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大型制药公司斥资数十亿美元研发新型“蛋白质降解”药物Big pharma is pouring billions into a new class of ‘protein degrader’ drugs

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在丽莎·摩尔接受的癌症治疗方案逐渐失效后,这位64岁的马萨诸塞州沃特利镇小企业主决定参加一项临床试验,尝试一种以全新方式靶向病变细胞的新药。十个月后,她的病情出现了缓解。“实在令人惊喜——此前我已接受了三年多的其他治疗方案,却始终未能达到这样的效果,”摩尔说道。

After Lisa Moore’s cancer treatments stopped working, the 64-year-old enrolled in a study to try out a new type of drug, one that is programmed to go after disease in cells in a novel way. Ten months later, she went into remission.“It was pretty amazing, considering I’d been over three years at that point on the other protocol and had never gotten there,” said Moore, a Whately, Mass., small-business owner.

丽莎·摩尔只是众多受益者中的一个。尽管她所试用的这种药物在后期临床试验中尚未被证实对广大患者群体均有效,但百时美施贵宝、辉瑞和罗氏等制药巨头正投入数十亿美元用于相关研发,期望借此开发出对抗癌症乃至帕金森病等疾病的新手段。这类被称为“蛋白质降解剂”的新型药物,有望精准作用于病变细胞中那些难以靶向的特定蛋白质。

Moore is just one case. The kind of drug she tested in a late-stage trial has yet to be proven widely effective across large patient populations, but companies such as Bristol Myers Squibb, Pfizer and Roche are pouring billions of dollars into them, hoping to find a new tool to attack diseases from cancer to Parkinson’s. A new class of medications—known as “protein degraders”—are showing promise in going after a certain kind of hard-to-target protein in diseased cells.

目前市面上大多数药物都是通过附着在蛋白质的粗糙表面来阻断其致病作用,但有些蛋白质表面过于平滑,难以被药物附着。这类难以捉摸的蛋白质正是目前研究人员尚无法干预的85%致病因素的“幕后推手”。

Most medicines on the market today work by latching onto the rough surface of a protein and blocking it from causing disease. But some proteins are so flat that they are hard to latch on to. These elusive, smooth proteins are involved in 85% of disease drivers that researchers have so far been unable to attack.

美国食品药品监督管理局目前已批准少数此类药物用于患者群体规模较小或缺乏其他治疗选择的癌症类型。不过目前仍有诸多未知因素:科学家们仍在探索蛋白质降解剂的最佳适用人群,并努力确保这类新药不会误伤健康的蛋白质。美国临床肿瘤学会首席医疗官朱莉·格拉洛博士指出:“我们是在干预人体细胞中至关重要的‘回收机制’,因此有可能出现药物误伤健康蛋白质的副作用。我们必须对此保持高度警惕。”

The Food and Drug Administration has already approved a handful of these drugs for cancers with small patient populations or with other treatment options. There are still many unknowns. Scientists are still figuring out where protein degraders can provide the most benefit and making sure these new drugs don’t accidentally kill healthy proteins.“We’re interfering with the cell’s recycling machinery that’s important in all of our healthy cells,” said Dr. Julie Gralow, chief medical officer of the American Society of Clinical Oncology.

目前,几乎所有大型制药企业都在通过自主研发或授权合作的方式积极开发蛋白质降解剂。

“There could be off-target effects that accidentally recruit and destroy healthy proteins. We just have to watch out for that.”

据生物制药情报机构Sleuth统计,目前全球约有200种蛋白质降解剂正处于研发阶段。2021年至2026年间,围绕这类药物的交易总额预计将超过50亿美元。部分企业正在测试这类降解剂是否能更有效地治疗那些已发生基因突变或对一线疗法产生耐药性的疾病;另一些企业则试图验证其能否在初次治疗时便取得更好的疗效。

Virtually all major pharmaceutical companies are developing protein degraders, through their own research or licensing deals. Around 200 protein degraders are being studied worldwide, with more than $5 billion in deals for these drugs from 2021 to 2026, according to biopharma-intelligence service Sleuth. Some companies are testing whether degraders can better target diseases that have mutated or become resistant to first-line treatments. Others are testing whether degraders are more effective at tackling disease on the first go-round.

首个获批上市的蛋白质降解剂是辉瑞与Arvinas联合研发的乳腺癌治疗药物Veppanu。该药于今年5月获得批准,适用于携带ESR1基因突变且对激素疗法无效的乳腺癌患者——这类人群约占全球新确诊乳腺癌患者的1%。然而,在那些肿瘤并非由ESR1突变引发的其他乳腺癌患者群体中,该药疗效并不理想。这一结果直接导致Arvinas的股价暴跌53%。最终,Arvinas与辉瑞以7000万美元的价格将该药出售给了Rigel Pharmaceuticals。

The first degrader to hit the market is Veppanu, a breast-cancer drug developed by Pfizer and Arvinas. The therapy, which was approved in May, works in patients with a specific genetic mutation called ESR1 who have failed hormone therapy, which represents around 1% of all newly diagnosed breast-cancer patients globally. The drug didn’t prove as effective in a wider population of breast-cancer patients whose tumors weren’t explicitly driven by the ESR1 mutation, a failure that led to a 53% stock selloff for Arvinas. Arvinas and Pfizer ended up unloading the drug to Rigel Pharmaceuticals for $70 million.

尽管临床数据不尽如人意,但此次获批仍增强了各企业攻克癌症、自身免疫性疾病及神经退行性疾病领域更复杂治疗靶点的信心。Arvinas创始人、耶鲁大学科学家克雷格·克鲁斯表示:“这一FDA批准将彻底改变业界对‘哪些靶点具备药物开发潜力’的认知。”目前研发最为成熟的两种蛋白质降解剂技术分别被称为“Protacs”(即蛋白质降解靶向嵌合体)与“分子胶”。

Despite the underwhelming data, the approval has given companies more confidence as they go after more ambitious targets in cancer, autoimmune and neurodegenerative spaces. The FDA approval “will change how the industry views what is potentially druggable,” Yale scientist Craig Crews, founder of Arvinas, said. The two most advanced types of protein degraders are known as Protacs, or proteolysis targeting chimeras, and molecular glue.

二者作用机制略有差异,但都能借助细胞的自我更新系统来清除那些诱发疾病的异常蛋白质。1998年,克鲁斯与加州理工学院教授雷蒙德·德沙耶斯共同发现了Protacs技术的基础原理。

They work slightly differently, but both commandeer a cell’s recycling system to destroy proteins that normally drive the course of a disease. In 1998, Crews and California Institute of Technology professor Raymond Deshaies discovered the underlying technology for Protacs.

他们证明了,通过将一种温和的蛋白质带到有助于清除细胞废物的酶附近,就可以破坏问题蛋白质——而无需像传统药物那样与蛋白质直接结合。这种“分子胶水”形式的降解剂是偶然发现的。药物沙利度胺(thalidomide)于20世纪50年代开发用于缓解孕吐,并在美国以外的多个国家使用,但它在被退市之前,因导致数千例出生缺陷而臭名昭著。

They proved you could destroy a problematic protein by bringing a smooth protein closer to an enzyme that helps dispose of cell waste—without needing to latch on to the protein like traditional drugs do. The molecular glue form of degraders were discovered serendipitously. The drug thalidomide was developed in the 1950s for morning sickness and used in several countries outside of the U.S., but it infamously caused thousands of birth defects before being taken off the market.

几十年后,科学家们重新利用这种药物及其衍生物,安全地治疗癌症和麻风病。在进一步研究过程中,研究人员发现它是一种蛋白质降解剂——该药物能够通过将问题蛋白质与合适的酶结合,从而攻击疾病。今年8月,百时美施贵宝(Bristol Myers Squibb)获得了一款新一代多发性骨髓瘤治疗药物Zenbexus的批准,该药物以“分子胶水”的形式发挥作用。

Decades later, scientists repurposed the drug and its derivatives to safely treat cancer and leprosy. In studying it further, researchers discovered it was a protein degrader—the drug was able to destroy a problem protein by binding it with the right enzyme to attack a disease. In August, Bristol Myers Squibb received approval for a next-generation multiple myeloma treatment, Zenbexus, that works as a form of molecular glue.

在临床试验中,在两种现有治疗基础上额外服用Zenbexus的重度多发性骨髓瘤患者,其癌症恶化前生存时间为42个月,而未使用百时美药物的患者仅为20个月。百时美施贵宝正在寻求另一种名为mezigdomide的降解剂的批准,该药物针对同种疾病。今年5月,该公司宣布,mezigdomide与其他治疗药物联合使用时,可使患者无疾病进展生存时间达到18个月,而仅使用现有治疗药物的患者为8个月。

In clinical trials, severe multiple myeloma patients who took Zenbexus on top of two existing treatments lived 42 months before their cancer got worse, compared with 20 months for those without Bristol’s drug. Bristol Myers is seeking approval of another degrader, called mezigdomide, targeting the disease. In May, the company announced that mezigdomide in combination with other treatments led to patients living 18 months without progression, versus eight months in those on existing treatments.

这正是癌症患者摩尔(Moore)所服用的药物。此外,还有几款蛋白质降解剂药物已进入晚期临床试验。加州的生物科技公司Nurix Therapeutics及其制药合作伙伴罗氏(Roche),以及总部位于瑞士的BeOne Medicines,都在开发能够清除BTK蛋白的降解剂,这种蛋白会引发常见的血液癌症。他们正在将这些药物与白血病和淋巴瘤患者的常规治疗方案进行比较测试。

This is the drug that Moore, the cancer patient, was taking.A few other protein degrader drugs have reached late-stage trials. California biotech Nurix Therapeutics, along with pharma partner Roche, and Switzerland-based BeOne Medicines are each developing degraders to eliminate the BTK protein, which drives common blood cancers. They are testing those drugs against the normal medical regimen for patients with leukemia and lymphoma.

BeOne的临床试验结果预计于2028年公布,Nurix的则预计在2029年公布。这些试验有助于证实这些药物相较于现有疗法所具有的优势。各公司也在探索这类药物在癌症以外的治疗领域的应用潜力。Arvinas正在研发两种候选药物,分别用于治疗帕金森病以及脊髓延髓肌萎缩症——这是一种会导致肌肉逐渐无力、萎缩的罕见疾病。Kymera Therapeutics则正在研究这类药物在哮喘、特应性皮炎等自身免疫性疾病中的疗效。

BeOne’s results are expected in 2028, Nurix’s in 2029. These trials should help establish these drugs’ advantages when compared with existing therapies. Companies are exploring the potential for degraders outside of cancer as well. Arvinas is pursuing two candidates for Parkinson’s disease and for spinal and bulbar muscular atrophy, a rare disorder that leads to progressive muscle weakness and wasting. Kymera Therapeutics is studying degraders in autoimmune disorders such as asthma and atopic dermatitis.

可发送邮件至Lizzy Lawrence,邮箱地址:lizzy.lawrence@wsj.com

Write to Lizzy Lawrence at lizzy.lawrence@wsj.com