ALLERGENIC PRODUCTS ADVISORY
COMMITTEE
CENTER FOR BIOLOGICS EVALUATION
AND RESEARCH
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ALLERGENIC PRODUCTS ADVISORY
COMMITTEE MEETING
By Teleconference
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PUBLIC MEETING
Friday, April 2,
2004
This transcript has not been edited or corrected,
but appears as received from the commercial transcribing services. Accordingly, the Food and Drug
Administration makes no representation as to its accuracy.
The
above-entitled Public Meeting was held at 1:00 p.m., in Conference Rooms A and
B, Building 29B, on the National Institutes of Health campus, Bethesda,
Maryland, Dr. Wesley A. Burks, Acting Chair, presiding.
PARTICIPANTS:
A. WESLEY BURKS, M.D.,
Acting Chair (via telephone)
JANE
S. BROWN, Committee Management Specialist
WILLIAM
FREAS, Ph.D., Executive Secretary
COMMITTEE MEMBERS: (via telephone)
MELVIN
BERGER, M.D.
LYNELLE
C. GRANADY, M.D.
REBECCA
S. GRUCHALLA, M.D., Ph.D.
PETER
R. HAUCK
DOLORES
C. LIBERA
HAROLD
S. NELSON, M.D.
PRESENTERS:
RONALD
RABIN, M.D.
JAY
SLATER, M.D.
A-G-E-N-D-A
Page
No.
Administrative Remarks 4
Opening Remarks, WESLEY BURKS, M.D.,, Acting
8
Committee
Chair
COMMITTEE UPDATES:
Laboratory of Immunobiochemistry: Personnel 10
and Regulatory Updates, JAY E. SLATER, M.C.,
DBPAP, Laboratory Chief
Research Summary, JAY E. SLATER, M.D., DBPAP,
13
Laboratory Chief, RONALD RABIN, M.D., DBPAP,
27
Senior
Staff Fellow
Cockroach Allergen Standardization 42
JAY E. SLATER, M.D., DBPAP, Laboratory
Chief
Use of Microarray Technology in Allergen 60
Standardization, JAY E. SLATER, M.D., DBPAP,
Laboratory Chief
Open Public Hearing 81
Committee Discussion 82
P-R-O-C-E-E-D-I-N-G-S
1:04
p.m.
DOCTOR
FREAS: Let me just introduce myself to everybody. I am Bill Freas, I'm the Executive Secretary for today's advisory
committee meeting, and this is the 20th meeting of the Allergenic
Products Advisory Committee.
We
are holding this meeting in Conference Rooms A and B, in Building 29B, on the
NIH campus. There's a speaker phone
here for public participation, and, of course, the public is more than welcome
to participate in our advisory committee meetings.
The
entire meeting for today will be open to the public, as announced in the Federal
Register on March 10, 2004.
At
this time, for the people in the room and for the people on the phone lines, I
would like to go around and introduce the committee members. They are our Acting Chair, Doctor Wesley
Burks, Chief of Pediatric Allergy and Immunology, Duke University Medical
Center. Doctor Burks can you say
present?
ACTING
DIRECTOR BURKS: Present.
DOCTOR
FREAS: Doctor Rebecca Gruchalla is next, Associate Professor of Internal
Medicine, University of Texas Southwestern Medical School.
DOCTOR
GRUCHALLA: Present.
DOCTOR
FREAS: Doctor Melvin Berger, Professor of Pediatrics and Pathology, Case
Western Reserve School of Medicine.
DOCTOR
BERGER: Present.
DOCTOR
FREAS: Doctor Harold Nelson, Senior Staff Physician, National Jewish Medical
Center.
DOCTOR
NELSON: Present.
DOCTOR
FREAS: Our non-voting industry representative, Peter Hauck, Executive Director
for Scientific Affairs, Allergen Products Manufacturers Association.
MR.
HAUCK: Present.
DOCTOR
FREAS: Our acting consumer representative, Ms. Dolores Libera, Director of
Publications, Allergy and Asthma Network, and Mothers of Asthmatics,
Incorporated, Fairfax, Virginia.
MS.
LIBERA: Present.
DOCTOR
FREAS: And, we will soon be joined by Doctor Lynelle Granady, Associate
Physician with ENT and Allergy Associates, New York, New York.
Unfortunately,
Doctor Susan McDonald, from the Johns Hopkins University, could not join us
today.
Now,
should anybody get dropped from this teleconference, you all have the
instructions of how to join us, but just to repeat, you dial 1-888-577-8990,
enter a pass code of 25660, and push the # sign, and please rejoin us.
Now,
as I said, there are about 20 people in the room. I will not introduce all of them, but there are several key FDA
staff that I would like to introduce.
Oh,
Doctor Granady, did you just join us?
DOCTOR
GRANADY: Yes.
DOCTOR
FREAS: Well, thank you very much. We
have just been joined by Lynelle Granady, Associate Physician with ENT and
Allergy Associates, New York, New York.
Thanks for joining us. We are
just going around now and introducing some of the key FDA people. There are about 25 people in the room now, I
would guess, and I won't introduce everybody, but I would like to acknowledge
Doctor Richard Walker, Director, Division of Bacterial, Parasitic and
Allergenic Products. At the table is
the organizer for this meeting here, Doctor Jay Slater, Chief of Laboratory and
Immunobiochemistry. And, also at the
table is Doctor Ronald Rabin, Senior Staff Fellow, Laboratory of
Immunobiochemistry.
Now,
we also have a transcriber here, and I must ask all committee members on the
telephone lines to please identify yourselves each and every time you speak,
because we are trying to transcribe an official record of this meeting, and we
want to be able to attribute the comments to the appropriate individual. So, please identify yourself each and every
time you speak.
Now,
I'd like to read into the public record the Conflict of Interest Statement
written for this meeting. "The
following announcement addresses the conflict of interest issues associated
with this meeting of the Allergenic Products Advisory Committee on April 2,
2004. The Director of the Center for
Biologics Evaluation and Research has appointed Ms. Dolores Libera as a
temporary voting member for this meeting.
Based on the agenda, it has been determined that there are no specific
products being approved at this meeting.
The committee participants have been screened for their financial
interests. To determine if any conflict
of interest existed, the Agency reviewed the agenda and all relevant financial
interests reported by the meeting participants. No waivers were required under 18 US Code 208. We would like to note for the record that
Mr. Peter Hauck is participating in this meeting as a non-voting industry
representative, acting on behalf of regulated industry. Mr. Hauck's appointment is not subject to 18
USC Code 208, he is employed by Alk Abello, Incorporated, and thus has
financial interests in his employer.
Mr. Hauck also serves as the Executive Director of Scientific Affairs,
Allergen Products Manufacturers Association.
In addition, in the interest of fairness, FDA is disclosing that his
employer, Alk Abello, is a manufacturer of allergen extracts. In the event the discussions involve specific
products or firms not on the agenda, for which members have a financial
interest, members are reminded of the need to exclude themselves from these
discussions. Their exclusion will be
noted in the public record. With
respect to all other meeting participants, we ask in the interest of fairness
that you address any current or previous financial involvement with any firm
whose products you wish to comment upon."
That
ends the reading of the Conflict of Interest Statement.
Doctor
Burks, I turn the meeting over to you.
ACTING
DIRECTOR BURKS: I want to thank everybody for the conference call, and I
especially thank Bill for allowing us to do the conference call, rather than
having to come to Washington, and thank Jay for helping arrange that.
What
we'll do for the next hour and a half or so is to listen to several
presentations by Jay and Ron Rabin, and it's on the agenda that you have, and I
think each of you have the slides. If
you have questions as you are going along, if you'd just identify yourself and
ask them, just try to stick to the topic that Jay is addressing at that time,
and then he'll leave time for questions at the end of each section to see if we
need to say anything else.
So,
with that, Jay, we are ready to get started.
DOCTOR
SLATER: Terrific, thank you very much, Wes, and thank you all for
participating. You know, as you well
know in the past this committee has been responsible for valuable
contributions, and we look forward to this meeting every year.
Since
I'm not in the room with you, I can't point to the slides. We are going to try, as we go along, to
identify what slide we are on. All of
the slides that we're using today are numbered, and we're going to identify
them as we go along every once in a while by number, to make sure we are all
literally on the same page.
We
are now in the first ? these
presentations are also numbered in order.
There are five presentation files that you were sent, and it should be
pretty easy to decide where we are but I will identify them as we go along ? we are now in the first presentation, the Lab
Overview, and after the title slide you can go on to the second slide, please.
This
is, basically, what we are going to cover today in our meeting. This is slide two out of ten. We'll start with the Lab Overview, in which
we cover some staffing issues, lot release, reference, maintenance activities
of our laboratory. That will be fairly
brief. We will then get into the meat
of the presentation, which involves a review by me and Ron broadly speaking of
the research activities in the lab.
Then I will focus on two specific areas of both research and regulatory
interests. One is our activities in
cockroach allergen standardization, and the other is our effort to develop
novel methods of determining the potency of allergenic extract, in particular,
our very recent and early work on using antibody micro arrays for this purpose.
Next
slide, please.
So,
quickly, we are going to go through the Lab Overview section, covering
staffing, lot release and reference maintenance activities.
Let's
go to slide four.
The
two principal investigators in our laboratory are myself, I've been here for
five years, and Ronald Rabin, who has been with us now for three years. We have three post doctoral fellows, Bo Chi,
Jinsong Chang, Nicolette deVore.
Next
slide, please.
Those
of you that have been here for meetings know that I would normally ask people
to stand up, but that would be a little silly under these circumstances, but
they are all here and listening to the presentations.
Our
research technicians, on slide five, Al Gam, Mona Febus, Marc Alston, Cherry
Valeriod and Katia Dobrovolskaia.
Next
slide, slide six. This is one of my
favorite slides. This is a slide in
which I give you an idea of where we are and where we have been, in terms of
our staffing. What I include in this
slide is only our research technicians, because those are the staff that really
are in the forefront of our intersection with the allergen products
manufacturers.
And,
as you can see, after a couple of years in which our staffing fluctuated up and
down we've really been in a very stable pattern for the last three and a half
years, with about five research technicians.
I think this has really helped us a lot, this stability, in terms of our
ability to provide service and to effectively regulate the allergenic products.
Next
slide, please.
The
routine regulatory activities that our research technicians are involved in
include lot release, reference distribution, reference maintenance
activities. As you know, for the
standardized allergenic extracts we maintain the U.S. Standards of Reference
that are used both by us and by all of our manufacturers for effective
measurement of the potency of their extracts.
And so, we devote quite a lot of effort and expense into maintaining and
distributing these references.
Next
slide, please. We are now on slide
eight.
In
the past year, in calendar year 2003, we received 450 protocols which we
reviewed prior to the release of Standardized Allergenic Extracts. Also, in the same calendar year we
distributed 1,423 vials of reference standards in 96 shipments sent to the
manufacturers.
On
the next slide, slide nine, we give a little context to some of these
numbers. You see here the lot release
protocols that were submitted by year for the past five years, and what you can
see is that 450 is more or less around the same mean where we have been for the
last several years, a little bit higher than last year, but definitely in the
same range.
The
next slide, slide ten, we look at our reference distribution activities. The number of shipments, the number of
vials, is down somewhat. It will
probably be a couple of years before we know whether this is really a
trend. If it is, then I'll be very
grateful to our manufacturers. One of
the things that we've been requesting for quite a while is that our
manufacturers use the reference standards economically. But, this is a trend, and they've been heeding
our request, and for that we can all be very thankful.
That's
the end of the first presentation.
I'm
happy to entertain any questions if there are any about that.
ACTING
DIRECTOR BURKS: Does anyone have questions for Jay for this part?
Okay,
you can go on to the next part, Jay.
DOCTOR
SLATER: Thanks very much.
Okay. We are now in presentation number two, which
is entitled, "Research Update."
We can go now to the second slide.
The
active research projects in the lab are detailed on this slide. Among the projects that I'm doing, we are
investing a significant effort in our Cockroach Allergen Standardization
Program, which I'll be talking to you about some more later.
Related
to this, but not absolutely essential, but something that we consider to be an
important contributor to this effort, is our effort to generate cockroach
specific IgE and IgG combinatorial libraries.
We've really been focusing on the IgG work recently, with an aim towards
micro array analysis of allergenic
extracts. And again, this work is very
preliminary, but it's exciting nonetheless, and I'll be going into that in some
more detail.
In
addition, you are all familiar with some of the work that we've doing on
endotoxins in allergen vaccines. We
have some additional data to discuss with you at this ? in fact, in this presentation.
Ron
Rabin has two major projects, the MDR proteins and their involvement in T cell
activation, and RSV responses in human tonsilar tissue, and he'll be talking
about the first of these projects in just a few minutes.
Next
slide, please.
These
are the publications that have come out of the lab this year. You can see them here. We published some of our first work with the
endotoxin content of standardized allergen vaccines. I was also invited to co-author an article in Middleton's
Textbook with Dick Lockey and Bob Esch.
Ron published a paper in the Journal of Immunology on his work
with the CXCR3 induction and CD4 T cell differentiation, and in addition he has
a manuscript in preparation about his work which he'll be talking about a
little bit more in a few minutes.
Next
slide.
At
this year's Academy of Allergy Meeting, this Laboratory contributed six
abstracts, which were all presented at the meeting, and they are detailed on
slide four.
Next
slide, please.
Ron
Rabin was invited to give two outside presentations, one at the SMI Conference
in London in February, 2004, on the relationship between viral respiratory
infections and asthma, and another at the most recent Academy of Allergy
Meeting in March, on the FDA Food, Drug and Cosmetics Act as it applies to
research studies.
Next
slide, please.
And,
I was invited to give a talk at the State of the Art Analytical Methods for The
Characterization of Biological Products Meeting, in June, 2003, in which I
talked about allergenic extracts, and I gave four presentations in workshops
and courses at the most recent Academy meeting.
Next
slide, please.
Ron
and I both maintain outside collaborations.
I've been collaborating with Larry Arlian, at Wright State University in
Dayton, Ohio, as well as with Doctor Patrick Murray, who is the Chief of the
Microbiology Service here at the NIH Clinical Center. Ron has active collaborations going on with Peter Collins at
NIAID, as well as with Mario Roederer at the Vaccine Research Center, also at
NIAID.
Next
slide, please.
So,
I'd like to spend just a few minutes talking about the endotoxin work, which I
first presented to this committee about one year ago, and just to quickly
summarize where we left it last year, we were embarked on an activity in which
we were, basically, trying to update some very old work that had been done in
this laboratory in collaboration with NIH back in the `70s, in which it was
first observed that allergen vaccines, especially dust mite vaccine, contained
a measurable amount of endotoxin.
Our
work focused exclusively on standardized allergen vaccines, in which we found
what's really summarized here on slide number eight, and that is that in
general, although we were able to detect endotoxin in virtually all the
allergen extracts that we examined, we found that the cat and mite extracts had
more than the pollen extracts, that the cat pelt had more than cat hair, and
what was most striking to us, and what really led us to the rest of what we're
going to be presenting today, was our observation that the D. farinae extracts
contained significantly more endotoxin than the D. pteronyssinus extracts.
As
I noted last year, it's not clear that any of these endotoxin amounts are
physiologically significant, but, nonetheless, we felt that we needed to
examine this further to characterize the nature of this endotoxin content.
And,
we wondered about several different possibilities. We wondered about the degree of bioburden that might be
present. We wondered about whether
there might be an endogenous heat-stable and debinding activator in D. farinae,
and we wondered whether there was actually endogenous endotoxin neutralizing
protein in D. pteronyssinus.
Just
to very quickly go through what else we found, next slide please. The next slide is a graphical representation
of the corrected endotoxin content of the different classes of vaccines. Note
that this is on a log scale. The
significant differences are shown, and this, basically, replicates what I had
in the previous slide.
Next
slide, please.
So,
our plan was to investigate the differences between D. farinae and D.
pteronyssinus and to attempt to identify some of these organisms.
Next
slide, please. We are now on slide 11.
Our
first approach, which consumed most of the year, was our attempt to actually
culture organisms out of these different mite preparations. We were fortunate enough to be able to
obtain fresh mite and egg materials from three different sources. These mites were all washed, free of media,
using two different methods. One was
sieving, in which the mites were caught on a fine mesh sieve, and the growth
medium was washed off with sterile water.
Another method we used was with sucrose gradients, and both of these
were quite effective, at least visually, at removing all traces of
contaminating material from the mites or the eggs. And then, we submitted the material for culture to Pat Murray's
lab over at NIH.
Next
slide, please.
This
slide really summarizes several months' worth of culture work, and the bottom
line is, we were able to culture organisms, both gram positive and gram
negative, out of both of these sources, and there was no really big difference
between the two, either quantitatively or qualitatively.
You'll
note that we obtained E. cloacae, R. pickitii and acinetobacter from both
species of dust mites. We also have
some unidentified gram negative rods, but, basically, our culturing techniques
really did not show us any large differences between the two species of mites.
Next
slide, please.
Possible
problems with this approach include the fact that the culture data were really
non-quantitative, and that, in fact, the bioburdens between the two species
might be very different. We are
actually working on quantifying this now.
The
culture techniques, we should note, of course, have been optimized for human
pathogens, and it's not likely that what we are dealing with in these dust
mites are, in fact, human pathogens, although that's a possibility.
The
organisms may be in privileged sites, and the optimal conditions for extraction
of the organisms may be uncertain. And,
in addition, endosymbiotic organisms are notoriously difficult to culture.
So,
we tried a different approach, even while we are continuing with the culturing
at the same time.
Next
slide, please.
Approach
number two has been used by other investigators to identify endosymbiotic
organisms, and that's actually to look for characteristic DNA of the bacteria
from DAN that's extracted from the mites.
In this approach, we extract genomic DNA from fresh washed mite
material, and then amplify with 16S ribosomal RNA primers. As you know, 16 S ribosomal RNA is specific
for bacteria, and the sequencing has been well identified. In fact, this approach of amplifying 16S
ribosomal RNA is a well-established technique to try to track bacteria.
We
identified individual clones with restriction fragment analyses. We sequenced and then we attempt ? the idea was to attempt to identify predominant
organisms.
Slide
15, next slide, please.
What
you can see here is just an acerose gel that shows that we were, in fact,
successful at extracting what appeared to be reasonably good quality DNA from
both species of mites. This was using
standard techniques.
Next
slide, please.
These
are the 16S ribosomal primers that we used.
The sequences were based on an article from 1991 by Weisburg in the Journal
of Bacteriology, and these primers have, in fact, been used in multiple
experiments by many investigators since that time. It's the upper case bases that are specific for the 16S RNA, the
lower case segments of the primers are tails that include, as you can see,
specific restriction enzyme sites for easy insertion and characterization.
Next
slide, please.
On
the next slide you can see that we were able to obtain 1.6 KB TCR fragments of
DNA using this amplification method from both D. pteronyssinus and D.
farinae. Now, you'll note that we used
two different primer pairs. One primer
pair, primer pair No. 1, really is relatively non-specific, and would be expected
to generate results from most eubacteria, and primer pair No. 2 would allegedly
be more specific for enterics.
But,
you can see that we were able to obtain fragments from both organisms. Qualitatively, there appears to be somewhat
more from D. farinae, but as you know without good internal controls it's
impossible to quantify TCR results.
Next
slide, please.
We
then did a substantial amount of DNA sequencing, and these are the sequences
that we recovered. Now, the fact is that from both organisms of dust mites the
most predominant recovery is the first organisms ? the first two organisms that are indicated on this slide, Bartonella
or Rochalimaea species, specifically, Bartonella henselae and Bartonella
quintana. Just to refresh your
memories, Bartonella organisms are responsible ? are the pathogens in cat scratch fever and in trench fever, which we
don't normally see very much nowadays, although cat scratch fever we certainly
see. Bartonella is also associated with
infections in immune compromised individuals.
There has been a series of reports of it causing endocarditis in immune
compromised individuals, such as HIV positive patients and homeless
individuals. It's also responsible for
bacillary angiomatous in HIV positive patients.
Needless
to say, if there were Bartonella in our dust mites they would not survive into
the final extract. There's no evidence
whatever of live Bartonella in our extracts at all. But, there is evidence, based on this very preliminary study,
that Bartonella species may be in this endosymbiotic with some of our dust mite
species.
Next
slide, please.
Just
a quick review, Bartonella endotoxin
has, in fact, been fairly well described, both functionally and
structurally. It's of interest from a scientific point of view, because it has
a high degree of LAL reactivity, but in both human cells and in rat cells it
has minimal inflammatory responses, and there's actually minimal activation of ? like receptors 2 and 4, and the two publications
very recent are indicated in the bottom of this slide.
Next
slide, please.
Obviously,
this is a very early finding, and we are not ready yet to publish it in a peer
review journal, because we really need to verify the source of the
endotoxin. We need to do high-fidelity
PCR and verify some of this sequencing data.
We need to get some additional mite sources, and we need to attempt to
profile the LPS structurally, which we actually can do with colleagues here at
CBER.
We
are also in the process of putting together internal standards so that we can
quantify the DNA in our source materials.
Obviously, if there's just as much signal from D. farinae and D.
pteronyssinus, this may be of interest, but it certainly does not explain the
finding of much more LAL reactive endotoxin in D. farinae extracts.
And,
we are going to also need to look physiologically at the effects of this
endotoxin on immune responses. These
are all studies that are in progress.
That's
the end of my presentation. We are
going to go on next to Ron Rabin's research presentation, but I'd like to give
you an opportunity to ask questions before we do that.
DOCTOR
GRANADY: This is Lynelle Granady.
DOCTOR
SLATER: Hi, Lynelle.
DOCTOR
GRANADY: Hi. This is actually really
very, very interesting. I have a quick
question about the initial cultures, if you were able to culture the bacteria
from the extracts or culture small amounts of bacteria from the extracts?
DOCTOR
SLATER: No, no, I'm sorry, let me stop you.
You can go on with the question afterwards, but we cultured nothing at
all from the extracts. They are
sterile. We cultured this from mites,
live mites.
DOCTOR
GRANADY: Oh, okay, from the live mites.
DOCTOR
SLATER: Yes.
DOCTOR
GRANADY: Now, is it possible to ? how do you
determine which ? I don't
know how to exactly ask the question ? but how ? is it possible to actually measure endotoxin
from that same ? from the
live mites, or not really?
DOCTOR
SLATER: Yes, we've actually done that.
Well, I mean, measuring the ? you have to
sort of mulch up the mites to measure the endotoxins.
DOCTOR
GRANADY: Right.
DOCTOR
SLATER: You kill them in the process of doing it.
DOCTOR
GRANADY: Right.
DOCTOR
SLATER: But, we've done that. In our
studies that we presented last year, we were able to show that endotoxin was
not only present in the extract, but also in the source material, which is the
live mites. So, it's present in both.
Are
you asking whether it's possible to identify which organism the endotoxin comes
from?
DOCTOR
GRANADY: Yes.
DOCTOR
SLATER: Yes, the answer is yes. We haven't really successfully done that yet,
but there are a number of papers in which endotoxins can be profiled, both
crudely on SDS-PAGE, and also much more sophisticated using HPLC and gas
chromatography. We haven't done that
yet, although we had intended to do that, we just sort of got sidetracked a
little bit, but that's definitely something that we are interested in.
The
problem, Lynelle, is that no one has really ever attempted to do this on a
mixed culture, and that would be a little bit hard to sort out. The profiling activities, in general, are on
pure cultures or vaccines, and my guess is that ? we are certainly planning on doing this, but my guess is that the data
are going to be a little bit messy, just because they are mixed.
DOCTOR
GRANADY: I see.
Thank
you.
DOCTOR
SLATER: Thank you.
ACTING
DIRECTOR BURKS: Anybody else have questions for Jay?
All
right, go ahead.
DOCTOR
RABIN: Hi, this is Ron Rabin, and what I'm going to discuss with you is a
project, and show you some data of a manuscript that's pretty much
written. We are waiting for one
experiment and then, you know, the final touches and getting it out.
If
you'll to slide number two then. So, my
interest in the multi-drug resistant proteins came from a serendipitous
observation that I made while I was still a Fellow in Josh Farber's lab. And, as some of you may know, I have a
reasonable amount of experience in flow cytometry, and spent some time in that
laboratory looking at calcium flux in response to chemokines, and as a
relationship to chemokine receptor expression on lymphocytes.
And,
as sort of a side project I began to look at responses in ? in patients with Wegener's granulomatosis with a
friend of mine. We were, basically,
just playing, and in the process of looking at this I noticed that the patient
cells had lost a lot ? or had a
lot less of the calcium probe, which is
ENDO 1, in their cells than cells from the healthy controls that we were
using in the experiment. This was
consistent from experiment to experiment, and so I wondered, I thought about
that and wondered whether or not because these patients sort of had ? were in a state of inflammation, or activation,
in a very general term, whether or not that affects this probe concentration,
and the probe concentration then would reflect gene expression of some sort of
a probe transporter, which might then modulate activation and give incite into
a pharmacologic target. So, that was
sort of the fantasy.
And,
the cartoon that I'm showing you is drawing what I basically observed. So, when one does calcium studies on a flow
cytometer with ENDO 1 you are looking at a ratio, which is essentially the
slope of fluorescent's emission into violet on the Y axis or blue on the X
axis, and you could see at normal the cells were kind of high up on the X/Y
plot there, and the Wegener's granulomatosis patients that slope was down in
the corner. But, the slope ? the lines were in different positions, but the
slopes were the same, and it's the slope that reflects the calcium. So, it wasn't an issue of calcium, it was an
issue of probe concentration, and that's really the bottom line.
And
so, if you go to slide number three, that brought me to the MDR family, because
the MDR family are proteins that transport substances across cellular
membranes, against a concentration gradient, in an energy-dependent manner.
They
are in a larger group of what are called ABC proteins, ATP Binding Cassette
proteins, that contain distinctive nucleotide binding domains, and their genes
are highly conserved across species.
The first member that was identified was MDR1, which I'm sure many of
you have also heard of identified as P-glycoprotein. And, its substrates are large hydrophobic cations, including such
molecules as Doxorubicin and Ritonavir, and even the calcium channel blocker
Verapamil.
A
little bit later, the MDR-associated Resistant Protein-1 was identified, and
now there are nine proteins that carry that prefix of MRP, and it has some
homology to MDR, but it's actually more closely related to the Cystic Fibrosis
transport protein.
MDR
? MRP1 transports organic anions and it also
transports glutathione and glutathione conjugates, and it transports ? in fact, it is the mechanism by which cells
export LTC4, so it does have a physiologic function, and it is the
transporter of many of these florescent molecules that we use as probes in
cellular biology, because the molecules themselves are organic anions. So, my
attention was then turned to MRP1, slide four.
Just
to give you a little bit of context of these MDR family proteins, or the MRPs,
you can see there's an identity amongst them or between them, the low, and they
are widely distributed along the human genome.
Many of them do transport conjugated glutathione, and some of them have
known physiologic substrates and some of them don't, and there's various new
level of distribution of expression, as you can see.
Slide
five, please.
So,
the first thing that we did was just to look at the basic ? if the basic hypothesis had any truth to it,
then we would see two things. We might
see a difference in expression of MRP1 in mammary cells versus naive T cells,
and we should see a difference with activation. And, this 35 cycle RT-PCR on slide five demonstrates that that,
in fact, is the case. So, if you look
at the set of ? the area
MRP1 there, you'll notice that the band is much brighter on CD4 memory versus
naive, CD8 memory versus naive is also a little bit brighter, it seems to be
expressed to some degree, and then K cells, B cells, and a little bit in
monocytes.
To
further drive home the preferential expression, these cells were ? the memory and naive cells were sorted by flow
cytometry, using two markers in addition to CD4 and CD8, but we know for a fact
that that isn't ? you don't
get pure naive cells, and really one way to get absolutely pure naive cells is
to use cord CD4 T cells. And there on
the far right lanes you can see that there's no expression of MRP1 in cord CD4
T cells, and that after three days with anti-CD3 and anti-CD28 there is
expressions regulated.
Now,
I'm showing you a number of the members of the family for two reasons, one to
call attention that this isn't just some sort of general thing, non-specific
event, because MRP3, for example, is not expressed in any context, and MRP54
doesn't really appear to be affected by memory subsets in any event, but then
there are some molecules that seem to have this same level or the same pattern
of expression, such as MRP4 and MDR1.
Next
slide, please.
So,
we started ? we set about using a small
molecule inhibitor of MRP1, that is well known in the literature, called
MK-571. MK-571, as many of you might
know, is sort of the granddaddy of singular or monteleukast, and so it is a leukotron,
it is a ? LTR1 antagonist at very
low concentrations, but I'm sure related to the fact that MRP1 is the exporter
of LTC4 at higher concentrations MK-571 does block this pump. And so, we first
just looked at ? we used the
molecule TSST, the superantigen, to stimulate our T cells for, I think, all of
the studies that I'm showing you here, because in certain times we thought we
might want to look at those responding cells, and since TSST-1 is fairly
specific for V beta 2, we can follow the responding cells if we wish.
And
so, on the left these cells have been stimulated with the superantigen
overnight, and you can see that they look like cells, they look as cells
generally look when they've been stimulated overnight with some sort of
superantigen, they tend to cluster and become aggregates. And, on your right, with the MK-571, they
are just in a homogenous suspension.
They
are mostly alive by the way.
Next
slide.
So,
slide number seven then shows some ? a little
bit more specific characterizations of the inhibition here, and so these cells
now were stimulated and we looked at them four hours after stimulation with
TSST-1 in the presence of absence of this inhibitor MK-571, and on the far left
you can see on the X axis that there's a subset of cells that express CD69
after activation and then a subset of those are staining positive for
interferon gamma. In the presence of 50
micromolar, we've cut that down ? the MK-571,
we've lost a lot of expression of the interferon gamma and CD69 both, and it's
practically all ablated at 125 micromolar.
Next
experiment.
To
look at the cytokine profiles a little bit more closely, we did experiments
such as demonstrated on slide number eight here, which shows interferon gamma
on the X axis and IL-4 on the Y axis, and you'll see a very clear
dose-dependent decrease in interferon gamma, as the dose of MK-571 goes
up. What you don't see is that IL-4, or
what you also see, I guess, is that IL-4 is similarly ? is not affected, okay, and that has struck us,
you know, as very odd.
Now,
we've tried to make sure that this is, in fact, the case, because, as you know,
there's a lot of ? there's a
lot more ? you know, the numbers are
better for gamma than 4, and so we wanted to be sure we weren't playing with a
number game, but, in fact, this does look like the case. It does look like at
least in the context of these experiments MK-571 inhibiting MRP1 doesn't seem
to affect IL-4. And, at the time I was
a bit baffled by that, and I have a number of thoughts about that that I can
share with you towards the end.
Next
slide.
The
specificity ? but, at any rate, to look
at the gamma at least, this is ? we did a
number of experiments now, so these are experiments similar to and including
the one that I showed you on the previous slide, showing the dose response, and
on the upper half of the panel there is the cumulative normalized response to
interferon gamma of all these, and you can see that this is a statistically
significant, dose-dependent decrease, and that this dose-dependent decrease in
cellular expression of interferon gamma protein is at least ? is reflected by a decrease in gene expression,
as shown by the TaqMan assay below.
Next
slide, please.
We
looked at a bunch of other cytokines using the BD biosciences cytokine bead
assay, and so this is now secreted into the supernatant, and the interferon
gamma, as you can see, is no surprise, it's reflected by supernatant
concentration, as is TNF and IL-10, and to some degree IL-2. What's kind of
interesting about IL-2, and it may give us some incite into the mechanism that
this is working, is that you can see that the curves are a bit different, and
it appears that IL-2 is not as easily affected by the MRP1 inhibition. But, it is affected, nonetheless.
And,
this last point at 125 micromolar was excluded from the regression line,
because a queue test demonstrated that it was clearly different than the
previous five points.
Next
slide, please.
Well,
we wanted ? I was curious about
whether or not this inhibition was cell specific, was T cell specific or not,
and so one of the things that I did was, we looked at monocyte-derived
macrophages, and we stimulated them with both SAC versus TNF in blue, SAC is
red, and you could see that the MK-571 decreased TNF in response to the LPS,
but not so much, and really not at all, in fact, with regard to the SAC.
So,
while the effect occurs across a number of cell lines, it's clearly regulating
something specific, in that certain cytokines are affected, certain cytokines
are not affected, and the response may even be different depending upon
signaling pathways.
And,
the next slide just amplifies that point even more, because in the same
supernatants we looked for IL-6, and we saw really no effect whatsoever. And so, this, you know, was comforting
because, of course, the MDR family, people do think of them in terms of
proteins that are simply there for self-survival, and that, you know, toxins
build up, and are you just killing the cells, and this selectivity is one more
demonstration that we're not.
And,
we have done, I would state that I'm not showing you but we've done a number of
cells looking at indicators of cell death ? blue, ? orange ethidium bromide. We've done stains for mitochondrial
potential change for apoptosis, and we only ? we see some small changes above 75 micromolar, but not huge, and it's
clearly not having a major role in what we are seeing here.
But,
the paper that's being submitted is primarily descriptive, but we did want to
look into mechanism a little bit, and one of the things that we looked at was
to go back to the calcium flux, and so this is a calcium flux on T cells that
have been stained with a bitintillated CD-3, and then cross linked with abadan,
and on your left is just to demonstrate they are just overlapping histograms of
CD-3 expression on peripheral blood lymphocytes to demonstrate that the MK-571
is not decreasing CD-3 expression at all.
And, in the first calcium flux panel there, the multi-colored panel, you
see time on the X axis and the ratio of fluorescence on the Y axis, and that's
a pretty standard calcium flux response that one sees by flow cytometry after
cross linking CD-3, and that's pretty much ablated after treatment with 25
micromolar of MK-571.
In
addition, next slide, please, so slide number 14 also shows that the calcium
flux in response to CXCL12, also known as SDF-1, is also ablated, and so that's
kind of interesting. And then, on the
histograms on the left, once again demonstrate that there's really no
difference in expression of the receptor.
So, this is an effect of signaling.
Next
slide, please.
Well,
if one is thinking about a pharmacologic target, and one is worried about
whether or not you are killing the cells, you don't necessarily want to make an
individual permanently inergic, you'd like to know whether or not this sort of
a thing is reversible. And so, we did
this kind of an experiment here, where we incubated the cells with MK-571
overnight, and then we washed out the MK-571 and stimulated them, you know, on
day zero, day one, day two, day three, and the important thing is really
demonstrated on the histogram on the top the line plot below being derived from
the data above, simply normalized from the data on the top, which just shows
that if you wash up the MK-571 compared to cells that had not been ever exposed
to the MK-571 you regain most of your responsiveness with regard to interferon
gamma expression the CD4 T cells, so it's reversible, and that's a good thing.
Next
slide, please.
And
then, just sort of coincident somewhat with the issue of the signaling studies
that I showed you, we were curious as to how long before the MK simulation the
MK-571 needed to be added. For the
studies that I showed you, it was 30 minutes, it was 30 to 60 minutes, though here we demonstrate that, in fact, if we
add it really with, or even somewhat slightly after the TSST-1 we still get
inhibition, and it's only if we delay its addition 60 to 120 minutes after the
superantigen does it lose its effect.
Next
slide, please.
Well,
one of the questions was, you know, the fact is, is that we are allowed this
concern with allergens, allergy and allergic disease, and so while this is
quite interesting it was a little bit disturbing that we didn't really see any
response in the IL-4 side of the picture.
And, while I was thinking about this, a paper was published in PNAS
just last year that demonstrates that MRP4 transports the other arachidonic
acid products, such as PGA2
and PGE1, and all those that you see listed, and as I'm sure
that many of you know the prostaglanens have been shown to have a role in the
Th1, Th2 paradigm.
Next
slide, please.
And
so, just to look at MRP1 versus MRP4 expression Th1 and Th2 cell lines, I did
these TaqMan experiments and demonstrated that while MRP1 seems to be expressed
fairly equally well in both, the MRP4 is somewhat preferentially expressed,
this is gene expression now, in the Th2 versus the Th1 cell line.
Next
slide, please.
And
then finally, just to try to integrate my two projects to some degree, because
my other fellow, Bo Chi, is working on, we are very interested in this issue of
viral infections and their effect on asthma pathogenesis and episodes of
wheezing, I was curious about whether or not RSV might increase MRP4 in
dendritic cells, so we just did this one experiment which was somewhat promising,
but needs to be repeated. It
demonstrates that this, yes, does seem to be the case.
Next
slide, please.
And
so, what I've shown you is that MRP1 blockade abrogates a Type 1 T cell
function, and blocks at least two signaling responses that we've looked
at. MRP1 may have a very analogous
function, MRP4 may regulate Th2 T cell responses analogous to this, and the
ultimate objective of all this is not to suggest that a blockade of these pumps
might be a good way to provide therapeutic immunomodulation, but, in fact, what
we really want to do is, we want to define the mechanisms by which this
works. We think that by the mechanisms
by which this will work will provide us some drug targets for immunomodulation.
And,
I think that's it.
Okay,
so again, I want to acknowledge Jay Slater, of course, he supports this work,
and Marc Alston has really done a lot of work, he's one of the biologists in
the lab, Jinsong Zhang is the Fellow who is working on this particular project,
and although I didn't show you any of Bo Chi's work, she's been very helpful in
getting this project going.
So,
thanks for your time, and I'll take any questions.
ACTING
DIRECTOR BURKS: Does anybody have questions for Ron? Ron, that was good.
DOCTOR
GRUCHALLA: This is Becky Gruchalla. I
guess the only question I have is, and I think you've just shown all the data,
it's very, very interesting, so it looks like it's specific, I guess I
shouldn't use the word specific, for interferon, it can down regulate or
decrease interferon production, does not touch IL-4, doesn't look like it
touched IL-6 either, correct? Were
there any other cytokines that you looked at, again, you've probably shown all
the data.
DOCTOR
RABIN: Yes, those were the only ones that I looked at. Do you have any ? well, we tried to look at IL-13, but, you know,
it's really tough to get IL-13 responses in this kind of system.
But,
you know, obviously, we are always keeping in mind that, at least to my way of
thinking, that IL-13 is sort of the pathogenic, you know, Th2 cytokine. So, I always sort of keep it in mind.
Any
other questions?
DOCTOR
GRUCHALLA: That's all I have.
ACTING
DIRECTOR BURKS: Okay, thank you, Ron.
DOCTOR
SLATER: Okay. We're going to go now to
presentation number four. This is the one
entitled, "Cockroach Allergen Standardization."
Go
to slide number two. I can't resist
showing this slide. I supposed after a
couple years I'm going to have to stop.
UNIDENTIFIED
SPEAKER: Yes, you are.
DOCTOR
SLATER: Okay, thank you. Well, all
right. I have to reach a certain number
of people to whom I've given nightmares before I stop this, but probably at the
point I give this up we'll be able to animate the slides.
UNIDENTIFIED
SPEAKER: Oh, no.
DOCTOR
SLATER: Okay, let's go to ? Bill, let's
go to slide number three quickly. Okay.
What
we are going to talk about today is our progress with cockroach allergen
standardization. The actual progress
that I have to report has to do with the clinical studies that are actually
underway.
We'll
talk then briefly at the end of this about our efforts to develop an
appropriate surrogate potency measure.
I'm going to introduce the topic at the end of this presentation, which
is presentation number four, and then in presentation number five will actually
discuss some of the issues about appropriate surrogate measures in greater
depth, and try to explain to you why, at least for the meantime, we are
actually looking at this microarray technology as what we hope to be a new
technique that will be very, very helpful.
Next
slide, please. We are now on slide
number four.
I
know I'm reviewing things that this committee knows well, but let's just go
through it quickly.
Cockroach
allergy is important because roaches are ubiquitous. They are difficult to control, and cockroach allergen exposure
has been associated in a number of studies with asthma, especially inner-city
asthma.
We
presented this work to this committee in February 2000, and outlined an
approach to standardizing new allergen extracts, and at that time the
standardization of cockroach allergen extracts, among others, was supported by
the advisory committee on that date.
Next
slide, please.
Cockroach
allergen standardization is important to the patient, to the physician and
scientist, and to the FDA. It's
important to the patient because of the ability to make more accurate
diagnoses, and, hopefully, safer and more effective allergen
immunotherapy. To the physician and
scientist, it's critical because without standardization you have a problem, in
that the science is hampered by the fact that you can't measure what you've got
with scientific experiments that are needed, our pathophysiology experiments, epidemiologic
work, and environmental control. And,
it's important to the FDA because our mandate is to make for safer and more
effective products, and clearly this will lead to safer and more effective
product.
Next
slide, please.
Our
initial studies, which we presented to this committee before, were in the
laboratory, and those actually have been discussed before. We were comparing allergen content to
different lots of U.S. manufactured materials.
Next
slide, please.
That
was reported in Clinical and Experimental Allergy in 2002, and on the
next slide, which is slide number eight, our conclusions were that
commercially-available cockroach allergen extracts in the U.S., vary widely in
their protein content, in their Bla g 2 content, in the SDS-PAGE banding
pattern, and in overall allergenicity, as best measures as we had at that time.
And,
when we compared them to some candidate reference extracts which we had, they
were less potent, uniformly less potent, and they contained less bla g 1.
Of
note is that even among these highly-variable extracts, the amount of bla g 1
was actually fairly constant, although it was low. Our conclusion was that cockroach allergen vaccines should be
standardized and based on both the public health implications and what we found
in our laboratory studies, we wanted to go ahead and proceed with this as our
next target.
Next
slide, please.
So,
the next stage is to do some clinical testing.
And, in particular, based on models that we've used before, we wish to
proceed with skin testing to help establish the biological unitage of the
products and to try to establish ideal dosing ranges.
Next
slide, please.
Our
goal was to obtain valid clinical data on the biological potency of three
commercial German cockroach allergen extracts, and to develop surrogate potency
testing.
Next
slide, please. Next slide. Let's go to slide number 12.
The
clinical method that we used was the ideal method that was developed in the
1970s, both here at CBER and at Hopkins.
You are all well familiar with this technique, which is based on serial
dilutions, intradermal testing, the measurement of the erythema response, the
erythema responses that are measured are plotted against the negative log of
the serial dilutions, and from that a D50, which is the dilution at which a 50
millimeter erythema response occurs, is measured. The D50 is directly translatable by simple arithmetic into the
bioequivalent allergy units, which is the standard that's used for grass pollen
extracts and for cat extracts today.
Next
slide, please.
The
effort to do an appropriate, and well-designed, and well-controlled, and
geographically-diverse ideal study for cockroach was a little bit daunting,
but, fortunately, we were able to approach the NIAID Inner City Asthma
Consortium, which as you can see in slide 13 was established in Fiscal Year
2002, to explore and evaluate promising new strategies for the treatment of
asthma among minority children residing in the inner city.
Next
slide, please.
The
steering committee of the Inner City Asthma Consortium was enthusiastic in
supporting the idea of using their resources to perform this study, and we
proceeded on that basis.
You'll
notice that Doctor Gruchalla, who is on this Advisory Committee, is also on the
Consortium Steering Committee, and a number of individuals on that committee
were highly supportive of our efforts in this regard, and we are very thankful
to them, to the committee, and to the Consortium, for supporting this work.
Next
slide, please.
So,
out of the ten ICAC or Clinical Research Centers, four were designated to do this
study. The centers in Baltimore,
Chicago, Denver and Washington, D.C., are all on board to do the study.
Next
slide, please.
Our
recruitment, we are recruiting adult individuals with a history of allergic
disease, such as allergic rhinitis, related to exposure of cockroaches,
although with cockroach exposure this is certainly difficult to discern
clinically, we also have a standard that on screening these individuals have a
puncture sum of erythema response to the allergen concentrate greater than or
equal to 30 millimeters in size.
Next
slide, please.
Several
exclusion criteria were indicated for both practical, scientific and safety
reasons. We were not interested in
recruiting individuals whose asthma was severe enough to require the use of
systemic steroids in the past 12 months.
We certainly did not want individuals whose flows were below 75 percent
of predicted at the time of testing.
For practical reasons, since we are measuring erythema, we needed
individuals whose skin coloring or condition would not preclude the measurement
of erythema responses, although that's a fairly uncommon exclusion criteria,
even in the inner city. We've not had
any problems with that.
Dermographism,
dermographic subjects were excluded. Individuals who had received cockroach
immunotherapy in the past were excluded, and individuals with current use of
antihistamines, tricyclic antidepressants, MAO inhibitors or beta-blockers are
excluded as well.
Next
slide, please.
We
then went about selecting three commercially-available German cockroach
extracts. These are all FDA approved
materials. We decided again, for
practical reasons, to get 50 percent glycerinated materials, and we wanted
three different manufacturers.
Next
slide, please.
What
you see in slide number 19 are some of our initial determinations on those
three extracts that are designated A, B and C.
In addition, at the bottom you have measurements on E2Cg. This is not so much a candidate reference material, but a highly-concentrated
dialyzed and purified material that the FDA purchased some years ago and has
been using for a number of studies. The
tests that were done on it were bla g 1, bla g 2, and bla g 5 content. We actually did these tests with our own
direct ELISA that we designed here in the laboratory, but the data that I'm
showing you are from the two-site ELISA that's done by Indoor Biotech. These were concordant with our results, but
I'm only reporting their results here.
In
addition, we determined the relative potency of these extracts, again, compared
to E2Cg, which may or may not be a fair comparator, by three different
methods. In the first method, we used a
pooled monospecific rabbit sera, in other words, we had injected rabbits and
hyperimmunized them with bla g 1, bla g 2, bla g 4 and bla g 5, we were able to
get good immune responses in all of the rabbits, and in RP1 we took a pooled
sample of sera from those four animal sources.
In
RP2, again, the same competition ELISA design, but this time we used serum from
a single rabbit that was injected with German cockroach allergen extracts, and
in RP3 we did a relative potency using a human serum pool that was created some
years ago here against cockroach allergens.
And, what you can see is that the bla g 1 content, again, of the three
extracts is relatively constant, but again, much less than an E2Cg, again, I'm
not sure how significant that is. We
don't really know what content we are looking for, in terms of either diagnosis
or immunotherapy of any of these allergens.
The
bla g 2 content was somewhat more variable, but present in all three, again,
much less than in E2Cg. Interestingly,
bla g 5 was almost completely absent from extracts A and C, but was present in
extract B in just about the same amount as in E2Cg. The potencies seemed to suggest in all three methods that extract
B was the most potent, and that extract C and A were less potent. Again, I want to be cautious about not over
interpreting the data on slide 19. We
were not using these data to include or to exclude any extracts from our study,
rather we are going to be using these data and other data to correlate with our
skin testing data, which we hope will be coming fairly soon.
Next
slide, please.
So,
here we are with our time table for the clinical study, and, in fact, we are
doing quite well. The steering
committee approved it, the study centers were identified, we ordered the
extracts, all of the IRBs approved the study.
The IND submission to the FDA was approved. The materials have been distributed, and we are now at the stage
of proficiency testing, which is a very important stage. In this stage, each of the study site
testers are refining their ability with this fairly labor-intensive technique,
using histamine and non-allergic individuals.
That's in process, and we hope within a few weeks that we are going to
be obtaining real data with the cockroach allergens from these sites.
Next
slide, please.
So
now, with the data that we hope and assume will be in our hands in a few
months, the idea will be to develop surrogate potency tests. This is a critical stage in
standardization. We certainly cannot
ask our manufacturers to go out and recruit individuals to skin test with every
new lot of material that they develop.
Next
slide, please.
Now,
the surrogate tests that we are planning on evaluating are competition ELISA,
which is a technique that we use now, and we'll talk a little bit more about
the pros and cons of these different techniques in a few minutes.
It's
important to note that as part of the study, in addition to obtaining skin test
data from these individuals, we will be obtaining about 30 to 40 mL of serum
from each individual in the study. So,
we are going to have a substantial amount of serum to study and to compare to
the skin test data, and, hopefully, that will increase the power of our ability
to develop good surrogate tests.
We
are also going to be doing specific allergen testing, although as you know it
is not clear what the major or immunodominant allergens in German cockroach
are, but we will be doing some testing and, hopefully, again by correlating
these data with the skin test data we may be able to come to some biologically
meaningful conclusions. We are going to
talk more about the antibody microarray profiles in a few minutes. You should note as well that Doctor Sampson
at Mt. Sinai is going to be using the sera that we obtain in this study to look
at sensitized mass cell lines and look at whether that is an appropriate
surrogate measure as well.
Next
slide, please.
So,
in the next few slides, and in the first few slides of the next presentation,
I'm going to be using a cartoon method that I've used quite a bit over the last
few years. In this cartoon, I use
arrows as the antibody or the detector system, and I use the antigen, I use the
smiley face as the antigen and analyte.
Color is used to indicate some specificity, so just as an example, a red
arrow would be expected to be specific to a red smiley face.
Next
slide, please.
So,
the competition ELISA with pooled human allergic sera is really our workhorse
assay that we used for dust mite allergens and for grass pollen allergens in
the determination of their potency. The
advantage of it is that it is quantitative.
We have a great deal of experience with it. It reflects a broad spectrum of allergen recognition, and very
importantly it does not require identification of relevant allergens. So, when you are approaching a new allergen
to standardize, and you know very little about it, this is really our default
position. This is a good method that
works quite well in our hands, and has for many years.
The
disadvantage of it is that it uses pooled sera which is hard to replicate when
the serum runs out, and most importantly, and I'll discuss this in more detail
in the next presentation, the effects of fluctuations in individual allergens
is sometimes difficult to measure.
Again, I'll come back to that point shortly.
Next
slide, please.
Another
approach is the ELISA with monospecific antiserum. This is a standard ELISA technique, and it's an extension of the
radial immunodiffusion assay that we currently use. The advantage is that it's quantitative, it's monospecific, but
the disadvantage, of course, is you need to know which allergens are important.
Again,
as a consequence of this study, we may be able to do this, but you need to do
that before you can actually decide which allergens are important.
Next
slide, please.
Again,
the two-site ELISA with monoclonal antibodies, the advantages of this are that
it's highly specific. The disadvantage,
in fact, is that it's highly specific.
Again, you really need to know what you are measuring, and even with
this specificity there is sometimes some degree of cross reactivity, and you do
have to be cautious.
Next
slide, please.
And
finally, antibody microarray, which we'll talk about again in greater detail
later, the advantages are that it's quantitative, it does reflect a broad
spectrum of allergen recognition, it doesn't require identification of specific
relevant allergens. The disadvantage is
that it's a new technology, and the initial development is, in fact, labor
intensive and expensive, but we hope it's worth it.
Again,
I'm going to come back to that in just a couple of minutes. I want to wrap up
on the cockroach standardization specifically with the last slide, and that is
that standardized German and American cockroach allergen vaccine will
facilitate definitive studies on the role of cockroach allergens in inner city
asthma, and the best methods of eradication and treatment, and will make for
safer and more effective product.
Just
to clarify, we had intended and hoped to standardize American cockroach
allergen vaccines, it was the opinion of the Consortium that we ought to start,
at least, with German roach, which is probably more important pathogenically in
inner city asthma, and we are happy to do this in a stepwise manner.
That's
the end of the fourth presentation. I'm
going to come back to some of the ? a lot of
the issues that have to do with the assays themselves, but I really want to
stop here and see if there are any questions or comments about the clinical
studies, and then we'll go on and have a more thorough discussion of the
assays.
DOCTOR
NELSON: Jay, this is Hal Nelson.
What
do you know about the protease activity in this cockroach extract in 50 percent
glycerine? Is it inactivated, or are
they inactivated, or is there still proteolytic activity?
DOCTOR
SLATER: You know, it's a good question.
I'm not really sure. My guess is
that it's substantially inactivated. We
don't see evidence of ? I really
only have indirect evidence for this, Hal.
When we looked at the allergens that we used in our 2002 study, and we
looked at them over six months later, we really didn't see any substantial
difference. In fact, we went back and
replicated a large amount of our data, and really found that it was fairly
stable.
In
addition, E1Cg, which I haven't shown you any data on, is a glycerinated
extract. It was made, oh gosh, at least
ten years ago, it's potency and allergen content doesn't seem to have changed
much in that time.
My
guess is that ? well, you
know well that there is a substantial amount of protease activity in roach
extracts, but my guess is that the glycerol substantially inactivates it.
MR.
HAUCK: Jay, this is Peter Hauck.
On
slide 16, you talk about puncture sum of erythema equal to or greater than 30
millimeters. Maybe my memory is wrong,
but I think when we did the mite, and the cat, and the grasses, I think the
threshold was 40 millimeters. Did that
change?
DOCTOR
SLATER: Actually, you are wrong, but you are wrong in the wrong way. The original ? I'm sorry, you are right, but you are right in the wrong way, I'm
sorry. The original proposal encourages
us to look for individuals whose size of their screening test is 70
millimeters, but it provides for the possibility that that might be difficult
to try.
When
we looked at data from the mid-1990s, both in-house data and published data on
testing with German roach extracts, we decided that it was really unlikely that
we were going to be able to recruit individuals that had 50 to 70 millimeter
responses.
The
fact is, you can get fairly good data, even from less reactive individuals, and
we are interested in the most reactive individuals that we can get. But, based on both the clinical data from
the `90s, based on also our estimate of the allergen content, analogies with
existing allergens, responses that we can predict, we decided to go with a
lower cutoff.
The
danger of that is that our data may come in more heterogenous than what we
want, but our investigators were concerned that we were going to have
difficulty recruiting, and that's why we lowered it.
MR.
HAUCK: Okay.
DOCTOR
BERGER: Jay, it's Mel Berger.
Can
you just remind me what method is used now to standardize from lot to lot of
something like grass which is standardized?
DOCTOR
SLATER: Right, good question. The grass pollen allergen extracts were
standardized, they were standardized in the `90s on the basis of this ideal
testing.
DOCTOR
BERGER: Yes, but what's going from lot to lot now?
DOCTOR
SLATER: Yes, right, lot to lot we use the competition ELISA.
DOCTOR
BERGER: Okay.
DOCTOR
SLATER: Using a pooled human serum against grass pollens, with specific
references for each of the different standardized grass species. The exception to that is Bermuda grass,
which has its own serum pool.
DOCTOR
BERGER: Thanks.
DOCTOR
NELSON: Jay, Hal Nelson, just a quick question about slide number 19. What are the units, and are they all
measuring the same unit, or are these different units, particularly, with the
pooled rabbit sera and the, I guess, monoclonal antibody?
DOCTOR
SLATER: Okay. So, in bla g 1, 2 and 5,
bla g 1 and 5 are in arbitrary units that were defined by Martin Chapman in his
work at Indoor Biotech. Bla g 2 is in,
I believe, I'm not sure whether it's micrograms or nanograms per mil. I'm sorry
to say I'm not sure, but that is in mass unitage.
RPs
1, 2 and 3 are relative potencies.
Those are fractions relative to E2Cg.
What you see if you look on the E2Cg line is the statistical variation
inherent in this test. Normally, you
would expect E2Cg to be exactly one. In
fact, as our allergen manufacturers well know, even when you compare an extract
to itself, based on the number of tests you do, there will be a variation
around that mean of one, and that can be anywhere between .7 and 1.4.
DOCTOR
NELSON: Great, thanks.
ACTING
DIRECTOR BURKS: Any other questions for Jay?
DOCTOR
SLATER: Okay.
ACTING
DIRECTOR BURKS: Okay, Jay, do you want to go on to the next part?
DOCTOR
SLATER: Okay, terrific, thank you.
So,
we are now on our last presentation, and in that one I'm going to ? bear with me, because we are going to be at our
most speculative work that we are doing, but we are very hopeful that this will
help us introduce some new and very useful methods for measurement of potency
of complex allergen mixtures.
Slide
two, how do we measure potency? It
depends on the extract, and we've already touched on this a bit already. There are some extracts, specifically, the
hymenoptera extracts, in which we, basically, measure total protein. You are all aware that we measure the amount
of hyaluronidase and phospholipaes activity in these extracts, but the potency
itself is actually in mass unitage of total protein, and that's because it
correlates quite well with the actual allergenic potency.
For
other extracts, for the grass pollen extracts, there is a less close
correlation between total protein and potency.
On the other hand, we don't know exactly which allergens are the most
important, and, therefore, we've used the pooled human antibody to determine
overall allergenicity using the competition ELISA>
For
the allergen extracts cat and ragweed, in which a specific allergen has been
identified that's important, we measure that specific allergen. In this
particular case, we used sheep antibody, using the radial immunodiffusion assay
method, which is actually covered on the next slide.
Go
to slide number three.
The
RID method, using monospecific antiserum, is shown in this slide. Again, just to ? we are using a monospecific antibody, in this
case it's polyclonal, but it's an antibody directed towards only one of those
smiley faces in the lower right-hand corner.
It's a blue arrow aimed at the blue smiley face.
But,
the disadvantage of this approach, as we try to apply it to complex allergen
mixtures, is we really need to know beforehand what allergens are important.
Next
slide.
And
again, this is our workhorse method, this is the competition ELISA, using
pooled human allergic serum, and in this case we have multiple antibodies with
multiple specificities, looking at a complex allergen mixture.
But,
on the next slide we have the issue that dogs us about the competition
ELISA. It's true that the allergens
that we're measuring, the potency of the competition ELISA are ones in which we
really are not sure which proteins are most important, but surely you'll all
agree that the individual proteins probably are important, we just don't know
what they are.
The
question is, if we lost a single allergen in this complex mixture, would this
method be sensitive enough to detect the difference. And, in fact, when we have looked at this, Al Gamm in my
laboratory has specifically depleted cockroach allergens of bla g 1, 2 and 5,
and in our hands we have ? although
we've demonstrated using specific allergen measures that we've virtually
completely eliminated the specific allergens from these complex mixtures, we've
really been unable to detect this loss using the competition ELISA method.
Next
slide, please.
So,
the dilemma that we face with these potency measures is that, in order to
measure specific allergens we need to know which allergens are relevant, but on
the other hand if we measure overall allergenicity we are unable to detect the
absence of specific and potentially important allergens.
Next
slide, please.
So,
it seemed to us that there were two possible solutions to this problem. The idea here is that we need to use
multiple antibodies to look at multiple allergens, but we need to split the
signal that we get. The problem with
the competition ELISA is not the reagents that we use, but the fact that we
come out with a single signal at the end of the assay, and we need to figure
out a way to split the signal.
Now,
the next slide, you know, I'm sure you all thought immediately that one
specific way that scientists and investigators split the signal is by doing
Western Blots. You separate the
proteins out, you can see the smiley faces are now quite distinguished from
each other, and if you come at them even with the serum pool you can detect
which proteins are present and which are absent.
You
all know the advantages. You also know
the disadvantages. It's fundamentally a
qualitative method. We are continuing
to use pool sera that can be difficult to obtain and replace. There's no
definitive identification of allergens specifically, and again, there's
problems with cross reactivity, especially in allergens that contain proteases.
Next
slide, please.
So,
we wanted to look at this newer method, and this is antibody microarrays, and
this is where we split the signal, instead of splitting it by dividing up the
allergens, we are splitting it by dividing up the antibodies. It's a quantitative method. It reflects the full spectrum of allergen
recognition. It doesn't require
identification of relevant allergens, but again, it's a new technology and
that's the major disadvantage that we see so far.
Let's
go to the next slide. We are on slide
ten now.
Our
aims are to develop an antibody microarray method. We are profiling complex allergy mixtures, and our aim is also to
apply this technique to our current endeavor in standardizing German cockroach
allergen extract.
Next
slide, please.
I
just want to clarify what we are not talking about. We are not talking about allergen microarrays. You are all aware of really groundbreaking
work that has gone on for several years now of putting allergens, specific
allergens, cloned allergens, allergen epitopes, on microarrays, and using that
to study the specific IgE responses of humans.
That's not what we are doing here.
Next
slide.
What
we doing is, we are taking antibodies and putting them on the microarrays, and
this is a technique that's actually been well developed, largely for the
purpose of diagnostics, looking for specific antigens in the serum. One example is looking at prostate-specific
antigens, by putting specific antibodies on the microarray. But, it's not been applied to the
characterization of complex protein mixtures other than sera.
Next
slide, please.
So,
the idea here is, we have Nitrocellulose coated chips. We have an allergen mixture that we expose
to the coated chips. The chips actually
have clonal antibodies spotted onto them, and these clonal antibodies line to
the specific allergens in the mixture.
Next
slide.
To
do this technique, we do need clonal antibodies, and those can be generated by
the standard monoclonal antibody techniques, or we have preferred to switch
over to a new method that many of you, I'm sure, are familiar with, phage
display technology. In bare bones, the
technique involves hyperimmunizing animals, and we'll talk about the choice of
animals in a moment, taking ? extracting
RNA from the spleens and bone marrows of these hyperimmunized animals, using
RT-PCR to generate cDNA libraries with expression of antibody on phage
surfaces, using the technique of phage panning, which I'll cover in a few
minutes, to select for allergen specific cDNA, and then expressing the selected
antibodies in either E. coli or yeast.
Next
slide. We are now on slide 15.
The
advantage of phase display technology is that with a single experiment you can
theoretically clone the entire immunoglobulin repertoire of the animal, and you
can go back repeatedly and probe that repertoire to look for allergen
specificity of interest. You can
generate large quantities of allergen-specific antibodies that can, of course,
be used for structural studies, allergen purification, the definition of B-cell
epitopes, and again, what we are doing, the analysis of complex protein
mixtures by antibody microarray.
The
retrieved antibodies can be expressed in E. coli or yeast, and the use of
several different species to generate these libraries can mean the generation
of fragments with considerably different allergen specificities.
Next
slide, please.
Well,
which animals and why? Clearly, mice
have been the most constantly used going back for decades in the general of
monoclonal antibodies, but in the development stage mice provide fairly small
samples of serum, and most importantly for our purposes they have a large
number of variable region families, which means that the construction of
libraries using PCR involves multiple primer pairs and is very complex.
Rabbits,
on the other hand, provide large quantities of serum during the
hyperimmunization phase, and those sera, as you know, are very useful in
development, and they have a relatively smaller set of V-region families. That makes it simpler to do these
amplifications, and in addition they are a well-established model for
recombinant antibody generation.
We
focused on rabbits and chickens at this point in our studies, and the chickens
are very useful. They have been found
that others respond strongly to mammalian antigens that may generate weak
responses in some mammals. Examples, of
course, are cat and dog allergens, although you are all aware that it's not a
problem eliciting strong responses, but we could expect that birds might give a
stronger response.
A
technical point of interest is that they don't require bleeding. These chickens lay eggs almost every day,
and we can isolate milligram qualitites of IgY from the egg yolk using a
relatively simple technique.
And,
most importantly, the chicken genome encodes only two variable immunoglobulin
domains. This means a very small primer
set and a significant reduction of the serious problem of primer bias in
library construction.
Next
slide.
Just
a review of Fabs versus scFvs. ScFvs
are single chain fragment variable regions.
Fabs are the fragment antibody binding regions. You know the structures of these. There are technical advantages and
disadvantages of both, and it's our intention to develop both methods to have
both kinds of reagents as our reagents for these assays.
The
next few slides summarize the PCR methods that we are using. Basically, we isolate the RNA from the
spleens and the bone marrow of these animals after they have an established
immune response. We use standard Oligo
dT priming to do RT-PCR, generate the cDNA, then through a series of PCR
experiments we generate heavy chains and light chains.
Next
slide, please.
Finally,
constructing through an overlap PCR the product that you see in slide number
20, next slide, please, which is an overlap product that contains, in the case
of Fab both variable regions, both constant regions, and some cloning markers
at the ends.
Next
slide, please. We are now on slide 21.
Once
we've used PCR methods to develop our library, we then insert that library into
a vector, in this case we used a pCOMB3X vector, which generates an M13
filamentous phage. The phage expresses
on its surface the p3 code protein and if you place the gene fragments in the
right location on the end of that p3 code protein it will express the Fab or
the scFv that you've inserted ? that you've
encoded and inserted.
Next
slide, please.
And
here, you see how we use this expression on the surface of the phage to pan for
antibodies of interest. Remember, in
this experiment, and I'll show you more in the next few slides, we are actually
injecting the animals with multiple allergens at once. We extract the RNA and generate a library
that reflects the entire immunoglobulin repertoire, using specific
primers. We then insert this repertoire
into the phage, and now we get to some specificity.
On
the left side of the slide you see a phage with the specific scFv on its surface. We go to the upper panel, we then take that
phage, put it into wells that have been coated with the specific allergen or
allergens that we are interested in. We
can easily wash the unbound phage off the surface. The only phage that then remain are the phage that are specific
to the allergen of interest. We can use
trypsin, now we are going to the lower right-hand corner of your slide, to
release the phase. Notice that we leave
the antibody behind, but that doesn't matter.
What we are really after is the
gene that's in the phage. We take that
phage that's been cleaved, we infect E. coli, expand the phage overnight,
isolate the phage, and then start the cycle all over again.
Next
slide, please.
So,
what we are doing now in LIB with antibody phage display technology is, we are
trying to generate monospecific recombinant antibody fragments from rabbit and
chicken, and we are doing two lines of experiments concurrently. On the one hand, we are looking for
responses to allergens that we have pretty well characterized. We are looking for Fel d 1, Amb a 1, and the
full yellow jacket venom responses, but in addition we are generating antibody
fragments for the allergenic proteins of German and American roaches.
Next
slide, please.
Here's
a summary of the antibody animal libraries that we've built so far. On the left side you see the chicken
libraries, middle column the rabbit libraries, and on the right column the
allergens to which these animals were exposed.
Next
slide.
We
are focusing now on the C160 library.
This is a chicken library, in which the animal is a single animal, by
the way, was immunized with recombinant Fel d 1, with native Amb a 1, and with
whole yellow jacket venom.
Next
slide.
So,
what I'm going to show in the next few slides is the kinds of antibodies that
we could pull out of this single library, of this multi-immunized animal, using
appropriate panning techniques. When we
pan the C160 library with fel D 1, in other words, we put fel D 1 on the
surface of the plastic that we use for the panning experiment, you can see that
we develop scFv that's highly specific for fel D 1. In other words, we purified the scFv, we diluted it out, you see
multiple log 10 dilutions, and we tested that scFv against yellow jacket, fel D
1, and Amb a 1, and what you can see is that we had a very good response
against fel D 1 when we panned it this way, down to 10 to the -5 dilution, but
we really have no significant response to either Amb a 1 or yellow jacket
venom.
Next
slide, please.
Same
library, C160 library, and the same animal, but now we have panned with Amb a 1
on the panning surface, and you see here that we get a fairly specific response
to Amb a 1. At the highest
concentration, 10 to the -1 dilution, we do have a small signal from the ? with fel D 1, but really it doesn't last very
long, again, good titers, out to 10 to the -4 or 10 to the -5.
Next
slide, please.
And
finally, when we pan with yellow jacket venom, again, crude yellow jacket venom
material, we get a great deal of specificity for yellow jacket venom. Again, all from the same animal, same
library, multi-immunized, but panned in three different ways.
Next
slide, please.
And,
what you can see here is that the scFvs that we obtained are fairly specific on
Western Blot as well. There are four
panels in front of you. They all have
exactly the same proteins run on them.
In each panel, the leftmost lane has molecular weight markers, the next
lane has yellow jacket venom, the third lane has ragweed extract, not pure Amb
a 1, true ragweed extract, and the fourth lane, the rightmost lane, has cat
hair extract.
What
you can see when we stain with coomasjie blue, this is in the left panel, is
that again you see the markers perfectly well, the yellow jacket venom you see
a very prominent albumin band. We used
in this experiment, and certainly this was something that I'm revisiting, we
should have done otherwise, but we used a yellow jacket venom extract that
contained albumin, and you see that's really the prominent band on gel
staining.
However,
you can see, more faintly I hope, other bands as well in the yellow jacket
venom extract. Next lane over you see
the ragweed extract is quite complex, and finally the cat hair extract really
doesn't show any bands on coomasjie blue staining. This is not unusual for this technique.
What
you see in the next panel is that when we come back with the anti fel D 1 scFv,
you pick up a single band, just around 10 kD in the cat hair extract, and you
pick up some very faint bands in the other two, but not too much.
Likewise,
when you come back to the third panel with anti Amb a 1, you get a very nice
strong specific response to three bands in this complex ragweed mixture,
presumably, Amb a 1, isoforms and, perhaps, proteolytic components at the
bottom.
And
finally, with the anti yellow jacket venom, scFv, again, predominant response
to albumin, this is not a shock, but what was really reassuring is that we also
seem to have good responses to multiple other bands, even bands that were
visible in the coomasjie blue stained panel on the left.
Next
slide, please.
So,
our conclusion from this series of experiments is that we can raise chicken
antibodies against multiple allergens from a single immune library, panning
against multiple proteins at once can work effectively, antibodies raised
against recombinant fel D 1 appear to recognize native fel D 1. That's not a surprise, but it is reassuring
to see. We were very successful at
raising these chicken scFvs in E. coli and having them secrete, and we used the
HIS-TAG method to purify the scFv and we can use these scFvs effectively in
both ELISAS and in Western Blot.
Next
slide.
So
again, let's go back. We have multiple
other libraries that we're working with and are going to proceed with on a very
active basis, but I wanted to highlight in the next slide what we are going to
do with the microarray technology.
There are really basically two approaches to use. One is the simple array, in which we put the
scFv down on the plate, interact with the antigen, and then detect the antigen
using some other antibody, either Fabs or polyclonal antibodies.
Alternatively,
we could use the so-called dense array approach, in which the antigens are
actually flourifor labeled. That maybe
a direction in which we will go in the future, but at the moment we are really
trying to prove a concept with what we are going to call the simple array
technique.
Next
slide.
And,
let's just go over the experimental design of this simple array. The
experimental design here is to apply the scFv against either Amb a 1 or against
Fel d 1 onto the nitrocellulose slide, spot these on the slide, blot them with
ovalbumin and then incubate with either ragweed extract, or cat hair extract,
or negative control, which would just be ovalbumin.
We
would then come back and detect the bound antigens with rabbit polyvalent serum
R91. Remember, R91, like C160, was
exposed to Amb a 1 and Fel d 1 and yellow jacket venom, so it's a multivalent
reagent.
And
then, of course, detect the rabbit serum with an anti rabbit conjugate.
Next
slide, please.
So
again, just to review, we are using the specific scFvs that we derived from
C160 as our spots on the slide, but then detect ? we are using the crude polyvalent antiserum R91 that has been shown
reacts with multiple allergens, including Fel d 1 and Amb a 1.
Let's
look at the actual microarray. In the
next slide, you see three different slides.
They are all spotted the same way.
They were spotted in the top two rows with anti Amb a 1, the bottom two
rows with anti Fel d 1. The leftmost
one is then exposed with cat hair extract 1 to 20 dilution. The middle one exposed to ragweed 1 to 20,
and the right one to just 1 percent albumin.
They were then all exposed to the same R91 serum. You can see in the leftmost one that only
that Fel d 1 spots light up, in the middle one the ragweed spots light up, and
in the right one none of the spots light up.
So,
what we've been able to show in a very primitive and early way is that we are
able to use these scFvs to detect, and separate, and distinguish specific
allergens from each other.
Next
slide.
So,
our plan is to get considerably more complex at this point. What we want to do is, we want to develop a
quantifiable fingerprint of complex allergen mixtures using clonal allergen
specific scFvs and polyvalent sera.
Clearly,
what we need to do at this point is advance the more complex allergens, and
using the same reagents we can go forward and look at yellow jacket venom,
which is, obviously, considerably more complex. But, we are also looking to
develop microarrays to German roach and to American roach, and I can tell you,
without showing you the data at this point, that we've been very successful at
developing specific scFvs to German roach allergens.
How
are we going to assure that our arrays recognize diverse allergens or
epitopes? Well, we are going to use
Bst01 analysis. This is a restriction
enzyme, in which we can at least make sure that the gene products that were
isolated from the different clones are different, and we'll, of course, use
standard Western techniques to make sure that we are not just spotting the same
antibodies over and over again in multiple addresses on the microarray chip.
We'll
also be doing cluster analyses of the reactivity of allergens with the
different spots on the microarray chips, and, obviously, if by cluster analysis
we find that two, or three, or four, or five spots co-react 100 percent of the
time, we will no longer use all five.
We are looking for a diverse fingerprint of these allergen mixtures.
Next
slide.
The
key players in this work, which is exciting to us and very labor intensive,
Jonny Finlay was my Post Doc. He has
gone on to another position in Ireland at this point. Nicky deVore joined us over the summer, and she hit the ground
running, and she's going to be taking it forward over the next couple of years.
Thank
you very much, and I'll be happy to take questions on this presentation.
DOCTOR
BERGER: Jay, it's Mel Berger. Is there
any concern that the chicken may recognize a different epitope than humans
would?
DOCTOR
SLATER: Yes.
DOCTOR
BERGER: Do you have any plan to do something like taking a good single chain
sv, or a good serum and then do peptide mapping of the antigen?
DOCTOR
SLATER: Well, we certainly can, and I think it's going to be absolutely
irresistible to do that once we get the reagents. But, I think it's important to emphasize that one of the beauties
of this technique is that it can be very effective, and yet at the same time be
totally descriptive. In other words,
what we really need to do here, and our objective here, is to use these
fingerprints, which, again, we can quantify, and those techniques are out there
very clearly, to use these fingerprints as a way of profiling the
allergens. Toward that end, we really
don't need to know exactly what each spot of antibody recognizes.
DOCTOR
BERGER: I understand that, but it would be nice to have the reassurance that we
didn't miss a major human ? major
epitope that humans see.
DOCTOR
SLATER: I think that's absolutely right, and once we get to the stage with
roaches, with the roach extracts or any other extracts that we are studying,
where we actually know what we are looking for, then it's going to be critical
to go back and make sure that we're recognizing it. And, there's no doubt that we can do that.
DOCTOR
BERGER: That would be a nice sort of icing on the cake.
DOCTOR
SLATER: Thank you.
ACTING
DIRECTOR BURKS: Anybody else have questions for Jay? That was good.
DOCTOR
BERGER: And, it really is a tour de force.
UNIDENTIFIED
SPEAKER: Absolutely.
DOCTOR
SLATER: Thank you very much.
ACTING
DIRECTOR BURKS: Jay or Bill, do we have other things that we need to talk about
before we ask for any comments?
DOCTOR
FREAS: I believe we're ready to move into the open public hearing session of
this Advisory Committee meeting, with your permission, Doctor Burks.
ACTING
DIRECTOR BURKS: Yes.
DOCTOR
FREAS: And, let me just explain, this is a very important part of this Advisory
Committee meeting, in the fact that this is how FDA gives the public an
opportunity to participate in its Advisory Committee meetings. We welcome any member of the public to come
and ? come up here and ask
questions of either the presenters and/or the committee, and we're opening up
the microphone at this time.
Would
anyone like to address the committee?
Doctor
Burks, I do not see anyone, so at this time we're going to close the open
public hearing portion of this meeting, and see if there's any additional
committee discussion.
ACTING
DIRECTOR BURKS: Okay.
I
think for the most part what Jay and Ron have done today is to try and inform
us of what's been going on in their laboratories, both from a product and from
a research standpoint.
So,
does anybody have any other questions or comments that would be helpful to
them?
If
not, I think that really concludes our business.
Jay,
Bill, do you have anymore comments?
DOCTOR
FREAS: No, Doctor Burks, I want to thank you for helping us set up and plan for
this meeting, and for being the chair for the meeting, and I want to thank all
the committee members for giving us of their time, their comments. We do really appreciate your input as we
move forward with our research and regular duties.
ACTING
DIRECTOR BURKS: Okay, thank you, I think you did a really good job.
UNIDENTIFIED
SPEAKER: Jay, you did an excellent job, thank you.
UNIDENTIFIED
SPEAKER: Yes, thank you, Jay.
DOCTOR
SLATER: Thank you.
UNIDENTIFIED
SPEAKER: Okay, see you later.
UNIDENTIFIED
SPEAKER: Bye-bye.
ACTING
DIRECTOR BURKS: Bye.
(Whereupon,
the above-entitled matter was concluded at 2:55 p.m.)