Erythropoietin and Erythropoietin-Like Agents As Pharmacological Countermeasures During Space Exploration Arthur J. Sytkowski, MD Laboratory for Cell and Molecular Biology Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Center for Advanced Space Studies, Houston , 28 June 2005 Outline of the Presentation • Physiology and cell biology of erythropoietin, a.k.a. “Epo”. • Hematopoietic and non-hematopoietic antiapoptotic actions of Epo. • Epo as a pharmacologic countermeasure in spaceflight. • Long-acting Epo-like agents. Epo Physiology in the Adult Human Ebert & Bunn, 1999 Importantly, Epo also acts on other organs and tissues and is produced and acts locally (autocrine/paracrine action). Peritubular Interstitial Cells Produce Epo: mRNA Detected By In Situ Hybridization and Autoradiography Koury et al., 1988 Primary Structure of Human Epo Oligosaccharides are critical for in vivo activity. Cytokine Receptor Superfamily Type I, Homodimer Watowich, 1996 EpoR Dimerization and Conformational Change Upon Epo Binding Initiates Signal Transduction There is also evidence of pre-formed EpoR dimers. dimers Structure of the Epo Receptor Phosphorylated tyrosines and other special domains are docking sites for signal transduction molecules. Signaling Proteins That Associate With the EpoR • • • • Jak2, STAT5, Cis1. PTKs: Lyn, Syk, Tec PTPs: SHP1 & SHP2 Phospholipid modifying enzymes: PI3-K, PLCγ & SHIP • Adaptor proteins: GRB2, Shc, Cbl, CrkL, APS, IRS-2, Gab1 & Gab2. • Nucleotide exchange factors: Vav, C3G & mSOS Principal EpoR Signaling Pathways • JAK2/STAT5…Phospho-STAT 5b is a hallmark of Epo’s anti-apoptotic signal. • PI3-Kinase…regulates c-myc transcription and phosphorylates Akt, another anti-apoptotic signal. • Raf/MEK/MAP kinase …also regulates c-myc transcription by a different mechanism. • PKC…the epsilon isoform is especially important. EpoR Is Found on Other Tissues: Epo Also Has Non-Hematopoietic Actions • • • • • Endothelium: angiogenesis and wound healing. Central nervous system: neuroprotection. Heart: tissue protection. Gastrointestinal tract: tissue protection. Other cell types: actions unknown. Epo Stimulates Endothelial Cell Growth and Binds to Cell Surface Receptors Anagnostou et al. 1990 Epo and Endothelial Cells • Increases angiogenesis in rat aortic ring. Carlini et al. 1995. • Up-regulates immediate/early genes (growth). Fodinger et al. 2000. • Induces phosphorylation of JAK2 and STAT5 antiapoptosis. Fuste et al. 2002. • Protects against hypoxia-induced apoptosis by activation of AKT-1. Chong et al. 2002. Epo Promotes Wound Healing • Increases granulation tissue an in vivo woundhealing assay. Haroon 2003. • Stimulates angiogenesis and healing of experimental ischemic skin wounds. Buemi 2004. • Stimulates angiogenesis and wound healing in the genetically diabetic mouse. Galeano 2004. Epo and EpoR in the CNS • Hypoxia induces appearance of endogenous Epo mRNA in rat brain. Tan et al. 1992. • 125I-Epo binds to mouse brain slices. Endogenous Epo and EpoR mRNA detected by RT-PCR. Digicaylioglu et al. 1995. • Epo and EpoR detected in monkey and human brain by RTPCR. Marti et al. 1996. • Epo and EpoR detected in developing human brain by immunohistochemistry. Juul et al. 1999. Affinity Cross-Linking of 125I-Epo to EpoR of Erythroid and Neuronal Cells Difference in size of cross-linked complexes implies fundamental difference between EpoRs of the two cell types. Some Effects of Epo on Neuronal Cells • Increases intracellular free calcium. Assandri 1999. • Increases membrane polarization, dopamine release and tyrosine hydroxylase activity. Koshimura 1999. • Promotes differentiation of oligodendrocytes and growth of astrocytes. Sugawa 2002. EpoR Is Found Within And Around Human Brain Capillaries. Brines 2000 (A) EpoR in capillaries (arrow). (B) High-power view (C) EpoR at capillary (c) identified as an astrocytic process (a). Astrocytes contain EpoR. (D) EM shows EpoR within astrocytic foot processes (*), and ECs (arrows). Epo Crosses the Blood-Brain Barrier (A) Biotinylated Epo (bEPO) seen around capillaries 5 h after i.p. injection. (B) bEPO surrounds the lumen of capillaries (arrow). (C) bEpo not observed if injected along with 100 times excess of unlabeled Epo (bEPO + EPO). Epo Attenuates Brain Injury After Blunt Trauma Injury without Epo pretreatment Injury with Epo pretreatment Brines et al. PNAS 2000 Anti-Inflammatory Effect on the CNS: Exptl Autoimmune Encephalomyelitis H & E stain Anti-glial fibrillary acidic protein (GFAP) stain Anti-CD11b stain Rat lumbar spinal cord sections from unimmunized (control), EAE rat (immunized with myelin basic protein), and EAE/Epo rat. Agnello et al., 2002. 2002 Epo Protects Retinal Neurons From Acute Ischemia-Reperfusion Injury Non-ischemic Ischemic Ischemic + Epo Pre-Rx Ischemic + Epo Post-Rx Histological appearances of the non-ischemic (control) and ischemic (vehicle and Epo-treated) retinas at 7 days of reperfusion after ischemia. A, control; B, ischemic (45-min) vehicle-treated; C, ischemic (45-min) and Epo-pretreated; D, ischemic (45-min), Epo-posttreated. Epo-treated animals have significantly less retinal thinning compared with vehicle-treated controls. Junk et al, 2002 Epo and the Heart • Epo and retinoic acid are secreted from epicardium during embryogenesis. • Blocking of endogenous Epo inhibits proliferation and survival of cardiomyocytes. • Epo (both endogenous and administered) protects against ischemia/reperfusion injury. Epo and the Gut • Epo found in human milk. • EpoR detected in small bowel of human fetuses. • Enterocytes of post-natal rats migrate faster if exposed to Epo. • Reduced incidence of necrotizing enterocolitis in low birth weight infants receiving rhEpo. Epo and Other Cell Types • EpoR in kidneys. • Epo in myoblasts. • EpoR on pancreatic islets. So What Does All Of This Have To Do With Spaceflight? • Long-term human spaceflight presents unique problems in autonomous medical care as well as identified risks to health for which countermeasures, including novel pharmaceuticals, especially longacting pharmaceuticals, will be needed. • Among the risks identified in the Bioastronautics Roadmap of special relevance to Epo are • hemorrhage/anemia /blood replacement, • major trauma and • pharmacology of space medicine delivery. We hypothesize that long-acting and ultra-longacting forms of Epo will prove to be valuable therapeutic agents and pharmacological countermeasures in support of the treatment/prevention of trauma and of hemorrhage/anemia/blood replacement. Importantly, Epo has several crucial non-hematopoietic actions including • • • increased wound healing neuroprotection and cardioprotection. Thus, Epo can serve as a new countermeasure for these and, potentially, other diverse risks of human spaceflight. Long-acting forms of Epo, such as those that we are developing, should have even greater impact. In addition to these risks for which Epo and derivatives may serve as valuable countermeasures/treatments, additional health risks may be counteracted by other long-acting recombinant protein therapeutic agents, including, but not limited to, muscle wasting and bone loss. Problems With Conventional Recombinant Epo • • • • Must be glycosylated- produced in mammalian cells. Relatively short in vivo half-life: 6-12 hr. Must be injected. Delay in physiological response: 2-4 weeks. There are several approaches to address these problems, including darbepoetin, an Epo mutant with two additional glycosylation sites, which increase its half-life.. Our strategy is the production of Epo dimers by chemical crosslinking or as a fusion protein. Hypothetical Action of Epo Dimer Monomer Epo Dimer Increased affinity and EpoR clustering amplifies signaling. Linker length is critical • Also, the increased size and glycosylation of the Epo-Epo dimer should result in a markedly prolonged plasma half-life. • So we predict a double effect of Epo dimerization, increased action on the cell and increased survival in the circulation. Chemical Crosslinking of Epo • Purpose • Hypothesize that T1/2 is a function of size • Create a “large Epo” or oligomer with increase number of EpoR binding sites • Approach • Control degree of crosslinking and size • Use two chemical modifying agents to prepare two pools of modified Epo First Approach: Chemical Crosslinking of Epo LC-SPDP Epo A SMCC SH M Epo B LC-SPDP = succinimidyl 6-[3-(2-pyridyldithio) propionamido] hexanoate SMCC = succinimidyl 4-(N-maleimidomethyl M = maleimido group SDS-PAGE of Epo-SH, M-Epo and Crosslinked Epo Dimer and Trimer Trimer Dimer Monomer SH M Epo-SH + M-Epo Activity of Epo Oligomers Separated By SE HPLC IU/µg Monomer 160 Dimer 210 Trimer 100 Pharmacokinetics of Epo Monomer and Dimer in Rabbits Epo Dimer ( ) Activity Is Superior to Monomer ( ) In Vivo A: 300 IU/kg 3X B: 300 IU/kg 1X C: 30 IU/kg 3X D: 30 IU/kg 1X Groups of 6 mice were injected subcutaneously. A Second Approach: Epo-Epo Fusion Protein cDNA Encodes A “Recombinant Dimer” Epo 5’ UTR Leader Epo Linker Peptide 3’ UTR Stop SDS-PAGE and Western Blot of Epo and Epo-Epo Fusion Protein Specific Activity, U/µg U/pmol Epo Epo-Epo 350 13 1000 76 Pharmacokinetics of Epo and Epo-Epo in Mice Intravenous injection. Each curve represent 1 mouse. mouse Epo Epo-Epo Note much longer half-life of Epo-Epo Epo-Epo is Active In Vivo And is Superior To Epo Single subcutaneous dose of 300 U/kg. Post-Hct done after 7 days. Each line represent 1 mouse. New Epo Fusion Proteins Under Study In Our Laboratory Hexamer Pentamer M.W. Tetramer Trimer Dimer = Epo-Epo SDS PAGE and Western Blot Summary • Long-term human spaceflight is associated with novel risks that require countermeasures, including new pharmacological agents, and with unique problems in autonomous medical care. • Long-acting and ultra-long-acting protein therapeutic agents can be designed to address some of these risks. • The Epo dimer and fusion protein concept can serve as a paradigm for the development of these new agents. For more information about Erythropoietin www.wiley.com Acknowledgment • • • • • • • Julia Sue James Fisher Laurie Feldman Yijuang Chern Jennifer Grodberg Elizabeth Lunn Mary Risinger • • • • • • • Kelly Donahue Kerry Wellenstein Rudy Spangler Stephen Bailey Hiren Patel Yuqui Li Changmin Chen Funding from NIH, DOD and NASA Greetings from the Laboratory for Cell and Molecular Biology Thank you for your kind attention Arthur J. Sytkowski, MD 617 632 9980 asytkows@bidmc.harvard.edu