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TIP 2006 3 Vol 21 No3 p21-24 TGN1412 I NPO 3 13 15 [1,2] I TGN1412 18 40 1 ICU 19 6 4 3 [3] The Medicines and Healthcare Products Regulatory Agency MHRA [2] TGN1412 TGN1412 CD28-SuperMAB T TGN1412 T superagonistic anti-cd28 antibody ( CD28 CD28 superagonists) [4] B [5] TeGenero Immuno Therapeutics Boehringer-Ingelheim [6] 2005 EMEA [7] [4] [4] 1)superagonistic anti-cd28 mab T signal-1 (T cell antigen receptor T TCR) signal-2 (costimulation ) Signal-1 TCR APC MHC Major Histocompatibility complex :MHC CD28 [4] TCR in vitro TCR anti-tcr signal-1 CD28 T anergy [8] [4] signal-1 CD28 T ( ) anti-tcr T 2 IL-2 TGN1412 superagonistic anti-cd28 antibody anti-cd28 T IL-2 ( ) [4] TGN1412 superagonistic anti-cd28 antibody CD28 superagonists CD28 CD28 C D loop [4] CD28 2 [4] 1

2

2)B B-CLL [5] B B-CLL APC T TGN1412 CD28 superagonists CLL B APC T TGN1412 CLL [5] 3) T TGN1412 [5] TGN1412 T TCR T TGN1412 T IL-10 TGN1412 regulatory T cell ( T regulatory T cell T ) [5] 3

PAREXEL CRO Northwick Park Hospital [1] Raste Khan (23 ) Times Online [9] 5 3 4 40 Ryan Wilson (21 ) 3 [10,11] 20 12 [11] TGN1412 [11] PAREXEL TeGenero [1] 500 [11-13] Dr. David Glover( ) TGN1412 CD28 [11,14] [11] 2 MHRA I CD4 T CD8 T superagonistic anti-rat CD28 antibody JJ316 0.5mg/body/ [15] ( ) JJ316 JJ316 CD4 T T CD8 T T [3H] [16] CD4 T 120 CD8 T 30 T T in vitro [16] 1mg JJ316 1 CD4 T B superagonistic anti-cd28 antibody in vitro CD4 T CD8 T 1 - CD4 T B superagonistic anti-cd28 antibody T 4

Angus Dalgleish [12] The previous studies which caused similar severe side effects were in patients already suffering from cancer, but [the researchers] should have known they would get a meltdown because this drug was hitting exactly the same immune response pathways, 2005 5 American Society of Clinical Oncology ASCO) TGN1412 NCI Steven Rosenberg [12] T T T IL-2 T PAREXEL TeGenero 500 2 8 10 8 2 1 15 3 30 2 TGN1412 CD28 CD28 I MHRA MHRA I [17-19] NPO 2005 7 [20] ( 3 ) [21] 5

1. PAREXEL (2006-03-15). Media Advisory: PAREXEL International Statement Regarding TeGenero AG Phase I Trial at Northwick Park Hospital, U.K. http://www.parexel.com/news_and_events/press_releasessingle.asp?id=233 2. BBC News 1 2006.3.15 Six taken ill after drug trials http://news.bbc.co.uk/2/hi/uk_news/england/london/4807042.stm 3. Drugs trial men 'still improving' http://news.bbc.co.uk/2/hi/uk_news/england/london/4822574.stm 4. Beyersdorf N, Hanke T, Kerkau T, Hunig T. Superagonistic anti-cd28 antibodies: potent activators of regulatory T cells for the therapy of autoimmune diseases. Ann Rheum Dis. 2005 Nov;64 Suppl 4:iv91-5 5. TeGenero (2006-02-20). Drug Development. TeGenero. http://www.tegenero.com/research development/drug_development/index.php 6. TeGenero (2003-11-17). Boehringer Ingelheim and TeGenero sign agreement to develop and manufacture CD28- SuperMAB?. http://www.tegenero.com/documents/2003_11_tg005_pressrelease_e.pdf 7. TeGenero (2005-03-13). TeGenero AG receives EU-orphan drug designation for Humanized Agonistic Anti-CD28 Monoclonal Antibody TGN1412 for the treatment of B-cell Chronic Lymphocytic Leukaemia, B-CLL. http://www.tegenero.com/documents/pr_tegenero_march_11_2005.pdf 8. Wikipedia T helper cell http://en.wikipedia.org/wiki/helper_t_cell 9. Lister S., and Smith L. Doctors seek international help in treating victims March 17, 2006 http://www.timesonline.co.uk/article/0,,8122-2090146,00.html 10. Alex Peake,?"Ryan: Spare me this pain", The Sun, 2006-03-16. http://www.thesun.co.uk/article/0,,2-2006120430,00.html 11. TGN1412, Wikipedia, the free encyclopedia. http://en.wikipedia.org/wiki/tgn1412 12. TGN1412 round-up March 18th, 2006 http://blacktriangle.org/blog/ TGN1412 - American perspectives March 24th, 2006 http://blacktriangle.org/blog/ 13. Flemming N We're praying for them. 2006.3.17 http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/03/17/ntrial217.xml&ssheet=/news/2006/03/17/ixhome.h tml 14. "Protein differences may explain drug reaction", Reuters, Sun 19 March 2006 2:39 PM GMT6. http://www.newscientist.com/article/dn8863-catastrophic-immune-response-may-have-caused-drug-trial-horror.html 15. Rodriguez-Palmero M, Franch A, Castell M et al, Effective treatment of adjuvant arthritis with a stimulatory CD28- specific monoclonal antibody. J Rheumatol. 2006 Jan;33(1):110-8. 16. Tacke M, Hanke G, Hanke T, Hunig T. CD28-mediated induction of proliferation in resting T cells in vitro and in vivo without engagement of the T cell receptor: evidence for functionally distinct forms of CD28. Eur J Immunol. 1997 Jan; 27(1):239-47. 17. http://www.mhlw.go.jp/shingi/other.html#iyaku 18. http://search.egov.go.jp/servlet/public?classname=pcm1010&bid=495050107&objcd=&group= 19. PK/PD http://www.jssx.org/jp/pdf/dmpk21-1teigen.pdf 20. NPO a)tip 20(7) 82-84 2005 b No57(2005.07) http://www.npojip.org/sokuho/no57.pdf 21. NPO No64(2006.03) http://npojip.org/sokuho/060315.html 6

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