Halofuginone to treat fibrosis in chronic graft-versus-host disease and scleroderma.

Abstract

Chronic graft-versus-host disease (cGvHD) and systemic sclerosis (scleroderma [SSc]) share clinical characteristics, including skin and internal organ fibrosis. Fibrosis, regardless of the cause, is characterized by extracellular matrix deposition, of which collagen type I is the major constituent. The progressive accumulation of connective tissue results in destruction of normal tissue architecture and internal organ failure. In both SSc and cGvHD, the severity of skin and internal organ fibrosis correlates with the clinical course of the disease. Thus, there is an unmet need for well-tolerated antifibrotic therapy. Halofuginone is an inhibitor of collagen type I synthesis in cells derived from various tissues and species and in animal models of fibrosis in which excess collagen is the hallmark of the disease. Halofuginone decreased collagen synthesis in the tight skin mouse (Tsk) and murine cGvHD, the 2 experimental systems that show many features resembling those of human GvHD. Inhibition of collagen synthesis by halofuginone is achieved by inhibiting transforming growth factor beta-dependent Smad3 phosphorylation. Dermal application of halofuginone caused a decrease in collagen content at the treated site of a cGvHD patient, and reduction in skin scores was observed in a pilot study with SSc patients. The results of the human studies provide basis for using halofuginone treatment for dermal fibrosis. As a first step toward future treatment of internal organ involvement, an oral administration study was performed in which halofuginone was well tolerated and plasma levels surpassed the predicted therapeutic exposure.

• Authors: Mark Pines, David Snyder, Shai Yarkoni, Arnon Nagler
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 9 Issue 7 Pg. 417-25 (Jul 2003) ISSN: 1083-8791 [Print] United States
• PMID: 12869955 (Publication Type: Journal Article, Review)

Chemical References

• Collagen Type I
• Piperidines
• Protein Synthesis Inhibitors
• Quinazolines
• Quinazolinones
• halofuginone

Topics

• Administration, Cutaneous
• Animals
• Clinical Trials, Phase I as Topic
• Clinical Trials, Phase II as Topic
• Collagen Type I (drug effects)
• Fibrosis
• Graft vs Host Disease (drug therapy, metabolism, pathology)
• Humans
• Mice
• Piperidines
• Protein Synthesis Inhibitors (therapeutic use)
• Quinazolines (therapeutic use)
• Quinazolinones
• Scleroderma, Systemic (drug therapy, metabolism, pathology)