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Itacitinib adipate, the adipate salt of itacitinib which is also known as INCB39110, is a potent, selective and orally bioavailable inhibitor of JAK1 (Janus-associated kinase 1) with potential antineoplastic activity, currently in Phase II clinical trials for the treatment of myelofibrosis, rheumatoid arthritis and plaque psoriasis.
Targets |
JAK1/Janus-associated kinase 1
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ln Vitro |
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ln Vivo |
Itacitinib is able to inhibit tumor growth in human pancreatic xenograft models in mice at clinically relevant doses, both as monotherapy and in combination with cytotoxic agents such as gemcitabine.
Itacitinib reduces cytokine levels in murine models of acute hyperinflammation [3] As CRS is the most common side effect associated with CAR T-cell treatment, we investigated whether Itacitinib is able to reduce the levels of cytokines associated with acute hyperactivation leading to CRS. Therefore, we conducted experiments in which naïve animals were challenged with ConA, a potent T-cell mitogen capable of inducing broad inflammatory cytokine releases and proliferation. Similar to individuals experiencing CRS, animals receiving ConA have elevated serum levels of multiple inflammatory cytokines as well as behavioral changes such as fever, malaise, hypotension, hypoxia, capillary leak, multi-organ toxicity, and potentially death. To study the effect of itacitinib in this model, corresponding animals were prophylactically dosed with 60 or 120 mg/kg of itacitinib to achieve JAK1 inhibition coverage equivalent to that observed in clinical trials. When compared with vehicle-dosed animals, itacitinib was able to significantly reduce serum levels of many of the cytokines implicated in CRS (i.e., IL-6, IL-12, and IFN-γ) in a dose-dependent manner (Fig. 1A). As expected, itacitinib did not have a significant effect on cytokines independent of the JAK1 pathway (i.e., IL-5, Fig. 1A). However, not all JAK-mediated cytokines were significantly decreased (i.e. IL-4, Fig 1A). Additionally, itacitinib was also able to dose-dependently reduce CRS-implicated cytokines in a therapeutic mode, where animals were dosed with itacitinib 30 minutes after ConA challenge (Fig. 1B). To confirm the capacity of itacitinib to reduce hyperinflammation, naïve animals were challenged with anti-CD3 to induce nonspecific T-cell activation and cytokine response. Once again, corresponding animals were either prophylactically or therapeutically dosed with 120 mg/kg of Itacitinib. Compared with vehicle-treated mice, itacitinib was able to significantly reduce serum levels of many of the cytokines implicated in CRS, but have no effect on cytokines independent of the JAK1 pathway (Supplementary Fig. S1A) [3]. Having determined that Itacitinib is able to reduce IL-6 production in vitro, we next expanded our studies to an in vivo context to assess the effect of itacitinib on activated macrophages in mice. Mice were prophylactically treated with itacitinib or vehicle for 3 days to achieve steady state before receiving an intraperitoneal injection of LPS. Two hours after injection, cytokines were measured from intraperitoneal lavages. As seen in Fig. 2B, doses of itacitinib that mimic the JAK1 inhibition coverage achieved in clinical trials significantly reduced IL-6 production by activated macrophages in vivo. Thus, data from both in vitro and in vivo systems indicate that itacitinib is capable of downregulating the major cellular source of inflammatory IL-6 during an experimentally induced model of CRS [3]. Itacitinib does not impair T-cell antitumor activity in vivo [3] To further test the effect of Itacitinib on antigen-specific T-cell proliferation and in vivo antitumor activity, we isolated splenocytes from OT-1 mice, transgenic for the TCR Vα2Vβ5 specific for the peptide OVA257–264 (SIINFEKL) (36). OT-1 T-cells were expanded with the SIINFEKL peptide in the presence of increasing concentrations of itacitinib, and their expansion was measured by flow cytometry. As expected, itacitinib concentrations relevant to the IC50 have a minimal effect on the expansion rate (Supplementary Fig. S3A). Itacitinib concentrations relevant to maximum free concentrations (189 and 244 nM, in the absence or presence of potent CYP3A4 inhibitors, respectively) induced a modest reduction on T-cell proliferation (Supplementary Fig. S3A). To evaluate the effect of itacitinib on the in vivo antitumor efficacy of OT-1 CD8, we conducted experiments involving adoptive transfer of OVA-specific CD8 cells into C57BL/6 mice previously transplanted with an OVA-expressing tumor cell line (EG7). Five days after tumor challenge, corresponding animals were orally dosed b.i.d. with vehicle or 60 or 120 mg/kg of itacitinib for 2 weeks. Eight days after tumor inoculation, animals received an adoptive transfer of OVA-specific OT-1 naïve CD8 cells. When compared with the control group, adoptive transfer of OT-1 CD8 was able to significantly reduce tumor growth (Fig. 4). Importantly, itacitinib doses equivalent to the JAK1 coverage target doses do not affect the antitumor efficacy of OT-1 cells (Fig. 5). Itacitinib does not affect CD19-CAR T-cell antitumor activity in vivo [3] To test the effect of Itacitinib in vivo, we studied the effect of oral Itacitinib on the antitumor efficacy of CD19-CAR T-cells. Immunodeficient mice (NSG) were challenged with CD19+ nalm6-luciferase expressing human lymphoma cells. Once the tumor was engrafted (day 4), the mice received an adoptive transfer of 3 × 106 human CD19-CAR T-cells. In this model, CAR T-cells were able to control tumor growth, measured by luciferin expression (Fig. 7). Importantly, daily oral itacitinib dosing (120 mg/kg) of the animals did not affect the antitumor activity of adoptively transferred CAR T-cells, thus indicating that, at targeted doses, itacitinib does not have a significant effect on the antitumor activity of CAR T-cells. Finally, to confirm that itacitinib would not affect CAR T-cell activity on a more aggressive model, immunodeficient mice (NSG) were challenged with 5 × 106 CD19+ NAMALWA-luciferase expressing human lymphoma cells. Once the tumor was engrafted (day 7), the mice received an adoptive transfer of human CD19-CAR T-cells. When compared with animals receiving control cells, animals receiving an adoptive transfer of CAR T-cells had a significant tumor growth delay, measured both by luciferin expression (Supplementary Fig. S4B) and expansion of survival (P = 0.0014) (Supplementary Fig. S4C). Even in this aggressive tumor model, daily oral itacitinib dosing of the animals did not affect the antitumor activity of adoptively transferred CAR T-cells (P = 0.1860), thus confirming the safety of prophylactic itacitinib dosing to prevent CRS [3]. Combined Janus kinase 1 (JAK1) and JAK2 inhibition therapy effectively reduces splenomegaly and symptom burden related to myelofibrosis but is associated with dose-dependent anemia and thrombocytopenia. In this open-label phase II study, we evaluated the efficacy and safety of three dose levels of Itacitinib/INCB039110, a potent and selective oral JAK1 inhibitor, in patients with intermediate- or high-risk myelofibrosis and a platelet count ≥50×109/L. Of 10, 45, and 32 patients enrolled in the 100 mg twice-daily, 200 mg twice-daily, and 600 mg once-daily cohorts, respectively, 50.0%, 64.4%, and 68.8% completed week 24. A ≥50% reduction in total symptom score was achieved by 35.7% and 28.6% of patients in the 200 mg twice-daily cohort and 32.3% and 35.5% in the 600 mg once-daily cohort at week 12 (primary end point) and 24, respectively. By contrast, two patients (20%) in the 100 mg twice-daily cohort had ≥50% total symptom score reduction at weeks 12 and 24. For the 200 mg twice-daily and 600 mg once-daily cohorts, the median spleen volume reductions at week 12 were 14.2% and 17.4%, respectively. Furthermore, 21/39 (53.8%) patients who required red blood cell transfusions during the 12 weeks preceding treatment initiation achieved a ≥50% reduction in the number of red blood cell units transfused during study weeks 1-24. Only one patient discontinued for grade 3 thrombocytopenia. Non-hematologic adverse events were largely grade 1 or 2; the most common was fatigue. Treatment with INCB039110 resulted in clinically meaningful symptom relief, modest spleen volume reduction, and limited myelosuppression [1]. |
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Enzyme Assay |
Janus kinase (JAK) inhibitors (also termed Jakinibs) constitute a family of small drugs that target various isoforms of JAKs (JAK1, JAK2, JAK3 and/or tyrosine kinase 2 (Tyk2)). They exert anti-inflammatory properties linked, in part, to the modulation of the activation state of pro-inflammatory M1 macrophages. The exact impact of JAK inhibitors on a wider spectrum of activation states of macrophages is however still to be determined, especially in the context of disorders involving concomitant activation of pro-inflammatory M1 macrophages and profibrotic M2 macrophages. This is especially the case in autoimmune pulmonary fibrosis like scleroderma-associated interstitial lung disease (ILD), in which M1 and M2 macrophages play a key pathogenic role. In this study, we directly compared the anti-inflammatory and anti-fibrotic effects of three JAK inhibitors (ruxolitinib (JAK2/1 inhibitor); tofacitinib (JAK3/2 inhibitor) and itacitinib (JAK1 inhibitor)) on five different activation states of primary human monocyte-derived macrophages (MDM). These three JAK inhibitors exert anti-inflammatory properties towards macrophages, as demonstrated by the down-expression of key polarization markers (CD86, MHCII, TLR4) and the limited secretion of key pro-inflammatory cytokines (CXCL10, IL-6 and TNFα) in M1 macrophages activated by IFNγ and LPS or by IFNγ alone. We also highlighted that these JAK inhibitors can limit M2a activation of macrophages induced by IL-4 and IL-13, as notably demonstrated by the down-regulation of the M2a associated surface marker CD206 and of the secretion of CCL18. Moreover, these JAK inhibitors reduced the expression of markers such as CXCL13, MARCO and SOCS3 in alternatively activated macrophages induced by IL-10 and dexamethasone (M2c + dex) or IL-10 alone (M2c MDM). For all polarization states, Jakinibs with inhibitory properties over JAK2 had the highest effects, at both 1 μM or 0.1 μM. [2]
Kinase biochemical profiling [4] Enzyme assays were performed using a homogeneous time-resolved fluorescence assay with recombinant epitope tagged kinase domains (JAK1, 837–1142; JAK2, 828–1132; JAK3, 718–1124; TYK2, 873–1187) and peptide substrate (Biotin-EQEDEPEGDYFEWLE). Each enzyme reaction was carried out with or without test compound (11-point dilution), JAK enzyme, 500 nM peptide, adenosine triphosphate (ATP; 1 mM), and 2.0% dimethyl sulfoxide in assay buffer. The 50% inhibitory concentration (IC50) was calculated as the compound concentration required for inhibition of 50% of the fluorescent signal. Additional activity against a panel of 60 non-JAK family kinases was assessed with standard screening conditions testing 100 nM Itacitinib/INCB039110 using the respective Km concentrations for ATP for each individual kinase. Significant inhibition was defined as more than or equal to 30% (average of duplicate assays) compared with control values. |
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Cell Assay |
Validation of polarization markers and respective toxicity of the considered JAK inhibitors for two concentrations relevant of human plasma levels[2]
CXCL10, IL-6, IL1Ra and TNFα were all significantly over-expressed in the IFNγ-induced M1i MDM and in the (IFNγ + LPS)-induced M1Li MDM (Fig. 1A-B) in comparison with M0 unstimulated MDM. CCL18, PDGFbb, PPARγ and tenascin C (TenaC) were significantly over-expressed in the (IL-4/IL-13)-induced M2a MDM in comparison with M0 unstimulated MDM (Fig. 1C-D). CXCL13, IL-10, MARCO and SOCS3 were all upregulated in the IL-10-induced M2c MDM and in the (IL-10/Dexamethasone)-induced M2c + Dex (Fig. 1E). T-cell proliferation assay [3] Peripheral blood mononuclear cells (PBMCs) were prepared from human whole blood samples using a Ficoll-Hypaque separation method, and T-cells were then obtained from the PBMCs by centrifugal elutriation. T-cells were maintained in RPMI 1640 medium supplemented with 10% fetal bovine serum, 1% HEPES, 2 mM L-glutamine, 0.05 mM 2-mercaptoethanol and 100 μg/mL streptomycin, and 100 units/mL penicillin (complete RPMI or CM). T-cells were activated with Dynabeads (immobilized agonist antibodies against CD3/CD28) at a 3:1 ratio, resuspended at a density of 0.5 × 106 cells/mL in 24-well plates and treated with Itacitinib at various concentrations (from 50 to 1000 nM). The plates were incubated at 37°C in 5% CO2 atmosphere for 10 days, and the proliferation was determined every other day by bead-based methods. Cultures were replenished every other day with fresh CM. Cytotoxicity assays [3] Luciferase expressing SY5Y neuroblastoma cells (GD-2+) were plated in a 96-well plate at 50,000 cells/well. Twenty-four hours later, 150,000 CAR T-cells were added to corresponding wells in a final volume of 200 μL. Target cells alone were seeded in parallel to quantify the maximum luciferase expression (relative luminescent units; RLUmax). Seventeen hours later 100 μL of luciferin substrate was added to the co-culture. Luminescence was measured after a 10-minute incubation using an EnVision plate reader. The percent cell lysis was obtained using the following calculation: [1 − (RLUexperimental)/(RLUmax)] × 100. The experiment was performed in triplicates. Monocyte chemotatic protein (MCP)-1 assay [4] Human PBMCs were preincubated with Itacitinib for 10 min at 37 °C, 5% CO2 and cultured at 1.5 × 106 cells/ml in RPMI media. Wells were stimulated by adding 30 ng/ml of human recombinant IL-6 and incubated for 48 h at 37 °C, 5% CO2. Supernatants were harvested and analyzed for levels of human MCP-1 by commercial ELISA. Itacitinib IC50 determination was performed by curve fitting using GraphPad Prism 5.0 software. cell proliferation assay [4] Human T cells were then obtained from PBMCs and maintained in RPMI with 10% fetal bovine serum. For IL-2 stimulated cell proliferation analysis, cells were first treated with 10 μg/ml of phytohemagglutinin for 3 days to stimulate expression of IL-2 receptors. Cells were subsequently washed and resuspended in RPMI media at 6000 cells per well and treated with Itacitinib in the presence of 100 U/ml human IL-2. The plates were incubated at 37 °C in 5% CO2 for 3 days and proliferation determined by adding CellTiter-Glo® Reagent and detecting luminescence. Itacitinib IC50 determination was performed using the GraphPad Prism 5.0 software. IL-17/IL-22 cytokine analysis [4] Human PBMCs were were maintained in RPMI supplemented with 10% fetal bovine serum, and T cell were activated with 1 μg/ml anti-CD3 and 5 μg/ml anti-CD28 antibodies. After 2 days, the cells were washed and recultured with IL-23 (100 ng/ml), IL-2 (10 ng/ml) and Itacitinib. Cells were incubated for an additional 4 days at 37 °C. IL-17 and IL-22 concentrations in the supernatants were measured by ELISA. Human phosphorylated STAT3 (pSTAT3) whole blood assay [4] Blood from healthy human volunteers were collected into heparinized tubes. Blood was incubated with various Itacitinib concentrations for 10 min at 37 °C. Cells were subsequently stimulated with 100 ng/ml of IL-6 for 15 min at 37 °C. Red blood cells were lysed using hypotonic conditions, and the supernatant was removed by centrifugation. White blood cells were pelleted and lysed to make total cellular extracts. The extracts were analyzed for pSTAT3 using a commercial phospho-STAT3 specific ELISA. Emerging evidence has demonstrated the importance of tumor-associated inflammation in the development and progression of pancreatic ductal adenocarcinoma. Specifically, constitutive activation of the inflammation-related IL-6/JAK/STAT3 signaling pathway has been reported in pancreatic tumors and has been suggested to be a poor prognostic factor for overall survival in patients with advanced disease. The aim of this study was to assess the effects of inhibition of IL-6/JAK/STAT3 signaling on pancreatic cell growth in vitro and tumor growth in vivo. INCB039110, a JAK1 selective inhibitor currently in multiple Phase 2 clinical trials, was used to block the IL-6/JAK/STAT3 signaling pathway in cells. We show that while inhibition of IL-6/JAK/STAT3 signaling by INCB039110 showed no effects on the proliferation of pancreatic cell lines grown under conventional 2D monolayer cell culture conditions, this inhibitor demonstrated growth inhibitory activity against the pancreatic tumor cell lines, Hs700T and BxPC-3, in a 3D-spheroid culture system. Importantly, addition of cytokines that stimulated JAK/STAT3 signaling in these cells significantly promoted the growth of the spheroids, and this could be completely reversed by INCB039110. Furthermore, JAK1 inhibition enhanced the cytotoxicity induced by gemcitabine in both Hs700T and BxPC-3 spheroids in a combination study. The results were confirmed with another novel Jak1 selective inhibitor, INCB052793 which is currently in a Phase 1 clinical trial in patients with advanced malignancies. [2] |
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Animal Protocol |
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ADME/Pharmacokinetics |
Pharmacokinetics of itacitinib in mice following multiple oral dosing [4]
The pharmacokinetics of itacitinib in female BALB/c mice was determined following twice daily oral doses at 20, 40, and 80 mg/kg for 12 days (Fig. 4). The mean peak plasma concentration (Cmax) and area under the curve values increased with the dose although not proportionally. Pharmacokinetics studies [4] The oral absorption of itacitinib was determined in commercially purchased female BALB/c mice (BALB/cAnNCrl strain# 028, Charles River Laboratories). Itacitinib was formulated in 0.5% methylcellulose and administered by oral gavage at 20, 40, or 80 mg/kg twice daily for 12 days. Retro-orbital blood samples were collected at 1, 2, 8, and 16 h post-dose on the last day. All blood samples were collected using EDTA as the anticoagulant and centrifuged to obtain plasma samples. Plasma concentrations of itacitinib were determined by liquid chromatography coupled to tandem mass spectrometry using a positive interface on a Sciex API-4000 mass spectrometer and multiple reaction monitoring. The plasma concentration-time data was used to determine the pharmacokinetic parameters by standard non compartmental methods using WinNonlin® version 5.0.1. This article presents the population pharmacokinetic (PopPK) analysis and exposure-response analyses for the primary efficacy end point-acute graft-versus-host disease (aGVHD) day 28 response-and select safety measures (incidence of thrombocytopenia, hypertriglyceridemia, and cytomegalovirus infection) from a phase 3 randomized, double-blind study comparing itacitinib plus corticosteroids versus placebo plus corticosteroids for the treatment of aGVHD. The PopPK data set contained sparse data from patients with aGVHD and select enriched data from healthy volunteers. The structural model was a 2-compartment model with first-order elimination and dose-dependent nonlinear absorption with dual first-order absorption pathways with lag times. Strong cytochrome P450 (CYP) 3A inhibitor coadministration, moderate renal impairment, and participant population (healthy volunteers vs patients with aGVHD) were covariates on apparent clearance. Participant population was also a covariate on apparent intercompartmental clearance and lag time of the secondary absorption compartment. Apparent clearance decreased 42% with coadministration of strong CYP3A inhibitors. Simulations supported the following dose reductions with concomitant use of a strong CYP3A inhibitor: 300 mg once daily to 200 mg once daily, 400 mg once daily to 300 mg once daily, and 600 mg once daily to 400 mg once daily. No dose adjustment is recommended for any other covariate based on the magnitude of impact when they were retained in the model. The exposure-response relationship was characterized between itacitinib exposure and probability of aGVHD day 28 response using a linear logistic regression model. Both itacitinib exposure and aGVHD risk status were significant predictors of response. There was no relationship between itacitinib exposure and thrombocytopenia, hypertriglyceridemia, or cytomegalovirus infection. https://pubmed.ncbi.nlm.nih.gov/36601737/ |
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Toxicity/Toxicokinetics |
Safety and tolerability [1]
The median (range) exposure to INCB039110 was 102 (23–519) days in the 100 mg twice-daily cohort, 268 (22–535) days in the 200 mg twice-daily cohort, and 197 (58–343) days in the 600 mg once-daily cohort. The most common non-hematologic adverse events regardless of causality are shown in Table 2; most were grade 1 or 2. Grade ≥3 non-hematologic adverse events that occurred in more than one patient were: pneumonia, dyspnea, and hypertension (3 patients each), and congestive heart failure, rectal hemorrhage, asthenia, pyrexia, urinary tract infection, hyperkalemia, increased alkaline phosphatase, and acute renal failure (2 patients each). These 25 events occurred in 18 unique patients. Although infections were common (44.8%), including upper respiratory tract infections in 19.5% of patients (Online Supplementary Table S1), most were mild or moderate, and only four cases (1 each of bronchitis, folliculitis, Herpes simplex, and urinary tract infection) were considered treatment-related by the investigator. All of these four cases were grade 2 and not considered serious, and all resolved without changes to study treatment. Two patients (both in the 600 mg once-daily cohort) died during the study: a 62-year old patient died of pneumonia after approximately 5 months on therapy, and a 61-year old patient died of unspecified causes potentially related to disease progression after slightly less than 4 months on therapy. Both deaths were considered by the investigator to be unrelated to treatment. |
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References |
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Additional Infomation |
Itacitinib Adipate is the adipate salt form of itacitinib, an orally bioavailable inhibitor of Janus-associated kinase 1 (JAK1) with potential antineoplastic and immunomodulating activities. Upon oral administration, itacitinib selectively inhibits JAK-1, thereby inhibiting the phosphorylation of signal transducer and activator of transcription (STAT) proteins and the production of proinflammatory factors induced by other cytokines, including interleukin-23 (IL-23) and interleukin-6 (IL-6). The JAK-STAT pathway plays a key role in the signaling of many cytokines and growth factors and is involved in cellular proliferation, growth, hematopoiesis, and the immune response; JAK kinases may be upregulated in inflammatory diseases, myeloproliferative disorders, and various malignancies.
Itacitinib has been used in trials studying the treatment of Melanoma, Carcinoma, Metastatic Cancer, Endometrial Cancer, and B-cell Malignancies, among others. Itacitinib is an orally bioavailable inhibitor of Janus-associated kinase 1 (JAK1) with potential antineoplastic and immunomodulating activities. Upon oral administration, itacitinib selectively inhibits JAK-1, thereby inhibiting the phosphorylation of signal transducer and activator of transcription (STAT) proteins and the production of proinflammatory factors induced by other cytokines, including interleukin-23 (IL-23) and interleukin-6 (IL-6). The JAK-STAT pathway plays a key role in the signaling of many cytokines and growth factors and is involved in cellular proliferation, growth, hematopoiesis, and the immune response; JAK kinases may be upregulated in inflammatory diseases, myeloproliferative disorders, and various malignancies. Drug Indication Treatment of acute graft versus host disease. Janus kinase (JAK) inhibitors (also termed Jakinibs) constitute a family of small drugs that target various isoforms of JAKs (JAK1, JAK2, JAK3 and/or tyrosine kinase 2 (Tyk2)). They exert anti-inflammatory properties linked, in part, to the modulation of the activation state of pro-inflammatory M1 macrophages. The exact impact of JAK inhibitors on a wider spectrum of activation states of macrophages is however still to be determined, especially in the context of disorders involving concomitant activation of pro-inflammatory M1 macrophages and profibrotic M2 macrophages. This is especially the case in autoimmune pulmonary fibrosis like scleroderma-associated interstitial lung disease (ILD), in which M1 and M2 macrophages play a key pathogenic role. In this study, we directly compared the anti-inflammatory and anti-fibrotic effects of three JAK inhibitors (ruxolitinib (JAK2/1 inhibitor); tofacitinib (JAK3/2 inhibitor) and itacitinib (JAK1 inhibitor)) on five different activation states of primary human monocyte-derived macrophages (MDM). These three JAK inhibitors exert anti-inflammatory properties towards macrophages, as demonstrated by the down-expression of key polarization markers (CD86, MHCII, TLR4) and the limited secretion of key pro-inflammatory cytokines (CXCL10, IL-6 and TNFα) in M1 macrophages activated by IFNγ and LPS or by IFNγ alone. We also highlighted that these JAK inhibitors can limit M2a activation of macrophages induced by IL-4 and IL-13, as notably demonstrated by the down-regulation of the M2a associated surface marker CD206 and of the secretion of CCL18. Moreover, these JAK inhibitors reduced the expression of markers such as CXCL13, MARCO and SOCS3 in alternatively activated macrophages induced by IL-10 and dexamethasone (M2c+dex) or IL-10 alone (M2c MDM). For all polarization states, Jakinibs with inhibitory properties over JAK2 had the highest effects, at both 1 μM or 0.1 μM. Based on these in vitro results, we also explored the effects of JAK2/1 inhibition by ruxolitinib in vivo, on mouse macrophages in a model of HOCl-induced ILD, that mimics scleroderma-associated ILD. In this model, we showed that ruxolitinib significantly prevented the upregulation of pro-inflammatory M1 markers (TNFα, CXCL10, NOS2) and pro-fibrotic M2 markers (Arg1 and Chi3L3). These results were associated with an improvement of skin and pulmonary involvement. Overall, our results suggest that the combined anti-inflammatory and anti-fibrotic properties of JAK2/1 inhibitors could be relevant to target lung macrophages in autoimmune and inflammatory pulmonary disorders that have no efficient disease modifying drugs to date. [2] Purpose: T-cells engineered to express a chimeric antigen receptor (CAR T-cells) are a promising cancer immunotherapy. Such targeted therapies have shown long-term relapse-free survival in patients with B-cell leukemia and lymphoma. However, cytokine release syndrome (CRS) represents a serious, potentially life-threatening side effect often associated with CAR T-cell therapy. CRS manifests as a rapid (hyper)immune reaction driven by excessive inflammatory cytokine release, including interferon-γ and interleukin-6. Experimental Design: Many cytokines implicated in CRS are known to signal through the Janus kinase–signal transducers and activators of transcription (JAK-STAT) pathway. Here we study the effect of blocking JAK pathway signaling on CAR T-cell proliferation, anti-tumor activity and cytokine levels in in vitro and in vivo models. Results: We report that itacitinib, a potent, selective JAK1 inhibitor, was able to significantly and dose-dependently reduce levels of multiple cytokines implicated in CRS in several in vitro and in vivo models. Importantly, we also report that at clinically relevant doses that mimic human JAK1 pharmacologic inhibition, itacitinib did not significantly inhibit proliferation or antitumor killing capacity of three different human CAR T-cell constructs (GD2, EGFR, and CD19). Finally, in an in vivo model, antitumor activity of CD19-CAR T-cells adoptively transferred into CD19+ tumor bearing immuno-deficient animals was unabated by oral itacitinib treatment. Conclusion: Together, these data suggest that itacitinib has potential as a prophylactic agent for the prevention of CAR T-cell–induced CRS, and a phase II clinical trial of itacitinib for prevention of CRS induced by CAR T-cell therapy has been initiated (NCT04071366).[3] Pharmacological modulation of the Janus kinase (JAK) family has achieved clinically meaningful therapeutic outcomes for the treatment of inflammatory and hematopoietic diseases. Several JAK1 selective compounds are being investigated clinically to determine their anti-inflammatory potential. We used recombinant enzymes and primary human lymphocytes to assess the JAK1 specificity of itacitinib (INCB039110) and study inhibition of signal transducers and activators of transcription (STAT) signaling. Rodent models of arthritis and inflammatory bowel disease were subsequently explored to elucidate the efficacy of orally administered itacitinib on inflammatory pathogenesis. Itacitinib is a potent and selective JAK1 inhibitor when profiled against the other JAK family members. Upon oral administration in rodents, itacitinib achieved dose-dependent pharmacokinetic exposures that highly correlated with STAT3 pharmacodynamic pathway inhibition. Itacitinib ameliorated symptoms and pathology of established experimentally-induced arthritis in a dose-dependent manner. Furthermore, itacitinib effectively delayed disease onset, reduced symptom severity, and accelerated recovery in three distinct mouse models of inflammatory bowel disease. Low dose itacitinib administered via cannula directly into the colon was highly efficacious in TNBS-induced colitis but with minimal systemic drug exposure, suggesting localized JAK1 inhibition is sufficient for disease amelioration. Itacitinib treatment in an acute graft-versus-host disease (GvHD) model rapidly reduced inflammatory markers within lymphocytes and target tissue, resulting in a marked improvement in disease symptoms. This is the first manuscript describing itacitinib as a potent and selective JAK1 inhibitor with anti-inflammatory activity across multiple preclinical disease models. These data support the scientific rationale for ongoing clinical trials studying itacitinib in select GvHD patient populations.[4] |
Molecular Formula |
C₃₂H₃₃F₄N₉O₅
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Molecular Weight |
699.66
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Exact Mass |
699.254
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Elemental Analysis |
C, 54.93; H, 4.75; F, 10.86; N, 18.02; O, 11.43
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CAS # |
1334302-63-4
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Related CAS # |
Itacitinib;1334298-90-6
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PubChem CID |
67390313
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Appearance |
White to light yellow solid powder
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Hydrogen Bond Donor Count |
3
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Hydrogen Bond Acceptor Count |
15
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Rotatable Bond Count |
10
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Heavy Atom Count |
50
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Complexity |
1090
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Defined Atom Stereocenter Count |
0
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InChi Key |
CEGWJIQFBNFMHQ-UHFFFAOYSA-N
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InChi Code |
InChI=1S/C26H23F4N9O.C6H10O4/c27-20-18(1-7-32-22(20)26(28,29)30)24(40)37-9-3-17(4-10-37)38-13-25(14-38,5-6-31)39-12-16(11-36-39)21-19-2-8-33-23(19)35-15-34-21;7-5(8)3-1-2-4-6(9)10/h1-2,7-8,11-12,15,17H,3-5,9-10,13-14H2,(H,33,34,35);1-4H2,(H,7,8)(H,9,10)
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Chemical Name |
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Synonyms |
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HS Tariff Code |
2934.99.9001
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Storage |
Powder -20°C 3 years 4°C 2 years In solvent -80°C 6 months -20°C 1 month Note: Please store this product in a sealed and protected environment (e.g. under nitrogen), avoid exposure to moisture. |
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Shipping Condition |
Room temperature (This product is stable at ambient temperature for a few days during ordinary shipping and time spent in Customs)
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Solubility (In Vitro) |
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Solubility (In Vivo) |
Solubility in Formulation 1: ≥ 2.5 mg/mL (3.57 mM) (saturation unknown) in 10% DMSO + 40% PEG300 + 5% Tween80 + 45% Saline (add these co-solvents sequentially from left to right, and one by one), clear solution.
For example, if 1 mL of working solution is to be prepared, you can add 100 μL of 25.0 mg/mL clear DMSO stock solution to 400 μL PEG300 and mix evenly; then add 50 μL Tween-80 to the above solution and mix evenly; then add 450 μL normal saline to adjust the volume to 1 mL. Preparation of saline: Dissolve 0.9 g of sodium chloride in 100 mL ddH₂ O to obtain a clear solution. Solubility in Formulation 2: ≥ 2.5 mg/mL (3.57 mM) (saturation unknown) in 10% DMSO + 90% (20% SBE-β-CD in Saline) (add these co-solvents sequentially from left to right, and one by one), clear solution. For example, if 1 mL of working solution is to be prepared, you can add 100 μL of 25.0 mg/mL clear DMSO stock solution to 900 μL of 20% SBE-β-CD physiological saline solution and mix evenly. Preparation of 20% SBE-β-CD in Saline (4°C,1 week): Dissolve 2 g SBE-β-CD in 10 mL saline to obtain a clear solution. View More
Solubility in Formulation 3: ≥ 2.5 mg/mL (3.57 mM) (saturation unknown) in 10% DMSO + 90% Corn Oil (add these co-solvents sequentially from left to right, and one by one), clear solution. |
Preparing Stock Solutions | 1 mg | 5 mg | 10 mg | |
1 mM | 1.4293 mL | 7.1463 mL | 14.2927 mL | |
5 mM | 0.2859 mL | 1.4293 mL | 2.8585 mL | |
10 mM | 0.1429 mL | 0.7146 mL | 1.4293 mL |
*Note: Please select an appropriate solvent for the preparation of stock solution based on your experiment needs. For most products, DMSO can be used for preparing stock solutions (e.g. 5 mM, 10 mM, or 20 mM concentration); some products with high aqueous solubility may be dissolved in water directly. Solubility information is available at the above Solubility Data section. Once the stock solution is prepared, aliquot it to routine usage volumes and store at -20°C or -80°C. Avoid repeated freeze and thaw cycles.
Calculation results
Working concentration: mg/mL;
Method for preparing DMSO stock solution: mg drug pre-dissolved in μL DMSO (stock solution concentration mg/mL). Please contact us first if the concentration exceeds the DMSO solubility of the batch of drug.
Method for preparing in vivo formulation::Take μL DMSO stock solution, next add μL PEG300, mix and clarify, next addμL Tween 80, mix and clarify, next add μL ddH2O,mix and clarify.
(1) Please be sure that the solution is clear before the addition of next solvent. Dissolution methods like vortex, ultrasound or warming and heat may be used to aid dissolving.
(2) Be sure to add the solvent(s) in order.
NCT Number | Recruitment | interventions | Conditions | Sponsor/Collaborators | Start Date | Phases |
NCT04239989 | Recruiting | Drug: Itacitinib Drug: Itacitinib Adipate |
Bronchiolitis Obliterans | M.D. Anderson Cancer Center | April 8, 2021 | Phase 1 |
NCT04070781 | Terminated | Drug: Itacitinib Drug: Tocilizumab | Steroid Refractory GVHD Graft Vs Host Disease |
Columbia University | January 20, 2020 | Phase 1 |
NCT04339101 | Active, not recruiting Has Results |
Drug: Fludarabine Drug: Itacitinib Adipate |
Acute Leukemia Hematologic and Lymphocytic Disorder |
City of Hope Medical Center | November 11, 2020 | Phase 2 |
NCT04200365 | Terminated | Drug: Itacitinib | Chronic Graft-versus-host-disease | SCRI Development Innovations, LLC | June 5, 2020 | Phase 2 |
Treatment effects on total symptom score (TSS).Haematologica.2017 Feb;102(2):327-335 td> |
Treatment effects on spleen volume.Haematologica.2017 Feb;102(2):327-335. td> |
Mean hemoglobin level and platelet count over time by dose cohort.Haematologica.2017 Feb;102(2):327-335. td> |