E5564, a synthetic
lipid A analogue, is a selective, highly active antagonist of
endotoxin-mediated activation of immune cells. Preclinical research has indicated that
E5564 can block
endotoxin-mediated induction of
cytokines and
endotoxin or Gram-negative bacterial-induced death in animal models. Recent phase I clinical trials have focused on the ability of
E5564 to block responsiveness to
endotoxin. This was done in two ways: in vivo challenge of human volunteers with 4 ng/kg
endotoxin, and by use of an ex vivo assay which utilizes blood drawn from volunteers administered
E5564 and challenged with
endotoxin at concentrations that ranged from 50 pg/ml to 10 ng/ml. In vivo, > or = 100 microg of
E5564 completely blocked signs, symptoms and
cytokines induced by concomitantly-administered
endotoxin. In contrast, subjects receiving a 50 microg dose of
E5564 demonstrated a graded response;
cytokines were inhibited > or = 95%, but many signs and symptoms of
endotoxemia were still evident.
E5564 demonstrated a long pharmacokinetic half-life (> 30 h); however, ex vivo analysis indicated that while single doses of 350 microg induced a nearly complete block of the effects of 1 ng/ml
endotoxin immediately upon
E5564 administration, antagonistic activity declined rapidly (t(1/2) < 1 h). Similar results were obtained in vivo using a delayed
endotoxin challenge. These results have driven us to examine antagonistic activity of
E5564 in vivo and ex vivo after administration by continuous infusion or twice-daily dosing. Results from these multiple-dose studies indicate that under these conditions of administration, plasma levels of
E5564 can be predictive of long-term pharmacodynamic activity.