<p>CHS 828 is a cyanoguanidine with anti-tumour properties which has shown promising effects in several preclinical models. This thesis describes both preclinical and clinical studies aiming to investigate disease specific activity, clinical tolerability and efficacy of CHS 828.</p><p>In paper I we investigated CHS 828 activity in a cell line panel with human myeloma cells, three of these cell-lines were also tested in vivo using a hollow fibre rat-model. In paper II we investigated CHS 828 activity in primary human tumour samples from patients. CHS 828 showed an effect on all tumour cell types tested both the primary human tumour samples and the myeloma cell lines. Notably, CHS 828 showed a high relative in vitro activity against tumour cells from chronic lymphocytic leukaemia and high-grade lymphoma. </p><p>In a phase I trial we determined the maximum tolerated dose (MTD) of CHS 828. Haematological toxicity was generally mild and dominated by transient thrombocytopenia and lymphocytopenia. Non-haematological toxicity was mostly of gastrointestinal origin. The recommended phase two dose (RPTD) of CHS 828 was estimated to be 20 mg once daily for five days in cycles of 28 days duration.</p><p>In a phase II trial we investigated the effect of CHS 828 on patients diagnosed with B-CLL. In total 12 patients were enrolled. CHS 828 was found to be well tolerated and the most common haematological toxicity was thrombocytopenia. Non-haematological toxicities were generally mild. Transient decreases in lymphocyte counts could be discerned coinciding with drug dosing, but no sustained clinical responses could be achieved.</p><p>In conclusion, CHS 828 demonstrated marked effects in the preclinical investigations suggesting haematological malignancies as the main target. The clinical phase I study established a safe dose and the subsequent phase II trial in B-CLL patients showed biological effect but with no clinical disease response. </p>

CHS 828 is a cyanoguanidine with anti-tumour properties which has shown promising effects in several preclinical models. This thesis describes both preclinical and clinical studies aiming to investigate disease specific activity, clinical tolerability and efficacy of CHS 828. In paper I we investigated CHS 828 activity in a cell line panel with human myeloma cells, three of these cell-lines were also tested in vivo using a hollow fibre rat-model. In paper II we investigated CHS 828 activity in primary human tumour samples from patients. CHS 828 showed an effect on all tumour cell types tested both the primary human tumour samples and the myeloma cell lines. Notably, CHS 828 showed a high relative in vitro activity against tumour cells from chronic lymphocytic leukaemia and high-grade lymphoma. In a phase I trial we determined the maximum tolerated dose (MTD) of CHS 828. Haematological toxicity was generally mild and dominated by transient thrombocytopenia and lymphocytopenia. Non-haematological toxicity was mostly of gastrointestinal origin. The recommended phase two dose (RPTD) of CHS 828 was estimated to be 20 mg once daily for five days in cycles of 28 days duration. In a phase II trial we investigated the effect of CHS 828 on patients diagnosed with B-CLL. In total 12 patients were enrolled. CHS 828 was found to be well tolerated and the most common haematological toxicity was thrombocytopenia. Non-haematological toxicities were generally mild. Transient decreases in lymphocyte counts could be discerned coinciding with drug dosing, but no sustained clinical responses could be achieved. In conclusion, CHS 828 demonstrated marked effects in the preclinical investigations suggesting haematological malignancies as the main target. The clinical phase I study established a safe dose and the subsequent phase II trial in B-CLL patients showed biological effect but with no clinical disease response.

The market for drugs and treatments using biological products is rapidly growing. This is mainly due to the great potential that biological products have in comparison to traditional drugs. Biological products are composed of bigger molecules such as proteins and antibodies, and therefore allow a much more specific treatment. With the complexity of the molecules comes complexity in the upscaling of manufacturing. Start-up companies tend to lack knowledge of this process; consequently, outsourcing is often a requirement for the companies to grow. Outsourcing can be both risky and costly and the companies could benefit from having the skills in-house instead. This report provides information about needs, obstacles and driving forces regarding the future market for biological medicine and also outsourcing’s effect on the market. Desktop research was used to provide necessary information about the market and biological medicines, and also to find companies, research groups and investors that we mapped according to parameters, such as location and what field of medicine they engage in. Through phone and email contact, we gained further understanding about the actors we targeted. Desktop research and interviews were used to identify needs, obstacles and driving forces regarding the development of biological medicine. The result gives insight into where in Sweden the different candidates operate and it tells what pursuits and holdbacks they are facing when developing biological medicines. The major driving force is providing patients efficient treatments but also the opportunity to capitalise in a novel and successful type of industry. The major obstacle is first and foremost the great amount of money needed. Also, companies fail to grasp the many complex and time consuming steps in developing biological medicines. The interviews also showed that outsourcing is practically inevitable, especially for small companies, due to the difficulties of concentrating the competence in-house. In conclusion, the report shows that the benefits of biological medicine creates great driving forces for its development and that Sweden makes up a good climate for this. It also enlightens the importance of test beds to ensure that the future development relies on competence.

<p>Despite major advances in the understanding of the biology of chronic lymphocytic leukaemia (CLL), progress in improving its treatment has been limited and it still remains an incurable disorder. In the present research, we have performed <i>in vitro</i> drug sensitivity testing of primary CLL cells for preclinical evaluation of cytotoxic drugs, using the fluorometric microculture cytotoxicity assay (FMCA).</p><p>The tumour type-specific activities of 14 standard drugs, evaluated <i>in vitro</i> on tumour cells from patients with CLL and acute leukaemias, were in good agreement with their known clinical activities. A correlation between drug treatment and development of cellular drug resistance was demonstrated in CLL, but not in the acute leukaemias. Moreover, the nucleoside analogues fludarabine, cladribine, cytarabine and gemcitabine, as well as the anthracycline idarubicin, were highly active in CLL cells.</p><p>A new cytotoxic drug candidate, CHS 828, was evaluated in primary cell cultures from a broad spectrum of tumours. CHS 828 was highly active against haematological malignancies <i>in vitro</i>, especially CLL, but also against some solid tumours. The drug appeared to be non cross-resistant with standard drugs.</p><p>In addition, the relationship between drug sensitivity <i>in vitro</i> and a recently described prognostic factor in CLL, the mutational status of the immunoglobulin variable heavy chain (IgV_H) gene, was evaluated. Interestingly, cells with unmutated IgV_H genes were more chemosensitive than the mutated cells. </p><p>In summary, our results indicate that <i>in vitro</i> studies on tumour cellsfrom leukaemia patients may yield considerable information regarding the activity, mechanisms of action and cross-resistance of cytotoxic drugs, as well as concerning the relationship between drug sensitivity and prognostic factors, which can be useful in the preclinical evaluation of new cytotoxic drugs. Furthermore, the results suggest that the pyrimidine analogues cytarabine and gemcitabine, as well as the anthracycline idarubicin, may have a role in the treatment of CLL. The new cyanoguanidine CHS 828 is highly active in CLL cells and appears to be non cross-resistant with standard drugs. The poorer prognosis in patients with CLL cells with unmutated IgV_H genes can not be explained by increased chemoresistance.</p>

Despite major advances in the understanding of the biology of chronic lymphocytic leukaemia (CLL), progress in improving its treatment has been limited and it still remains an incurable disorder. In the present research, we have performed in vitro drug sensitivity testing of primary CLL cells for preclinical evaluation of cytotoxic drugs, using the fluorometric microculture cytotoxicity assay (FMCA). The tumour type-specific activities of 14 standard drugs, evaluated in vitro on tumour cells from patients with CLL and acute leukaemias, were in good agreement with their known clinical activities. A correlation between drug treatment and development of cellular drug resistance was demonstrated in CLL, but not in the acute leukaemias. Moreover, the nucleoside analogues fludarabine, cladribine, cytarabine and gemcitabine, as well as the anthracycline idarubicin, were highly active in CLL cells. A new cytotoxic drug candidate, CHS 828, was evaluated in primary cell cultures from a broad spectrum of tumours. CHS 828 was highly active against haematological malignancies in vitro, especially CLL, but also against some solid tumours. The drug appeared to be non cross-resistant with standard drugs. In addition, the relationship between drug sensitivity in vitro and a recently described prognostic factor in CLL, the mutational status of the immunoglobulin variable heavy chain (IgVH) gene, was evaluated. Interestingly, cells with unmutated IgVH genes were more chemosensitive than the mutated cells. In summary, our results indicate that in vitro studies on tumour cellsfrom leukaemia patients may yield considerable information regarding the activity, mechanisms of action and cross-resistance of cytotoxic drugs, as well as concerning the relationship between drug sensitivity and prognostic factors, which can be useful in the preclinical evaluation of new cytotoxic drugs. Furthermore, the results suggest that the pyrimidine analogues cytarabine and gemcitabine, as well as the anthracycline idarubicin, may have a role in the treatment of CLL. The new cyanoguanidine CHS 828 is highly active in CLL cells and appears to be non cross-resistant with standard drugs. The poorer prognosis in patients with CLL cells with unmutated IgVH genes can not be explained by increased chemoresistance.

In drug development, molecular docking methods aim at characterizing the binding of a drug-like molecule to a protein. In a typical drug development process, a docking task is repeated millions of time, which makes optimization efforts essential. In particular, modern heterogeneous architectures, such as GPUs, allow for significant acceleration opportunities. AutoDock-GPU, a state-of-the-art GPU-accelerated molecular docking software, estimates the geometrical conformation of a docked ligand-protein complex by minimizing an energy-based scoring function. Our profiling results indicated that a reduction operation, which is performed several millions times in a single docking run, limits performance in AutoDock-GPU. Thus, we proposed a method to accelerate the block-level sum reduction of four-element vectors by using matrix operations. We implemented our method to make use of the high throughput capabilities offered by NVIDIA Tensor Cores to perform matrix operations. We evaluated our approach by designing a simple benchmark, and achieved a 4 to 7-fold runtime improvement compared to the original method. We then integrated our reduction operation into AutoDock-GPU and evaluated it on multiple chemical complexes on three GPUs. This evaluation allowed to assess the possibility to use half-precision reduction operations in parts of AutoDock-GPU code, without detrimental effects on the simulation result. In addition, our implementation achieved an average 27% improvement on the overall docking time during a real-world docking run. / Vid läkemedelsutveckling syftar molekylär dockningsmetoder till att karakterisera bindningen av en läkemedelsliknande molekyl till ett protein. I en typisk läkemedelsutvecklingsprocess upprepas en dockinguppgift miljontals gånger, vilket gör optimeringsinsatser nödvändiga. Framför allt moderna heterogena arkitekturer som GPU:er ger betydande accelerationsmöjligheter. AutoDock-GPU, en modern GPU-accelererad programvara för molekylär dockning, uppskattar den geometriska konformationen hos ett ligand-protein-komplex genom att minimera en energibaserad poängsättningsfunktion. Våra profileringsresultat visade att en reduktionsoperation, som utförs flera miljoner gånger i en enda dockningskörning, begränsar prestandan i AutoDock-GPU. Vi har därför föreslagit en metod för att accelerera summareduktionen på blocknivå av vektorer med fyra element med hjälp av matrisoperationer. Vi implementerade vår metod för att utnyttja den höga genomströmningskapacitet som erbjuds av NVIDIA Tensor Cores för att utföra matrisoperationer. Vi utvärderade vårt tillvägagångssätt genom att utforma ett enkelt testfall och uppnådde en 4- till 7-faldig förbättring av körtiden jämfört med den ursprungliga metoden. Vi integrerade sedan vår reduktionsoperation i AutoDock-GPU och utvärderade den på flera kemiska komplex på tre GPU:er. Denna utvärdering lät oss bedöma möjligheten att använda reduktionsoperationer med halvprecision i delar av AutoDock-GPU-koden, utan negativa effekter på simuleringsresultatet. Dessutom uppnådde vår version en genomsnittlig förbättring på 27% av den totala dockningstiden under en riktig dockningskörning.