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Muelepas, J.M., & Brenner, D.J., et al., Is there Unmeasured Indication Bias in Radiation — Related Cancer Risk Estimates from Studies of Computed Tomography?
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Murley, J.S., & Grdina, D.J., et al., Delayed radioprotection by nuclear transcription factor κB-mediated induction of manganese superoxide dismutase in human microvascular endothelial cells after exposure to the free radical scavenger WR1065;
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Grdina, D.J., Carnes, B.A., et al., Protection against Late Effects of Radiation by S-2-(3-Aminoprophylamino)-ethylphosphorothioic Acid;
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Grdina, D.J., Nagy, B., & Sigdestad, C.P., Radioprotectors in treatment therapy to reduce risk in secondary tumor induction
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Clark, S.J., Albertini, R.J., & Nicklas, J.A., HPRT mutations in human T-lymphocytes reflect radioprotective effects of the aminothiol, WR-1065;
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Grdina, D.J., Murley, J.S., and Kataoka, Y., Amifostine: mechanisms of action underlying ctoprotection and chemoprevention;
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Grdina, D.J., Ionizing Radiation;
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Dziegielewski, J., Murley, J.S., Grdina, D.J., et al., WR-1065, the active metabolite of amifostine, mitigates radiation-induced delayed genomic instability;
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Hofer, M., Falk, M. Komourkova, D., et al., Two New Faces of Amifostine: Protector from DNA Damage in Normal Cells and Inhibitor of DNA Repair in Cancer Cells;
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Oliai, C., & Yang, L., Radioprotectants to reduce the risk of radiation-induced carcinogenesis; and
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Boei, J., Vermeulen, S., Skubakova, M.M., et al., No threshold for the induction of chromosomal damage at clinically relevant low doses of X rays.
The Company has not had any direct conversations with the FDA regarding the 505(b)(2) pathway approval. The Company hired FDA consultants and GreenLeaf for them to guide us based on their experience working at the FDA and with amifostine and processing eight to ten similar 505(b)(2) submissions like ours every year.
Molecular Structure
Amifostine is an organic thiophosphate cytoprotective agent, 2-[(3-aminopropyl) amino] ethanethiol dihydrogen phosphate (ester), with an empirical formula of C5H15N2O3PS and a molecular weight of 214.22. The amifostine drug substance is a white crystalline powder which is freely soluble in water. Injectable amifostine is supplied as a sterile, lyophilized powder requiring reconstitution with 9.7 mL of sterile 0.9% Sodium Chloride Injection (known as “USP”). Each single-use vial contains 910 mg/m2 of amifostine on the anhydrous basis. The reconstituted solution (910 mg/m2 amifostine/10 mL USP) is chemically stable for up to 5 hours at room temperature (approximately 25°C) or up to 24 hours under refrigeration (2°C to 8°C).
The polyamine-like structure of amifostine was found to be capable of protecting against and repairing the DNA damaging effects of ionizing radiation (and subsequent mutations) by attaching to the DNA and protecting healthy cells from free radicals. While shielding individual DNA strands from further damage, the attached sulfhydryl group continues to scavenge nearby free radicals, in turn protecting and repairing other portions from harm while shielding a specific strand. The drug was subsequently declassified and developed for clinical use in the protection of dose limiting normal tissue in patients against the damaging effects of radiation and chemotherapy. Amifostine’s structure and properties give it the potential to participate in a range of cellular processes, making it an important and exciting radioprotectant and cytoprotectant.
Mechanism of Action — Amifostine as a Genomic Stabilizing Agent
The underlying mechanism of action driving amifostine’s cytoprotective properties is its ability to scavenge free radicals. However, amifostine’s effects on preventing genomic instability are mediated not simply through a free radical scavenging mechanism but rather through its polyamine-like properties that allow it to electrostatically bind to both mitochondrial and nuclear DNA resulting in modifications of