Nonclinical evaluation of HS630, a proposed biosimilar of trastuzumab emtansine: affinity, pharmacokinetics, and immunogenicity

Objective: The aim of this study is to evaluate the similarity of affinity, pharmacokinetics, and immunogenicity shared by HS630 and trastuzumab emtansine (T-DM1).

Methods: In vitro, affinity was tested using a Biacore™ T200 apparatus. In vivo studies were conducted on tumor-bearing mice and cynomolgus monkeys in the context of different dosages and frequencies of administration. Double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to determine the concentration of total antibody (including naked antibody and antibody–drug conjugate (ADC)) and the ADC of HS630 and Kadcyla®. Furthermore, HPLC–MS/MS was used to determine the concentration of free DM1. The bridge ELISA method was performed to determine anti-drug antibody for immunogenicity analysis.

Results: In vitro, HS630 and Kadcyla® exhibited similar binding affinities for human epidermal growth factor receptor 2 (HER2), with K_D values of 6.372 E-11M and 9.424 E-11 M, respectively. After injecting 10 mg·kg⁻¹ of HS630 and Kadcyla® into tumor-bearing mice, the concentration of total antibody and ADC in serum reached its peak concentration at 5 min, and the concentration of total antibody reached its peak concentration at 24 h in the tumor. Meanwhile, in cynomolgus monkeys, the concentration of total antibody and ADC of HS630 exhibited non-linear pharmacokinetic characteristics following a single intravenous administration of HS630 at 0.33 mg·kg⁻¹, 1 mg·kg⁻¹, and 3 mg·kg⁻¹, respectively. No significant drug accumulation was observed after continuous intravenous administration of 3 mg·kg⁻¹ HS630. Biosimilarity evaluation showed that HS630 met the criteria for C_max and AUC(0-t) geometric mean ratios with Kadcyla® in the serum of tumor-bearing mice, as well as tumors and serum of cynomolgus monkey. No anti-drug antibody was detected in the serum samples obtained from cynomolgus monkeys after intravenous administration of HS630 and Kadcyla®.

Conclusion: HS630 and originator drug Kadcyla® exhibit pharmacokinetic similarity in tumor-bearing mice and cynomolgus monkeys following intravenous infusion. The comprehensive nonclinical evaluations of this study provide robust evidence for regulatory approval, in addition to addressing of key scientific and technical challenges in biosimilar development.

GRAPHICAL ABSTRACT

GRAPHICAL ABSTRACT |

1 Introduction

There is currently a remarkable surge in the incidence of malignant tumors in China with the increase in environmental pollution and life stress, accompanied by a distinctly younger onset (Zheng et al., 2022; Han et al., 2024). However, conventional chemotherapeutic drugs have poor targeting and strong toxic side effects, highlighting an urgent need to develop more targeted antitumor drugs (Juthani et al., 2024). The ideal drug should integrate both target-specific antibodies and small molecule drugs of excellent clinical efficacy—antibody–drug conjugate (ADC). The structure of ADC formulation consists of a monoclonal antibody (mAb) with a targeting effect linked to a compound with specific pharmacological properties, such as cytotoxic effects (Udofa et al., 2024). As of July 2025, 19 ADC drugs have been approved worldwide. However, in actual practice, it is a challenge to target the chemotherapeutic agent to tumor cells using an mAb. The mAb must be conjugated to a cytotoxin with therapeutic effect, and this binding must be sufficiently stable to ensure minimal release of the cytotoxic payload into the systemic circulation. In the case of destabilized binding, cytotoxin would be released and ultimately internalized by the target cells (Wang et al., 2023; Kumari et al., 2024). Moreover, the process of coupling a cytotoxin to an mAb may produce an ADC, which should maintain target recognition of the target after coupling (Colombo et al., 2024; Li et al., 2025). Simultaneously, in order to minimize batch-to-batch variability, it is critical to strictly control the amount of cytotoxin bound to each intact mAb, such as the drug-to-antibody ratio (DAR) and the level of unbound antibody. It is exceptionally complex to evaluate batch differences given that each of the three main components of ADC must meet stringent criteria (Ji et al., 2015; Bechtold-Peters et al., 2023; Li et al., 2024).

Trastuzumab emtansine (T-DM1) is an ADC developed by Roche, which consists of humanized mAb trastuzumab (also known as Herceptin) and a cytotoxic drug called maytansine derivative (DM1). It was approved by the US Food and Drug Administration (FDA) in 2013 for the treatment of advanced human epidermal growth factor receptor 2 (HER2, as known as ErbB2)-positive breast cancer. The schematic of T-DM1 is shown in Figure 1 (Lewis Phillips et al., 2008; Krop et al., 2010; von Arx et al., 2023). Trastuzumab can specifically target HER2 in breast and gastric cancer, while emtansine is a synthetic derivative of maytansine (a small molecule cytotoxin that binds to tubulin, preventing microtubule formation through a non-reduced bis-maleimide monopropylenediol conjugate). Trastuzumab was approved only for HER2-positive cancers and is not capable of precipitating apoptosis in all HER2-positive cells. In response to this issue, trastuzumab and emtansine were integrated into an ADC, resulting in a proportional binding of the antibody to the HER2 receptor that can induce cellular internalization of maytansine released from the conjugate, leading to the killing of tumor cells (Lambert and Chari, 2014). Both in vitro and in vivo studies revealed that, compared with trastuzumab, T-DM1 has better overall efficacy and pharmacokinetic properties and less toxicity. Clinical trials also suggested that the survival rate of patients treated with T-DM1 is higher than those treated with trastuzumab alone (Minckwitz et al., 2019; Geyer et al., 2025). Critically, HS630 is a proposed T-DM1 biosimilar under development by Zhejiang Hisun pharmaceutical industry.

Figure 1

Figure 1. Schematic of trastuzumab emtansine (T-DM1).

A biosimilar is a therapeutic biological product with demonstrably similar quality, safety, and efficacy to an approved originator drug (Schellekens et al., 2016; Perez et al., 2017). While regulatory agencies such as the FDA, National Medical Products Administration (NMPA), and World Health Organization (WHO) may vary in their descriptions of the similarity of biosimilars, the core concept of biosimilar similarity is a comprehensive assessment based on evidence chain from pharmaceutical, nonclinical, and clinical trials (Kurki et al., 2022; Kang et al., 2023). Quality similarity studies are integral to the entire development of biosimilars. They aim to ensure the consistency of the proposed biosimilar with the originator product in the structure, physical and chemical properties, purity and impurities, biological functions, immunological characteristics, biological activity, pharmacokinetics, pharmacodynamics, efficacy, safety, immunogenicity, and other attributes, as well as no clinical differences (Verrill et al., 2019; Mascarenhas-Melo et al., 2024; Monga et al., 2025).

Accordingly, this study was conducted to assess the similarity between HS630 and the original drug with respect to in vitro affinity, nonclinical pharmacokinetics, immunogenicity, and distribution in target tissues.

2 Materials and methods

2.1 Reagents

The study drug: HS630 (recombinant anti-HER2 humanized mAb conjugated to maytansine derivative DM1 for injection), obtained from Zhejiang Hisun Pharmaceutical Co., Ltd., lot no.: 20131101, specification: 100 mg, sterile powder for injection, stored at 5 °C ± 3 °C. Control drug: Kadcyla® (Trastuzumab emtansine, T-DM1), manufactured by Roche and provided by Zhejiang Hisun Pharmaceutical Co., Ltd., lot no.: 566313, specification: 100 mg/vial, sterile powder for injection, stored at 5 °C ± 3 °C. DM1 standard, lot no.: S140101, white powder, 99.3% purity, Zhejiang Hisun Pharmaceutical Co., Ltd. Internal standard: Maytansinol, lot no.: S131102, white powder, >93% purity, Zhejiang Hisun Pharmaceutical Co., Ltd. All were stored at −20 °C ± 5 °C in the dark. Anti-DM1 antibody: Zhejiang Hisun Pharmaceutical Co., Ltd., concentration: 4 mg·mL⁻¹, stored at −80 °C. Recombinant human ErbB2 (also known as HER2): Sino Biological Inc., catalog: 100040-H08H, lot no.: LC08SE2313, stored at −20 °C. Biotin Labeling Kit-NH2: Dojindo Molecular Technologies. Inc. Corp., lot no.: FN744, goat anti-human IgG-heavy and light chain monkey-adsorbed antibody HRP-conjugated: Bethyl Laboratories, Inc., catalog: A80-319P, lot no.: A80-319P-15, stored at 2 °C–8 °C. TMB single component color development solution: Beijing Solai Bao Technology Co., Ltd., catalog: PR1200; lot no.: 20140625.

2.2 Animals

This study involved thirty cynomolgus monkeys (laboratory animal qualifying number 45001200000032), obtained from Guangxi Guidong Primate Development Experiment Co., Ltd. (experimental animal production license number SCXK (GUI) 2011-0001) (both sexes, weighing 3.2 ± 0.4 kg). All experimental monkeys were fed in separate cages with free access to water and fresh fruit twice daily in good feeding condition. Female BALB/cA-nude mice (5–6 weeks old, SPF-grade) were purchased from Shanghai Lingchang Biotech Co. Ltd. (experimental animal production license number: SCXK (Hu)2013-0018; laboratory animal qualifying number: 2013001801695; weighing 15–20 g). Animal welfare and experimental procedures and related ethical regulations were carried out strictly in accordance with the Guide for the Care and Use of Laboratory Animals.

2.3 Affinity studies in vitro

The experiments were conducted using a Biacore™ T200 apparatus (GE Healthcare Life Sciences, Uppsala, Sweden) on Sensor Chip CM5 (Biacore™) at 25 °C. The active and reference surfaces were the flow cell (Fc2) bound to HS630 and Kadcyla® and the flow cell (Fc2) not bound to HS630 and Kadcyla®, respectively. HBS-EP + buffer solution was used as the mobile phase to achieve similar response values for the next test, with 3 M MgCl₂ as the regeneration solution. After testing, all samples were finally bound to the active surfaces at 333 ng·mL⁻¹. Then, different concentrations of HER2 solutions, diluted by a factor of running buffer based on the surface test, to formulate standards with HER2 concentration gradients of 10, 5, 2.5, 1.25, 0.625, and 0 nM at different concentration, were injected through both active and reference surfaces. Finally, the sample were injected at a flow rate of 30 µL·min⁻¹ with 3 min association time and 30 min dissociation time.

2.4 Precision and accuracy verification by bioanalysis

ADC and total antibody concentrations in serum samples were quantified using methodologically validated enzyme-linked immunosorbent assay (ELISA). The small molecule fraction was detected using an LC–MS/MS method. Immunogenicity analysis was performed by the bridge ELISA method. According to the methodological reliability test, the established HPLC–MS/MS for the DM1 concentration determination in monkey and mice serum exhibited high specificity, sensitivity, precision, and stability, meeting the requirements of pharmacokinetic study.

2.5 Pharmacokinetics and tissue distribution in tumor-bearing mice

Following subcutaneous inoculation of BT-474/T721 cells, BALB/cA-nude mice were randomly divided into groups when the tumor volume reached 300–400 mm³. The experiment design is shown in Table 1. There were three single intravenous administration HS630 groups (10 mg·kg⁻¹) and three single intravenous administration Kadcyla® groups (10 mg·kg⁻¹). Serum and tumor samples of mice were collected at 0.083 h, 4 h, 24 h, 48 h, 72 h, 96 h, and 168 h post-dose, respectively.

Table 1

Table 1. Animal grouping and sample collection design.

2.6 In vivo pharmacokinetics and immunogenicity in cynomolgus monkeys

In this experiment, six cynomolgus monkeys (half male and half female) were assigned to each dose group, with corresponding animal numbers shown in Figure 2. This involved three single intravenous administration HS630 groups (0.33, 1, and 3 mg·kg⁻¹), one continuous intravenous administration HS630 group (3 mg·kg⁻¹), and one single intravenous administration control Kadcyla® group (3 mg·kg⁻¹). For the single intravenous administration groups of HS630 and the control Kadcyla® group, cynomolgus monkey serum was collected at 0 h pre-dose and 0.5 h, 4 h, 8 h, 24 h, 48 h, 72 h, 96 h, 120 h, 168 h, 240 h, 336 h, and 504 h post-dose. For the continuous intravenous administration HS630 group, serum was collected from cynomolgus monkeys 0 h before drug administration, 0.5 h after the first dose, 4 h, 8 h, 24 h, 48 h, 72 h, 96 h, 120 h, 168 h, and 336 h before the second dose, 0.5 h after the second dose and before the third dose, 0.5 h after the third dose and before the fourth dose, and 0.5 h, 4 h, 8 h, 24 h, 48 h, 72 h, 96 h, 120 h, 168 h, 336 h, 504 h, 672 h, 840 h, and 1,008 h after the fourth dose.

Figure 2

Figure 2. Dose design and grouping.

2.7 Establishment and validation of the analytical method

2.7.1 Establishment and validation of the ELISA method for ADC

In this method, the ADC was quantified by double-antibody sandwich ELISA. The anti-DM1 mAb was coated on a 96-well plate as the primary antibody, with the addition of a series of concentrations of standard solution or diluted serum samples. The ADC in the standard solution or serum would specifically bind to the primary antibody, followed by supplementation of the diluted goat anti-human IgG-HRP (secondary antibody) adsorbed by monkey serum. The secondary antibody specifically bound to the ADC, which bound to the primary antibody. The next step was the addition of the substrate chromogenic agent. Finally, it was terminated with stop solution sulfuric acid, after which optical density (OD) values were detected using a microplate reader within a wavelength range of 450 nm–560 nm. The depth of color was proportional to the concentration of the ADC in the sample.

2.7.2 Establishment and validation of the ELISA method for total antibody

In this method, total antibody was quantified using the double-antibody sandwich ELISA. Recombinant human HER2 was used as the primary antibody to coat the 96-well plate, followed by the addition of a series concentration of standard solution or diluted serum samples. The total antibody in the standard solution or serum would specifically bind to the primary antibody, after which the diluted goat anti-human IgG-HRP (secondary antibody) adsorbed by monkey serum was added. The secondary antibody specifically bound to the total antibody, which bound to the primary antibody, with the addition of the substrate chromogenic agent subsequently. Finally, it was terminated with stop solution sulfuric acid, and the OD values were detected using a microplate reader within 450 nm–560 nm. The depth of color was proportional to the concentration of total antibody in the sample.

2.7.3 Validation of HPLC–MS/MS for detecting DM1

HPLC–MS/MS was used to determine the concentration of free DM1 in the serum of cynomolgus monkeys, combined with an investigation of the distribution characteristics of DM1 in cynomolgus monkey after intravenous administration of HS630 and Kadcyla® at different doses for injection. Consequently, the specificity, sensitivity, precision, and stability of the established HPLC–MS/MS met the requirements for pharmacokinetic studies.

2.8 Establishment of the ELISA for the anti-HS630 antibody

2.8.1 DM1-positive determination by screening bridge ELISA

Based on the cut-off value, samples were determined to be negative (below cut-off) or positive (above cut-off). A bridge ELISA assay was performed on the serum samples of 60 healthy normal cynomolgus monkeys, which were assayed three times in parallel. The cut-off value was calculated as the average of serum samples from each batch of negative samples plus thrice the standard deviation. Finally, the average of the three batches of critical values for this test was calculated to determine the negative or positive result.

2.8.2 ELISA

The concentration of anti-HS630 antibody in serum was investigated by the ELISA. The test sample and negative controls were added after coating a 96-well plate with the HS630. Then, the HS630 was detected by biotin labelled, followed by signal amplification through the addition of Hrp–strep, with the recording of the absorbance values at 450 nm–560 nm. Samples with OD above the cut-off value were considered positive.

2.8.3 Corroboration: immune clearance

The serum samples, which were determined to be positive by the bridge ELISA, were further confirmed for the presence of monkey anti-HS630 antibody by immune clearance.

1. Principle of the assay. Excess HS630 was added in serum samples which tested positive. The excess HS630 would compete with the coated HS630 for binding to monkey anti-HS630 antibody when the sample contained monkey anti-HS630 antibody. The bound antibody would be removed from the liquid phase of this fraction during the wash process, ultimately resulting in a reduced signal value.

2. Test methods. Serum samples from each time point of collecting serum samples that tested positive by the screening method were subjected to an immune clearance test. The samples contained anti-HS630 antibody and were judged to be positive when the signal values were significantly reduced in the control group compared to the group without and with the addition of HS630 (p < 0.05). False positives were judged if there was no significant difference in the signal values (p > 0.05) and if the positive result was likely due to non-specific binding of the serum matrix.

3 Results

3.1 Affinity studies in vitro

Surface plasmon resonance (SPR) signals were acquired and saved using Biacore™ T200 control software. Each concentration of a subject injected onto a flow cell (FC2) incorporating HS630 and Kadcyla® was corrected by subtracting the corresponding reference flow cell (FC1) profile. Simultaneously, a 1:1 binding kinetics model was used for curve fitting to most appropriately describe the reaction kinetics and calculate the K_a, K_d, and K_D values. The binding signal response value at the end of the experiment was similar to that at its beginning. Therefore, the receptor binding was stable and multiple regenerations produced no impact on the binding ability to the ligand, supporting its repeated utilization after activation. Figures 3, 4 show the fitted curves (black lines) for the binding kinetics curves (colored lines) of HER2 with HS630 and Kadcyla® after treatment with 1:1 binding model, respectively. The kinetic parameters obtained are listed in Table 2. The K_D values of HS630 and Kadcyla® for HER2 were 6.372 E-11M and 9.424 E-11 M, respectively.

Figure 3

Figure 3. Binding kinetic curves of HS630 to HER2.

Figure 4

Figure 4. Binding kinetic curves of Kadcyla® to HER2.

Table 2

Table 2. Affinity constants of HER2 with HS630 and Kadcyla^®.

3.2 Bioanalysis

The linear range of HS630 ELISA was 1.5625–100 ng·mL⁻¹, and the recovery of LOQ (1.5625 ng·mL⁻¹) was evaluated as intra-assay CV% <20% (4.47%). Intra-assay precision was 7.77%, 5.74%, and 7.16%, and intra-assay accuracy was +1.08%, +3.67%, and +2.13% for the high, medium, and low concentrations, respectively. Inter-assay precision was 8.06%, 5.40%, and 8.68%, and inter-assay accuracy was −3.61%, +1.66%, and −5.88% for the high, medium, and low concentrations, respectively. This method had excellent specificity without cross-reactivity of trastuzumab, bevacizumab, adalimumab, or infliximab. HS630 revealed no altered stability after storage in serum at −80 °C (after three freeze/thaw cycles), room temperature for 4 h, 4 °C for 4 h, and −80 °C for 40 and 100 days, but its stability could not be ensured following long-term storage at −80 °C for 160 days. Therefore, sample testing was completed before 160 days of storage. In addition, 12,500-, 62,500-, and 500,000-fold dilutions also produced no effect on sample detection. The methodological validation showed that the specificity, precision, and accuracy of the ELISA method for measuring HS630 concentrations in monkey serum fulfilled the requirements of pharmacokinetic studies. Supplementary Appendixes 1–3 summarize the method validation of ELISA and HPLC–MS/MS.

3.3 Pharmacokinetics and tissue distribution in tumor-bearing mice

In this experiment, 10 mg·kg⁻¹ HS630 and Kadcyla® were injected via the tail vein into tumor-bearing mice. Consequently, in serum, the peak concentration C_max of total antibody was 292.038 μg·mL⁻¹ and 307.519 μg·mL⁻¹, respectively; time to peak concentration T_max was 0.083 h; AUC_(0–t) was 12288.120 h·μg·mL⁻¹ and 13934.246 h·μg·mL⁻¹, respectively; AUC_(0–inf) was 12543.592 h·μg·mL⁻¹ and 14185.157 h·μg·mL⁻¹, respectively; apparent distribution volume (V_SS) was 37.549 mL·kg⁻¹ and 33.005 mL·kg⁻¹, respectively; clearance (CL) was 0.797 mL·h⁻¹·kg⁻¹ and 0.705 mL·h⁻¹·kg⁻¹, respectively; terminal elimination half-life (T_1/2) was 31.076 h and 30.130 h, respectively; and mean residence time (MRT) was 47.113 h and 46.816 h, respectively. WinNonlin was used for biosimilarity evaluation. The serum concentration–time curve is shown in Figure 5, and the pharmacokinetics parameters are shown in Table 3. HS630 showed the same trend as Kadcyla®. Simultaneously, ADC C_max was 149.962 μg·mL⁻¹ and 159.041 μg·mL⁻¹; T_max was 0.083 h; AUC_(0–t) was 6,517.445 h·μg·mL⁻¹ and 8,129.677 h·μg·mL⁻¹; AUC_(0–inf) was 16613.594 μg·mL⁻¹ and 8,264.784 h·μg·mL⁻¹; V_SS was 63.330 mL·kg⁻¹ and 49.800 mL·kg⁻¹; CL was 1.512 mL·h⁻¹·kg⁻¹ and 1.210 mL·h⁻¹·kg⁻¹; T_1/2 was 27.610 h and 27.944 h; and MRT was 41.885 h and 41.157 h, respectively. The serum concentration–time curve is presented in Figure 6, and the pharmacokinetics parameters are listed in Table 4. HS630 showed the same trend as Kadcyla®.

Figure 5

Figure 5. Comparison of total antibody (including naked antibody and ADC) concentration in serum after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® in tumor-bearing mice (n = 3).

Table 3

Table 3. Comparison of total antibody (including naked antibody and ADC) parameters in serum of tumor-bearing mice after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla^®.

Figure 6

Figure 6. Comparison of ADC in the serum of tumor-bearing mice after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® (n = 3).

Table 4

Table 4. Comparison of ADC parameters in the serum of tumor-bearing mice after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla^®.

After the tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® in tumor-bearing mice, in the tumors, C_max was 1.170 μg·g^-1 and 1.187 μg·g^-1; AUC_(0–t) was 98.692 h·μg·g^-1 and 97.536 h·μg·g^-1; AUC_(0–inf) was 112.438 h·μg·g^-1 and 113.429 h·μg·g^-1; V_SS was 5,471.822 g·kg⁻¹ and 5,569.924 g·kg⁻¹; CL was 88.938 g·h⁻¹·kg⁻¹ and 88.161 g·h⁻¹·kg⁻¹; T_1/2 was 53.721 h and 55.887 h; and MRT was 61.524 h and 63.179 h, respectively. The tumor concentration–time curve is depicted in Figure 7, and the parameters of total antibody concentration of HS630 and Kadcyla® in the tumors are provided in Table 5. The trend of HS630 was consistent with that of Kadcyla®.

Figure 7

Figure 7. Comparison of total antibody (including naked antibody and ADC) concentration in tumor after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® in tumor-bearing mice (n = 3).

Table 5

Table 5. Comparison of total antibody (including naked antibodies and ADC) parameters in tumor after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla^® in tumor-bearing mice.

In addition, irregular ADC data in tumors of tumor-bearing mice at each time point after tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® were observed. Owing to the detection method, there was no trend on peak increasing or decreasing. The anti-DM1 antibody was used as the coating primary antibody to detect ADC, which was connected with the DM1 part of ADC, while goat anti-human IgG-HRP adsorbed by HRP-labeled monkey serum was used as the secondary antibody. The secondary antibody for detection was connected with the macromolecular antibody part of the ADC, but the ADC cannot be detected, given that the link bond between the macromolecule and DM1 was broken in the tumors. The specific data of each sample is summarized in Supplementary Appendix 4.

3.4 In vivo pharmacokinetics in cynomolgus monkeys

3.4.1 Pharmacokinetic parameters of the ADC after a single intravenous infusion of HS630 at different doses in cynomolgus monkeys

Figure 8 shows the concentration of ADC in the serum of cynomolgus monkeys after a single intravenous infusion of 0.33 mg·kg⁻¹, 1 mg·kg⁻¹, and 3 mg·kg⁻¹ HS630; Table 6 describes the ADC pharmacokinetic parameters of HS630 at these doses. The post-administration T_1/2 were 121.81 ± 4.71 h, 74.05 ± 5.63 h, and 101.68 ± 8.05 h, respectively, while AUC_(0–504 h) were 235.74 ± 23.47 μg·h·mL⁻¹, 1,573.49 ± 139.77 μg·h·mL⁻¹ and 5,712.66 ± 528.5 μg·h·mL⁻¹, respectively, showing statistically significant differences among the groups (p < 0.01). CL was 1.39 ± 0.13 mL·kg⁻¹·h⁻¹, 0.64 ± 0.06 mL·kg⁻¹·h⁻¹, and 0.51 ± 0.05 mL·kg⁻¹·h⁻¹, respectively. T_max was all at 0.5 h after administration, and C_max was 7.37 ± 1.04 μg·mL⁻¹, 38.56 ± 3.61 μg·mL⁻¹, and 93.56 ± 14.21 μg·mL⁻¹, respectively. The dose ratio was 1:3:9, the ratio of AUC_(0–504 h) was 1:6.67: 24.23, and the ratio of C_max was 1:5.23: 12.69. Therefore, HS630 exhibited non-linear pharmacokinetic characteristics in cynomolgus monkeys, within a dose range of 0.33∼3 mg·kg⁻¹.

Figure 8

Figure 8. ADC serum concentration–time curves of HS630 after single intravenous infusion at different doses in cynomolgus monkeys.

Table 6

Table 6. Pharmacokinetic parameters of ADC after single intravenous infusion at different doses of HS630 in cynomolgus monkeys.

3.4.2 Pharmacokinetic parameters of the ADC after continuous intravenous administrations of high-dose HS630 in cynomolgus monkeys

The ADC concentration–time curve at administration is shown in Figure 9. Table 7 indicates the ADC pharmacokinetic parameters calculated after the first and last administration of HS630 3 mg·kg⁻¹. There was no statistically significant difference in the comparison of AUC_(0–504 h) and C_max between the first and last doses, with an accumulation factor of 1.04 ± 0.20. The serum concentration of ADC in the first and last doses is summarized for comparison in Table 8.

Figure 9

Figure 9. ADC serum concentration time curves of HS630 3 mg·kg⁻¹ after continuous intravenous infusion in cynomolgus monkeys.

Table 7

Table 7. Comparison of ADC pharmacokinetic parameters between the first and last doses after continuous intravenous infusion of HS630 3 mg·kg⁻¹ in cynomolgus monkeys.

Table 8

Table 8. Comparison of ADC serum concentration between the first and last doses after continuous intravenous infusion of HS630 3 mg·kg⁻¹ in cynomolgus monkeys (n = 6).

3.4.3 Comparison of ADC pharmacokinetic parameters after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla® in cynomolgus monkeys

Figure 10 presents the results for comparing the ADC concentration–time curve in pharmacokinetics between HS630 and control drugs of the same dose, showing almost complete coincidence in the two curves. Table 9 reveals the pharmacokinetic parameters after a 3 mg·kg⁻¹ single intravenous infusion of the control drug Kadcyla® in cynomolgus monkeys. The post-administration T_max of ADC was also 0.5 h, followed by a slower elimination with a detectable serum drug concentration of 504 h. T_1/2 after a single administration of the 3 mg·kg⁻¹ HS630 and Kadcyla® were 101.68 ± 8.05 h and 107.78 ± 5.99 h; AUC_(0–504 h) was 5,712.66 ± 528.5 μg·h·mL⁻¹ and 6,007.31 ± 954.41 μg·h·mL⁻¹; CL was 0.51 ± 0.05 mL·kg⁻¹·h⁻¹ and 0.49 ± 0.07 mL·kg⁻¹·h⁻¹; and C_max was 93.56 ± 14.21 μg·mL⁻¹ and 88.50 ± 17.43 μg·mL⁻¹, respectively. WinNonlin was used for biosimilarity assessment HS630 and Kadcyla®. The 90% confidence intervals (CIs) of the geometric mean ratio of C_max and AUC_(0–t) were 109.15% and 97.51%, respectively.

Figure 10

Figure 10. Comparison of ADC serum concentration–time curves after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla® in cynomolgus monkeys.

Table 9

Table 9. Comparison of ADC pharmacokinetic parameters after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla^® in cynomolgus monkeys.

3.4.4 Pharmacokinetic parameters of total antibody after single intravenous infusion of different doses of HS630 in cynomolgus monkeys

The concentrations of total antibody in the serum of cynomolgus monkeys after a single intravenous infusion of HS630 0.33 mg·kg⁻¹, 1 mg·kg⁻¹, and 3 mg·kg⁻¹ is shown in Figure 11. Table 10 summarizes the total antibody pharmacokinetic parameters of HS630 at these doses. The peak times were all at 0.5 h after administration, followed by slower elimination, and the serum drug concentrations were detectable up to 504 h for all three doses. Terminal phase half-lives T_1/2 were 87.12 ± 3.79 h, 100.55 ± 10.11 h, and 97.08 ± 8.29 h, respectively. AUC_(0–504 h) was 276.24 ± 19.08 μg·h·mL⁻¹, 1781.05 ± 156.35 μg·h·mL⁻¹, and 7,770.31 ± 514.83 μg·h·mL⁻¹, respectively, revealing statistically significant differences among the three groups (p < 0.01). CL was 1.19 ± 0.08 mL·kg⁻¹·h⁻¹, 0.56 ± 0.05 mL·kg⁻¹·h⁻¹, and 0.38 ± 0.02 mL·kg⁻¹·h⁻¹, respectively. T_max was all at 0.5 h after administration, and C_max was 8.45 ± 1.63 μg·mL⁻¹, 43.25 ± 2.88 μg·mL⁻¹, and 142.80 ± 19.21 μg·mL⁻¹, respectively.

Figure 11

Figure 11. Total antibody serum concentration–time curves of HS630 after single intravenous infusion at different doses in cynomolgus monkeys.

Table 10

Table 10. Pharmacokinetic parameters of total antibody after single intravenous infusion of different doses of HS630 in cynomolgus monkeys.

3.4.5 Pharmacokinetic parameters of total antibody after continuous intravenous administrations of high-dose HS630 in cynomolgus monkeys

The total antibody concentration–time curve is plotted in Figure 12 in cynomolgus monkeys after continuous intravenous infusion of 3 mg·kg⁻¹ HS630. Table 11 shows the total antibody pharmacokinetic parameters calculated after the first and last administration. The AUC _(0–504 h) and C_max of total antibody exhibited no statistically significant difference in the comparison between the first and last doses, and the accumulation factor was 1.22 ± 0.18. The concentrations of total antibody in serum at the first and last doses are summarized in Table 12.

Figure 12

Figure 12. Total antibody serum concentration–time curves of HS630 3 mg·kg⁻¹ after continuous intravenous infusion in cynomolgus monkeys.

Table 11

Table 11. Comparison of total antibody pharmacokinetic parameters between the first and last doses after continuous intravenous infusion of 3 mg·kg⁻¹ HS630 in cynomolgus monkeys.

Table 12

Table 12. Comparison of the total antibody serum concentration between the first and last doses after continuous intravenous infusion of HS630 3 mg·kg⁻¹ in cynomolgus monkeys (n = 6).

3.4.6 Comparison of total antibody pharmacokinetic parameters after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla® in cynomolgus monkeys

The comparison of total antibody concentration–time curve in serum concentration between HS630 and control drugs at the same dose is shown in Figure 13 and Table 13. Table 14 is the total antibody pharmacokinetic parameters after a 3 mg·kg⁻¹ single intravenous infusion of the control drug Kadcyla® in cynomolgus monkeys. T_max of total antibodies was also 0.5 h after administration, followed by slow elimination, and the serum drug concentration could be detected to 504 h. T_1/2 of 3 mg·kg⁻¹ control drug was 112.72 ± 12.46 h, AUC_(0–504 h) was 5,789.06 ± 705.97 μg·h·mL⁻¹ after a single administration, CL was 0.51 ± 0.05 mL·kg⁻¹·h⁻¹, and C_max was 126.14 ± 24.18 μg·mL⁻¹. WinNonlin was used for biosimilarity assessment HS630 and Kadcyla®. The 90% CI of the geometric mean ratio of the total antibody C_max and _AUC(0–t) was 116.23% and 136.16%, respectively.

Figure 13

Figure 13. Comparison of total antibody serum concentration–time curves after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla® in cynomolgus monkeys.

Table 13

Table 13. Comparison of the total antibody serum concentration after single intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla^® in cynomolgus monkeys.

Table 14

Table 14. Comparison of total antibody pharmacokinetic parameters between the first and last doses after continuous intravenous infusion of 3 mg·kg⁻¹ HS630 and Kadcyla^® in cynomolgus monkeys.

3.4.7 Results of DM1 concentration determination in the serum samples of cynomolgus monkeys

Data for DM1 concentration in serum are summarized in Table 15 without further statistical analysis. It highlights that the HS630 conjugated drug was stable and not easily broken in the blood.

Table 15

Table 15. Comparison of DM1 serum concentration after single intravenous infusion of HS630 and Kadcyla^® in cynomolgus monkeys.

3.5 Immunogenicity in cynomolgus monkeys

3.5.1 Positive judgment value

As indicated in Table 16 and Figure 14, the cut-off values of the three batches were 0.0076, 0.0092, and 0.0071, respectively, and their mean value was 0.0080. As a result, the positive judgment value was set as 0.0080, with the positive result determined for samples with a value higher than 0.0080.

Table 16

Table 16. Data for critical value determination.

Figure 14

Figure 14. Fluctuations of OD values for different assay batches of 60 cynomolgus monkey serum samples.

3.5.2 Results of bridge ELISA assay

In Tables 17–21, through double-antibody sandwich ELISA, the test values of samples 4 # (0.5 h), 8 # (96 h), 13 # (24 h), 17 # (504 h), 20 # (1,008.5 h and 1,512.5 h), 22 # (1,512.5 h), 24 # (1,008.5 h and 1,512.5 h), and 28 # (48 h) were higher than the cut-off value. The samples required further confirmation, and other samples did not produce anti-drug antibody.

Table 17

Table 17. Anti-HS630 antibody detection of pharmacokinetic serum samples after single intravenous infusion of 0.33 mg·kg⁻¹ HS630.

Table 18

Table 18. Anti-HS630 antibody detection of pharmacokinetic serum samples after single intravenous infusion of 1 mg·kg⁻¹ HS630.

Table 19

Table 19. Anti-HS630 antibody detection of pharmacokinetic serum samples after single intravenous infusion of 3 mg·kg⁻¹ HS630.

Table 20

Table 20. Anti-HS630 antibody detection of pharmacokinetic serum samples after continuous intravenous infusion of 3 mg·kg⁻¹ HS630.

Table 21

Table 21. Anti-HS630 antibody detection of pharmacokinetic serum samples after single intravenous infusion of 3 mg·kg⁻¹ Kadcyla^®.

3.5.3 Corroboration: immune clearance

The immune confirmation results are shown at Table 22. There was no significant decrease in the signal value of the samples after immune clearance of 4# (0.5 h), 8# (96 h), 13# (24 h), 17# (504 h), 20# (1,008.5 h and 1,512.5 h), 22# (1,512.5 h), 24# (1,008.5 h and 1,512.5 h), and 28# (48H). The samples were false-positive, with the high signal value being attributed to the impact of the serum matrix.

Table 22

Table 22. Results of immune confirmation.

4 Discussion

HS630 is a proposed T-DM1 biosimilar of Kadcyla®. Through in vitro and in vivo experiments, this study intended to demonstrate the similarity between HS630 and Kadcyla®. Biosimilars of such ADCs are critical in improving global access to targeted cancer therapies, but their approval hinges on a rigorous demonstration of similarity to the originator. The intracellular trafficking of T-DM1 usually relies on binding to the HER2 on the plasma membrane, and the HER2–T-DM1 complex enters cells via receptor-mediated endocytosis (Ritchie et al., 2013; Barok et al., 2014). Therefore, the tumor-specific delivery of cytotoxic payloads depends largely on high-affinity binding between the ADC and its target. In vitro, the affinity of HS630 and Kadcyla® was produced via the SPR technique on Biacore™ T200. The K_D values of HS630 and Kadcyla® for HER2 were 6.372 E-11M and 9.424 E-11 M, respectively. As suggested by the Biacore criteria, there is no difference in binding affinity if the difference is less than five-fold. In view of the above values, no significant difference was observed in the binding biological activities of HS630 and Kadcyla® to HER2.

HS630 is an ADC that can be metabolized into a total antibody and small molecule drug in vivo (total antibody: the sum of naked antibodies and ADC; ADC: antibody-coupled small molecule drug; small molecule: broken part of the small molecule drug). To accurately quantify the concentration in vivo, this study used double-antibody sandwich ELISA for total antibody and ADC, as well as HPLC-MS/MS for DM1. Double-antibody sandwich ELISA was used to determine the concentration of total antibody (including naked antibody and ADC) and the ADC of HS630 and Kadcyla® in the serum and tumors of tumor-bearing mice (Damen et al., 2009; Lee et al., 2011; Kaur et al., 2013; Kozak et al., 2013). When detecting total antibody concentration, the coated primary antibody was HER2, which can simultaneously bind naked antibody and ADC. Meanwhile, the coated primary antibody for detecting the ADC was the specific anti-small molecule drug antibody, which can only detect the ADC in the sample. The goat anti-human mAb adsorbed by HRP-labeled monkey serum was utilized to detect the Fc fragment of the binding antibody of the secondary antibody (Dere et al., 2013; Barok et al., 2014). Based on the results of method optimization and validation, a series of in vivo pharmacokinetic experiments were carried out to verify the similarity.

In vivo, total antibody concentration (including naked antibody and ADC) in the serum of HS630 and Kadcyla® groups peaked at 5 min and then gradually decreased after 10 mg·kg⁻¹ HS630 and Kadcyla® were injected into the tail vein of tumor-bearing mice. WinNonlin was used for biosimilarity evaluation. According to the guidelines of FDA, NMPA, and WHO for pharmacokinetic similarity assessment, the 90% CI of the primary endpoint for pharmacokinetic studies such as C_max and AUC_(0–t) should fall within the range of 80%–125% on the evaluation of biosimilars (FDA., 2014; NMPA., 2021; WHO., 2022). The 90% CI of the C_max geometric mean ratio of HS630 and reference preparation Kadcyla® was 89.205%, and the 90% CI of AUC_(0–t) geometric mean ratio was 88.186%, both of which met the aforementioned evaluation criteria. The ADC concentration in the serum of HS630 and Kadcyla® groups peaked at 5 min as total antibody and then gradually decreased. The 90% CI of the C_max geometric mean ratio of HS630 and reference preparation Kadcyla® was 89.270% and the 90% CI of the AUC_(0–t) geometric mean ratio was 80.169%, both of which fell within the standard range (80%–125%). Furthermore, in order to evaluate the post-injection tissue distribution of HS630 and Kadcyla® into tumor, this study also measured the drug concentrations in tumors at various time points after administration. After tail vein injection of 10 mg·kg⁻¹ HS630 and Kadcyla® into tumor-bearing mice, the total antibody concentration (including naked antibody and ADC) in the tumor peaked at 24 and then gradually decreased. With the WinNonlin used for biosimilarity evaluation, the 90% CI of the geometric mean ratio of C_max for HS630 and the control was 128.036%, and the 90% CI of the geometric mean ratio of AUC_(0–t) was 101.185%, meeting the above criteria. The conjugated drug (ADC) in tumor tissue could not be detected using ELISA. It can be inferred that the ADC in the tumor tissue antibody to the small molecule drug (DM1) was basically broken, and the drug played a role after entering the tumor tissue (Erickson et al., 2006; Kaur et al., 2013; Barok et al., 2014). The sample size required for ELISA is large, and the sample processing of ELISA is different from that of HPLC-MS/MS. In our study, there was a small volume of tumor-bearing mice and an insufficient amount of serum and tumor samples that could be provided. Thus, the small molecule drugs in the serum and tumor tissue of tumor-bearing mice are limited by the number of samples not examined, which should be verified in subsequent testing of experimental samples for toxicities and drug delivery.

In general, nonhuman primates (NHPs) such as cynomolgus monkeys, given their high consistency with humans in target homology, metabolic pathways, and drug responses, are used for nonclinical pharmacokinetic and toxicological studies of ADC. The efficacy of an ADC depends on their specific binding to target antigens. Significantly, the target proteins of NHPs exhibit high homology to those of humans, supporting their abilities to stimulate binding efficiency and specificity of the drug in humans. Meanwhile, NHPs share high similarities in the hepatic metabolic enzymes and clearance mechanisms to humans, allowing for the accurate prediction of their absorption, distribution, metabolism, and excretion in humans. Therefore, in this study, a series of pharmacokinetic experiments were conducted to evaluate the similarity between HS630 and Kadcyla®.

Following a single intravenous infusion of HS630 at 0.33 mg·kg⁻¹, 1 mg·kg⁻¹, and 3 mg·kg⁻¹ in cynomolgus monkeys, the serum concentration of the ADC increased with the dose administered. The peak times were all at 0.5 h after administration, followed by a slower elimination, and the serum-drug concentrations were detectable up to 504 h for all three dose groups. The ratio of doses, AUC_(0–504 h), and C_max was 1:3:9, 1:6.67:24.23, and 1:5.23:12.69, respectively, suggesting that within the dose range of 0.33∼3 mg·kg⁻¹, HS630 behaves as a non-linear pharmacokinetic profile in cynomolgus monkeys. Meanwhile, through continuous intravenous infusions of 3 mg·kg⁻¹ HS630 in cynomolgus monkeys, T_max was at 0.5 h after the first dose and every 504 h thereafter. The serum concentration of the ADC showed an obvious peak–trough trend with the number of administrations and peaked 0.5 h after the last (fourth) dose, followed by a slower elimination, with the serum drug concentration detectable up to 1,008 h after the last dose. There was a difference between the last and first doses at 0 and 504 h, yet without any significant difference in any of the remaining time points. AUC_(0–504 h) and C_max after the last dose were not statistically significantly different from after the first dose, and the accumulation factor was 1.04 ± 0.20, revealing no significant drug accumulation produced after the continuous administration of HS630 at 3 mg·kg⁻¹.

After a single intravenous infusion of Kadcyla® at 3 mg·kg⁻¹ in cynomolgus monkeys, T_max was also 0.5 h after administration, followed by a slower elimination, and the serum-drug concentration of the ADC was detectable up to 504 h, without statistically significant differences between HS630 and the control at all time points except for 72 and 504 h. WinNonlin was used for biosimilarity evaluation, and the 90% CI of the ratio of geometric means of C_max for HS630 and Kadcyla® was 109.15%, meeting the criteria for biosimilarity of 80%–125%. Similarly, the 90% CI for the geometric mean ratio of AUC_(0–t) was 97.51%, also meeting the biosimilarity decision criteria of 80%–125%.

Furthermore, the total antibody concentration increased with the administration dose according to the results observed, following a single intravenous infusion of HS630 at 0.33 mg·kg⁻¹, 1 mg·kg⁻¹, and 3 mg·kg⁻¹ in cynomolgus monkeys. The peak times were all at 0.5 h after administration, followed by a slower elimination, and the serum drug concentrations were detectable up to 504 h for all three dose groups. The ratios of dosage, AUC_(0–504 h), and C_max were 1:3:9, 1:6.46: 29.08, and 1:5.12: 16.90, respectively. Therefore, the total antibody in 0.33∼3 mg·kg⁻¹ of HS630 exhibited non-linear pharmacokinetic characteristics in cynomolgus monkeys.

With continuous intravenous infusions of 3 mg·kg⁻¹ HS630 in cynomolgus monkeys, total antibody T_max was at 0.5 h after the first dose, followed by every 504-h administration. The total antibody concentration showed an obvious peak–trough trend with the number of administrations, and the serum concentration peaked at 0.5 h after the last (fourth) dose followed by a slower elimination, with the serum drug concentration detectable up to 1,008 h after the last dose. There was a difference between the last and first dose at 0 and 504 h but without significant difference in any of the remaining time points. However, no statistically significant difference was observed in AUC_(0–504 h) and C_max after the last dose and the first dose, and the accumulation factor was 1.22 ± 0.18, suggesting no significant drug accumulation with continuous administration of HS630 3 mg·kg⁻¹.

After a single intravenous infusion of Kadcyla® at 3 mg·kg⁻¹ in cynomolgus monkeys, the T_max of total antibody was also 0.5 h after administration, followed by a slower elimination with detectable serum drug concentrations to 504 h after the administration of HS630 and Kadcyla® at each time point. There were statistically significant differences in the total antibody serum concentrations at 24, 48, 96, 120, 168, and 504 h but without any statistical difference in other time points. WinNonlin was used for biosimilarity assessment. The 90% CI of the geometric mean ratio of the total antibody C_max for HS630 and Kadcyla® was 116.23%, which met the bioequivalent decision criteria of 80%–125%; that of AUC_(0–t) was 136.16%, which basically met the criteria. No anti-drug antibody was detected in the serum samples from cynomolgus monkeys after intravenous administration of HS630 and Kadcyla®. However, the possibility of a fortuitous result cannot be excluded, considering the limited number of administrations and the small sample size of animals in this study. We recommend paying close attention to clinical trials, given the individual differences in animal experiments.

Altogether, this study designed and conducted in vivo pharmacokinetic experiments to comprehensively characterize the pharmacokinetic profile of HS630 and validate the similarity to the originator Kadcyla®. These experiments evaluated dose dependency and compared the dose effects of continuous and direct similarity of HS630 in cynomolgus monkeys. The similarity between HS630 and Kadcyla® was assessed by analyzing their pharmacokinetic changes in cynomolgus monkeys with single and multiple administrations. The post-administration concentration of total antibody and ADC remained essentially consistent, with the observation of relative similarity in multiple pharmacokinetic parameters. Combined with the pharmacokinetic results of tumor-bearing mice and pharmacokinetic guidelines, HS630 exhibited a high degree of similarity of Kadcyla®. It should be acknowledged that pharmacokinetic experiments provided critical data to support the similarity of HS630 and Kadcyla®. However, this study still has several limitations, which should be considered when interpreting the findings and extrapolating these to clinical settings. In the tissue distribution experiment of tumor-bearing mice, this study failed to investigate the distribution in other organs, despite the detection of a concentration in tumors. There is a need to determine drug concentrations in more tissues to fully illustrate the safety and potential unintended off-target effects. Meanwhile, the pharmacokinetic experiments were conducted in a relatively small number of cynomolgus monkeys. Although it was sufficient to detect major pharmacokinetic differences between HS630 and Kadcyla®, there might be a lack of statistical power to assess subtle individual variability or sex-specific pharmacokinetic differences. Moreover, the pharmacokinetic profiles of HS630 and Kadcyla® exhibited similarities, although these were insufficient to fully confirm their pharmacological consistency. Our in vitro studies evaluated the binding ability of HS630 and Kadcyla® to HER2 to assess their protein affinity and potential therapeutic efficacy. However, the pharmacodynamic indicators need to be reflected through the actual therapeutic effects of model animals in nonclinical trials, highlighting the necessity for additional in vivo animal studies to provide further supportive evidence in the future.

5 Conclusion

The present study developed a method of ELISA for detecting total antibody and ADC drugs of HS630. Its specificity, precision, and accuracy in measuring total antibody and ADC fulfill the requirements of pharmacokinetic studies. HS630 and the originator drug Kadcyla® revealed pharmacokinetic similarity after intravenous infusion in tumor-bearing mice and cynomolgus monkeys. Comprehensive nonclinical evaluations of this study provide robust evidence for regulatory approval, beyond addressing key scientific and technical challenges in biosimilar development. Eventually, the findings of this study may contribute to the acceleration of the translation of HS630 and related biosimilars from laboratory to the market, as well as improving patients’ opportunities to obtain high-quality, cost-efficient biotherapeutics.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author.

Ethics statement

The animal study was approved by the Animal Ethics Committee of Beijing Institute of Pharmacology and Toxicology. The study was conducted in accordance with the local legislation and institutional requirements.

Author contributions

HJ: Methodology, Writing – original draft, Investigation, Data curation, Formal analysis. JC: Writing – review and editing, Supervision, Methodology, Resources, Conceptualization, Project administration.

Funding

The authors declare that financial support was received for the research and/or publication of this article. The authors declare that this study received funding from Zhejiang Hisun Pharmaceutical Co., Ltd. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication.

Acknowledgements

The authors gratefully thank Zhejiang Hisun Pharmaceutical Co., Ltd. for providing test drugs.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The authors declare that no Generative AI was used in the creation of this manuscript.

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Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphar.2025.1698727/full#supplementary-material

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