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Published in: Current Neurology and Neuroscience Reports 5/2011

01-10-2011

Fingolimod for Multiple Sclerosis: Mechanism of Action, Clinical Outcomes, and Future Directions

Authors: Matthias Mehling, Ludwig Kappos, Tobias Derfuss

Published in: Current Neurology and Neuroscience Reports | Issue 5/2011

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Abstract

The oral sphingosine 1-phosphate receptor (S1PR) modulator fingolimod functionally antagonizes S1PR hereby blocking lymphocyte egress from secondary lymphoid organs to the peripheral blood circulation. This results in a reduction in peripheral lymphocyte counts, including potentially encephalitogenic T cells. In patients with relapsing multiple sclerosis fingolimod has been shown to be an effective treatment. In phase 2 and phase 3 studies fingolimod-treated patients had reduced disease activity clinically and in MRI. Although severe infectious complications occurred in single cases treated with fingolimod, the frequency of overall infections was comparable in fingolimod-treated patients and controls. Overall, in clinical studies fingolimod was well tolerated and had a favorable safety profile. In follow-up studies with continuous fingolimod, treatment showed sustained efficacy while being well tolerated.
Literature
1.
go back to reference Kappos L, Moeri D, Radue EW, et al. Predictive value of gadolinium-enhanced magnetic resonance imaging for relapse rate and changes in disability or impairment in multiple sclerosis: a meta-analysis. Gadolinium MRI meta-analysis group. Lancet. 1999;353:964–9.PubMedCrossRef Kappos L, Moeri D, Radue EW, et al. Predictive value of gadolinium-enhanced magnetic resonance imaging for relapse rate and changes in disability or impairment in multiple sclerosis: a meta-analysis. Gadolinium MRI meta-analysis group. Lancet. 1999;353:964–9.PubMedCrossRef
3.
go back to reference •• Kappos L, Antel J, Comi G, et al. Oral fingolimod (FTY720) for relapsing multiple sclerosis. N Engl J Med. 2006;355:1124–40. The first POC study with fingolimod in Multiple sclerosis. •• Kappos L, Antel J, Comi G, et al. Oral fingolimod (FTY720) for relapsing multiple sclerosis. N Engl J Med. 2006;355:1124–40. The first POC study with fingolimod in Multiple sclerosis.
4.
go back to reference •• Kappos L, Radue EW, O’Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401. This phase 3 study confirmed the safety and tolerability and also the efficacy of oral fingolimod in patients with relapsing MS.PubMedCrossRef •• Kappos L, Radue EW, O’Connor P, et al. A placebo-controlled trial of oral fingolimod in relapsing multiple sclerosis. N Engl J Med. 2010;362:387–401. This phase 3 study confirmed the safety and tolerability and also the efficacy of oral fingolimod in patients with relapsing MS.PubMedCrossRef
5.
go back to reference •• Cohen JA, Barkhof F, Comi G, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15. This phase 3 study confirmed the safety and tolerability of oral fingolimod in patients with relapsing MS and also demonstrated increased efficacy when compared with IFN-β1a.PubMedCrossRef •• Cohen JA, Barkhof F, Comi G, et al. Oral fingolimod or intramuscular interferon for relapsing multiple sclerosis. N Engl J Med. 2010;362:402–15. This phase 3 study confirmed the safety and tolerability of oral fingolimod in patients with relapsing MS and also demonstrated increased efficacy when compared with IFN-β1a.PubMedCrossRef
6.
go back to reference Brinkmann V, Davis MD, Heise CE, et al. The immune modulator FTY720 targets sphingosine 1-phosphate receptors. J Biol Chem. 2002;277:21453–7.PubMedCrossRef Brinkmann V, Davis MD, Heise CE, et al. The immune modulator FTY720 targets sphingosine 1-phosphate receptors. J Biol Chem. 2002;277:21453–7.PubMedCrossRef
7.
go back to reference Paugh SW, Payne SG, Barbour SE, et al. The immunosuppressant FTY720 is phosphorylated by sphingosine kinase type 2. FEBS Lett. 2003;554:189–93.PubMedCrossRef Paugh SW, Payne SG, Barbour SE, et al. The immunosuppressant FTY720 is phosphorylated by sphingosine kinase type 2. FEBS Lett. 2003;554:189–93.PubMedCrossRef
8.
go back to reference Rosen H, Gonzalez-Cabrera PJ, Sanna MG, Brown S. Sphingosine 1-phosphate receptor signaling. Annu Rev Biochem. 2009;78:743–68.PubMedCrossRef Rosen H, Gonzalez-Cabrera PJ, Sanna MG, Brown S. Sphingosine 1-phosphate receptor signaling. Annu Rev Biochem. 2009;78:743–68.PubMedCrossRef
9.
go back to reference Rosen H, Goetzl EJ. Sphingosine 1-phosphate and its receptors: an autocrine and paracrine network. Nat Rev Immunol. 2005;5:560–70.PubMedCrossRef Rosen H, Goetzl EJ. Sphingosine 1-phosphate and its receptors: an autocrine and paracrine network. Nat Rev Immunol. 2005;5:560–70.PubMedCrossRef
10.
go back to reference Rao TS, Lariosa-Willingham KD, Lin FF, et al. Pharmacological characterization of lysophospholipid receptor signal transduction pathways in rat cerebrocortical astrocytes. Brain Res. 2003;990:182–94.PubMedCrossRef Rao TS, Lariosa-Willingham KD, Lin FF, et al. Pharmacological characterization of lysophospholipid receptor signal transduction pathways in rat cerebrocortical astrocytes. Brain Res. 2003;990:182–94.PubMedCrossRef
11.
go back to reference Harada J, Foley M, Moskowitz MA, Waeber C. Sphingosine-1-phosphate induces proliferation and morphological changes of neural progenitor cells. J Neurochem. 2004;88:1026–39.PubMedCrossRef Harada J, Foley M, Moskowitz MA, Waeber C. Sphingosine-1-phosphate induces proliferation and morphological changes of neural progenitor cells. J Neurochem. 2004;88:1026–39.PubMedCrossRef
12.
go back to reference Tham CS, Lin FF, Rao TS, et al. Microglial activation state and lysophospholipid acid receptor expression. Int J Dev Neurosci. 2003;21:431–43.PubMedCrossRef Tham CS, Lin FF, Rao TS, et al. Microglial activation state and lysophospholipid acid receptor expression. Int J Dev Neurosci. 2003;21:431–43.PubMedCrossRef
13.
go back to reference Yu N, Lariosa-Willingham KD, Lin FF, et al. Characterization of lysophosphatidic acid and sphingosine-1-phosphate-mediated signal transduction in rat cortical oligodendrocytes. Glia. 2004;45:17–27.PubMedCrossRef Yu N, Lariosa-Willingham KD, Lin FF, et al. Characterization of lysophosphatidic acid and sphingosine-1-phosphate-mediated signal transduction in rat cortical oligodendrocytes. Glia. 2004;45:17–27.PubMedCrossRef
14.
go back to reference Chun J, Weiner JA, Fukushima N, et al. Neurobiology of receptor-mediated lysophospholipid signaling. From the first lysophospholipid receptor to roles in nervous system function and development. Ann N Y Acad Sci. 2000;905:110–7.PubMedCrossRef Chun J, Weiner JA, Fukushima N, et al. Neurobiology of receptor-mediated lysophospholipid signaling. From the first lysophospholipid receptor to roles in nervous system function and development. Ann N Y Acad Sci. 2000;905:110–7.PubMedCrossRef
15.
go back to reference Mandala S, Hajdu R, Bergstrom J, et al. Alteration of lymphocyte trafficking by sphingosine-1-phosphate receptor agonists. Science. 2002;296:346–9.PubMedCrossRef Mandala S, Hajdu R, Bergstrom J, et al. Alteration of lymphocyte trafficking by sphingosine-1-phosphate receptor agonists. Science. 2002;296:346–9.PubMedCrossRef
16.
go back to reference Graler MH, Goetzl EJ. The immunosuppressant FTY720 down-regulates sphingosine 1-phosphate G-protein-coupled receptors. FASEB J. 2004;18:551–3.PubMed Graler MH, Goetzl EJ. The immunosuppressant FTY720 down-regulates sphingosine 1-phosphate G-protein-coupled receptors. FASEB J. 2004;18:551–3.PubMed
17.
go back to reference Chiba K, Yanagawa Y, Masubuchi Y, et al. FTY720, a novel immunosuppressant, induces sequestration of circulating mature lymphocytes by acceleration of lymphocyte homing in rats. I. FTY720 selectively decreases the number of circulating mature lymphocytes by acceleration of lymphocyte homing. J Immunol. 1998;160:5037–44.PubMed Chiba K, Yanagawa Y, Masubuchi Y, et al. FTY720, a novel immunosuppressant, induces sequestration of circulating mature lymphocytes by acceleration of lymphocyte homing in rats. I. FTY720 selectively decreases the number of circulating mature lymphocytes by acceleration of lymphocyte homing. J Immunol. 1998;160:5037–44.PubMed
18.
go back to reference Matloubian M, Lo CG, Cinamon G, et al. Lymphocyte egress from thymus and peripheral lymphoid organs is dependent on S1P receptor 1. Nature. 2004;427:355–60.PubMedCrossRef Matloubian M, Lo CG, Cinamon G, et al. Lymphocyte egress from thymus and peripheral lymphoid organs is dependent on S1P receptor 1. Nature. 2004;427:355–60.PubMedCrossRef
19.
go back to reference Chun J, Hartung HP. Mechanism of action of oral fingolimod (FTY720) in multiple sclerosis. Clin Neuropharmacol. 2010;33:91–101.PubMedCrossRef Chun J, Hartung HP. Mechanism of action of oral fingolimod (FTY720) in multiple sclerosis. Clin Neuropharmacol. 2010;33:91–101.PubMedCrossRef
20.
go back to reference Mehling M, Brinkmann V, Antel J, et al. FTY720 therapy exerts differential effects on T cell subsets in multiple sclerosis. Neurology. 2008;71:1261–7.PubMedCrossRef Mehling M, Brinkmann V, Antel J, et al. FTY720 therapy exerts differential effects on T cell subsets in multiple sclerosis. Neurology. 2008;71:1261–7.PubMedCrossRef
21.
go back to reference Korn T, Bettelli E, Oukka M, Kuchroo VK. IL-17 and Th17 Cells. Annu Rev Immunol. 2009;27:485–517.PubMedCrossRef Korn T, Bettelli E, Oukka M, Kuchroo VK. IL-17 and Th17 Cells. Annu Rev Immunol. 2009;27:485–517.PubMedCrossRef
22.
go back to reference Reboldi A, Coisne C, Baumjohann D, et al. C-C chemokine receptor 6-regulated entry of TH-17 cells into the CNS through the choroid plexus is required for the initiation of EAE. Nat Immunol. 2009;10:514–23.PubMedCrossRef Reboldi A, Coisne C, Baumjohann D, et al. C-C chemokine receptor 6-regulated entry of TH-17 cells into the CNS through the choroid plexus is required for the initiation of EAE. Nat Immunol. 2009;10:514–23.PubMedCrossRef
23.
go back to reference Brucklacher-Waldert V, Stuerner K, Kolster M, et al. Phenotypical and functional characterization of T helper 17 cells in multiple sclerosis. Brain. 2009;132:3329–41.PubMedCrossRef Brucklacher-Waldert V, Stuerner K, Kolster M, et al. Phenotypical and functional characterization of T helper 17 cells in multiple sclerosis. Brain. 2009;132:3329–41.PubMedCrossRef
24.
go back to reference Matusevicius D, Kivisakk P, He B, et al. Interleukin-17 mRNA expression in blood and CSF mononuclear cells is augmented in multiple sclerosis. Mult Scler. 1999;5:101–4.PubMed Matusevicius D, Kivisakk P, He B, et al. Interleukin-17 mRNA expression in blood and CSF mononuclear cells is augmented in multiple sclerosis. Mult Scler. 1999;5:101–4.PubMed
25.
go back to reference Tzartos JS, Friese MA, Craner MJ, et al. Interleukin-17 production in central nervous system-infiltrating T cells and glial cells is associated with active disease in multiple sclerosis. Am J Pathol. 2008;172:146–55.PubMedCrossRef Tzartos JS, Friese MA, Craner MJ, et al. Interleukin-17 production in central nervous system-infiltrating T cells and glial cells is associated with active disease in multiple sclerosis. Am J Pathol. 2008;172:146–55.PubMedCrossRef
26.
go back to reference Kebir H, Kreymborg K, Ifergan I, et al. Human T(H)17 lymphocytes promote blood-brain barrier disruption and central nervous system inflammation. Nat Med. 2007;13:1173–5.PubMedCrossRef Kebir H, Kreymborg K, Ifergan I, et al. Human T(H)17 lymphocytes promote blood-brain barrier disruption and central nervous system inflammation. Nat Med. 2007;13:1173–5.PubMedCrossRef
27.
go back to reference Mehling M, Lindberg R, Raulf F, et al. Th17 central memory T cells are reduced by FTY720 in patients with multiple sclerosis. Neurology. 2010;75:403–10.PubMedCrossRef Mehling M, Lindberg R, Raulf F, et al. Th17 central memory T cells are reduced by FTY720 in patients with multiple sclerosis. Neurology. 2010;75:403–10.PubMedCrossRef
28.
go back to reference Brinkmann V. Sphingosine 1-phosphate receptors in health and disease: mechanistic insights from gene deletion studies and reverse pharmacology. Pharmacol Ther. 2007;115:84–105.PubMedCrossRef Brinkmann V. Sphingosine 1-phosphate receptors in health and disease: mechanistic insights from gene deletion studies and reverse pharmacology. Pharmacol Ther. 2007;115:84–105.PubMedCrossRef
29.
go back to reference Bohler T, Schutz M, Budde K, et al. Differential effects of single dose FTY720 on CD62L+B-cells in stable renal allograft recipients. Int Immunopharmacol. 2007;7:88–95.PubMedCrossRef Bohler T, Schutz M, Budde K, et al. Differential effects of single dose FTY720 on CD62L+B-cells in stable renal allograft recipients. Int Immunopharmacol. 2007;7:88–95.PubMedCrossRef
30.
go back to reference Vaessen LM, van Besouw NM, Mol WM, et al. FTY720 treatment of kidney transplant patients: a differential effect on B cells, naive T cells, memory T cells and NK cells. Transpl Immunol. 2006;15:281–8.PubMedCrossRef Vaessen LM, van Besouw NM, Mol WM, et al. FTY720 treatment of kidney transplant patients: a differential effect on B cells, naive T cells, memory T cells and NK cells. Transpl Immunol. 2006;15:281–8.PubMedCrossRef
31.
go back to reference Lan YY, De Creus A, Colvin BL, et al. The sphingosine-1-phosphate receptor agonist FTY720 modulates dendritic cell trafficking in vivo. Am J Transplant. 2005;5:2649–59.PubMedCrossRef Lan YY, De Creus A, Colvin BL, et al. The sphingosine-1-phosphate receptor agonist FTY720 modulates dendritic cell trafficking in vivo. Am J Transplant. 2005;5:2649–59.PubMedCrossRef
32.
go back to reference Durafourt BA, Lambert C, Johnson TA, et al. Differential responses of human microglia and blood-derived myeloid cells to FTY720. J Neuroimmunol. 2011;230:10–6.PubMedCrossRef Durafourt BA, Lambert C, Johnson TA, et al. Differential responses of human microglia and blood-derived myeloid cells to FTY720. J Neuroimmunol. 2011;230:10–6.PubMedCrossRef
33.
go back to reference Sanchez T, Hla T. Structural and functional characteristics of S1P receptors. J Cell Biochem. 2004;92:913–22.PubMedCrossRef Sanchez T, Hla T. Structural and functional characteristics of S1P receptors. J Cell Biochem. 2004;92:913–22.PubMedCrossRef
34.
go back to reference Li H, Meno-Tetang GM, Chiba K, et al. Pharmacokinetics and cell trafficking dynamics of 2-amino-2-[2-(4-octylphenyl)ethyl]propane-1,3-diol hydrochloride (FTY720) in cynomolgus monkeys after single oral and intravenous doses. J Pharmacol Exp Ther. 2002;301:519–26.PubMedCrossRef Li H, Meno-Tetang GM, Chiba K, et al. Pharmacokinetics and cell trafficking dynamics of 2-amino-2-[2-(4-octylphenyl)ethyl]propane-1,3-diol hydrochloride (FTY720) in cynomolgus monkeys after single oral and intravenous doses. J Pharmacol Exp Ther. 2002;301:519–26.PubMedCrossRef
35.
go back to reference Meno-Tetang GM, Li H, Mis S, et al. Physiologically based pharmacokinetic modeling of FTY720 (2-amino-2[2-(−4-octylphenyl)ethyl]propane-1,3-diol hydrochloride) in rats after oral and intravenous doses. Drug Metab Dispos. 2006;34:1480–7.PubMedCrossRef Meno-Tetang GM, Li H, Mis S, et al. Physiologically based pharmacokinetic modeling of FTY720 (2-amino-2[2-(−4-octylphenyl)ethyl]propane-1,3-diol hydrochloride) in rats after oral and intravenous doses. Drug Metab Dispos. 2006;34:1480–7.PubMedCrossRef
36.
go back to reference Van Doorn R, Van Horssen J, Verzijl D, et al. Sphingosine 1-phosphate receptor 1 and 3 are upregulated in multiple sclerosis lesions. Glia. 2010;58:1465–76.PubMed Van Doorn R, Van Horssen J, Verzijl D, et al. Sphingosine 1-phosphate receptor 1 and 3 are upregulated in multiple sclerosis lesions. Glia. 2010;58:1465–76.PubMed
37.
go back to reference Miron VE, Jung CG, Kim HJ, et al. FTY720 modulates human oligodendrocyte progenitor process extension and survival. Ann Neurol. 2008;63:61–71.PubMedCrossRef Miron VE, Jung CG, Kim HJ, et al. FTY720 modulates human oligodendrocyte progenitor process extension and survival. Ann Neurol. 2008;63:61–71.PubMedCrossRef
38.
go back to reference Coelho RP, Payne SG, Bittman R, et al. The immunomodulator FTY720 has a direct cytoprotective effect in oligodendrocyte progenitors. J Pharmacol Exp Ther. 2007;323:626–35.PubMedCrossRef Coelho RP, Payne SG, Bittman R, et al. The immunomodulator FTY720 has a direct cytoprotective effect in oligodendrocyte progenitors. J Pharmacol Exp Ther. 2007;323:626–35.PubMedCrossRef
39.
go back to reference Jung CG, Kim HJ, Miron VE, et al. Functional consequences of S1P receptor modulation in rat oligodendroglial lineage cells. Glia. 2007;55:1656–67.PubMedCrossRef Jung CG, Kim HJ, Miron VE, et al. Functional consequences of S1P receptor modulation in rat oligodendroglial lineage cells. Glia. 2007;55:1656–67.PubMedCrossRef
40.
go back to reference Miron VE, Ludwin SK, Darlington PJ, et al. Fingolimod (FTY720) enhances remyelination following demyelination of organotypic cerebellar slices. Am J Pathol. 2010;176:2682–94.PubMedCrossRef Miron VE, Ludwin SK, Darlington PJ, et al. Fingolimod (FTY720) enhances remyelination following demyelination of organotypic cerebellar slices. Am J Pathol. 2010;176:2682–94.PubMedCrossRef
41.
go back to reference Miron VE, Hall JA, Kennedy TE, et al. Cyclical and dose-dependent responses of adult human mature oligodendrocytes to fingolimod. Am J Pathol. 2008;173:1143–52.PubMedCrossRef Miron VE, Hall JA, Kennedy TE, et al. Cyclical and dose-dependent responses of adult human mature oligodendrocytes to fingolimod. Am J Pathol. 2008;173:1143–52.PubMedCrossRef
42.
go back to reference Osinde M, Mullershausen F, Dev KK. Phosphorylated FTY720 stimulates ERK phosphorylation in astrocytes via S1P receptors. Neuropharmacology. 2007;52:1210–8.PubMedCrossRef Osinde M, Mullershausen F, Dev KK. Phosphorylated FTY720 stimulates ERK phosphorylation in astrocytes via S1P receptors. Neuropharmacology. 2007;52:1210–8.PubMedCrossRef
43.
go back to reference O’Connor P, Comi G, Montalban X, et al. Oral fingolimod (FTY720) in multiple sclerosis: two-year results of a phase II extension study. Neurology. 2009;72:73–9.PubMedCrossRef O’Connor P, Comi G, Montalban X, et al. Oral fingolimod (FTY720) in multiple sclerosis: two-year results of a phase II extension study. Neurology. 2009;72:73–9.PubMedCrossRef
44.
go back to reference Comi G, O’Connor P, Montalban X, et al. Phase II study of oral fingolimod (FTY720) in multiple sclerosis: 3-year results. Mult Scler. 2010;16:197–207.PubMedCrossRef Comi G, O’Connor P, Montalban X, et al. Phase II study of oral fingolimod (FTY720) in multiple sclerosis: 3-year results. Mult Scler. 2010;16:197–207.PubMedCrossRef
45.
go back to reference •• Khatri B, Barkhof F, Comi G, et al. Comparison of fingolimod with interferon beta-1a in relapsing-remitting multiple sclerosis: a randomised extension of the TRANSFORMS study. Lancet Neurol. 2011;10:520–9. This extension study from the phase 3 TRANSFORMS study demonstrated that patients receiving continuous fingolimod had unchanged beneficial effects, whereas patients who were switched from IFN-β1a to fingolimod showed a significant decrease of clinical and MRI disease activity.PubMedCrossRef •• Khatri B, Barkhof F, Comi G, et al. Comparison of fingolimod with interferon beta-1a in relapsing-remitting multiple sclerosis: a randomised extension of the TRANSFORMS study. Lancet Neurol. 2011;10:520–9. This extension study from the phase 3 TRANSFORMS study demonstrated that patients receiving continuous fingolimod had unchanged beneficial effects, whereas patients who were switched from IFN-β1a to fingolimod showed a significant decrease of clinical and MRI disease activity.PubMedCrossRef
Metadata
Title
Fingolimod for Multiple Sclerosis: Mechanism of Action, Clinical Outcomes, and Future Directions
Authors
Matthias Mehling
Ludwig Kappos
Tobias Derfuss
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Neurology and Neuroscience Reports / Issue 5/2011
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-011-0216-9

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