Targeting the hepcidin–ferroportin pathway in anaemia of chronic kidney disease

Abstract

Aims: Erythropoiesis-stimulating agents used to treat anaemia in patients with chronic kidney disease (CKD) have been associated with cardiovascular adverse events. Hepcidin production, controlled by bone morphogenic protein 6 (BMP6), regulates iron homeostasis via interactions with the iron transporter, ferroportin. High hepcidin levels are thought to contribute to increased iron sequestration and subsequent anaemia in CKD patients. To investigate alternative therapies to erythropoiesis-stimulating agents for CKD patients, monoclonal antibodies, LY3113593 and LY2928057, targeting BMP6 and ferroportin respectively, were tested in CKD patients.Methods: Preclinical in vitro/vivo data and clinical data in healthy subjects and CKD patients were used to illustrate the translation of pharmacological properties of LY3113593 and LY2928057, highlighting the novelty of targeting these nodes within the hepcidin-ferroportin pathway.Results: LY2928057 bound ferroportin and blocked interactions with hepcidin, allowing iron efflux, leading to increased serum iron and transferrin saturation levels and increased hepcidin in monkeys and humans. In CKD patients, LY2928057 led to slower haemoglobin decline and reduction in ferritin (compared to placebo). Serum iron increase was (mean [90% confidence interval]) 1.98 [1.46-2.68] and 1.36 [1.22-1.51] fold-relative to baseline following LY2928057 600 mg and LY311593 150 mg respectively in CKD patients. LY3113593 specifically blocked BMP6 binding to its receptor and produced increases in iron and transferrin saturation and decreases in hepcidin preclinically and clinically. In CKD patients, LY3113593 produced an increase in haemoglobin and reduction in ferritin (compared to placebo). Conclusion: LY3113593 and LY2928057 pharmacological effects (serum iron and ferritin) were translated from preclinical-to-clinical development. Such interventions may lead to new CKD anaemia treatments.

H2O2 induces oxidative stress damage through the BMP‐6/SMAD/hepcidin axis

“…The regulation of Hepcidin expression in vivo is very complex. Ischemia and hypoxia, serum iron levels, the erythropoiesis rate, inflammation and other factors affect the expression of hepcidin (Rauber et al, ; Sheetz et al, ). The BMP‐SMAD pathway is considered the core pathway that regulates the basic expression of ferritin (Goh, Wallace, Hong, & Subramaniam, ).…”

Hepcidin and Anemia: A Tight Relationship

“…Hepcidin antagonists are inhibitors of hepcidin synthesis/regulators (Ganz, 2019), hepcidin binders that block its function, and compounds that interfere with hepcidin-ferroportin interaction (Table 2). Some compounds are in clinical trials especially in chronic kidney disease (Sheetz et al, 2019). In IRIDA, manipulation of the hepcidin pathway has been proposed in preclinical studies with the use of anti-HJV MoAb (Kovac et al, 2016).…”

Anemia of Inflammation with An Emphasis on Chronic Kidney Disease

“…One example of such an FPN stabilizer is the anti-ferroportin monoclonal antibody, which prevents the interaction between hepcidin and FPN [128]. Two other monoclonal antibodies, LY3113593 and LY2928057, targeting BMP6 and ferroportin, respectively, tested in CKD patients resulted in an increase in haemoglobin and reduction in ferritin (compared to the placebo) [134]. Serum iron efflux increased through LY2928057 binding to ferroportin and blocking interactions with hepcidin.…”