Intradermal substance P as a challenge agent in healthy individuals

Pharmacological challenge models are deployed to evaluate drug effects during clinical development. Intradermal injection of Substance P (SP) neuropeptide, a potential challenge agent for investigating local mediators, is associated with wheal and flare response mediated by the MRGPRX2 receptor. Alt...

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Bibliographic Details
Published in:	Clinical and translational science Vol. 16; no. 10; pp. 1856 - 1865
Main Authors:	Ten Voorde, Wouter, Akinseye, Chika, Abdisalaam, Ismahaan, Wind, Selinde, Klarenbeek, Naomi, Bergmans, Menthe, van Doorn, Martijn, Rissmann, Robert, Kaur, Rejbinder, Hotee, Sarah, Foster, Katie, Nair, Arati, Fortunato, Lea, Macphee, Colin, Mole, Sarah, Baumann, Katrine, Brigandi, Richard
Format:	Journal Article
Language:	English
Published:	United States John Wiley & Sons, Inc 01-10-2023 John Wiley and Sons Inc Wiley
Subjects:	Drug delivery Drug dosages Histamine Hypersensitivity Inflammatory diseases Microdialysis Skin Substance P Urticaria
Online Access:	Get full text
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Summary:	Pharmacological challenge models are deployed to evaluate drug effects during clinical development. Intradermal injection of Substance P (SP) neuropeptide, a potential challenge agent for investigating local mediators, is associated with wheal and flare response mediated by the MRGPRX2 receptor. Although dose-dependent data on SP effects exist, full characterization and information on potential carryover effect after repeated challenge are lacking. This open-label, two-part, prospective enabling study of SP intradermal challenge in healthy participants aimed to understand and distinguish between wheal and flare responses following various SP doses. Part 1 included one challenge visit to determine optimum SP dose range for evaluation in part 2, which determined variability in 20 participants and used intradermal microdialysis (IDM) for SP-challenged skin sampling. At 5, 15, 50, and 150 pmol doses, respectively, posterior median area under the curve (AUC; AUC ) was 4090.4, 5881.2, 8846.8, and 9212.8 mm /min, for wheal response, and 12020.9, 38154.3, 65470.6, and 67404.4 mm /min for flare response (SP-challenge visit 2). When the challenge was repeated ~2 weeks later, no carryover effect was observed. IDM histamine levels were relatively low, resulting in low confidence in the data to define temporal characteristics for histamine release following SP challenge. No safety concerns were identified using SP. Wheal and flare responses following intradermal SP challenge were dose-dependent and different. The results indicate that this challenge model is fit-for-purpose in future first-in-human studies and further assessment of novel drugs targeting dermal inflammatory disease responses, such as chronic spontaneous urticaria, chronic inducible urticaria, and pseudo-allergic reactions.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Clinical trial registration number: NCT04676763. These authors should be considered joint first authors.
ISSN:	1752-8054 1752-8062
DOI:	10.1111/cts.13592