumor effect in both tumor models. However, a significant inhibition of tumor outgrowth and suppression of established tumor growth was observed when BCH-1393 was administered in combination with subtherapeutic doses of Cy. Combination treatment of 50 mg/kg BCH-1393 with 100 mg/kg Cy (given as single intravenous bolus injection) starting 2 days prior to DA-3 tumor cell inoculation prevented tumor outgrowth in 70-80% of treated mice. In the remaining 20-30% of mice that had developed tumors, a nearly complete (90%) tumor growth inhibition was observed at days 22-24 post tumor implant. In the MC38 tumor model, combination treatment of established tumors with BCH-1393 and Cy (CTX) at 50 mg/kg resulted in a significant delay in tumor growth compared to CTX treatment alone. The observed concomitant anti-tumor activity of BCH-1393 with cyclophosphamide warrants further investigation of this immunomodulator as an adjunctive treatment of cancer.

Background . The efficacy of prophylactic ϵ-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context. Methods . Patients (n = 134) received either ϵ-aminocaproic acid (15-g bolus + infusion of 1 g/h), high-dose tranexamic acid (10-g bolus + placebo infusion), or normal saline solution in a double-blind fashion. Anticoagulation and conduct of cardiopulmonary bypass were standardized. Results . Tranexamic acid and ϵ-aminocaproic acid produced a significant reduction in postoperative blood loss compared with placebo (median loss, 438 mL, 538 mL, and 700 mL, respectively). Transfusion of red cells was similar in all three groups. Nonetheless, the percentage of patients receiving hemostatic blood products was significantly decreased in the ϵ-aminocaproic acid group compared with the placebo group (20% versus 43%; p = 0.03). Both tranexamic acid and ϵ-aminocaproic acid significantly decreased total exposure to allogeneic blood products compared with placebo ( p = 0.01 and p = 0.05, respectively), and this reduction was clinically important (median exposure, 2, 2, and 7.5 units, respectively). Fibrinolysis was inhibited significantly in both treatment groups. Conclusions . We conclude that either high-dose tranexamic acid or ϵ-aminocaproic acid effectively reduces transfusions in patients undergoing primary, elective myocardial revascularization.

Doxacurium (DOX), a new nondepolarizing neuromuscular blocking drug (NMBD), was compared in a randomized, double-blind fashion to high-dose vecuronium (VEC) in 60 coronary artery bypass grafting (CABG) patients. A third group of 15 patients older than 70 years of age (DOX-70) was added to compare the effects of DOX to VEC in the older population. Endpoints of the study were hemodynamic stability, ease of ventilation and intubation, anesthesiologist's satisfaction, drug interventions to correct hemodynamic instability, and total cost of the drug. Anesthesia was induced with fentanyl (30 micrograms/kg) along with the NMBD (DOX 80 micrograms/kg, VEC 400 micrograms/kg) over a 2-minute period. Following induction, heart rate (HR) and mean arterial pressure (MAP) were decreased (P0.01) in all groups. Tracheal intubation caused the HR to return to baseline in the DOX-70 group. There was no difference in central venous pressure, pulmonary artery occlusive pressure, cardiac index, systemic vascular resistance, and drug intervention for DOX and VEC. None of the patients had evidence of myocardial ischemia. There was a statistically significant but clinically irrelevant decrease in central venous pressure and systemic vascular resistance in the DOX-70 group. The durations of the induction and maintenance doses of DOX were similar in the younger and older patients. Although the intubating dose of VEC had a faster onset of action, this had no effect on the ease of ventilation, conditions for tracheal intubation, and overall anesthesiologist satisfaction. The total cost for each NMBD was not different.(ABSTRACT TRUNCATED AT 250 WORDS)

BACKGROUND: PBI-1402 reduces the need for transfusion and increases hemoglobin (Hb) level and red blood cell count (RBC) in chemotherapy-induced anemia (CIA) by a mechanism of action distinct from erythropoietin (EPO). AIM: The objective was to compare the effect of PBI-1402 and EPO on modulation of tumor growth. METHODS: The effect of PBI-1402 (200 mg/kg, oral, once a day) or EPO (200 or 2000 U/kg, s.c. injection, twice a week) was studied in a subcutaneous P815 mastocytoma model. P815 cells express both PBI-1402 and EPO receptors. Tumor growth, metastasis, serum nitric oxide (NO) and hematocrit (Ht) were assessed. RESULTS: P815 tumor growth is rapid and metastasizes to the liver. Inflammation is also associated with P815 tumor growth. PBI-1402 significantly reduced tumor growth (T/C=37%) and invasion as demonstrated by a 33% reduction of mice with liver metastasis. In comparison, EPO had no effect (200 U/kg, equivalent dose used in CKD treatment). However, high dose EPO (2000 U/kg, equivalent dose used in human cancer treatment) exacerbated tumor growth (T/C: 135%). Both doses of EPO induced a significant increase in the percentage of mice with liver metastasis (2X, 200 U/kg, and 3X, 2000 U/kg) compared to control. PBI-1402 treatment had no effect on NO and did not overshoot normal hematocrit. However, treatment with high dose EPO significantly increased NO and Ht levels (Table 1). CONCLUSION: These results suggest that oral treatment with PBI-1402 may inhibit growth and metastasis of cancer cells. As an important safety feature, PBI-1402 does not induce overshoot of hemoglobin. In contrast to EPO, PBI-1402 may offer the advantage of reducing tumor growth and metastasis while preventing anemia induced by chemotherapy. In conclusion, PBI-1402 has the potential to be a safe erythropoiesis-regulating agent useful in treating anemia in cancer patients. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 672. doi:10.1158/1538-7445.AM2011-672

Background: PBI-1402 reduces the need for transfusion and increases hemoglobin (Hb) level and red blood cell count (RBC) in chemotherapy-induced anemia (CIA) patients by a mechanism of action which is distinct from erythropoietin (EPO). The PBI-1402 receptor is also expressed on certain cancer cells such as leukemia (K562), lung (LL-2), prostate (PC-3) and pancreas (Panc-02). Aim: The objective of this study was to determine the role of the PBI-1402 receptor on tumor growth. Methods: Cell proliferation and differentiation of K562 (human erythroleukemia) was studied in presence of PBI-1402 or EPO using 2,7-diaminofluorene for hemoglobin quantification. The effect of oral administration of PBI-1402 in combination with chemotherapy agents (gemcitabine or cyclophosphamide) was studied in subcutaneous syngeneic Panc02, LL-2 and xenogeneic PC-3 models. Results: PBI-1402 inhibits proliferation of K562 cells and promotes differentiation of the remaining cells. K562 cells express both EPO and PBI-1402 receptors. EPO increases phosphorylation of ERK1/2 and Stat3 (linked to cell proliferation) while PBI-1402 decreases it in a dose dependent manner. The antitumor efficacy of oral administration of PBI-1402 was studied in combination with gemcitabine in subcutaneous LL2 and Panc02 as well as in orthotopic Panc02 cancers. In subcutaneous Panc02, gemcitabine induced a significant inhibition (p Conclusion: These results suggest that PBI-1402 has the potential to inhibit the growth of lung, prostate and pancreatic cancer by induction of cell differentiation. PBI-1402-differentiated cancer cells appear to be more susceptible to chemotherapeutic agents. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3534. doi:10.1158/1538-7445.AM2011-3534

Background: PBI-1402 is a novel orally active low molecular weight synthetic compound with erythropoiesis stimulating activity. Furthermore, a clinical phase I study showed that PBI-1402 induced a significant increase (100%, p < 0.0001, compared to placebo) of relative and absolute reticulocyte count in healthy volunteers after 21 days of oral treatment and was devoid of significant side effects. Outcomes: The objectives of this clinical phase Ib/II trial were to study the safety and tolerability of PBI-1402 and to assess its biological efficacy on hemoglobin (Hb) level and red blood cell (RBC) count in patients with Chemotherapy-Induced Anemia (CIA). Methods: An open label phase Ib/II trial, monitored by a US CRO (Pharm-Olam International), was conducted in patients developing anemia after chemotherapy treatment. Three cohorts of 6 CIA patients received 8 weeks of treatment with PBI-1402 once a day, at different doses, and were monitored every two weeks for safety, tolerability, Hb level, RBC count and blood chemistry. Patients remained on their chemotherapy during PBI-1402 treatment. Results: To date, 12 CIA patients have completed their PBI-1402 treatment. 83% of patients demonstrated a significant increase in RBC (p = 0.015) and 66% in Hb (p = 0.038). Among the responders, the mean Hb increase was 1.1 g/dL (p = 0.0007) from a baseline Hb value of 9.8 g/dL. No patient required a blood transfusion and only one patient had an Hb content below 9 g/dL (8.9 g/dL). PBI-1402 was well tolerated and no significant side effects were observed. Conclusion: PBI-1402, via a mechanism of action distinct from erythropoietin, induced sufficient erythropoiesis to raise the RBC level and Hb in CIA patients. In addition, PBI-1402 is safe and well tolerated. PBI-1402 offers the potential for a novel therapy of the anemia of CIA.

The goal of this study was to determine the potential of PBI-1402, a compound that was shown to provide radio- and chemoprotection, to ameliorate the myeloablative therapy induced cytopenia and/or accelerate blood cell recovery of myeloablated hosts following autologous bone marrow transplantation in mouse model. Mice were exposed to irradiation and transplanted the following day with 5×105 bone marrow cells from syngeneic donors. Following transplantation, mice were divided into two groups that received two different doses of PBI-1402 orally and a control group that received PBS for 14 days post transplantation. The results showed that PBI-1402 treatment significantly diminished post-transplant erythropenia in a dose dependent manner. Similarly, determination of haemoglobin (Hb) demonstrated a significant attenuation of Hb loss and additionally, significantly accelerated post-transplantation recovery with the highest dose of PBI-1402. A significantly higher number of platelets was observed with the highest dose of PBI-1402. In addition, similar results were obtained with analysis of white blood cell (WBC) recovery. To determine if the observed effect of PBI-1402 treatment on red blood cell cytopenia and Hb recovery is the consequence of increased erythrocyte progenitor response to Epo, we performed an Epo dose response experiment on CFU-E bone marrow samples obtained from treated and control mice at different time points post transplantation. The results indicated that erythroid progenitors from treated and control mice responded similarly to Epo. However, PBI-1402 treated mice contained significantly higher number of CFU-E. Interestingly, analysis of more primitive Sca1+ progenitors revealed a significant increase in the number of Sca1+ cells from the bone marrow of mice treated with PBI-1402 (p < 0.05). These results demonstrate that PBI-1402 treatment significantly reduced irradiation induced erythropenia with concomitant acceleration in erythroid and Hb recovery. Additionally, treatment with PBI-1402 accelerated WBC recovery and platelet recovery and increased more primitive Sca1+ progenitors. PBI-1402 may offer protection from myeloabaltive therapy or accelerate recovery from remaining resident or transplanted stem cells.

PBI-1402 is an orally active low molecular weight synthetic compound which is currently in a phase Ib/II clinical trial in patients with anemia associated with cancer and/or chemotherapy. PBI-1402 stimulates the in vitro/ex vivo proliferation and maturation of hematopoietic progenitors (erythroid and myeloid populations) with an activity comparable to EPO. Furthermore, an additive effect is observed in combination with EPO. PBI-1402 enhances the differentiation of pluripotent stem cells: CFU-GEMM, CFU-GM with a predominant effect on BFU-E. Clinical phase I study showed that PBI-1402 is devoid of significant side effects. In addition, the clinical phase I results showed statistical increase (100%, p