Biologics, Volume 5, Issue 1 (March 2025) – 7 articles

The molecular regulation and therapeutic applications of brain-derived neurotrophic factor (BDNF)–tropomyosin-related kinase B (TrkB) signaling in major depressive disorder (MDD) through interaction with vascular endothelial growth factor (VEGF) and N-methyl-D-aspartic acid (NMDA) receptors show promise. While BDNF-TrkB signaling is implicated in antidepressant action, the association between BDNFs and depression has not yielded conclusive results. Some studies show decreased BDNF levels in depression, while others indicate that increased BDNF expression in certain brain regions can induce depression susceptibility. The role of BDNFs varies across different brain regions, necessitating further study of individual mechanisms. This regional variability complicates the development of targeted therapies. The antidepressant-like and neurotrophic actions of BDNFs require VEGF signaling, but there is also a reciprocal interdependence, as VEGF actions are dependent on BDNFs. This complex relationship complicates the development of targeted therapies. Full article

Background: Biosimilars are designed to closely resemble their reference biologics in terms of quality, safety, and efficacy, with only minor variations in clinically inactive components and manufacturing methods. Evaluating the safety of switching between these products is critical for healthcare providers and patients. Concerns may arise when transitioning patients from a reference biologic to a biosimilar or between different biosimilars. Objective: This systematic review and meta-analysis aims to evaluate the frequency of adverse events associated with switching from a reference biologic to its biosimilar, using data derived from randomized controlled trials (RCTs). Methods: A comprehensive search was conducted in MEDLINE and Cochrane Central databases from their inception to December 2024. Studies included RCTs that reported adverse reactions related to switching between reference-to-reference biologics and reference-to-biosimilar biologics. Record screening, data extraction, and risk of bias assessment were performed independently by two reviewers. Random effects models were applied to pool crude outcome data. Results: The search identified 668 abstracts, with an additional 14 studies found through hand-searching review articles. Of these, 12 trials involving 1326 participants in the reference–reference group and 1176 participants in the reference–biosimilar group met the inclusion criteria. The frequency of adverse events, serious adverse events, and treatment-related adverse events did not differ significantly between the reference–reference and reference–biosimilar groups: relative risk (RR) = 0.96 (95% confidence interval [CI], 0.85–1.08), RR = 1.06 (95% CI, 0.68–1.65), and RR = 1.03 (95% CI, 0.66–1.59), respectively. Heterogeneity was generally low to moderate across outcomes, and subgroup analyses based on disease type and reference product showed no differences. Conclusions: Switching between reference biologics and biosimilars demonstrates a comparable safety profile, suggesting that both options are viable. However, the findings are limited by the small number of trials and the scope of patient populations and products studied. PROSPERO registration number: CRD42021267205. Full article

Background/Objectives: Dupilumab was recently approved to treat eosinophilic phenotypes of chronic obstructive pulmonary disease (COPD). This systematic review aimed to collect and appraise the efficacy and safety of dupilumab to treat patients with COPD. Methods: Databases searched included Ovid Medline, Embase, Web of Science, Directory of Open Access Journals, and International Pharmaceutical Abstracts. Experimental and observational studies, including case reports/series, were eligible for inclusion. Reports were independently screened, appraised, and extracted by three investigators; disagreements were resolved through discussion and agreement. Quality appraisal was conducted using the Cochrane Risk of Bias Tool 2.0, Newcastle–Ottawa Scale, and JBI Checklist for experimental, observational, and case studies, respectively. Results: A total of 307 unique reports were identified, of which 17 were included in this systematic review. The majority (n = 11, 64.7%) of reports presented evidence from the BOREAS and NOTUS trials, the landmark trials serving as the basis for dupilumab’s approval to treat refractory eosinophilic COPD. The results from this systematic review found that dupilumab reduced exacerbations of COPD in patients treated with inhaled triple therapy and it was well tolerated. Conclusions: When added to inhaled triple therapy, dupilumab may decrease patients’ risk for acute exacerbations of COPD. Additional research is necessary to substantiate these findings for broader generalizability, including populations with non-eosinophilic COPD phenotypes. Full article

Idiopathic nephrotic syndrome (INS) and other pediatric kidney diseases represent significant challenges due to their complex pathogenesis, often involving dysregulated immune responses and renal injury. Biologic therapies, defined as targeted treatments derived from living organisms, have gained traction in managing these conditions, offering a potential shift in therapeutic paradigms. This review examines the current and emerging role of biologics in treating pediatric kidney diseases, focusing on indications, contraindications, adverse effects, therapeutic positioning, and a comparison with alternative immunosuppressive treatments. Full article

Background: Dupilumab, a fully human monoclonal antibody targeting the interleukin (IL)-4/IL-13 pathway, is able to dampen T helper (Th)2-mediated inflammation in several conditions characterized by this particular type of phlogosis. The aim of this study was to review the efficacy and safety of dupilumab treatment in conditions underpinned by Th2-type inflammation in a cohort of real-world patients referred to our outpatient clinic. Methods: Data from all patients with atopic dermatitis, chronic rhinosinusitis with nasal polyps, asthma, and other Th2-type-mediated inflammatory conditions treated with dupilumab were retrospectively reviewed. Results: Twenty-two patients were included in the study: 14 with atopic dermatitis, 5 with chronic rhinosinusitis with nasal polyps, 2 with asthma, and 1 with prurigo nodularis; some of the patients had more than one atopic condition. A complete response was observed in 13 out of 22 patients (59.1%); when partial responses were included in the analysis, the overall response rate was 86.4%. No adverse events were recorded, either locally or systemically. Total IgE levels dropped in all patients, in some cases reaching values close to those typically observed in nonatopic subjects. When eosinophilia was present at baseline, this also normalized during dupilumab treatment. Conclusions: Dupilumab was safe and effective across multiple conditions driven by Th2-type chronic inflammation; effective interference with the Th2-type pathway was inferred by the progressive reduction in serum total IgE levels, which reached the normal range in a fraction of patients, and by the reduction in peripheral blood eosinophil counts. Further studies in different Th2-mediated diseases are warranted. Full article

Background/Objectives: Perilla frutescens has historically been used to protect against inflammation and redox stress. This has been partly attributed to its high polyphenolic content; however, polyphenolic components in Perilla extract remain incompletely defined. This study aimed to characterise the polyphenolic composition in Perilla extract and evaluate its effect on the transcription factor nuclear factor erythroid 2-related factor 2 (Nrf2), regulating antioxidant defenses during inflammation and oxidative stress. Methods: Hot water extraction from Perilla leaves was followed by fractionation using four solvents of different polarity, namely methanol, butanol, ethyl acetate and ether. The polyphenolic composition of these fractions was analysed using RP-HPLC, and some of these compounds were quantified. The total phenolic, flavonoid, and ortho-diphenolic contents of each Perilla fraction were determined. The antioxidant activity was assessed using metal cation reduction and radical scavenging assays. A dual-luciferase assay using a human NQO1 ARE-luciferase reporter plasmid was employed to quantify Nrf2 activation by the Perilla fractions. Results: HPLC analysis identified 35 polyphenolic compounds, with the highest phenolic content present in the polar fractions and rosmarinic acid being the major constituent. Radical scavenging tests (DPPH and ABTS) confirmed the highest antioxidant capacity in the polar fractions. On cells in vitro, the methanol Perilla fraction displayed the strongest antioxidant activity, showing up to a 1.5-fold increase in human NQO1 ARE-luciferase reporter induction. Conclusions: This study has shown that Perilla extract contains a diversity of polyphenolic compounds contributing to its potent antioxidant effects, with methanol and butanol being the most efficient extraction solvents. While rosmarinic acid is expected to be the major contributor towards providing protection against inflammation and redox stress, further work is required on the synergystic effects between different polyphenols. Full article

Psoriatic arthritis (PsA) is a systemic inflammatory condition affecting the joints, spine, and entheses, as well as the skin and nails. It affects about 6–42% of patients with psoriasis (PsO), with a prevalence of 1–2 per 1000. PsA can precede skin disease in 7–14% of patients. Different clinical domains may be involved, including psoriatic skin disease, peripheral arthritis, axial involvement, dactylitis, enthesitis, and nail disease. Psoriatic arthritis is a complex, systemic inflammatory condition. While the exact mechanisms underlying PsA are not fully understood, it is believed that the disease arises from a combination of genetic predisposition and environmental triggers that lead to inflammatory processes in both the skin and joints. The treatment approach for PsA focuses on controlling inflammation, improving symptoms, and preventing joint damage. Early initiation of treatment is crucial for achieving better functional outcomes. Various therapeutic agents are available that target different inflammatory pathways. In this review article, various treatment options, focusing on biologic and targeted synthetic disease-modifying antirheumatic drugs, are discussed. Full article