Nonclinical Pharmacokinetics, Disposition, and Drug-Drug Interaction Potential of a Novel d-Amino Acid Peptide Agonist of the Calcium-Sensing Receptor AMG 416 (Etelcalcetide).

AMG 416 (etelcalcetide) is a novel synthetic peptide agonist of the calcium-sensing receptor composed of a linear chain of seven d-amino acids (referred to as the d-amino acid backbone) with a d-cysteine linked to an l-cysteine via a disulfide bond. AMG 416 contains four basic d-arginine residues and is a +4 charged peptide at physiologic pH with a mol. wt. of 1048.3 Da. The pharmacokinetics (PK), disposition, and potential of AMG 416 to cause drug-drug interaction were investigated in nonclinical studies with two single (14)C-labels placed either at a potentially metabolically labile acetyl position or on the d-alanine next to d-cysteine in the interior of the d-amino acid backbone. After i.v. dosing, the PK and disposition of AMG 416 were similar in male and female rats. Radioactivity rapidly distributed to most tissues in rats with intact kidneys, and renal elimination was the predominant clearance pathway. No strain-dependent differences were observed. In bilaterally nephrectomized rats, minimal radioactivity (1.2%) was excreted via nonrenal pathways. Biotransformation occurred primarily via disulfide exchange with endogenous thiol-containing molecules in whole blood rather than metabolism by enzymes, such as proteases or cytochrome P450s; the d-amino acid backbone remained unaltered. A substantial proportion of the plasma radioactivity was covalently conjugated to albumin. AMG 416 presents a low risk for P450 or transporter-mediated drug-drug interactions because it showed no interactions in vitro. These studies demonstrated a (14)C label on either the acetyl or the d-alanine in the d-amino acid backbone would be appropriate for clinical studies.

Human liver cytochrome P450 2D6 genotype, full-length messenger ribonucleic acid, and activity assessed with a novel cytochrome P450 2D6 substrate.

OBJECTIVE: The goal of this study was to develop and validate a cytochrome P450 (CYP) 2D6 probe substrate with improved sensitivity to elucidate the relationship of CYP2D6 ribonucleic acid transcript levels, genotype, and enzyme activity in human liver biopsy samples. METHODS: CYP2D6 activity in tissue homogenates of liver biopsy specimens collected from control subjects (with no apparent liver disease), liver biopsy subjects, liver transplant subjects, and liver bank specimens was assessed with a calcimimetic, R-568, a high-clearance and specific substrate of CYP2D6. The livers were genotyped for the 6 most common CYP2D6 genetic variants (ie, *3, *4, *5, *6, *7, and *8). The 1.5-kilobase CYP2D6 messenger ribonucleic acid (referred to as full-length) transcripts were estimated with a semiquantitative reverse transcription-polymerase chain reaction assay. RESULTS: As a CYP2D6-specific catalytic probe, R-568 offers a 20-fold higher sensitivity compared with that of dextromethorphan. The improved assay sensitivity allowed evaluation of CYP2D6 enzyme activity in a few milligrams of tissue collected from biopsy specimens. The ratio of CYP2D6 enzyme activity to transcript remained relatively constant within each group of subjects, especially within the control group. However, mean activity to transcript varied greatly across the 4 groups of subjects. The liver samples in the control group showed significantly higher enzyme activity but a lower transcript level. CONCLUSIONS: A combination of genotyping and messenger ribonucleic acid level determination could allow a quantitative estimation of functional CYP2D6 activity in healthy human livers with a reasonable degree of confidence. Kinetic study with R-568 indicates that this compound is probably the most sensitive CYP2D6 probe substrate available.

In vitro studies in drug discovery and development: an analysis of study objectives and application of good laboratory practices (GLP).

In vitro drug metabolism studies play a dual role along the path from drug discovery to preclinical development. By analyzing the objectives of each type of study the question of whether to apply good laboratory practices (GLP) requirements is clarified. This review outlines the various in vitro techniques available and categorizes the goals for which they are applied as either supporting drug discovery or influencing decisions of clinical safety. Based on this categorization it is proposed that studies performed to explore the utility of a potential drug candidate be conducted non-GLP, while studies used to support IND and post-IND submissions be considered for GLP.