Patent Application
20200406230
The present invention relates to a protein-binding product comprising porous polymer beads, a device containing said protein-binding product and a method for extracorporeal elimination of at least one galactose-binding protein and optionally at least one other protein in blood plasma.
An example of galactose binding proteins in blood plasma is a group of proteins called galectins. Galectins are a class of proteins that bind specifically to β-galactoside sugars. These proteins have been associated with a range of diseases. E. g. increased levels of galectins in blood have been detected in humans suffering from inflammatory conditions, autoimmune diseases and cancer.
A range of galactoside derivatives, e. g. galactose compounds modified with aliphatic and or aromatic compounds, have been proposed as injectable compounds which potentially can inhibit the galectin activity. However, since galectins are important in the normal cell and tissue activities, the injection of the galactoside derivatives may lead to unfavourable side effects. A long-term use of these drugs might lead to more or less toxic effects. It is also difficult to assess the concentration of these injected or otherwise administered organic compounds in the different body parts, and thus to ascertain the inhibition effect achieved at the desired sites of galectin action.
An object of the present invention is to overcome the drawbacks and disadvantages disclosed above. This object is achieved by providing a protein-binding product comprising porous polymer beads, a device containing said protein-binding product and a method for extracorporeal elimination of at least one galactose-binding protein and optionally at least one other protein in blood plasma.
The present invention refers to a product as defined in independent claim 1, more precisely to a protein-binding product comprising one or more porous polymer beads, wherein at least one ligand is bound to the surfaces of said polymer beads via a spacer (R), and wherein said at least one ligand is Galβ1-3HexNAcβ—O—, Galβ1-4GlcNAcβ—O— and/or a derivative thereof.
The present invention refers also to a method as defined in independent claim 15, more precisely to a method for extracorporeal reduction of the level of at least one galactose-binding protein and optionally at least one other protein in blood plasma, said method comprising the steps of:
a) passing the blood plasma through the device according to claim 14,
b) allowing said at least one galactose-binding protein, preferably a galectin, and optionally at least one other protein, preferably an antibody, more preferably a blood group A specific antibody, a blood group B specific antibody, an autoantibody, more preferably an AChR (acetylcholine receptor) antibody and a MuSK (muscle-specific kinase) receptor antibody; or a toxin to bind to said at least one ligand of the protein-binding product,
c) allowing at least one blood plasma volume to pass through the device after passage of one blood plasma volume through the device,
d) repeating step c) until the desired reduction of the level of said at least one galactose-binding protein and optionally at least one other protein in the blood plasma is achieved.
The present invention refers also to a method as defined in independent claim 16, more precisely to a method for extracorporeal reduction of the level of at least one galactose-binding protein and optionally at least one other protein in blood plasma, said method comprising the steps of:
a) passing the blood plasma through the device according to claim 14,
b) allowing said at least one galactose-binding protein, preferably a galectin, and optionally at least one other protein, preferably an antibody, more preferably a blood group A specific antibody, a blood group B specific antibody, an autoantibody, more preferably an AChR (acetylcholine receptor) antibody and a MuSK (muscle-specific kinase) receptor antibody, or a toxin to bind to said at least one ligand of the protein binding product,
c) allowing at least one blood plasma volume to pass through the device after passage of one blood plasma volume through the device,
d) repeating step c) until the desired reduction of the level of said at least one galactose-binding protein and optionally at least one other protein in the blood plasma is achieved,
e) optionally performing dialysis concomitantly with the steps above,
f) continuously returning the treated blood plasma to the patient.
Further embodiments of the present invention are disclosed in the subsequent independent claims.
In another aspect, the present invention also refers to a to use of said protein-binding product for reduction of the level of at least one galactose-binding protein and optionally at least one other protein in blood plasma.
In further aspect, the present invention also refers to a device containing said protein-binding product.
With the present invention the treatment method of a patient in need for reduction of the levels of galectins in the blood can be adjusted for each patient in order to achieve the desired treatment effect, or a desired galectin level, by determining the reduction of the levels of galectins in a blood sample of the patient.
Throughout the application text, the expression “blood” is generally intended to mean whole blood, but here it also covers partially purified blood components, e.g. IVIG (intravenous IG), unless otherwise is stated. The expression “blood plasma” used throughout the application text is intended to also cover partly purified plasma, unless otherwise is stated. The expression “the surfaces of the polymer beads” is intended to cover both the outer surface of the polymer beads and the surfaces in the pores of the polymer beads.”
In the present invention porous polymer is provided, wherein the polymer is a non-soluble beaded matrix, which contains at least one covalently bound ligand, that is bound via a spacer (R) to the matrix and where the ligand is at least one of the following: Galβ1-3HexNAcβ—O—, Galβ1-4GlcNAcβ—O— and any derivative of these disaccharides.
The spacer, also called R, consists of or comprises an aliphatic and/or aromatic compound, which is glycosidically linked or bound to at least one of the following ligand compounds: Galβ1-3HexNAcβ—O—, Galβ1-4GlcNAcβ—O— and/or any derivative thereof. Examples of R are (CH2)nNH—, (CH2)nPhNH—, PhNH— and Ph(CH2)nNH—, wherein Ph is a phenyl group and n is an integer, preferably wherein n is one of 1, 2, 3, 4, 5 or 6. The spacer is covalently linked to the polymer, more precisely to the surfaces of the polymer beads, i. e. both to the outer surface of the polymer beads and to the polymer surfaces in the pores of the polymer beads. As the polymer is porous, this allows entrance of plasma containing galactose binding proteins and larger molecules.
In a preferred embodiment of the invention the polymer is agarose or crosslinked agarose beads, hydroxymethacrylate beads or some other kinds of porous plastic beads. The spacer is covalently bound directly to carbon atoms of the polymer or to a second spacer covalently bound to the polymer.
Thus, as an example, the NH group of the spacer (R) can bind covalently to carbon atoms of a portion of the galactose units of e. g. agarose beads after so-called activation of a portion of the galactose residues in agarose with tosyl chloride (pyridine used as catalyst in e. g. acetone). This type of activation results in that tosyl groups are introduced on a portion of the galactose-OH groups of the agarose beads. Tosyl groups are released upon reaction of the tosylated agarose with amino groups to give a —NH—CH— galactose (in agarose) linkage, which is highly stable.
The binding to the polymer of the above/mentioned ligand can also be achieved via a second spacer by e. g. first covalently coupling of an aliphatic and/or aromatic compound containing e. g. a carboxyl group to e. g. galactose residues of the cross-linked agarose beads mentioned above. In another example, activation of the carboxyl group of the second spacer to give NHS—CO-second spacer-agarose (NHS is N-hydroxysuccinimide) allows for amide linkage formation (NH—CO) between the first and the second spacer, which is also a stable covalent linkage.
The Gal unit in the ligands defined above denotes a D-galactosyl group. HexNAc in the Galβ1-3HexNAcβ—O— ligand above is chosen from GlcNAc or GalNAc (N-acetyl-D-glucosamine or N-acetyl-D-galactosamine). As to the derivative of the Galβ1-3HexNAcβ—O— and Galβ1-4GlcNAcβ—O—, ligands, the derivative has the structure in which the 3-OH group of the Gal unit in any of the above with an α2-3-linked sialyl group, an α2-6-linked sialyl group, a β1-3-linked GlcNAc, an α1-3-linked D-galactosyl group or an α1-3-linked GalNAc group. In the two latter examples the 2-OH group of Gal in Gal β1-3HexNAcβ—O— and Galβ1-4GlcNAcβ—O—, may be additionally substituted with e. g. an α1-2-linked L-fucosyl group. As another example, the 3-OH group of Gal in Galβ1-3HexNAcβ—O— or Galβ1-4GlcNAcβ—O— may be substituted with a group containing an aromatic group.
An alternative way to define the structure of said at least one ligand is that it has a structure, wherein at least the 3-OH group of Gal is substituted with one of the following groups:
a 3-O—R2 group where the R2 group contains an alkyl group or an aromatic group,
a 3-NH—O—R2 group where the R2 group contains a sialyl group or a D-galactosyl group or GalNac group,
a 3-O—R2 group where the R2 group contains an alkyl group or an aromatic group,
a 3,5-dimethoxybenzamido group.
The above choice of the ligand, Galβ1-3HexNAcβ—O— or Galβ1-4GlcNAcβ—O— or a derivative thereof, as described above, will according to the invention be determined by the β-galactoside-binding protein or β-galactoside-binding proteins whose levels are desired to be reduced. Thus, e. g. a Galβ1-4GlcNAc β—O— ligand or a derivative thereof is preferred when the level of e. g. galectin-3 is desired to be reduced, whereas e. g. α2-3-sialylated Galβ1-3GalNAcβ—O— or a derivative thereof is preferred for the reduction of the level of galectin-8, and α2-6-sialylated Galβ1-3GlcNAcβ— or a derivative thereof is preferred for the reduction of the level of galectin-1.
According to the present invention, at least 5 μmol of one or more of the following ligands Galβ1-3HexNAcβ—O— and Galβ1-4GlcNAcβ—O— per mL polymer is used, preferably 5-20 μmol of ligand per mL polymer. When a derivative of any of the ligands Galβ1-3HexNAcβ—O— and Galβ1-4GlcNAcβ—O— is used according to the invention described above, a lower concentration of the ligand can be used per mL of matrix, e. g. 0.1-5 μmol ligand per mL polymer.
The polymer with the ligand bound thereto according to the present invention can be used to quantitatively reduce the level of galectin in human blood plasma. Thus, the level of galectin-3 in blood plasma from a patient can be reduced by more than 50% in one single passage through a column filled with porous polymer beads provided with a covalently bound ligand via a spacer, wherein the ligand e. g. is Galβ1-4GlcNAcβ—O, which can be modified in Gal as described above with a fucosyl group and with either GalNAc or Gal.
According to the invention, the reduction of the level of galectin, i. e. the treatment effect, will increase similarly for each patient plasma plasma volume treated, i. e. for each blood plasma volume that has passed the column when used in a continuous extracorporeal treatment with a column connected via a tubing to a blood plasma separator which in turn is connected via tubings to the patient. The blood plasma that has passed the column is in one embodiment returned to the blood line after passing through the blood plasma separator and thus continuously returned to the patient. In another embodiment the plasma which has passed the column is collected, i. e. is not returned to the patient. Therefore, in the example above, after the passage of the volume of blood plasma e. g. corresponding to the volume of blood plasma in 4 patients through the column, more than 90% of the original level of galectin in the plasma is removed by being bound to the column. According to the present invention, the volume of polymer in the column is e. g. 60 mL or between 5 and 70 mL. A higher or a lower volume can be chosen depending on the used flow rate of the blood plasma and the plasma volume of the patient. The flow rate is chosen preferably in a range of between 10 and 60 mL per minute. The reduction of the level of galectin in the patient plasma can be lower due to unintended equilibration with extravascular galectin. If this happens, the treatment could be prolonged, i. e. more patient plasma volumes may be treated per treatment session.
When the column contains a polymer-spacer-ligand complex, i. e. a protein-binding product, according to the present invention, e. g. a disaccharide derivative in which the 3-OH group of Gal in any of the disaccharide structures disclosed above is substituted with a 3-NH—CO—R2 group or with a 3-O—R2 group as described above, a higher reduction of the level of galectin per treated patient blood plasma volume can be achieved. For this type of polymer, a lower amount of polymer can be chosen in the column, i. e. amount of polymer in the lower range of the range mentioned above. The polymer according to the invention is not saturated with bound galectin during prolonged treatments. The reason for that is that the molar quantity of the carbohydrate or carbohydrate derivative constituting the ligand is higher than the molar quantity of galectin in the blood of the patient. This high reduction is surprising in view of what is known, since human blood plasma contains a range of glycoproteins that normally bind to galectin-3 and could thus be expected to inhibit the binding of the galectin to the polymer beads provided with the ligands.
In another embodiment of the invention, the device according to the invention contains, in addition to the above described polymer with a covalently bound carbohydrate or carbohydrate derivative as ligand, a polymer with at least one other covalently bound compound or ligand than that mentioned above, which can bind a protein other than a galectin, e. g. an antibody, a protein or a toxin. A simultaneous reduction of the levels of galectin, antibody, toxin or said other protein can thus be achieved in human blood plasma with the treatment method according to the present invention. The total volume of the two polymers in the column is preferably of a value presented above, and the volume ratio of the two polymers is preferably in the range between 1/0.1-0.1/1.
An example of such an antibody is a blood group specific antibody, such as a blood group A or B specific antibody, or an antibody involved in an autoimmune disease, preferably an autoantibody involved in Myasthenia gravis, more preferably an autoantibody for the antigens in an AChR (acetylcholine receptor) or a MuSK (muscle-specific kinase) receptor, or an autoantibody to an antigen involved in another autoimmune disease. The antigen is covalently bound to the type of polymer described above and using the same activation methods as described above. In the case of covalently bound antigen used for binding to the autoantibody, the amount of bound antigen is chosen to be between 0.1 to 5 mg antigen per mL polymer. In this embodiment of the present invention a reduction of the levels of both galactose-binding proteins, such as galectins, and another protein, such as an antibody or a toxin, in human blood can be achieved.
The simultaneous reduction of the levels of a blood group specific antibody and a galectin achieved by the present invention is described below. The polymer beads used in this case are made of one polymer with e. g. covalently bound blood group A and/or B antigen at a concentration in a range of 1 to 4 μmol per mL polymer, and another polymer with a covalently bound galectin-binding ligand at the concentration described above. In this way, the levels of both blood group A and/or B specific antibody can be reduced, as well as the level of galectin in human blood. This embodiment can e. g. be of interest in a transplant setting for treatment of the recipient where the donor and recipient are blood group incompatible and where the recipient has increased galectin levels. Increased galectin levels have been shown to be a marker for e. g. kidney and liver fibrosis. Here the volume of the polymer provided with the galectin-binding ligand is lower than the volume of the polymer provided with the blood group specific antibody-binding ligand. If no simultaneous reduction of the levels of blood group specific antibody and galectin is desired, e. g. in another application than a blood group incompatible transplantation, a galectin-binding ligand which does not bind anti-B antibody in blood group A plasma, i. e. for reduction of the level of galectin in a patient with the blood group A, or which does not bind anti-A antibody in blood group B plasma, i. e. for reduction of the level of galectin in a patient with the blood group B, can be used.
The treatment method according to the invention can be performed in a continuous fashion in an extracorporeal system, where the blood is continuously pumped from a reservoir or a patient to a plasma separator, which continuously separates out blood plasma from the blood line. The blood plasma is continuously treated with the device according to the invention, and the treated plasma with a reduced galectin content, optionally also with a reduced content of e. g. blood group antibody, autoantibody, other protein, or toxin, as described above, is continuously returned to the blood line and circulated back to the reservoir or to the patient. In an alternative plasma treatment method, the treated plasma is collected in a blood bag.
The polymer beads provided with ligands according to the invention can e. g. be filled in a column and be used in a continuous extracorporeal treatment method.
As mentioned above, several patient plasma volumes can be treated in a single treatment since the polymer beads provided with ligands will not be saturated with e. g. galectin and, optionally blood group antibody, autoantibody or other protein, since the molar quantity of the ligand used is higher than that of the compound(s) removed from the plasma.
In another embodiment of the present invention the device is a column. The column inlet is connected to a plasma filter or separator, which in turn is connected to the blood line out from the patient. The plasma filter continuously filters out plasma from the blood line. The blood plasma exiting the plasma filter passes through a tubing and then through the column with the above-described polymer beads. The treated plasma from the column outlet is returned via a tubing to the blood line, which is continuously returned back to the patient with the extracorporeal treatment continuous flow. The blood line back to the patient contains a reduced amount of galectin and optionally a reduced amount of any other protein, such as an antibody or a toxin.
The polymer beads can in another embodiment be filled in a tubing connected to the inlet and the outlet of a plasma filter, which is connected to the blood line from a patient and to the blood line back to patient or a blood reservoir. The polymer beads filled into the tubing are circulated by a pump through the plasma filter in the direction opposite to the flow of the blood line and within the space located between the porous hollow fibres present inside the plasma filter. Blood is continuously pumped from the patient to the plasma filter through the hollow fibres and back to the patient. Blood plasma is then filtered out through the hollow fibre pores and into the space between the hollow fibres and out into the connected tubing. The blood plasma is then continuously pumped through the tubing back to the space between the hollow fibres. The flow rate of the blood plasma line is higher than the flow of the blood line which is reverse to the one which is used in the above-mentioned column treatment. The so-treated blood plasma with a reduced galectin level is continuously filtered through the hollow fibre pores back to the blood line in the hollow fibres. The returned blood line to the patient or the reservoir contains a reduced amount of β-galactose binding protein and optionally also a reduced level of any other protein. In this way the level of galectin(s) and optionally other proteins (antibody and/or toxin) is reduced in the blood plasma contained within the blood reservoir or the patient.
In another embodiment, the above column treatment is performed simultaneously with dialysis. This embodiment is of interest in a dialysis treatment per se of a patient with increased levels of galectin, but also for treatment of blood group incompatible recipients who have increased levels of galectin. Here, a conventional dialysis is performed but with the dialysis machine blood line and after the passage through the dialysis filter connected to the plasma separator. The filtered out blood plasma passes through the column as described above, and the treated blood plasma is returned to the blood line in a continuous fashion. In this way both dialysis and a reduced level of galectin, optionally also of any other protein, in human blood plasma is achieved.
| Number | Date | Country | Kind |
|---|---|---|---|
| 1800056-2 | Mar 2018 | SE | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/SE2019/050211 | 3/8/2019 | WO | 00 |
