Patent Application
20240016951
The disclosure relates to compositions and methods of treating vascular diseases.
This application contains a Sequence Listing which has been submitted electronically as a WIPO Standard ST.26 XML file via Patent Center, created on Dec. 30, 2022, is entitled “4427-10504.xml” and is 161,166 bytes in size. The sequence listing is incorporated herein by reference in its entirety.
Myointimal proliferation or myointimal hyperplasia is a complex pathological process of the vascular system characterized by an abnormal proliferation of smooth muscle cells of the vascular wall. Proliferating smooth muscle cells migrate to the subendothelial area and form the hyperplastic lesion, which can cause stenosis and obstruction of the vascular lumen.
Cardiac Allograft Vasculopathy (CAV) is an accelerated fibroproliferative disorder affecting muscular vessels of the graft and is a leading cause of morbidity and mortality following cardiac transplantation. CAV is believed to be mediated by immunologic damage and infiltration of the endothelium, resulting in proliferation of vascular smooth muscle cells and subsequent luminal narrowing. Symptoms of CAV include progressive thickening of the arterial intima in both epicardial and intramyocardial arteries of the graft, often driven by immune-mediated vascular injury. CAV occurs in at least around a third (at varying severity) of all cardiac transplant recipients by three years post-transplant. CAV is often characterized by vascular smooth muscle cell proliferation, accumulation of inflammatory immune cells, and lipid deposition. CAV is a slow progressive disease but complications such as acute graft failure, arrhythmia, infarction, or cardiac death can often manifest without classic symptoms (such as angina) due to graft denervation.
Similar vasculopathy occurs in, and can severely limit long-term survival of, other solid organ allografts. Because such vasculopathies are difficult to treat, and can affect nearly all vessels of the allograft, they are associated with significant morbidity and mortality for allograft recipients and may require repeat transplantation. Therefore, effective therapies that may prevent or reduce the extent of such vasculopathies in solid organ allografts, such as cardiac allografts, are urgently needed.
Moyamoya is an occlusive cerebrovascular disorder first reported in 1957 in Japan and is characterized by stenosis of the supraclinoid portion of the internal carotid arteries (ICA) with the formation of an abnormal vascular network at the base of the brain. Moyamoya is a general term used to describe two different conditions affecting the intracranial internal carotid artery; moyamoya disease (MMD), a congenital disease causing bilateral arteriopathy which is more prominent among East Asian and Japanese children and adults, and Moyamoya syndrome (MMS), which is idiopathic, and typically seen among Caucasian adults ranging in age from 20 to 40 years. While there is no known genetic component in MMS, as there is in MMD, it is often associated with autoimmune disorders such as diabetes, lupus or rheumatoid arthritis. Treatment options for both MMD and MMS have involved daily aspirin use, lifestyle modifications to maximize cerebral perfusion, and surgical direct or indirect bypass to restore blood flow. Principally affecting women (70-85%) more than men (15-30%), moyamoya spans ethnicities, but is most prevalent in East Asians and Caucasians. Moyamoya disease (MMD) is prominent amongst the East Asian population presenting in both children and adults with a familial lineage. Moyamoya syndrome (MMS) is prominent amongst Caucasians in the 2nd/3rd decades of life, is idiopathic, and usually presents with co-morbidities (autoimmune diseases) Clinical literature often does not distinguish between those with MMD and MMS.
Chronic hemodialysis is a common treatment for patients suffering from poor kidney function. Such patients often undergo a surgical procedure in which an artificial arterio-venous fistula (AVF) is created usually in their non-dominant arm. The AVF provides a durable vascular access point for the hemodialysis process. A common complication with AVF is the occlusion of the AVF or vessels at or adjacent to the location of the AVF. Such occlusion can involve, for example, thromboses and intimal hyperplasia, and can result in permanent nerve damage or paralysis of the affected limb, if left untreated (see, e.g., Asif et al. (2006) Clin J Am Soc Nephrol. 1:332-339; Nath et al. (2003) Am J Pathol. 162:2079-90; and Stolic (2013) Med Pric Pract. 22(3):220-228).
In one aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy in a subject having an allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent allograft vasculopathy in said subject.
In another aspect, the disclosure relates to a method for preventing or ameliorating one or more symptoms associated with Moyamoya disease in a subject, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby prevent or ameliorate one or more symptoms associated with Moyamoya disease in the subject.
In another aspect, the disclosure relates to a method for inhibiting or preventing cerebral vascular occlusion in a subject who is expected to receive or who has received a surgical intervention as a treatment for Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent cerebral vascular occlusion in the subject.
In another aspect, the disclosure relates to a method for inhibiting or preventing unwanted vascular smooth muscle cell proliferation in a subject who is expected to receive or who has received a surgical intervention as a treatment for Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent unwanted vascular smooth muscle cell proliferation in the subject.
In another aspect, the disclosure also includes a method for inhibiting or slowing progression of Stage I Suzuki grade MMD to Stage II Suzuki grade MMD in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby inhibit and/or slow progression of Stage I MMD to Stage II MMD in said subject.
In another aspect, the disclosure also includes a method for inhibiting or slowing progression of Stage I Suzuki grade MMD to Stage III Suzuki grade MMD in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby inhibit and/or slow progression of Stage I MMD to Stage III MMD in said subject.
In yet another aspect, the disclosure relates to method for inhibiting or preventing cerebral vascular occlusion in a subject at risk for developing Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent cerebral vascular occlusion in the subject.
In yet another aspect, the disclosure relates to a method for inhibiting or preventing unwanted vascular smooth muscle cell proliferation in a subject at risk for developing Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent unwanted vascular smooth muscle cell proliferation in the subject.
In yet another aspect, the disclosure also relates to a method for treating a subject at risk for developing Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby treat the subject
In yet another aspect, the disclosure relates to a method for inhibiting or preventing cerebral vascular occlusion in a subject afflicted with Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent cerebral vascular occlusion in the subject. The disclosure relates to a method for inhibiting or preventing unwanted vascular smooth muscle cell proliferation in a subject afflicted with Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby inhibit or prevent unwanted cerebral vascular smooth muscle cell proliferation in the subject.
In yet another aspect, the disclosure relates to a method for treating a subject afflicted with Moyamoya disease, the method comprising: administering to the subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby treat the subject.
In yet another aspect, the disclosure relates to a method for treating a subject having Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby treat said Moyamoya disease in said subject.
In yet another aspect, the disclosure relates to a method for treating a subject having Moyamoya syndrome, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby treat said Moyamoya syndrome in said subject.
In yet another aspect, the disclosure includes a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said cerebral artery of said subject. In some embodiments of any of the methods described herein, the subject has stage I, stage II or stage III, grade IV Suzuki grade MMD.
In yet another aspect, the disclosure also includes a method for inhibiting or slowing progression of Stage I Suzuki grade MMD to Stage II Suzuki grade MMD in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby inhibit and/or slow progression of Stage I MMD to Stage II MMD in said subject.
In another aspect, the disclosure features a method for treating a subject having Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby treat said peripheral artery disease in said subject.
In another aspect, the disclosure relates to a method for treating a subject having Moyamoya syndrome, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby treat said Moyamoya syndrome in said subject.
In yet another aspect, the disclosure features a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject having Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said cerebral artery of said subject.
The disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject who undergoes surgery on said cerebral artery, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said cerebral artery at a surgical site of said cerebral artery in said subject.
The disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject who undergoes surgery on said cerebral artery, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said cerebral artery at a surgical site of said cerebral artery in said subject.
In another aspect, the disclosure features a method for treating a subject having Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby treat said peripheral artery disease in said subject. In another aspect, the disclosure relates to a method for treating a subject having Moyamoya syndrome, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby treat said Moyamoya syndrome in said subject. In yet another aspect, the disclosure features a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject having Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said cerebral artery of said subject.
In another aspect, the disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a subject's peripheral vessel at or around the site at which an arterio-venous dialysis shunt has been placed, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said peripheral vessel at or around the site the arterio-venous dialysis shunt has been placed.
In one aspect, the disclosure provides a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a peripheral vessel of a subject who undergoes surgery on said peripheral vessel, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said peripheral vessel at a surgical site of said peripheral vessel in said subject, wherein the surgery comprises placement of an arterio-venous dialysis shunt.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a peripheral vessel of a subject who requires surgery on said peripheral vessel, wherein the surgery comprises placement of an arterio-venous dialysis shunt, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said peripheral vessel at a surgical site of said peripheral vessel in said subject.
In another aspect, the disclosure also includes a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a peripheral vessel of a subject who undergoes shunt placement in a peripheral vessel, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in the peripheral vessel.
In another aspect, the disclosure features a method for reducing and/or preventing stenosis or restenosis in a peripheral vessel of a subject who undergoes shunt placement in the peripheral vessel, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent stenosis or restenosis in the peripheral vessel.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy (for example, cardiac allograft vasculopathy) in a subject having an allograft, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent allograft vasculopathy in said subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In yet another aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy (for example, cardiac allograft vasculopathy) in a subject having an allograft and who has received or is receiving a therapy comprising a complement inhibitor, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent allograft vasculopathy in said subject. In some embodiments, the methods further comprise administering the complement inhibitor to the subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy (for example, cardiac allograft vasculopathy) in a subject having an allograft and who has received or is receiving a therapy comprising an ENPP1 agent or ENPP3 agent, the method comprising: administering to the subject an effective amount of a complement inhibitor to thereby reduce and/or prevent allograft vasculopathy in said subject. In some embodiments, the methods further comprise administering the ENPP1 agent or ENPP3 agent to the subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in the vasculature of an allograft of a subject having said allograft, the method comprising administering to the subject an effective amount of: (i) an ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said vasculature of said allograft of said subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in the vasculature of an allograft of a subject having said allograft, wherein the subject has received or is receiving a therapy comprising a complement inhibitor, the method comprising administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said vasculature of said allograft of said subject. In some embodiments, the methods further comprise administering the complement inhibitor to the subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in the vasculature of an allograft of a subject having said allograft, wherein the subject has received or is receiving a therapy comprising an ENPP1 agent or an ENPP3 agent, the method comprising administering to the subject an effective amount of a complement inhibitor to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said vasculature of said allograft of said subject. In some embodiments, the methods further comprise administering the ENPP1 agent or ENPP3 agent to the subject.
In yet another aspect, the disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a solid organ transplant in a subject having a solid organ transplant and who undergoes surgery on said organ transplant, the method comprising administering to the subject an effective amount of: (i) an ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said solid organ transplant of said subject.
In yet another aspect, the disclosure also features a method for delaying or preventing or for prophylaxis against failure of an allografted vessel in a subject having said allografted vessel, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby delay, prevent or provide prophylaxis against failure of the allografted vessel in the subject. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In yet another aspect, the disclosure also features a method for delaying or preventing or for prophylaxis against failure of an allografted vessel in a subject having said allografted vessel, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby delay, prevent or provide prophylaxis against failure of the allografted vessel in the subject. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In yet another aspect, the disclosure also features a method for delaying solid organ allograft failure in a subject having said solid organ allograft, the method comprising: administering to the subject an effective amount of an: (i) ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby delay solid organ allograft failure in the subject. In some embodiments, the allograft failure can be delayed for at least two months (e.g., at least six months, at least one year, at least two years, at least three years, at least five years, at least seven years, at least 10 years, or even more than 10 years).
In yet another aspect, the disclosure also features a method for delaying failure of an allografted vessel in a subject having said allografted vessel, the method comprising: administering to the subject an effective amount of an: (i) ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby delay failure of the allografted vessel in the subject. In some embodiments, the allograft failure can be delayed for at least two months (e.g., at least six months, at least one year, at least two years, at least three years, at least five years, at least seven years, at least 10 years, or even more than 10 years).
In yet another aspect, the disclosure also features a method for delaying solid organ allograft failure in a subject having said solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby delay solid organ allograft failure in the subject. In some embodiments, the allograft failure can be delayed for at least two months (e.g., at least six months, at least one year, at least two years, at least three years, at least five years, at least seven years, at least 10 years, or even more than 10 years). In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In another aspect, the disclosure relates to a method for reducing and/or preventing stenosis or restenosis in the vasculature of a solid organ allograft of a subject having a solid organ allograft, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent stenosis or restenosis in said vasculature of said solid organ allograft.
In another aspect, the disclosure relates to a method for reducing and/or preventing stenosis or restenosis in the vasculature of a solid organ allograft of a subject having a solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent and a complement inhibitor to thereby reduce and/or prevent stenosis or restenosis in said vasculature of said solid organ allograft. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In yet another aspect, the disclosure also features a method for delaying or preventing or as prophylaxis against solid organ allograft rejection in a subject having said solid organ allograft, the method comprising: administering to the subject an effective amount of an: (i) ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby delay or prevent solid organ allograft rejection in the subject.
In yet another aspect, the disclosure also features a method for delaying or preventing or as prophylaxis against solid organ allograft rejection in a subject having said solid organ allograft, wherein the subject is receiving or has received a therapy comprising an ENPP1 agent or an ENPP3 agent, the method comprising: administering to the subject an effective amount of a complement inhibitor to thereby delay or prevent solid organ allograft rejection in the subject. In some embodiments, the method can also include administering to the subject the ENPP1 agent or ENPP3 agent.
In yet another aspect, the disclosure also features a method for delaying or preventing or as prophylaxis against rejection of an allografted vessel in a subject having said allografted vessel, the method comprising: administering to the subject an effective amount of an: (i) ENPP1 agent or an ENPP3 agent and (ii) a complement inhibitor to thereby delay or prevent rejection of said vessel in the subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In yet another aspect, the disclosure also features a method for delaying or preventing or as prophylaxis against rejection of an allografted vessel in a subject having said allografted vessel, wherein the subject is receiving or has received a therapy comprising an ENPP1 agent or an ENPP3 agent, the method comprising: administering to the subject an effective amount of a complement inhibitor to thereby delay or prevent rejection of the allografted vessel in the subject. In some embodiments, the method can also include administering to the subject the ENPP1 agent or ENPP3 agent. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in the vasculature of an allograft of a subject having said allograft, the method comprising administering to the subject an effective amount of an ENPP1 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said vasculature of said allograft of said subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing stenosis or restenosis in the vasculature of a solid organ allograft of a subject having a solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent stenosis or restenosis in said solid organ allograft
In another aspect, the disclosure relates to a method for prolonging the survival of a solid organ allograft in a subject having a solid organ allograft, the method comprising administering to said subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby prolong survival of said solid organ allograft in said subject
In another aspect, the disclosure relates to a method for inhibiting or preventing vasculopathy in a solid organ allograft of a subject having a solid organ allograft, the method comprising administering to said subject an ENPP1 agent or ENPP3 agent in an amount sufficient to inhibit or prevent vasculopathy in the solid organ allograft.
In another aspect, the disclosure relates to a method for inhibiting or preventing vasculopathy of an allografted blood vessel in a subject having a blood vessel allograft, the method comprising administering to a subject an ENPP1 agent or ENPP3 agent in an amount sufficient to prevent or inhibit vasculopathy of said allografted vessel.
In another aspect, the disclosure relates to a method for inhibiting or preventing vascular smooth muscle cell proliferation in an allografted blood vessel in a subject having a blood vessel allograft, the method comprising administering to said subject an ENPP1 agent or ENPP3 agent in an amount sufficient to prevent or inhibit vascular smooth muscle cell proliferation in said allografted vessel
In another aspect, the disclosure relates to a method for prolonging the survival of an allografted blood vessel in a subject having a blood vessel allograft, the method comprising administering to said subject an ENPP1 agent or ENPP3 agent in an amount sufficient to thereby prolong survival of said allografted blood vessel.
In another aspect, the disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a solid organ transplant in a subject having a solid organ transplant and who undergoes surgery on said organ transplant, the method comprising administering to the subject an effective amount of an ENPP1 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said solid organ transplant of said subject.
In another aspect, the disclosure also features a method for preventing or for prophylaxis against solid organ allograft failure in a subject having said solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby prevent or provide prophylaxis against solid organ allograft failure in the subject.
In another aspect, the disclosure also features a method for delaying solid organ allograft failure in a subject having said solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby delay solid organ allograft failure in the subject. In some embodiments, the allograft failure can be delayed for at least two months (e.g., at least six months, at least one year, at least two years, at least three years, at least five years, at least seven years, at least 10 years, or even more than 10 years).
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent vasculopathy of the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in an allografted vessel in a subject, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in the allografted vessel in said subject. In some embodiments, the vessel is an artery. In some embodiments, the vessel is a vein. In some embodiments, the subject has received or is receiving a therapy comprising a complement inhibitor. In some embodiments, the methods comprise administering to the subject a complement inhibitor.
In another aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy (for example, cardiac allograft vasculopathy) in a subject having an allograft, the method comprising: administering to the subject an effective amount of: (i) an ENPP1 agent or ENPP3 agent and (ii) a complement inhibitor to thereby reduce and/or prevent allograft vasculopathy in said subject.
In yet another aspect, the disclosure relates to a method for reducing and/or preventing allograft vasculopathy (for example, cardiac allograft vasculopathy) in a subject having an allograft and who has received or is receiving a therapy comprising a complement inhibitor, the method comprising: administering to the subject an effective amount of an ENPP1 agent or ENPP3 agent to thereby reduce and/or prevent allograft vasculopathy in said subject. In some embodiments, the methods further comprise administering the complement inhibitor to the subject.
In some embodiments of any of the methods described herein, the agent is administered prior to, during and/or after said surgery.
In some embodiments of any of the methods described herein, the agent is administered prior to, during and/or after shunt placement.
In some embodiments of any of the methods described herein, wherein the surgery and/or shunt placement further comprises introduction into the subject of a dialysis catheter.
In some embodiments, any of the methods described herein can comprise administering to the subject one or more of an anticoagulant, an antibiotic, and an antihypertensive.
In some embodiments, any of the methods described herein can comprise monitoring the subject for an occlusion of the shunt, such as a thrombosis.
In some embodiments, any of the methods described herein further include administering to the patient one or more immunosuppressants.
In some embodiments of any of the methods described herein, the ENPP1 agent comprises ENPP1 variants that retain enzymatic activity.
In some embodiments of any of the methods described herein, the ENPP3 agent comprises ENPP3 variants that retain enzymatic activity.
In some embodiments of any of the methods described herein, the subject is one who is receiving or who has received one or more of an anticoagulant, an antibiotic, and an antihypertensive.
In some embodiments of any of the methods described herein, the subject has received and/or is receiving an immunosuppressive therapy in conjunction with the solid organ allograft transplantation, such as one or more immunosuppressants.
In some embodiments of any of the methods described herein, the subject has received and/or is receiving in conjunction with the solid organ allograft transplantation one or more of a statin drug, a vasodialator, an anticoagulant (e.g., aspirin), and an immunosuppressant.
In some embodiments, any of the methods described herein further include administering to the patient one or more of a statin drug, a vasodialator, an anticoagulant (e.g., aspirin), and an immunosuppressant.
In some embodiments, any of the methods described herein further include performing revascularization surgery on the solid organ allograft.
In some embodiments of any of the methods described herein, the subject is expected to undergo, has undergone, or is undergoing revascularization surgery on the solid organ allograft.
In some embodiments, the revascularization surgery comprises angioplasty, a bypass graft, and/or a stent placement.
In some embodiments of any of the methods described herein, the agent is administered prior to, during and/or after said surgery.
In some embodiments of any of the methods described herein, the surgery comprises balloon angioplasty and/or placement of a stent.
In some embodiments, the methods described herein further comprise performing the surgery.
In some embodiments of any of the methods described herein, the ENPP1 agent comprises an ENPP1 polypeptide.
In some embodiments of any of the methods described herein, the ENPP1 agent comprises a nucleic acid encoding an ENPP1 polypeptide.
In some embodiments of any of the methods described herein, the ENPP1 agent comprises a viral vector comprising a nucleic acid encoding an ENPP1 polypeptide.
In some embodiments of any of the methods described herein, the ENPP1 polypeptide comprises the extracellular domain of ENPP1.
In some embodiments of any of the methods described herein, the ENPP1 polypeptide comprises the catalytic domain of ENPP1.
In some embodiments of any of the methods described herein, the ENPP1 polypeptide comprises amino acids 99 to 925 of SEQ ID NO:1.
In some embodiments of any of the methods described herein, the ENPP1 polypeptide comprises a heterologous protein.
In some embodiments of any of the methods described herein, the heterologous protein increases the circulating half-life of the ENPP1 polypeptide in mammal.
In some embodiments of any of the methods described herein, the heterologous protein is an Fc region of an immunoglobulin molecule.
In some embodiments of any of the methods described herein, the immunoglobulin molecule is an IgG1 molecule.
In some embodiments of any of the methods described herein, the heterologous protein is an albumin molecule.
In some embodiments of any of the methods described herein, the heterologous protein is carboxy-terminal to the ENPP1 polypeptide.
In some embodiments of any of the methods described herein, ENPP1 agent comprises a linker.
In some embodiments of any of the methods described herein, the linker separates the ENPP1 polypeptide and the heterologous protein.
In some embodiments of any of the methods described herein, the linker comprises the following amino acid sequence: (GGGGS)n, wherein n is an integer from 1 to 10.
In some embodiments of any of the methods described herein, the ENPP1 agent is administered to the subject subcutaneously.
In some embodiments of any of the methods described herein, the ENPP1 agent is administered to the subject intravenously.
In some embodiments of any of the methods described herein, the subject: is a tobacco user, has hypertension, has elevated cholesterol or triglyceride levels, is a diabetic, has renal disease, or is obese.
In some embodiments of any of the methods described herein, the subject has stage I, stage II or stage III, Suzuki grade MMD. In another aspect, the disclosure features a method for inhibiting or slowing progression of Stage I Suzuki grade MMD peripheral artery disease to Stage III Suzuki grade MMD in a subject, the method comprising: administering to the subject an effective amount of an ENPP3 agent to thereby inhibit and/or slow progression of Stage I Suzuki grade MMD to Stage III Suzuki grade MMD in said subject.
In another aspect, the disclosure features a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a cerebral artery of a subject who requires surgery on said cerebral artery, wherein the subject has Moyamoya disease, the method comprising: administering to the subject an effective amount of an ENPP1 agent or an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said cerebral artery at a surgical site of said cerebral artery in said subject.
In some embodiments of any of the methods described herein, the cerebral artery is one or more of an external carotid artery (ECA), an internal carotid artery (ICA), a middle cerebral artery (MCA) and an anterior cerebral artery (ACA).
In some embodiments of any of the methods described herein, the ENPP3 agent is administered prior to, during and/or after stent placement.
In some embodiments of any of the methods described herein, the solid organ allograft is a cardiac allograft.
In some embodiments of any of the methods described herein, the solid organ allograft is a lung allograft, a liver allograft, or a kidney allograft.
In some embodiments of any of the methods described herein, the complement inhibitor is a complement component C5 inhibitor, such as an anti-05 antibody, e.g., eculizumab or ravulizumab-cwvz.
In some embodiments, the complement inhibitor is an inhibitor of complement component C1 (including C1s and C1q), C2, C3, C4, C5, C6, C7, C8, and/or C9, such as an antibody that binds to and inhibits the function of any one of such complement components.
In some embodiments, the complement inhibitor is compstatin or an analog thereof.
In some embodiments, the complement inhibitor is a C5a inhibitor, a C5aR inhibitor, a C3 inhibitor, a Factor D inhibitor, a Factor B inhibitor, a C4 inhibitor, a C1q inhibitor, a C1s inhibitor, or any combination thereof.
In some embodiments of any of the methods described herein, the complement inhibitor is a lectin pathway inhibitor, such as an anti-MASP2 antibody (e.g., OMS721).
In another aspect, the disclosure relates to a method for reducing and/or preventing stenosis or restenosis in the vasculature of a solid organ allograft of a subject having a solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP1 agent to thereby reduce and/or prevent stenosis or restenosis in said vasculature of said solid organ allograft.
In another aspect, the disclosure relates to a method for reducing and/or preventing vasculopathy of an allograft in a subject having allograft vasculopathy, the method comprising administering to the subject an effective amount of an ENPP3 agent to thereby treat said allograft vasculopathy in said subject.
In another aspect, the disclosure relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in the vasculature of an allograft of a subject having said allograft, the method comprising administering to the subject an effective amount of an ENPP3 agent to thereby reduce and/or prevent progression of said vascular smooth muscle cell proliferation in said vasculature of said allograft of said subject.
In another aspect, the disclosure also relates to a method for reducing and/or preventing progression of vascular smooth muscle cell proliferation in a solid organ transplant in a subject having a solid organ transplant and who undergoes surgery on said organ transplant, the method comprising administering to the subject an effective amount of an ENPP3 agent to thereby reduce and/or prevent progression of vascular smooth muscle cell proliferation in said solid organ transplant of said subject.
In some embodiments of any of the methods described herein, the agent is administered prior to, during and/or after said surgery.
In some embodiments of any of the methods described herein, the surgery comprises balloon angioplasty and/or placement of a stent.
In some embodiments of any of the methods described herein, the subject does not have a deficiency of ENPP 1.
In some embodiments of any of the methods described herein, the ENPP3 agent comprises an ENPP3 polypeptide.
In some embodiments of any of the methods described herein, the ENPP3 agent comprises a nucleic acid encoding an ENPP3 polypeptide.
In some embodiments of any of the methods described herein, the ENPP3 agent comprises a viral vector comprising a nucleic acid encoding an ENPP3 polypeptide.
In some embodiments of any of the methods described herein, the ENPP3 polypeptide comprises the extracellular domain of ENPP3.
In some embodiments of any of the methods described herein, the ENPP3 polypeptide comprises the catalytic domain of ENPP3.
In some embodiments of any of the methods described herein, the ENPP3 polypeptide comprises amino acids 49 to 875 of SEQ ID NO:7
In some embodiments of any of the methods described herein, the ENPP3 polypeptide comprises a heterologous protein.
In some embodiments of any of the methods described herein, the heterologous protein increases the circulating half-life of the ENPP3 polypeptide in mammal.
In some embodiments of any of the methods described herein, the heterologous protein is an Fc region of an immunoglobulin molecule.
In some embodiments of any of the methods described herein, the immunoglobulin molecule is an IgG1 molecule.
In some embodiments of any of the methods described herein, the heterologous protein is an albumin molecule.
In some embodiments of any of the methods described herein, the heterologous protein is carboxy-terminal to the ENPP3 polypeptide.
In some embodiments of any of the methods described herein, the ENPP3 agent comprises a linker.
In some embodiments of any of the methods described herein, the linker separates the ENPP3 polypeptide and the heterologous protein.
In some embodiments of any of the methods described herein, the linker comprises the following amino acid sequence: (GGGGS)n, wherein n is an integer from 1 to 10.
In some embodiments of any of the methods described herein, the ENPP3 agent is administered to the subject subcutaneously.
In some embodiments of any of the methods described herein, the ENPP3 agent is administered to the subject intravenously.
In some embodiments of any of the methods described herein, the subject: is a tobacco user, has hypertension, has elevated cholesterol or triglyceride levels, is a diabetic, has renal disease, or is obese. In some embodiments of any of the methods describes herein, the subject has cerebral arterial occlusions.
In another aspect, the disclosure relates to a method for reducing and/or preventing stenosis or restenosis in the vasculature of a solid organ allograft of a subject having a solid organ allograft, the method comprising: administering to the subject an effective amount of an ENPP3 agent to thereby reduce and/or prevent stenosis or restenosis in said solid organ allograft.
Other features and advantages of the disclosure will be apparent from the following detailed description and claims.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. Although any methods and materials similar or equivalent to those described herein can be used in practice or testing of the present disclosure, the preferred methods and materials are described.
For clarity, “NPP1” and “ENPP1” refer to the same protein and are used interchangeably herein. As used herein, the term “ENPP1 protein” or “ENPP1 polypeptide” refers to ectonucleotide pyrophosphatase/phosphodiesterase-1 protein encoded by the ENPP1 gene that is capable of cleaving ATP to generate PPi and also reduces ectopic calcification in soft tissue.
ENPP1 protein is a type II transmembrane glycoprotein and cleaves a variety of substrates, including phosphodiester bonds of nucleotides and nucleotide sugars and pyrophosphate bonds of nucleotides and nucleotide sugars. ENPP1 protein has a transmembrane domain and soluble extracellular domain. The extracellular domain is further subdivided into somatomedin B domain, catalytic domain and the nuclease domain. The sequence and structure of wild-type ENPP1 is described in detail in PCT Application Publication No. WO 2014/126965 to Braddock, et al., which is incorporated herein in its entirety by reference.
ENPP1 polypeptides as used herein encompasses polypeptides that exhibit ENPP1 enzymatic activity, mutants of ENPP1 that retain ENPP1 enzymatic activity, fragments of ENPP1 or variants of ENPP1 including deletion variants that exhibit ENPP1 enzymatic activity. ENPP1 enzymatic activity refers to the ability of the ENPP1 polypeptide to cleave Adenosine Triphosphate (ATP) into plasma pyrophosphate (PPi), as noted below.
ENPP3 polypeptides as used herein encompasses polypeptides that exhibit ATP cleavage enzymatic activity, mutants of ENPP3 that retain ATP cleavage enzymatic activity, fragments of ENPP3 or variants of ENPP3 including deletion variants that exhibit ATP cleavage enzymatic activity. ATP cleavage enzymatic activity refers to the ability of the ENPP3 polypeptide to cleave Adenosine Triphosphate (ATP) into plasma pyrophosphate (PPi), as noted below.
Some examples of ENPP1 and ENPP3 polypeptides, mutants, or mutant fragments thereof, have been previously disclosed in International PCT Application Publications No. WO/2014/126965—Braddock et al., WO/2016/187408-Braddock et al., WO/2017/087936-Braddock et al., and WO2018/027024-Braddock et al., all of which are incorporated by reference in their entireties herein.
Enzymatically active” with respect to an ENPP1 polypeptide or an ENPP3 polypeptide is defined as possessing ATP hydrolytic activity into AMP and PPi and/or AP3a hydrolysis to ADP and AMP. NPP1 and NPP3 readily hydrolyze ATP into AMP and PPi. The steady-state Michaelis-Menten enzymatic constants of NPP1 are determined using ATP as a substrate. NPP1 can be demonstrated to cleave ATP by HPLC analysis of the enzymatic reaction, and the identity of the substrates and products of the reaction are confirmed by using ATP, AMP, and ADP standards. The ATP substrate degrades over time in the presence of NPP1, with the accumulation of the enzymatic product AMP. Using varying concentrations of ATP substrate, the initial rate velocities for NPP1 are derived in the presence of ATP, and the data is fit to a curve to derive the enzymatic rate constants. At physiologic pH, the kinetic rate constants of NPP1 are Km=144 μM and kcatt=7.8 s−1.
As used herein, the term “ENPP1 precursor protein” refers to ENPP1 with its signal peptide sequence at the ENPP1 N-terminus. Upon proteolysis, the signal sequence is cleaved from ENPP1 to provide the ENPP1 protein. Signal peptide sequences useful within the disclosure include, but are not limited to, Albumin signal sequence, Azurocidin signal sequence, ENPP1 signal peptide sequence, ENPP2 signal peptide sequence, ENPP7 signal peptide sequence, and/or ENPP5 signal peptide sequence.
As used herein, the term “ENPP3 precursor protein” refers to ENPP3 with its signal peptide sequence at the ENPP3 N-terminus. Upon proteolysis, the signal sequence is cleaved from ENPP3 to provide the ENPP3 protein. Signal peptide sequences useful within the disclosure include, but are not limited to, Albumin signal peptide sequence, Azurocidin signal peptide sequence, ENPP1 signal peptide sequence, ENPP2 signal peptide sequence, ENPP7 signal peptide sequence, and/or ENPP5 signal peptide sequence.
As used herein, the term “Azurocidin signal peptide sequence” refers to the signal peptide derived from human azurocidin. Azurocidin, also known as cationic antimicrobial protein CAP37 or heparin-binding protein (HBP), is a protein that in humans is encoded by the AZU1 gene. The nucleotide sequence encoding Azurocin signal peptide MTRLTVLALLAGLLASSRA (SEQ ID NO: 42) is fused with the nucleotide sequence of NPP1 or NPP3 gene which when encoded generates ENPP1 precursor protein or ENPP3 precursor protein. (Optimized signal peptides for the development of high expressing CHO cell lines, Kober et al., Biotechnol Bioeng. 2013 April; 110(4):1164-73)
As used herein, the term “ENPP1-Fc construct” refers to ENPP1 (e.g., the extracellular domain of ENPP1) recombinantly fused and/or chemically conjugated (including both covalent and non-covalent conjugations) to an FcR binding domain of an IgG molecule (preferably, a human IgG). In certain embodiments, the C-terminus of ENPP1 is fused or conjugated to the N-terminus of the FcR binding domain.
As used herein, the term “ENPP3-Fc construct” refers to ENPP3 recombinantly fused and/or chemically conjugated (including both covalent and non-covalent conjugations) to an FcR binding domain of an IgG molecule (preferably, a human IgG). In certain embodiments, the C-terminus of ENPP1 is fused or conjugated to the N-terminus of the FcR binding domain.
As used herein, the term “Fc” refers to a human IgG (immunoglobulin) Fc domain. Subtypes of IgG such as IgG1, IgG2, IgG3, and IgG4 are contemplated for use as Fc domains. The “Fc region or Fe polypeptide” is the portion of an IgG molecule that correlates to a crystallizable fragment obtained by papain digestion of an IgG molecule. The Fc region comprises the C-terminal half of the two heavy chains of an IgG molecule that are linked by disulfide bonds. It has no antigen binding activity but contains the carbohydrate moiety and the binding sites for complement and Fc receptors, including the FcRn receptor. The Fc fragment contains the entire second constant domain CH2 (residues 231-340 of human IgG1, according to the Kabat numbering system) and the third constant domain CH3 (residues 341-447). The term “IgG hinge-Fc region” or “hinge-Fc fragment” refers to a region of an IgG molecule consisting of the Fc region (residues 231-447) and a hinge region (residues 216-230) extending from the N-terminus of the Fc region. The term “constant domain” refers to the portion of an immunoglobulin molecule having a more conserved amino acid sequence relative to the other portion of the immunoglobulin, the variable domain, which contains the antigen binding site. The constant domain contains the CHL CH2 and CH3 domains of the heavy chain and the CHL domain of the light chain.
As used herein the term “functional equivalent variant”, as used herein, relates to a polypeptide substantially homologous to the sequences of ENPP1 or ENPP3 (defined above) and that preserves the enzymatic and biological activities of ENPP1 or ENPP3, respectively. Methods for determining whether a variant preserves the biological activity of the native ENPP1 or ENPP3 are widely known to the skilled person and include any of the assays used in the experimental part of said application. Particularly, functionally equivalent variants of ENPP1 or ENPP3 delivered by viral vectors is encompassed by the present disclosure.
The functionally equivalent variants of ENPP1 or ENPP3 are polypeptides substantially homologous to the native ENPP1 or ENPP3 respectively. The expression “substantially homologous”, relates to a protein sequence when said protein sequence has a degree of identity with respect to the ENPP1 or ENPP3 sequences described above of at least 80%, at least 85%, at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98% or at least 99% respectively and still retaining at least 50%, 55%, 60%, 70%, 80% or 90% activity of wild type ENPP1 or ENPP3 protein with respect to ATP cleavage.
The degree of identity between two polypeptides is determined using computer algorithms and methods that are widely known for the persons skilled in the art. The identity between two amino acid sequences is preferably determined by using the BLASTP algorithm (BLAST Manual, Altschul, S., et al., NCBI NLM NIH Bethesda, Md. 20894, Altschul, S., et al., J. Mol. Biol. 215: 403-410 (1990)), though other similar algorithms can also be used. BLAST and BLAST 2.0 are used, with the parameters described herein, to determine percent sequence identity. Software for performing BLAST analyses is publicly available through the National Center for Biotechnology Information.
Functionally equivalent variants of ENPP1 or ENPP3 may be obtained by replacing nucleotides within the polynucleotide accounting for codon preference in the host cell that is to be used to produce the ENPP1 or ENPP3 respectively. Such “codon optimization” can be determined via computer algorithms which incorporate codon frequency tables such as “Human high.cod” for codon preference as provided by the University of Wisconsin Package Version 9.0, Genetics Computer Group, Madison, Wis. The variants of ENPP1 or ENPP3 polypeptides are expected to retain at least 50%, 55%, 60%, 70%, 80% or 90% activity of wild type ENPP1 or ENPP3 protein with respect to ATP cleavage.
As used herein the term “ENPP1 fragment” refers to a fragment or a portion of ENPP1 protein or an active subsequence of the full-length NPP1 having at least an ENPP1 catalytic domain administered in protein form or in the form of a nucleic acid encoding the same.
As used herein, the term “ENPP1 agent” refers to ENPP1 polypeptide or fusion protein or ENPP1 fragment comprising at least catalytic domain capable of producing plasma pyrophosphate (Ppi) by cleavage of adenosine triphosphate (ATP) or a polynucleotide such as cDNA or RNA encoding ENPP1 fusion protein or ENPP1 fragment comprising at least catalytic domain capable of producing PPi by enzymatic cleavage of ATP or a vector such as a viral vector containing a polynucleotide encoding the same.
As used herein, the term “wild-type” refers to a gene or gene product isolated from a naturally occurring source. A wild-type gene is most frequently observed in a population and is thus arbitrarily designed the “normal” or “wild-type” form of the human NPP1 or NPP3 genes. In contrast, the term “functionally equivalent” refers to a NPP1 or NPP3 gene or gene product that displays modifications in sequence and/or functional properties (i.e., altered characteristics) when compared to the wild-type gene or gene product. Naturally occurring mutants can be isolated; these are identified by the fact that they have altered characteristics (including altered nucleic acid sequences) when compared to the wild-type gene or gene product.
“About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of +20% or +10%, more preferably +5%, even more preferably +1%, and still more preferably +0.1% from the specified value, as such variations are appropriate to perform the disclosed methods.
As defined herein, the term “moiety” refers to a chemical component or biological molecule that can be covalently or non-covalently linked to ENPP1 or ENPP3 polypeptide and has the ability to confer a desired property to the protein to which it is attached. For example, the term moiety can refer to a bone targeting peptide such as polyaspartic acid or polyglutamic acid (of 4-20 consecutive asp or glu residues) or a molecule that extends the half-life of ENPP1 or ENPP3 polypeptide. Some other examples of moieties include Fc, albumin, transferrin, polyethylene glycol (PEG), homo-amino acid polymer (HAP), proline-alanine-serine polymer (PAS), elastin-like peptide (ELP), and gelatin-like protein (GLK).
As defined herein, the term “subject”, “individual” or “patient” refers to mammal preferably a human who does not possess a loss of function mutation in the NPP1 gene, such as those loss of function mutations that result in pathological calcification and pathological ossification diseases such as Generalized Arterial Calcification of Infancy (GACI), Autosomal Recessive Hypophosphatemic Rickets Type 2 (ARHR2), Infantile idiopathic arterial calcification (IIAC), Ossification of the Posterior Longitudinal Ligament (OPLL), hypophosphatemic rickets, osteoarthritis, calcification of atherosclerotic plaques, hereditary and non-hereditary forms of osteoarthritis, ankylosing spondylitis, hardening of the arteries occurring with aging, calciphylaxis resulting from end stage renal disease and progeria. Such a patient will have a normal level of NPP1 in serum which refers to the amount of NPP1 required to maintain a normal level of plasma pyrophosphate (PPi) in a healthy subject. A normal level of PPi corresponds to 2-3 μM.
As used herein the term “plasma pyrophosphate (PPi) levels” refers to the amount of pyrophosphate present in plasma of animals. In certain embodiments, animals include rat, mouse, cat, dog, human, cow and horse. There are several ways to measure PPi, one of which is by enzymatic assay using uridine-diphosphoglucose (UDPG) pyrophosphorylase (Lust & Seegmiller, 1976, Clin. Chim. Acta 66:241-249; Cheung & Suhadolnik, 1977, Anal. Biochem. 83:61-63) with modifications.
Typically, plasma PPi levels in healthy human subjects range from about 1 μm to about 3 μM, in some cases between 1-2 μm. Subjects who have defective ENPP1 expression tend to exhibit low ppi levels which range from at least 10% below normal levels, at least 20% below normal levels, at least 30% below normal levels, at least 40% below normal levels, at least 50% below normal levels, at least 60% below normal levels, at least 70% below normal levels, at least 80% below normal levels and combinations thereof. In patients afflicted with Generalized Arterial Calcification of Infancy (GACI), the ppi levels are found to be less than 1 μm and in some cases are below the level of detection. In patients afflicted with Pseudoxanthoma Elasticum (PXE), the ppi levels are below 0.5 μm. (Arterioscler Thromb Vasc Biol. 2014 September; 34(9):1985-9; Braddock et al., Nat Commun. 2015; 6: 10006.)
As used herein, the term “PPi” refers to inorganic pyrophosphate.
A “low level of PPi” refers to a condition in which the subject has at least 0.1%-0.99% less than 2%-5% of normal levels of plasma pyrophosphate (PPi). Normal levels of Plasma PPi in healthy human subjects are in the range of 1.8 to 2.6 μM.+/−0.1 μM (Arthritis and Rheumatism, Vol. 22, No. 8 (August 1979))
As used herein the term “non-surgical tissue injury” refers to injuries sustained to a tissue or blood vessel during a traumatic event including but not limited to physical altercations involving use of blunt force or sharp objects such as knife, mechanical injury such fall from elevation, workplace injury due to heavy machinery or vehicular injury such as car accidents.
As used herein, the term “myocardial infarction” refers to a permanent damage to the heart muscle that occurs due to the formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply. The symptoms of MI include chest pain, which travels from left arm to neck, shortness of breath, sweating, nausea, vomiting, abnormal heart beating, anxiety, fatigue, weakness, stress, depression, and other factors.
As used herein, the term “moyamoya disease” or “moyamoya syndrome” refers to a steno-occlusive disease of the cerebral arteries, involving smooth muscle cell proliferation with intima hyperplasia causing arterial stenosis and occlusion around the circle of Willis. It involves development of new blood vessels resembling a “puff of smoke” (“moyamoya”) in the subcortical region. MMD occurs in children and adults with two peaks—at around age 5-10 and a second peak between the third and fifth decade of life. Common symptoms include headache or dizziness, weakness or paralysis in a limb or on one side of the body, problems with speech inability to speak or recall words, sensory or cognitive impairment, involuntary movements, seizures or loss of consciousness, vision problems, stroke, and cerebral hemorrhage. 80% of MMD cases are carriers of RNF213 and or R4810K mutations. Treatment options for both MMD and MMS involve daily aspirin use, lifestyle modifications to maximize cerebral perfusion, and surgical direct or indirect bypass to restore blood flow.
Diagnostic criteria for definitive MMD were revised to include patients with both bilateral and unilateral presentation of terminal carotid artery stenosis (ICA) with an abnormal vascular network at the base of the brain. Suzuki system of grading the patient population has been used for MMD. Definitive diagnosis of MMD requires catheter angiography in unilateral cases, whereas bilateral cases can be promptly diagnosed by either catheter angiography or magnetic resonance imaging/angiography (MRI/MRA).
As used herein, the phrase “cerebral vascular occlusion” refers to the temporary or permanent blockage of blood vessels in the brain. Restrictions in blood flow may occur from vessel narrowing (stenosis), clot formation (thrombosis), blockage (embolism) or blood vessel rupture (hemorrhage). Lack of sufficient blood flow (ischemia) affects brain tissue and may cause a stroke.
As used herein the term “Suzuki classification System” refers to classification system developed by Suzuki et al. (Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969; 20(3):288±99.). This classification system grades the clinical presentation of patients to four stages. The vast majority of patients will progress through some or all of the Suzuki stages, although progression may occur at different rates, and appears to occur more rapidly in children than in adolescents or adults. The system is solely based on conventional angiography and is as shown in table below.
As used herein, the term “internal carotid artery (ICA)” refers to the artery that is located in the inner side of the neck and supplies blood to the brain and eyes.
As used herein, the term “external carotid artery (ECA)” refers to a major artery of the head and neck. It arises from the common carotid artery when it splits into the external and internal carotid artery. ECA supplies blood to face, scalp, skull, and meninges. As used herein, the term “anterior Cerebral Artery (ACA)” refers is an artery on the brain that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes. A pair of anterior cerebral arteries arise from the internal carotid artery and are part of the circle of Willis.
As used herein, the term “medial cerebral artery (MCA)” refers to is one of the three major paired arteries that supply blood to the cerebrum. The MCA arises from the internal carotid and continues into the lateral sulcus where it then branches and projects to many parts of the lateral cerebral cortex. It also supplies blood to the anterior temporal lobes and the insular cortices.
As used herein, the term “conventional angiography” refers to Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.
As used herein, the term “catheter angiography” refers to a medical procedure wherein a catheter, x-ray imaging guidance and an injection of contrast material to examine blood vessels in key areas of the body such as brain or heart for abnormalities such as aneurysms and disease such as atherosclerosis (plaque).
As used herein, the phrase “magnetic resonance angiography (MRA)” refers to a medical process wherein magnetic resonance imaging scanner is used to visualize the blockages in the blood vessels of critical regions such as brain, lungs and heart with aid of a contrast agent administered with an intravenous needle. It is non-invasive method to diagnose blockages or occlusions in the blood vessels.
As used herein, the term “subject who requires surgery” refers to a patient who is not ENPP1 deficient and has arterial occlusion in the peripheral arteries such as femoral, femoropopliteal or tibial-peroneal arteries.
As used herein, the term “site of surgery” refers to the region of the artery upon which a tissue injury has occurred either due to vascular trauma or accidental trauma.
As used herein, the term “brain calcification” (BC) refers to a nonspecific neuropathology wherein deposition of calcium and other mineral in blood vessel walls and tissue parenchyma occurs leading to neuronal death and gliosis. Brain calcification is” often associated with various chronic and acute brain disorders including Down's syndrome, Lewy body disease, Alzheimer's disease, Parkinson's disease, vascular dementia, brain tumors, and various endocrinologic conditions Calcification of heart tissue refers to accumulation of deposits of calcium (possibly including other minerals) in tissues of the heart, such as aorta tissue and coronary tissue.
As used herein with respect to use of a dialysis shunt, stenosis slows and reduces blood flow through an AV fistula, causing problems with the quality of dialysis treatment, prolonged bleeding after puncture, or pain in the fistula. Stenosis can also lead to a blocked or clotted access.
As used herein the term “scapel incision” refers to incision made in a tissue using a sharp object such as a scapel during surgical procedure. An incision is a cut made into the tissues of the body to expose the underlying tissue, bone, or organ so that a surgical procedure can be performed.
As used herein, the term “site of surgery” refers to the region of the artery upon which a tissue injury has occurred either due to vascular trauma or accidental trauma.
The term “arterio-venous shunt” or “AV shunt” or simply “shunt” refers to an implanted device which includes a tube to which an artery and vein is attached. A shunt connects the arterial and venous cannulas and provides a larger than normal volume of blood flow for effective hemodialysis. A shunt can be located in any part of the body, and is most often located in an arm, a leg or the chest area below the right collarbone.
As used herein, the term “coated shunt” refers to shunts that are capable of slowly eluting therapeutic compounds or polypeptides such as ENPP1 or ENPP3 to reduce the amount of vascular smooth muscle cell proliferation at the site of surgery, typically performed to remove blockage of the arteries.
As used herein, the term “hemodialysis” refers to a treatment that is required to compensate for abnormal kidney function, in which wastes and water are filtered out of blood and the filtered cleaner blood is returned to the body. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in a subject's blood.
As used herein, the term “fistula” refers to an abnormal or surgically made passage between a hollow or tubular organ and the body surface, or between two hollow or tubular organs.
The term “stent” refers to a tubular support placed inside a blood vessel, canal, or duct to aid healing or relieve an obstruction.
The term “vessel” refers to a tubular structure carrying blood through the tissues and organs; a vein, artery, or capillary.
As used herein, the term “complement inhibitor” refer to a molecule (e.g., a protein (such as an antibody), a small molecule, or a peptide) that prevents or reduces activation and/or propagation of the complement cascade that results in the formation of C3a or signaling through the C3a receptor, C5a or signaling through the C5a receptor, or formation of terminal complement. Complement inhibitors are well known in the art and described in, e.g., Zipfel et al. (2019) Front Immunol 10:2166. See also, e.g., U.S. Pat. No. 5,679,345, the disclosure of which is incorporated by reference in its entirety.
As used herein the terms “alteration,” “defect,” “variation” or “mutation” refer to a mutation in a gene in a cell that affects the function, activity, expression (transcription or translation) or conformation of the polypeptide it encodes, including missense and nonsense mutations, insertions, deletions, frameshifts and premature terminations.
As defined herein, the phrase “medial area” is the area between lamina elastica externa and lamina elastica interna of an artery.
As defined herein, the phrase “intimal area” and said intimal area is the area between said lamina elastica interna and lumen of an artery.
As defined herein, the phrase “lamina elastica externa” refers to a layer of elastic connective tissue lying immediately outside the smooth muscle of the tunica media of an artery.
As defined herein, the phrase “lamina elastica interna” refers to a layer of elastic tissue that forms the outermost part of the tunica intima of blood vessels.
As defined herein, the phrase “lumen” refers to the interior of a vessel, such as the central space in an artery, vein or capillary through which blood flow occurs.
As defined herein, the phrase “vasculopathy” refers to disease of the vasculature. “Vasculature” refers to the arrangement of blood vessels in the body or in an organ, such as a solid organ transplant, or in a body part. A “blood vessel” refers to one or more of an artery, arteriole, capillary and vein in the body of a subject or of a solid organ allograft of a subject. “Vasculitis” refers to inflammation of veins, arteries, capillaries, or lymph vessels. A “vascularized graft” refers to a graft after the recipient vasculature has been connected with the vessels in the graft.
As defined herein, the phrase “cardiac allograft vasculopathy (CAV)” refers to a vascular complication of allograft or solid organ transplantation such as heart wherein the blood vessels supplying the transplanted heart gradually narrow and restrict its blood flow, subsequently leading to impairment of the heart muscle or sudden death. Diagnosis of CAV is by regular follow-up and monitoring of the transplanted organ such as heart for early signs of disease. This involves invasive diagnostics including coronary angiography and intravascular ultrasound, and non-invasive investigations including dobutamine stress echocardiography, positron emission tomography, computed tomographic angiography (CT angiography) and the levels of a variety of biomarkers such as C-reactive protein, serum brain natriuretic peptide, troponin and serum microRNA 628-5p.
As defined herein, “allograft” refers to the transplant of an organ or tissue from a donor to a recipient of the same species. Allografts account for many human organ and tissue transplants, including those from cadaveric, living related, and living unrelated donors.
As defined herein, a “solid organ allograft” refers to an allograft of a solid organ. A “solid organ” is an internal organ that has a firm tissue consistency and is neither hollow (such as the organs of the gastrointestinal tract) nor liquid (such as blood). A solid organ includes but is not limited to kidney, liver, cornea, intestines, heart, lung and pancreas.
As defined herein, the phrase “graft rejection” or “transplant rejection” refers to a condition wherein the transplanted organ or tissue is rejected by the recipient's immune system, which destroys the allograft and results in long-term loss of function in transplanted organs via fibrosis of the transplanted tissue blood vessels.
As defined herein, the phrase “prolonging the survival of an allograft” refers to the prevention of rejection of a transplanted donor organ or tissue by the recipient immune system and to improve the lifespan of the transplanted organ. Survival of an allograft may be prolonged by at least 12 months, 18 months, 2 years, 3 years, 4 years, 5 years, 8 years, 10 years or longer relative to allograft survival absent treatment.
As defined herein, the phrase “heart allograft” refers to a solid organ transplant involving a donor heart transplanted into a recipient or grafting of one or more donor arteries or veins into a recipient's heart. Graft rejection in heart allografts is commonly diagnosed by performing Endomyocardial biopsy.
As defined herein, the phrase “kidney allograft” refers to a solid organ transplant involving a donor kidney transplanted into a recipient or grafting of one or more donor arteries or veins into a recipient's kidney. Graft rejection in kidney allografts is commonly diagnosed by monitoring Urine protein levels such total protein-to-creatinine ratio, albumin-to-creatinine ratio, serum creatinine level and glomerular filtration rate.
As defined herein, the phrase “liver allograft” refers to a solid organ transplant involving a donor liver transplanted into a recipient or grafting of one or more donor arteries or veins into a recipient's liver. Graft rejection in liver allografts is diagnosed by monitoring Transaminase, bilirubin, and alkaline phosphatase levels.
As defined herein, the phrase “lung allograft” refers to refers to a solid organ transplant involving a donor lung transplanted into a recipient or grafting of one or more donor arteries or veins into a recipient's lung. Graft rejection in lung allografts is diagnosed by bronchoscopy with transbronchial biopsies and pulmonary function testing.
As defined herein, the phrase “allografted vessel” or “Allografted vasculature” refers to the grafting of one or more donor blood vessels such as artery, vein, capillary and/or arteriole into the recipient.
As defined herein, the phrase “allografted artery” refers to the grafting of one or more donor arteries into the recipient.
As defined herein, the phrase “allografted vein” refers to the grafting of one or more donor veins into the recipient.
As defined herein, the phrase “endomyocardial biopsy” refers to a procedure that percutaneously obtains small amounts of myocardial tissue for diagnostic, therapeutic, and research purposes. It is primarily used to (1) follow the transplanted heart for myocardial rejection; (2) diagnose specific inflammatory, infiltrative, or familial myocardial disorders; and (3) sample unknown myocardial masses.
As defined herein, the phrase “transbronchial lung biopsy” refers to a biopsy from the lung obtained by endoscopically-guided forceps, which is useful in evaluating lesions in the transplant distributed along bronchovascular bundles and in the central lung zones.
As defined herein, the phrase “surgery” refers to an invasive medical procedure that involves vascular interventions which result in tissue injury by scapel incision or radiofrequency ablation or cryoablation or laser ablation.
As defined herein, the phrase “tissue injury” refers to proliferation or onset of proliferation and migration of vascular smooth muscle eventually resulting in the thickening of arterial walls and decreased arterial lumen space resulting restenosis after percutaneous vascular interventions such as stenting or angioplasty.
As defined herein, the phrase “deficient for NPP1” or “ENPP 1 deficiency” refers to a reduction in an amount of NPP1 protein or in NPP1 activity relative to a normal serum level of NPP1 protein or normal activity of NPP1, wherein such a reduction results in a disease or disorder of pathological calcification and/or pathological ossification. Such pathological diseases include but are not limited to GACI and ARHR2. ENPP1 deficiency, as used herein, does not refer to small reductions in an amount of NPP1 protein and/or NPP1 activity that do not result in a disease or disorder of pathological calcification and/or pathological ossification.
As defined herein the phrase “restenosis” refers to recurrence of stenosis. Stenosis refers to the narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become re-narrowed. Restenosis is commonly detected by using one or more of ultrasound, X-ray computed tomography (CT), nuclear imaging, optical imaging or contrast enhanced image or immunohistochemical detection. As defined herein the phrase “myointimal proliferation” refers to the proliferation of vascular smooth muscle cells that occurs at the tunica intima of an arterial wall of an individual.
As used herein, the phrase “reduce or prevent myointimal proliferation” refers to the ability of soluble NPP1 upon administration to reduce the level of proliferation vascular smooth muscle cells at the site of tissue injury thereby reducing the thickening of arterial walls and prevent the occurrence of or reduce the level of restenosis of the artery.
As used herein, the term “treatment” or “treating” is defined as the application or administration of soluble NPP1 (alone or in combination with another pharmaceutical agent), to a patient, or application or administration of a therapeutic agent to an isolated tissue or cell line from a patient (e.g., for diagnosis or ex vivo applications), who has a disease or disorder, a symptom of a disease or disorder or the potential to develop a disease or disorder, with the purpose to cure, heal, alleviate, relieve, alter, remedy, ameliorate, improve or affect the disease or disorder, the symptoms of the disease or disorder, or the potential to develop the disease or disorder. Such treatments may be specifically tailored or modified, based on knowledge obtained from the field of pharmacogenomics.
As used herein, the term “prevent” or “prevention” or “reduce” means no disorder or disease development if none had occurred, or no further disorder or disease development if there had already been development of the disorder or disease. Also considered is the ability of one to prevent some or all of the symptoms associated with the disorder or disease.
As used herein, the term “effective amount” refers to an amount of an agent (e.g., NPP1 fusion or NPP3 fusion polypeptides) which, as compared to a corresponding subject who has not received such an amount, sufficient to provide improvement of a condition, disorder, disease, or to provide a decrease in progression or advancement of a condition, disorder, or disease. An effective amount also may result in treating, healing, preventing or ameliorating a condition, disease, or disorder. The term also includes within its scope amounts effective to enhance normal physiological function. As used herein, the term “polypeptide” refers to a polymer composed of amino acid residues, related naturally occurring structural variants, and synthetic non-naturally occurring analogs thereof linked via peptide bonds.
As used here the term “Isolated” means altered or removed from the natural state. For example, a nucleic acid or a polypeptide naturally present in a living animal is not “isolated,” but the same nucleic acid or polypeptide partially or completely separated from the coexisting materials of its natural state is “isolated.” An isolated nucleic acid or protein can exist in substantially purified form, or can exist in a non-native environment such as, for example, a host cell.
As used herein, “substantially purified” refers to being essentially free of other components. For example, a substantially purified polypeptide is a polypeptide that has been separated from other components with which it is normally associated in its naturally occurring state. Non-limiting embodiments include 95% purity, 99% purity, 99.5% purity, 99.9% purity and 100% purity.
As used herein the term “oligonucleotide” or “polynucleotide” is a nucleic acid ranging from at least 2, in certain embodiments at least 8, 15 or 25 nucleotides in length, but may be up to 50, 100, 1000, or 5000 nucleotides long or a compound that specifically hybridizes to a polynucleotide.
As used herein, the term “pharmaceutical composition” or “composition” refers to a mixture of at least one compound useful within the disclosure with a pharmaceutically acceptable carrier. The pharmaceutical composition facilitates administration of the compound to a patient. Multiple techniques of administering a compound exist in the art including, but not limited to, subcutaneous, intravenous, oral, aerosol, inhalational, rectal, vaginal, transdermal, intranasal, buccal, sublingual, parenteral, intrathecal, intragastrical, ophthalmic, pulmonary, and topical administration.
As used herein, the term “pharmaceutically acceptable” refers to a material, such as a carrier or diluent, which does not abrogate the biological activity or properties of the compound, and is relatively non-toxic, i.e., the material may be administered to an individual without causing undesirable biological effects or interacting in a deleterious manner with any of the components of the composition in which it is contained; for example, phosphate-buffered saline (PBS)
As used herein, the term “pathological calcification” refers to the abnormal deposition of calcium salts in blood vessels, soft tissues, secretory and excretory passages of the body causing it to harden. There are two types, dystrophic calcification which occurs in dying and dead tissue and metastatic calcification which elevated extracellular levels of calcium (hypercalcemia), exceeding the homeostatic capacity of cells and tissues. Calcification can involve cells as well as extracellular matrix components such as collagen in basement membranes and elastic fibers in arterial walls. Some examples of tissues prone to calcification include: Gastric mucosa—the inner epithelial lining of the stomach, Kidneys and lungs, Cornea, heart valves, Systemic arteries and Pulmonary veins.
As used herein, the term “pathological ossification” refers to a pathological condition in which bone arises in tissues not in the osseous system and in connective tissues usually not manifesting osteogenic properties. Ossification is classified into three types depending on the nature of the tissue or organ being affected, endochondral ossification is ossification that occurs in and replaces cartilage. Intramembranous ossification is ossification of bone that occurs in and replaces connective tissue. Metaplastic ossification the development of bony substance in normally soft body structures; called also heterotrophic ossification.
As used herein, “reduction of calcification” is observed by using non-invasive methods like X-rays, micro CT and Mill. Reduction of calcification is also inferred by using radio imaging with 99mTc-pyrophosphate (99mPYP) uptake. The presence of calcifications in mice are evaluated via post-mortem by micro-computed tomography (CT) scans and histologic sections taken from the heart, aorta and kidneys with the use of dyes such as Hematoxylin and Eosin (H&E) and Alizarin red by following protocols established by Braddock et al. (Nature Communications volume 6, Article number: 10006 (2015))
As used herein the term “ectopic calcification” refers to a condition characterized by a pathologic deposition of calcium salts in tissues or bone growth in soft tissues.
As used herein the term “ectopic calcification of soft tissue” refers to inappropriate biomineralization, typically composed of calcium phosphate, hydroxyapatite, calcium oxalates and ocatacalcium phosphates occurring in soft tissues leading to loss of hardening of soft tissues. “Arterial calcification” refers to ectopic calcification that occurs in arteries and heart valves leading to hardening and or narrowing of arteries. Calcification in arteries is correlated with atherosclerotic plaque burden and increased risk of myocardial infarction, increased ischemic episodes in peripheral vascular disease, and increased risk of dissection following angioplasty.
As used herein, the term “venous calcification” refers to ectopic calcification that occurs in veins that reduces the elasticity of the veins and restricts blood flow which can then lead to increase in blood pressure and coronary defects
As used herein, the term “vascular calcification” refers to the pathological deposition of mineral in the vascular system. It has a variety of forms, including intimal calcification and medial calcification, but can also be found in the valves of the heart. Vascular calcification is associated with atherosclerosis, diabetes, certain heredity conditions, and kidney disease, especially CKD. Patients with vascular calcification are at higher risk for adverse cardiovascular events. Vascular calcification affects a wide variety of patients. Idiopathic infantile arterial calcification is a rare form of vascular calcification where the arteries of neonates calcify.
The terms “adeno-associated viral vector”, “AAV vector”, “adeno-associated virus”, “AAV virus”, “AAV virion”, “AAV viral particle” and “AA V particle”, as used interchangeably herein, refer to a viral particle composed of at least one AAV capsid protein (preferably by all of the capsid proteins of a particular AAV serotype) and an encapsidated recombinant viral genome. The particle comprises a recombinant viral genome having a heterologous polynucleotide comprising a sequence encoding human ENPP1 or human ENPP3 or a functionally equivalent variant thereof,) and a transcriptional regulatory region that at least comprises a promoter flanked by the AAV inverted terminal repeats. The particle is typically referred to as an “AAV vector particle” or “AAV vector”.
As used herein, the term “vector” means a nucleic acid molecule capable of transporting another nucleic acid to which it has been linked. In some embodiments, the vector is a plasmid, i.e., a circular double stranded DNA loop into which additional DNA segments may be ligated. In some embodiments, the vector is a viral vector, wherein additional nucleotide sequences may be ligated into the viral genome. In some embodiments, the vectors are capable of autonomous replication in a host cell into which they are introduced (e.g., bacterial vectors having a bacterial origin of replication and episomal mammalian vectors). In other embodiments, the vectors (e.g., non-episomal mammalian vectors) is integrated into the genome of a host cell upon introduction into the host cell, and thereby are replicated along with the host genome. Moreover, certain vectors (expression vectors) are capable of directing the expression of genes to which they are operatively linked.
As used herein, the term “recombinant host cell” (or simply “host cell”), as used herein, means a cell into which an exogenous nucleic acid and/or recombinant vector has been introduced. It should be understood that “recombinant host cell” and “host cell” mean not only the particular subject cell but also the progeny of such a cell. Because certain modifications may occur in succeeding generations due to either mutation or environmental influences, such progeny may not, in fact, be identical to the parent cell, but are still included within the scope of the term “host cell” as used herein.
The term “recombinant viral genome”, as used herein, refers to an AAV genome in which at least one extraneous expression cassette polynucleotide is inserted into the naturally occurring AAV genome. The genome of the AAV according to the disclosure typically comprises the cis-acting 5′ and 3′ inverted terminal repeat sequences (ITRs) and an expression cassette.
The term “expression cassette”, as used herein, refers to a nucleic acid construct, generated recombinantly or synthetically, with a series of specified nucleic acid elements, which permit transcription of a particular nucleic acid in a target cell. The expression cassette of the recombinant viral genome of the AAV vector according to the disclosure comprises a transcriptional regulatory region operatively linked to a nucleotide sequence encoding ENPP1 or ENPP3 or a functionally equivalent variant thereof.
The term “transcriptional regulatory region”, as used herein, refers to a nucleic acid fragment capable of regulating the expression of one or more genes. The transcriptional regulatory region according to the disclosure includes a promoter and, optionally, an enhancer.
The term “promoter”, as used herein, refers to a nucleic acid fragment that functions to control the transcription of one or more polynucleotides, located upstream the polynucleotide sequence(s), and which is structurally identified by the presence of a binding site for DNA-dependent RNA polymerase, transcription initiation sites, and any other DNA sequences including, but not limited to, transcription factor binding sites, repressor, and activator protein binding sites, and any other sequences of nucleotides known in the art to act directly or indirectly to regulate the amount of transcription from the promoter. Any kind of promoters may be used in the disclosure including inducible promoters, constitutive promoters and tissue-specific promoters.
The term “enhancer”, as used herein, refers to a DNA sequence element to which transcription factors bind to increase gene transcription. Examples of enhancers may be, without limitation, RSV enhancer, CMV enhancer, HCR enhancer, etc. In another embodiment, the enhancer is a liver-specific enhancer, more preferably a hepatic control region enhancer (HCR).
The term “operatively linked”, as used herein, refers to the functional relation and location of a promoter sequence with respect to a polynucleotide of interest (e.g. a promoter or enhancer is operably linked to a coding sequence if it affects the transcription of the sequence). Generally, a promoter operatively linked is contiguous to the sequence of interest. However, an enhancer does not have to be contiguous to the sequence of interest to control its expression. In another embodiment, the promoter and the nucleotide sequence encoding ENPP1 or ENPP3 or a functionally equivalent variant thereof.
The term “effective amount” refers to a nontoxic but sufficient amount of a viral vector encoding ENPP1 or ENPP3 to provide the desired biological result. That result may be reduction and/or alleviation of the signs, symptoms, or causes of a disease, or any other desired alteration of a biological system.
The term “Cap protein”, as used herein, refers to a polypeptide having at least one functional activity of a native AAV Cap protein (e.g. VP1, VP2, VP3). Examples of functional activities of Cap proteins include the ability to induce formation of a capsid, facilitate accumulation of single-stranded DNA, facilitate AAV DNA packaging into capsids (i.e. encapsidation), bind to cellular receptors, and facilitate entry of the virion into host cells. In principle, any Cap protein can be used in the context of the present disclosure.
The term “capsid”, as used herein, refers to the structure in which the viral genome is packaged. A capsid consists of several oligomeric structural subunits made of proteins. For instance, AAV have an icosahedral capsid formed by the interaction of three capsid proteins: VP1, VP2 and VP3.
The term “Rep protein”, as used herein, refers to a polypeptide having at least one functional activity of a native AAV Rep protein (e.g. Rep 40, 52, 68, 78). A “functional activity” of a Rep protein is any activity associated with the physiological function of the protein, including facilitating replication of DNA through recognition, binding and nicking of the AAV origin of DNA replication as well as DNA helicase activity.
The term “adeno-associated virus ITRs” or “AAV ITRs”, as used herein, refers to the inverted terminal repeats present at both ends of the DNA strand of the genome of an adeno-associated virus. The ITR sequences are required for efficient multiplication of the AAV genome. Another property of these sequences is their ability to form a hairpin. This characteristic contributes to its self-priming which allows the primase-independent synthesis of the second DNA strand. Procedures for modifying these ITR sequences are known in the art (Brown T, “Gene Cloning”, Chapman & Hall, London, G B, 1995; Watson R, et al., “Recombinant DNA”, 2nd Ed. Scientific American Books, New York, N.Y., US, 1992; Alberts B, et al., “Molecular Biology of the Cell”, Garland Publishing Inc., New York, N.Y., US, 2008; Innis M, et al., Eds., “PCR Protocols. A Guide to Methods and Applications”, Academic Press Inc., San Diego, Calif., US, 1990; and Schleef M, Ed., “Plasmid for Therapy and Vaccination”, Wiley-VCH Verlag GmbH, Weinheim, Del., 2001).
The term “tissue-specific” promoter is only active in specific types of differentiated cells or tissues. Typically, the downstream gene in a tissue-specific promoter is one which is active to a much higher degree in the tissue(s) for which it is specific than in any other. In this case there may be little or substantially no activity of the promoter in any tissue other than the one(s) for which it is specific.
The term “inducible promoter”, as used herein, refers to a promoter that is physiologically or developmentally regulated, e.g. by the application of a chemical inducer. For example, it can be a tetracycline-inducible promoter, a mifepristone (RU-486)-inducible promoter and the like.
The term “constitutive promoter”, as used herein, refers to a promoter whose activity is maintained at a relatively constant level in all cells of an organism, or during most developmental stages, with little or no regard to cell environmental conditions. In another embodiment, the transcriptional regulatory region allows constitutive expression of ENPP1. Examples of constitutive promoters include, without limitation, the retroviral Rous sarcoma virus (RSV) LTR promoter (optionally with the RSV enhancer), the cytomegalovirus (CMV) promoter (optionally with the CMV enhancer), the SV40 promoter, the dihydrofolate reductase promoter, the β-actin promoter, the phosphoglycerol kinase (PGK) promoter, and the EF1a promoter (Boshart M, et al., Cell 1985; 41:521-530).
The term “polyadenylation signal”, as used herein, relates to a nucleic acid sequence that mediates the attachment of a polyadenine stretch to the 3′ terminus of the mRNA. Suitable polyadenylation signals include, without limitation, the SV40 early polyadenylation signal, the SV40 late polyadenylation signal, the HSV thymidine kinase polyadenylation signal, the protamine gene polyadenylation signal, the adenovirus 5 EIb polyadenylation signal, the bovine growth hormone polyadenylation signal, the human variant growth hormone polyadenylation signal and the like.
The term “signal peptide”, as used herein, refers to a sequence of amino acid residues (ranging in length from 10-30 residues) bound at the amino terminus of a nascent protein of interest during protein translation. The signal peptide is recognized by the signal recognition particle (SRP) and cleaved by the signal peptidase following transport at the endoplasmic reticulum. (Lodish et al., 2000, Molecular Cell Biology, 4th edition).
As used herein, the term “immune response” or “immune reaction” refers to the host's immune system to antigen in an invading (infecting) pathogenic organism, or to introduction or expression of foreign protein. The immune response is generally humoral and local; antibodies produced by B cells combine with antigen in an antigen-antibody complex to inactivate or neutralize antigen. Immune response is often observed when human proteins are injected into mouse model systems. Generally, the mouse model system is made immune tolerant by injecting immune suppressors prior to the introduction of a foreign antigen to ensure better viability.
As used herein, the term “immunesuppression” is a deliberate reduction of the activation or efficacy of the host immune system using immunesuppresant drugs to facilitate immune tolerance towards foreign antigens such as foreign proteins, organ transplants, bone marrow and tissue transplantation. Non limiting examples of immunosuppressant drugs include anti-CD4(GK1.5) antibody, Cyclophosphamide, Azathioprine (Imuran), Mycophenolate mofetil (Cellcept), Cyclosporine (Neoral, Sandimmune, Gengraf), Methotrexate (Rheumatrex), Leflunomide (Arava), Cyclophosphamide (Cytoxan) and Chlorambucil (Leukeran).
Ranges: throughout this disclosure, various aspects of the disclosure can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the disclosure. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from lto 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from lto 4, from lto 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. This applies regardless of the breadth of the range.
The present disclosure relates to administration of an ENPP1 or ENPP3 agent to treat PAD, which includes administering sNPP1 and sNPP3 polypeptides and fusion proteins thereof to a subject, and to administration of nucleic acids encoding such polypeptides. Sequences of such polypeptides include the following, without limitation.
MTRLTVLALLAGLLASSRA**A
PSCAKEVKSCKGRCFERTFGNCRCDAACVELGNCCLDYQETCIEPEHI
VDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQV
YTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQ
QGNVFSCSVMHEALHNHYTQKSLSLSPGK
MTRLTVLALLAGLLASSRA**APSCAKEVKSCKGRCFERTFGNCRCDAACVELGNCCLDYQETCIEPEHI
SYDEHAKLVQEVTDFAKTCVADESAANCDKSLHTLFGDKLCAIPNLRENYGELADCCTKQEPERNECFLQ
HKDDNPSLPPFERPEAEAMCTSFKENPTTFMGHYLHEVARRHPYFYAPELLYYAEQYNEILTQCCAEADK
ESCLTPKLDGVKEKALVSSVRQRMKCSSMQKFGERAFKAWAVARLSQTFPNADFAEITKLATDLTKVNKE
CCHGDLLECADDRAELAKYMCENQATISSKLQTCCDKPLLKKAHCLSEVEHDTMPADLPAIAADFVEDQE
VCKNYAEAKDVFLGTFLYEYSRRHPDYSVSLLLRLAKKYEATLEKCCAEANPPACYGTVLAEFQPLVEEP
KNLVKTNCDLYEKLGEYGFQNAILVRYTQKAPQVSTPTLVEAARNLGRVGTKCCTLPEDQRLPCVEDYLS
AILNRVCLLHEKTPVSEHVTKCCSGSLVERRPCFSALTVDETYVPKEFKAETFTFHSDICTLPEKEKQIK
KQTALAELVKHKPKATAEQLKTVMDDFAQFLDTCCKAADKDTCFSTEGPNLVTRCKDALARSWSHPQFEK
MTRLTVLALLAGLLASSRA**APSCAKEVKSCKGRCFERTFGNCRCDAACVELGNCCLDYQETCIEPEHI
SCAKEVKSCKGRCFERTEGNCRCDAACVELGNCCLDYQETCIEPEHIWTCNKERCGEKRLTRSLCACSDD
YVDGVEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQ
VYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRW
QQGNVFSCSVMHEALHNHYTQKSLSLSPGK
CSYDEHAKLVQEVTDFAKTCVADESAANCDKSLHTLFGDKLCAIPNLRENYGELADCCTKQEPERNECFL
QHKDDNPSLPPFERPEAEAMCTSFKENPTTFMGHYLHEVARRHPYFYAPELLYYAEQYNEILTQCCAEAD
KESCLTPKLDGVKEKALVSSVRQRMKCSSMQKFGERAFKAWAVARLSQTFPNADFAEITKLATDLTKVNK
ECCHGDLLECADDRAELAKYMCENQATISSKLQTCCDKPLLKKAHCLSEVEHDTMPADLPAIAADFVEDQ
EVCKNYAEAKDVFLGTFLYEYSRRHPDYSVSLLLRLAKKYEATLEKCCAEANPPACYGTVLAEFQPLVEE
PKNLVKTNCDLYEKLGEYGFQNAILVRYTQKAPQVSTPTLVEAARNLGRVGTKCCTLPEDQRLPCVEDYL
SAILNRVCLLHEKTPVSEHVTKCCSGSLVERRPCFSALTVDETYVPKEFKAETFTFHSDICTLPEKEKQI
KKQTALAELVKHKPKATAEQLKTVMDDFAQFLDTCCKAADKDTCFSTEGPNLVTRCKDALARSWSHPQFE
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Ala Ile Pro Asn Leu Arg Glu Asn Tyr Gly Glu Leu Ala Asp Cys Cys
Thr Lys Gln Glu Pro Glu Arg Asn Glu Cys Phe Leu Gln His Lys Asp
Asp Asn Pro Ser Leu Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met
Cys Thr Ser Phe Lys Glu Asn Pro Thr Thr Phe Met Gly His Tyr
Leu His Glu Val Ala Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu
Leu Leu Tyr Tyr Ala Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys
Cys Ala Glu Ala Asp Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp
Gly Val Lys Glu Lys Ala Leu Val Ser Ser Val Arg Gln Arg Met
Lys Cys Ser Ser Met Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala
Trp Ala Val Ala Arg Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe
Ala Glu Ile Thr Lys Leu Ala Thr Asp Leu Thr Lys Val Asn Lys
Glu Cys Cys His Gly Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala
Glu Leu Ala Lys Tyr Met Cys Glu Asn Gln Ala Thr Ile Ser Ser
Lys Leu Gln Thr Cys Cys Asp Lys Pro Leu Leu Lys Lys Ala His
Cys Leu Ser Glu Val Glu His Asp Thr Met Pro Ala Asp Leu Pro
Ala Ile Ala Ala Asp Phe Val Glu Asp Gln Glu Val Cys Lys Asn
Tyr Ala Glu Ala Lys Asp Val Phe Leu Gly Thr Phe Leu Tyr Glu
Tyr Ser Arg Arg His Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg
Leu Ala Lys Lys Tyr Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu
Ala Asn Pro Pro Ala Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln
Pro Leu Val Glu Glu Pro Lys Asn Leu Val Lys Thr Asn Cys Asp
Leu Tyr Glu Lys Leu Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu
Val Arg Tyr Thr Gln Lys Ala Pro Gln Val Ser Thr Pro Thr Leu
Val Glu Ala Ala Arg Asn Leu Gly Arg Val Gly Thr Lys Cys Cys
Thr Leu Pro Glu Asp Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu
Ser Ala Ile Leu Asn Arg Val Cys Leu Leu His Glu Lys Thr Pro
Val Ser Glu His Val Thr Lys Cys Cys Ser Gly Ser Leu Val Glu
Arg Arg Pro Cys Phe Ser Ala Leu Thr Val Asp Glu Thr Tyr Val
Pro Lys Glu Phe Lys Ala Glu Thr Phe Thr Phe 1395 Ser Asp Ile
Cys Thr Leu Pro Glu Lys Glu Lys Gln Ile Lys Lys Gln Thr Ala
Leu Ala Glu Leu Val Lys His Lys Pro Lys Ala Thr Ala Glu Gln
Leu Lys Thr Val Met Asp Asp Phe Ala Gln Phe Leu Asp Thr Cys
Cys Lys Ala Ala Asp Lys Asp Thr Cys Phe Ser Thr Glu Gly Pro
Asn Leu Val Thr Arg Cys Lys Asp Ala Leu Ala
Met Thr Ser Lys Phe Leu Leu Val Ser Phe Ile Leu Ala Ala Leu Ser
Leu Ser Thr Thr Phe Ser**Gly Leu Lys Pro Ser Cys Ala Lys Glu Val
Glu Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys
Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val
Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp
Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr
Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu His Gln Asp
Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu
Pro Ala Pro Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg
Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Glu Glu Met Thr Lys
Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp
Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr
Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu
Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn
Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His Tyr
Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Ala**Gly Leu Lys Pro Ser Cys Ala Lys Glu Val
Pro Ala Pro Glu Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro
Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys
Val Val Val Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp
Glu Gln Tyr Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu
His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn
Lys Ala Leu Pro Ala Pro Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly
Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Glu Glu
Met Thr Lys Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr
Pro Ser Asp Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu
Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser
Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln
Gln Gly Asn Val Phe Ser Cys Ser Val Met His Glu Ala Leu His
Asn His Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Ala**Pro Ser Cys Ala Lys Glu Val Lys Ser Cys
Asp
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Ala**Pro Ser Cys Ala Lys Glu Val Lys Ser Cys
Asp Leu Ile Asn Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro
Glu Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys
Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val
Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp
Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr
Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val Leu His Gln Asp
Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu
Pro Ala Pro Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg
Glu Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Glu Glu Met Thr Lys
Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser Asp
Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn Tyr
Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe Leu
Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly Asn
Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His Tyr
Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Ala**Pro Ser Cys Ala Lys Glu Val Lys Ser Cys
Asp Arg Ser Gly Ser Gly Gly Ser Met Lys Trp Val Thr Phe Leu Leu
Leu Leu Phe Val Ser Gly Ser Ala Phe Ser Arg Gly Val Phe Arg Arg
Glu Ala His Lys Ser Glu Ile Ala His Arg Tyr Asn Asp Leu Gly Glu
Gln His Phe Lys Gly Leu Val Leu Ile Ala Phe Ser Gln Tyr Leu Gln
Lys Cys Ser Tyr Asp Glu His Ala Lys Leu Val Gln Glu Val Thr Asp
Phe Ala Lys Thr Cys Val Ala Asp Glu Ser Ala Ala Asn Cys Asp Lys
Ser Leu His Thr Leu Phe Gly Asp Lys Leu Cys Ala Ile Pro Asn Leu
Arg Glu Asn Tyr Gly Glu Leu Ala Asp Cys Cys Thr Lys Gln Glu Pro
Glu Arg Asn Glu Cys Phe Leu Gln His Lys Asp Asp Asn Pro Ser Leu
Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met Cys Thr Ser Phe Lys
Glu Asn Pro Thr Thr Phe Met Gly His Tyr Leu His Glu Val Ala
Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu Tyr Tyr Ala
Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala Glu Ala Asp
Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp Gly Val Lys Glu Lys
Ala Leu Val Ser Ser Val Arg Gln Arg Met Lys Cys Ser Ser Met
Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala Val Ala Arg
Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu Ile Thr Lys
Leu Ala Thr Asp Leu Thr Lys Val Asn Lys Glu Cys Cys His Gly
Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu Ala Lys Tyr
Met Cys Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu Gln Thr Cys
Cys Asp Lys Pro Leu Leu Lys Lys Ala His Cys Leu Ser Glu Val
Glu His Asp Thr Met Pro Ala Asp Leu Pro Ala Ile Ala Ala Asp
Phe Val Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala Glu Ala Lys
Asp Val Phe Leu Gly Thr Phe Leu Tyr Glu Tyr Ser Arg Arg His
Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala Lys Lys Tyr
Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn Pro Pro Ala
Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln Pro Leu Val Glu Glu
Pro Lys Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr Glu Lys Leu
Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg Tyr Thr Gln
Lys Ala Pro Gln Val Ser Thr Pro Thr Leu Val Glu Ala Ala Arg
Asn Leu Gly Arg Val Gly Thr Lys Cys Cys Thr Leu Pro Glu Asp
Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala Ile Leu Asn
Arg Val Cys Leu Leu His Glu Lys Thr Pro Val Ser Glu His Val
Thr Lys Cys Cys Ser Gly Ser Leu Val Glu Arg Arg Pro Cys Phe
Ser Ala Leu Thr Val Asp Glu Thr Tyr Val Pro Lys Glu Phe Lys
Ala Glu Thr Phe Thr Phe His Ser Asp Ile Cys Thr Leu Pro Glu
Lys Glu Lys Gln Ile Lys Lys Gln Thr Ala Leu Ala Glu Leu Val
Lys His Lys Pro Lys Ala Thr Ala Glu Gln Leu Lys Thr Val Met
Asp Asp Phe Ala Gln Phe Leu Asp Thr Cys Cys Lys Ala Ala Asp
Lys Asp Thr Cys Phe Ser Thr Glu Gly Pro Asn Leu Val Thr Arg
Cys Lys Asp Ala Leu Ala Arg Ser Trp Ser His Pro Gln Phe Glu
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala**Lys Gln Gly Ser Cys Arg Lys Lys Cys Phe Asp Ala
His Thr Cys Pro Pro Cys Pro Ala Pro Glu Leu Leu Gly Gly Pro Ser
Val Phe Leu Phe Pro Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg
Thr Pro Glu Val Thr Cys Val Val Val Asp Val Ser His Glu Asp Pro
Glu Val Lys Phe Asn Trp Tyr Val Asp Gly Val Glu Val His Asn Ala
Lys Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr Arg Val Val
Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn Gly Lys Glu Tyr
Lys Cys Lys Val Ser Asn Lys Ala Leu Pro Ala Pro Ile Glu Lys Thr
Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu
Pro Pro Ser Arg Glu Glu Met Thr Lys Asn Gln Val Ser Leu Thr Cys
Leu Val Lys Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser
Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu
Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp
Lys Ser Arg Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met
His Glu Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu
Ser Pro Gly Lys
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Leu Lys**Pro Ser Cys Ala Lys Glu Val Lys Ser
Glu Asp Gly Gly Ser Gly Gly Ser Met Lys Trp Val Thr Phe Leu Leu
Leu Leu Phe Val Ser Gly Ser Ala Phe Ser Arg Gly Val Phe Arg Arg
Glu Ala His Lys Ser Glu Ile Ala His Arg Tyr Asn Asp Leu Gly Glu
Gln His Phe Lys Gly Leu Val Leu Ile Ala Phe Ser Gln Tyr Leu Gln
Lys Cys Ser Tyr Asp Glu His Ala Lys Leu Val Gln Glu Val Thr Asp
Phe Ala Lys Thr Cys Val Ala Asp Glu Ser Ala Ala Asn Cys Asp Lys
Ser Leu His Thr Leu Phe Gly Asp Lys Leu Cys Ala Ile Pro Asn Leu
Arg Glu Asn Tyr Gly Glu Leu Ala Asp Cys Cys Thr Lys Gln Glu Pro
Glu Arg Asn Glu Cys Phe Leu Gln His Lys Asp Asp Asn Pro Ser Leu
Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met Cys Thr Ser Phe Lys
Glu Asn Pro Thr Thr Phe Met Gly His Tyr Leu His Glu Val Ala
Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu Tyr Tyr Ala
Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala Glu Ala Asp
Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp Gly Val Lys Glu Lys
Ala Leu Val Ser Ser Val Arg Gln Arg Met Lys Cys Ser Ser Met
Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala Val Ala Arg
Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu Ile Thr Lys
Leu Ala Thr Asp Leu Thr Lys Val Asn Lys Glu Cys Cys His Gly
Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu Ala Lys Tyr
Met Cys Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu Gln Thr Cys
Cys Asp Lys Pro Leu Leu Lys Lys Ala His Cys Leu Ser Glu Val
Glu His Asp Thr Met Pro Ala Asp Leu Pro Ala Ile Ala Ala Asp
Phe Val Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala Glu Ala Lys
Asp Val Phe Leu Gly Thr Phe Leu Tyr Glu Tyr Ser Arg Arg His
Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala Lys Lys Tyr
Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn Pro Pro Ala
Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln Pro Leu Val Glu Glu
Pro Lys Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr Glu Lys Leu
Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg Tyr Thr Gln
Lys Ala Pro Gln Val Ser Thr Pro Thr Leu Val Glu Ala Ala Arg
Asn Leu Gly Arg Val Gly Thr Lys Cys Cys Thr Leu Pro Glu Asp
Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala Ile Leu Asn
Arg Val Cys Leu Leu His Glu Lys Thr Pro Val Ser Glu His Val
Thr Lys Cys Cys Ser Gly Ser Leu Val Glu Arg Arg Pro Cys Phe
Ser Ala Leu Thr Val Asp Glu Thr Tyr Val Pro Lys Glu Phe Lys
Ala Glu Thr Phe Thr Phe His Ser Asp Ile Cys Thr Leu
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala**Lys Gln Gly Ser Cys Arg Lys Lys Cys Phe Asp Ala
Phe Arg Arg Glu Ala His Lys Ser Glu Ile Ala His Arg Tyr Asn Asp
Leu Gly Glu Gln His Phe Lys Gly Leu Val Leu Ile Ala Phe Ser Gln
Tyr Leu Gln Lys Cys Ser Tyr Asp Glu His Ala Lys Leu Val Gln Glu
Val Thr Asp Phe Ala Lys Thr Cys Val Ala Asp Glu Ser Ala Ala Asn
Cys Asp Lys Ser Leu His Thr Leu Phe Gly Asp Lys Leu Cys Ala Ile
Pro Asn Leu Arg Glu Asn Tyr Gly Glu Leu Ala Asp Cys Cys Thr Lys
Gln Glu Pro Glu Arg Asn Glu Cys Phe Leu Gln His Lys Asp Asp Asn
Pro Ser Leu Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met Cys Thr
Ser Phe Lys Glu Asn Pro Thr Thr Phe Met Gly His Tyr Leu His
Glu Val Ala Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu
Tyr Tyr Ala Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala
Glu Ala Asp Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp Gly Val
Lys Glu Lys Ala Leu Val Ser Ser Val Arg Gln Arg Met Lys Cys
Ser Ser Met Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala
Val Ala Arg Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu
Ile Thr Lys Leu Ala Thr Asp Leu Thr Lys Val Asn Lys Glu Cys
Cys His Gly Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu
Ala Lys Tyr Met Cys Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu
Gln Thr Cys Cys Asp Lys Pro Leu Leu Lys Lys Ala His Cys Leu
Ser Glu Val Glu His Asp Thr Met Pro Ala Asp Leu Pro Ala Ile
Ala Ala Asp Phe Val Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala
Glu Ala Lys Asp Val Phe Leu Gly Thr Phe Leu Tyr Glu Tyr Ser
Arg Arg His Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala
Lys Lys Tyr Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn
Pro Pro Ala Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln Pro Leu
Val Glu Glu Pro Lys Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr
Glu Lys Leu Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg
Tyr Thr Gln Lys Ala Pro Gln Val Ser Thr Pro Thr Leu Val Glu
Ala Ala Arg Asn Leu Gly Arg Val Gly Thr Lys Cys Cys Thr Leu
Pro Glu Asp Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala
Ile Leu Asn Arg Val Cys Leu Leu His Glu Lys Thr Pro Val Ser
Glu His Val Thr Lys Cys Cys Ser Gly Ser Leu Val Glu Arg Arg
Pro Cys Phe Ser Ala Leu Thr Val Asp Glu Thr Tyr Val Pro Lys
Glu Phe Lys Ala Glu Thr Phe Thr Phe His Ser Asp Ile Cys Thr
Leu Pro Glu Lys Glu Lys Gln Ile Lys Lys Gln Thr Ala Leu Ala
Glu Leu Val Lys His Lys Pro Lys Ala Thr Ala Glu Gln Leu Lys
Thr Val Met Asp Asp Phe Ala Gln Phe Leu Asp Thr Cys Cys Lys
Ala Ala Asp Lys Asp Thr Cys Phe Ser Thr Glu Gly Pro Asn Leu
Val Thr Arg Cys Lys Asp Ala Leu Ala
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala**Lys Gln Gly Ser Cys Arg Lys Lys Cys Phe Asp Ala
Gly Ser Ala Phe Ser Arg Gly Val Phe Arg Arg Glu Ala His Lys Ser
Glu Ile Ala His Arg Tyr Asn Asp Leu Gly Glu Gln His Phe Lys Gly
Leu Val Leu Ile Ala Phe Ser Gln Tyr Leu Gln Lys Cys Ser Tyr Asp
Glu His Ala Lys Leu Val Gln Glu Val Thr Asp Phe Ala Lys Thr Cys
Val Ala Asp Glu Ser Ala Ala Asn Cys Asp Lys Ser Leu His Thr Leu
Phe Gly Asp Lys Leu Cys Ala Ile Pro Asn Leu Arg Glu Asn Tyr Gly
Glu Leu Ala Asp Cys Cys Thr Lys Gln Glu Pro Glu ArgAsn Glu
Cys Phe Leu Gln His Lys Asp Asp Asn Pro Ser Leu Pro Pro Phe
Glu Arg Pro Glu Ala Glu Ala Met Cys Thr Ser Phe Lys Glu Asn
Pro Thr Thr Phe Met Gly His Tyr Leu His Glu Val Ala Arg Arg
His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu Tyr Tyr Ala Glu Gln
Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala Glu Ala Asp Lys Glu
Ser Cys Leu Thr Pro Lys Leu Asp Gly Val Lys Glu Lys Ala Leu
Val Ser Ser Val Arg Gln Arg Met Lys Cys Ser Ser Met Gln Lys
Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala Val Ala Arg Leu Ser
Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu Ile Thr Lys Leu Ala
Thr Asp Leu Thr Lys Val Asn Lys Glu Cys Cys His Gly Asp Leu
1160 1165 1170
Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu Ala Lys Tyr Met Cys
Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu Gln Thr Cys Cys Asp
Lys Pro Leu Leu Lys Lys Ala His Cys Leu Ser Glu Val Glu His
Asp Thr Met Pro Ala Asp Leu Pro Ala Ile Ala Ala Asp Phe Val
Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala Glu Ala Lys Asp Val
Phe Leu Gly Thr Phe Leu Tyr Glu Tyr Ser Arg Arg His Pro Asp
Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala Lys Lys Tyr Glu Ala
Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn Pro ProAla Cys Tyr
Gly Thr Val Leu Ala Glu Phe Gln Pro Leu Val Glu Glu Pro Lys
Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr Glu Lys Leu Gly Glu
Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg Tyr Thr Gln Lys Ala
Pro Gln Val Ser Thr Pro Thr Leu Val Glu Ala Ala Arg Asn Leu
Gly Arg Val Gly Thr Lys Cys Cys Thr Leu Pro Glu Asp Gln Arg
Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala Ile Leu Asn Arg Val
Cys Leu Leu His Glu Lys Thr Pro Val Ser Glu His Val Thr Lys
Cys Cys Ser Gly Ser Leu Val Glu Arg Arg Pro Cys Phe Ser Ala
Leu Thr Val Asp Glu Thr Tyr Val Pro Lys Glu Phe Lys Ala Glu
Thr Phe Thr Phe His Ser Asp Ile Cys Thr Leu Pro Glu Lys Glu
Lys Gln Ile Lys Lys Gln Thr Ala Leu Ala Glu Leu Val Lys His
Lys Pro Lys Ala Thr Ala Glu Gln Leu Lys Thr Val Met Asp Asp
Phe Ala Gln Phe Leu Asp Thr Cys Cys Lys Ala Ala Asp Lys Asp
Thr Cys Phe Ser Thr Glu Gly Pro Asn Leu Val Thr Arg Cys Lys
Asp Ala Leu Ala
Met Arg Gly Pro Ala Val Leu Leu Thr Val Ala Leu Ala Thr Leu Leu
Ala Pro Gly Ala Gly Ala**Gly Leu Lys Pro Ser Cys Ala Lys Glu Val
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly**
Phe Thr Ala Gly
Leu Lys Pro Ser Cys Ala Lys Glu Val Lys Ser Cys Lys Gly Arg Cys
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly**Phe Thr Ala Gly
Leu Lys Pro Ser Cys Ala Lys Glu Val Lys Ser Cys Lys Gly Arg Cys
Asp Lys Thr His Thr Cys Pro Pro Cys Pro Ala Pro Glu Leu Leu Gly
Gly Pro Ser Val Phe Leu Phe Pro Pro Lys Pro Lys Asp Thr Leu Met
Ile Ser Arg Thr Pro Glu Val Thr Cys Val Val Val Asp Val Ser His
Glu Asp Pro Glu Val Lys Phe Asn Trp Tyr Val Asp Gly Val Glu Val
His Asn Ala Lys Thr Lys Pro Arg Glu Glu Gln Tyr Asn Ser Thr Tyr
Arg Val Val Ser Val Leu Thr Val Leu His Gln Asp Trp Leu Asn
Gly Lys Glu Tyr Lys Cys Lys Val Ser Asn Lys Ala Leu Pro Ala
Pro Ile Glu Lys Thr Ile Ser Lys Ala Lys Gly Gln Pro Arg Glu
Pro Gln Val Tyr Thr Leu Pro Pro Ser Arg Glu Glu Met Thr Lys
Asn Gln Val Ser Leu Thr Cys Leu Val Lys Gly Phe Tyr Pro Ser
Asp Ile Ala Val Glu Trp Glu Ser Asn Gly Gln Pro Glu Asn Asn
Tyr Lys Thr Thr Pro Pro Val Leu Asp Ser Asp Gly Ser Phe Phe
Leu Tyr Ser Lys Leu Thr Val Asp Lys Ser Arg Trp Gln Gln Gly
Asn Val Phe Ser Cys Ser Val Met His Glu Ala Leu His Asn His
Tyr Thr Gln Lys Ser Leu Ser Leu Ser Pro Gly Lys
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly**Phe Thr Ala Gly
Leu Lys Pro Ser Cys Ala Lys Glu Val Lys Ser Cys Lys Gly Arg Cys
Ser Gly Ser Ala Phe Ser Arg Gly Val Phe Arg Arg Glu Ala His Lys
Ser Glu Ile Ala His Arg Tyr Asn Asp Leu Gly Glu Gln His Phe Lys
Gly Leu Val Leu Ile Ala Phe Ser Gln Tyr Leu Gln Lys Cys Ser Tyr
Asp Glu His Ala Lys Leu Val Gln Glu Val Thr Asp Phe Ala Lys Thr
Cys Val Ala Asp Glu Ser Ala Ala Asn Cys Asp Lys Ser Leu His
Thr Leu Phe Gly Asp Lys Leu Cys Ala Ile Pro Asn Leu Arg Glu
Asn Tyr Gly Glu Leu Ala Asp Cys Cys Thr Lys Gln Glu Pro Glu
Arg Asn Glu Cys Phe Leu Gln His Lys Asp Asp Asn Pro Ser Leu
Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met Cys Thr Ser Phe
Lys Glu Asn Pro Thr Thr Phe Met Gly His Tyr Leu His Glu Val
Ala Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu Tyr Tyr
Ala Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala Glu Ala
Asp Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp Gly Val Lys Glu
Lys Ala Leu Val Ser Ser Val Arg Gln Arg Met Lys Cys Ser Ser
Met Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala Val Ala
Arg Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu Ile Thr
Lys Leu Ala Thr Asp Leu Thr Lys Val Asn Lys Glu Cys Cys His
Gly Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu Ala Lys
Tyr Met Cys Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu Gln Thr
Cys Cys Asp Lys Pro Leu Leu Lys Lys Ala His Cys Leu Ser Glu
Val Glu His Asp Thr Met Pro Ala Asp Leu Pro Ala Ile Ala Ala
Asp Phe Val Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala Glu Ala
His Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala Lys Lys
Tyr Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn Pro Pro
Ala Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln Pro Leu Val Glu
Glu Pro Lys Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr Glu Lys
Leu Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg Tyr Thr
Gln Lys Ala Pro Gln Val Ser Thr Pro Thr Leu Val Glu Ala Ala
Arg Asn Leu Gly Arg Val Gly Thr Lys Cys Cys Thr Leu Pro Glu
Asp Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala Ile Leu
Asn Arg Val Cys Leu Leu His Glu Lys Thr Pro Val Ser Glu His
Val Thr Lys Cys Cys Ser Gly Ser Leu Val Glu Arg Arg Pro Cys
Phe Ser Ala Leu Thr Val Asp Glu Thr Tyr Val Pro Lys Glu Phe
Lys Ala Glu Thr Phe Thr Phe His Ser Asp Ile Cys Thr Leu Pro
Glu Lys Glu Lys Gln Ile Lys Lys Gln Thr Ala Leu Ala Glu Leu
Val Lys His Lys Pro Lys Ala Thr Ala Glu Gln Leu Lys Thr Val
Met Asp Asp Phe Ala Gln Phe Leu Asp Thr Cys Cys Lys Ala Ala
Asp Lys Asp Thr Cys Phe Ser Thr Glu Gly Pro Asn Leu Val Thr
Arg Cys Lys Asp Ala Leu Ala Arg Ser Trp Ser His Pro Gln Phe
Glu Lys
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly Phe Thr Ala**Lys
Gln Gly Ser Cys Arg Lys Lys Cys Phe Asp Ala Ser Phe Arg Gly Leu
Cys Pro Ala Pro Glu Leu Leu Gly Gly Pro Ser Val Phe Leu Phe Pro
Pro Lys Pro Lys Asp Thr Leu Met Ile Ser Arg Thr Pro Glu Val Thr
Cys Val Val Val Asp Val Ser His Glu Asp Pro Glu Val Lys Phe Asn
Trp Tyr Val Asp Gly Val Glu Val His Asn Ala Lys Thr Lys Pro Arg
Glu Glu Gln Tyr Asn Ser Thr Tyr Arg Val Val Ser Val Leu Thr Val
Leu His Gln Asp Trp Leu Asn Gly Lys Glu Tyr Lys Cys Lys Val
Ser Asn Lys Ala Leu Pro Ala Pro Ile Glu Lys Thr Ile Ser Lys
Ala Lys Gly Gln Pro Arg Glu Pro Gln Val Tyr Thr Leu Pro Pro
Ser Arg Glu Glu Met Thr Lys Asn Gln Val Ser Leu Thr Cys Leu
Val Lys Gly Phe Tyr Pro Ser Asp Ile Ala Val Glu Trp Glu Ser
Asn Gly Gln Pro Glu Asn Asn Tyr Lys Thr Thr Pro Pro Val Leu
Asp Ser Asp Gly Ser Phe Phe Leu Tyr Ser Lys Leu Thr Val Asp
Lys Ser Arg Trp Gln Gln Gly Asn Val Phe Ser Cys Ser Val Met
His Glu Ala Leu His Asn His Tyr Thr Gln Lys Ser Leu Ser Leu
Ser Pro Gly Lys
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly Phe Thr Ala**Lys
Gln Gly Ser Cys Arg Lys Lys Cys Phe Asp Ala Ser Phe Arg Gly Leu
Phe Val Ser Gly Ser Ala Phe Ser Arg Gly Val Phe Arg Arg Glu Ala
His Lys Ser Glu Ile Ala His Arg Tyr Asn Asp Leu Gly Glu Gln His
Phe Lys Gly Leu Val Leu Ile Ala Phe Ser Gln Tyr Leu Gln Lys Cys
Ser Tyr Asp Glu His Ala Lys Leu Val Gln Glu Val Thr Asp Phe Ala
Lys Thr Cys Val Ala Asp Glu Ser Ala Ala Asn Cys Asp Lys Ser
Leu His Thr Leu Phe Gly Asp Lys Leu Cys Ala Ile Pro Asn Leu
Arg Glu Asn Tyr Gly Glu Leu Ala Asp Cys Cys Thr Lys Gln Glu
Pro Glu Arg Asn Glu Cys Phe Leu Gln His Lys Asp Asp Asn Pro
Ser Leu Pro Pro Phe Glu Arg Pro Glu Ala Glu Ala Met Cys Thr
Ser Phe Lys Glu Asn Pro Thr Thr Phe Met Gly His Tyr Leu His
Glu Val Ala Arg Arg His Pro Tyr Phe Tyr Ala Pro Glu Leu Leu
Tyr Tyr Ala Glu Gln Tyr Asn Glu Ile Leu Thr Gln Cys Cys Ala
Glu Ala Asp Lys Glu Ser Cys Leu Thr Pro Lys Leu Asp Gly Val
Lys Glu Lys Ala Leu Val Ser Ser Val Arg Gln Arg Met Lys Cys
Ser Ser Met Gln Lys Phe Gly Glu Arg Ala Phe Lys Ala Trp Ala
Val Ala Arg Leu Ser Gln Thr Phe Pro Asn Ala Asp Phe Ala Glu
Ile Thr Lys Leu Ala Thr Asp Leu Thr Lys Val Asn Lys Glu Cys
Cys His Gly Asp Leu Leu Glu Cys Ala Asp Asp Arg Ala Glu Leu
Ala Lys Tyr Met Cys Glu Asn Gln Ala Thr Ile Ser Ser Lys Leu
Gln Thr Cys Cys Asp Lys Pro Leu Leu Lys Lys Ala His Cys Leu
Ser Glu Val Glu His Asp Thr Met Pro Ala Asp Leu Pro Ala Ile
Ala Ala Asp Phe Val Glu Asp Gln Glu Val Cys Lys Asn Tyr Ala
Glu Ala Lys Asp Val Phe Leu Gly Thr Phe Leu Tyr Glu Tyr Ser
Arg Arg His Pro Asp Tyr Ser Val Ser Leu Leu Leu Arg Leu Ala
Lys Lys Tyr Glu Ala Thr Leu Glu Lys Cys Cys Ala Glu Ala Asn
Pro Pro Ala Cys Tyr Gly Thr Val Leu Ala Glu Phe Gln Pro Leu
Val Glu Glu Pro Lys Asn Leu Val Lys Thr Asn Cys Asp Leu Tyr
Glu Lys Leu Gly Glu Tyr Gly Phe Gln Asn Ala Ile Leu Val Arg
Tyr Thr Gln Lys Ala Pro Gln Val Ser Thr Pro Thr Leu Val Glu
Ala Ala Arg Asn Leu Gly Arg Val Gly Thr Lys Cys Cys Thr Leu
Pro Glu Asp Gln Arg Leu Pro Cys Val Glu Asp Tyr Leu Ser Ala
Ile Leu Asn Arg Val Cys Leu Leu His Glu Lys Thr Pro Val Ser
Glu His Val Thr Lys Cys Cys Ser Gly Ser Leu Val Glu Arg Arg
Pro Cys Phe Ser Ala Leu Thr Val Asp Glu Thr Tyr Val Pro Lys
Glu Phe Lys Ala Glu Thr Phe Thr Phe His Ser Asp Ile Cys Thr
Leu Pro Glu Lys Glu Lys Gln Ile Lys Lys Gln Thr Ala Leu Ala
Glu Leu Val Lys His Lys Pro Lys Ala Thr Ala Glu Gln Leu Lys
Thr Val Met Asp Asp Phe Ala Gln Phe Leu Asp Thr Cys Cys Lys
Ala Ala Asp Lys Asp Thr Cys Phe Ser Thr Glu Gly Pro Asn Leu
Val Thr Arg Cys Lys Asp Ala Leu Ala
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly Phe Thr Ala Gly
Leu Lys
Phe Thr Phe Ala Val Gly Val Asn Ile Cys Leu Gly
Phe Thr Ala
ct
ccttcctgcgccaaagaagtgaagtcctgcaagggcagatgcttcgagcggaccttcggcaactgtag
ENPP1, or an ENPP1 polypeptide, is prepared as described in US 2015/0359858 A1, which is incorporated herein in its entirety by reference. ENPP1 is a transmembrane protein localized to the cell surface with distinct intramembrane domains. In order to express ENPP1 as a soluble extracellular protein, the transmembrane domain of ENPP1 may be swapped for the transmembrane domain of ENPP2 or a signal peptide sequence such as Azurocidin, which results in the accumulation of soluble, recombinant ENPP1 in the extracellular fluid of the baculovirus cultures. Signal sequences of any other known proteins may be used to target the extracellular domain of ENPP1 for secretion as well, such as but not limited to the signal sequence of the immunoglobulin kappa and lambda light chain proteins. Further, the disclosure should not be construed to be limited to the polypeptides described herein, but also includes polypeptides comprising any enzymatically active truncation of the ENPP1 extracellular domain.
ENPP1 is made soluble by omitting the transmembrane domain. Human ENPP1 (SEQ ID NO:1) was modified to express a soluble, recombinant protein by replacing its transmembrane region (e.g., residues 77-98) with the corresponding subdomain of human ENPP2 (NCBI accession NP 00112433 5, e.g., residues 12-30) or Azurocidin signal sequence (SEQ ID 42).
The modified ENPP1 sequence was cloned into a modified pFastbac FIT vector possessing a TEV protease cleavage site followed by a C-terminus 9-F HS tag, and cloned and expressed in insect cells, and both proteins were expressed in a baculovirus system as described previously (Albright, et al., 2012, Blood 120:4432-4440; Saunders, et al., 2011, J. Biol. Chem. 18:994-1004; Saunders, et al., 2008, Mol. Cancer Ther. 7:3352-3362), resulting in the accumulation of soluble, recombinant protein in the extracellular fluid.
ENPP3 is poorly exported to the cell surface. Soluble ENPP3 polypeptide is constructed by replacing the signal sequence of ENPP3 with the native signal sequence of other ENPPs or Azurocidin or suitable signal sequences. Several examples of ENPP3 fusion constructs are disclosed in WO 2017/087936. Soluble ENPP3 constructs are prepared by using the signal export signal sequence of other ENPP enzymes, such as but not limited to ENPP7 and/or ENPP5. Soluble ENPP3 constructs are prepared using a signal sequence comprised of a combination of the signal sequences of ENPP1 and ENPP2 (“ENPP1-2-1” or “ENPP121” hereinafter). Signal sequences of any other known proteins may be used to target the extracellular domain of ENPP3 for secretion as well, such as but not limited to the signal sequence of the immunoglobulin kappa and lambda light chain proteins. Further, the disclosure should not be construed to be limited to the constructs described herein, but also includes constructs comprising any enzymatically active truncation of the ENPP3 extracellular domain.
In certain embodiments, the ENPP3 polypeptide is soluble. In some embodiments, the polypeptide of the disclosure includes an ENPP3 polypeptide that lacks the ENPP3 transmembrane domain. In another embodiment, the polypeptide of the disclosure includes an ENPP3 polypeptide wherein the ENPP3 transmembrane domain has been removed and replaced with the transmembrane domain of another polypeptide, such as, by way of non-limiting example, ENPP2, ENPPS or ENPP7 or Azurocidin signal sequence.
In some embodiments, the polypeptide of the disclosure comprises an IgG Fc domain. In certain embodiments, the polypeptide of the disclosure comprises an albumin domain. In other embodiments, the albumin domain is located at the C terminal region of the ENPP3 polypeptide. In yet other embodiments, the IgG Fc domain is located at the C terminal region of the ENPP3 polypeptide. In yet other embodiments, the presence of IgG Fc domain or albumin domain improves half-life, solubility, reduces immunogenicity and increases the activity of the ENPP3 polypeptide.
In certain embodiments, the polypeptide of the disclosure comprises a signal peptide resulting in the secretion of a precursor of the ENPP3 polypeptide, which undergoes proteolytic processing to yield the ENPP3 polypeptide. In other embodiments, the signal peptide is selected from the group consisting of signal peptides of ENPP2, ENPP5 and ENPP7. In yet other embodiments, the signal peptide is selected from the group consisting of SEQ ID NOs: 36-42.
In certain embodiments, the IgG Fc domain or the albumin domain is connected to the C terminal region of the ENPP3 polypeptide by a linker region. In other embodiments, the linker is selected from SEQ ID NOs: 43-75, where n is an integer ranging from 1-20.
To produce soluble, recombinant ENPP1 polypeptide for in vitro use, polynucleotide encoding the extracellular domain of ENPP1 (Human NPP1 (NCBI accession NP 006199)) was fused to the Fc domain of IgG (referred to as “ENPP1-Fc”) and was expressed in stable CHO cell lines. In some embodiments, ENPP1 polynucleotide encoding residues 96 to 925 of NCBI accession NP 006199 were fused to Fc domain to generate ENPP1 polypeptide.
Alternately the ENPP1 polypeptide can also be expressed from HEK293 cells, Baculovirus insect cell system or CHO cells or Yeast Pichia expression system using suitable vectors. The ENPP1 polypeptide can be produced in either adherent or suspension cells. Preferably the ENPP1 polypeptide is expressed in CHO cells. To establish stable cell lines the nucleic acid sequence encoding ENPP1 constructs are cloned into an appropriate vector for large scale protein production.
ENPP3 is produced by establishing stable transfections in either CHO or HEK293 mammalian cells. ENPP3 polynucleotide encoding ENPP3 (Human NPP3 (UniProtKB/Swiss-Prot: O14638.2) was fused to the Fc domain of IgG (referred to as “ENPP3-Fc”) and was expressed in stable CHO cell lines. In some embodiments, ENPP3 polynucleotide encoding residues 49-875 of UniProtKB/Swiss-Prot: O14638.2 was fused to Fc domain to generate ENPP3 polypeptide. The ENPP3 polypeptide can be produced in either adherent or suspension cells. To establish stable cell lines the nucleic acid sequence encoding NPP3 fusion polypeptides of the disclosure into an appropriate vector for large scale protein production. There are a variety of these vectors available from commercial sources and any of those can be used. ENPP3 polypeptides are produced following the protocols established in WO 2017/087936, the contents of which are hereby incorporated by reference in their entirety. ENPP1 polypeptides are produced following the protocols established in Albright, et al, 2015, Nat Commun. 6:10006, the contents of which are hereby incorporated by reference in their entirety.
A suitable plasmid containing the desired polypeptide constructs of ENPP1 or ENPP3 can be stably transfected into expression plasmid using established techniques such as electroporation or lipofectamine, and the cells can be grown under antibiotic selection to enhance for stably transfected cells. Clones of single, stably transfected cells are then established and screened for high expressing clones of the desired fusion protein. Screening of the single cell clones for ENPP1 or ENPP3 polypeptide expression can be accomplished in a high-throughput manner in 96 well plates using the synthetic enzymatic substrate pNP-TMP as previously described (Saunders, et al, 2008, Mol. Cancer Therap. 7(10):3352-62; Albright, et al, 2015, Nat Commun. 6:10006).
Upon identification of high expressing clones for ENPP3 or ENPP1 polypeptides through screening, protein production can be accomplished in shaking flasks or bio-reactors previously described for ENPP1 (Albright, et al, 2015, Nat Commun. 6:10006). Purification of ENPP3 or ENPP1 polypeptides can be accomplished using a combination of standard purification techniques known in the art. These techniques are well known in art and are selected from techniques such as column chromatograph, ultracentrifugation, filtration, and precipitation. Column chromatographic purification is accomplished using affinity chromatography such as protein-A and protein-G resins, metal affinity resins such as nickel or copper, hydrophobic exchange chromatography, and reverse-phase high-pressure chromatography (HPLC) using C8-C14 resins. Ion exchange may also be employed, such as anion and cation exchange chromatography using commercially available resins such as Q-sepharose (anion exchange) and SP-sepharose (cation exchange), blue sepharose resin and blue-sephadex resin, and hydroxyapatite resins. Size exclusion chromatography using commercially available S-75 and S200 Superdex resins can also be employed, as known in the art. Buffers used to solubilize the protein and provide the selection media for the above described chromatographic steps, are standard biological buffers known to practitioners of the art and science of protein chemistry.
Some examples of buffers that are used in preparation include citrate, phosphate, acetate, tris(hydroxymemyl)aminomethane, saline buffers, glycine-HCL buffers, Cacodylate buffers, and sodium barbital buffers, which are well known in art. Using a single techniques, or a series of techniques in combination, and the appropriate buffer systems purified ENPP3 and the crude starting material side by side on a Coomasie stained polyacrylamide gel after a single purification step. The ENPP3 protein can then be additionally purified using additional techniques and/or chromatographic steps as described above, to reach substantially higher purity such as −99% purity adjusted to the appropriate pH, one can purify the ENPP1 or ENPP3 polypeptides described to greater than 99% purity from crude material.
Following purification, ENPP1-Fc or ENPP3-Fc was dialyzed into PBS supplemented with Zn2+ and Mg2+(PBSplus) concentrated to between 5 and 7 mg/ml, and frozen at −80° C. in aliquots of 200-500 μl. Aliquots were thawed immediately prior to use and the specific activity of the solution was adjusted to 31.25 au/ml (or about 0.7 mg/ml depending on the preparation) by dilution in PBSplus.
In another embodiment, the hsNPP1 or hsNPP3 is administered in one or more doses containing about 1.0 mg/kg to about 5.0 mg/kg NPP1 or about 1.0 mg/kg to about 5.0 mg/kg NPP3 respectively. In another embodiment, the hsNPP1 or hsNPP3 is administered in one or more doses containing about 1.0 mg/kg to about 10.0 mg/kg NPP1 or about 1.0 mg/kg to about 10.0 mg/kg NPP3.
The time period between doses of the hsNPP1 or hsNPP3 is at least 2 days and can be longer, for example at least 3 days, at least 1 week, 2 weeks or 1 month. In one embodiment, the administration is weekly, bi-weekly, or monthly.
The recombinant hsNPP1 or hsNPP3 can be administered in any suitable way, such as intravenously, subcutaneously, or intraperitoneally.
The recombinant hsNPP1 or hsNPP3 can be administered in combination with one or more additional therapeutic agents. Exemplary therapeutic agents include, but are not limited to Bisphosphonate, Statins, Fibrates, Niacin, Aspirin, Clopidogrel, and warfarin.
In some embodiments, the recombinant hsNPP1 or hsNPP3 and additional therapeutic agent are administered separately and are administered concurrently or sequentially. In some embodiments, the recombinant hsNPP1 or hsNPP3 is administered prior to administration of the additional therapeutic agent. In some embodiments, the recombinant hsNPP1 or hsNPP3 is administered after administration of the additional therapeutic agent. In other embodiments, the recombinant hsNPP1 or hsNPP3 and additional therapeutic agent are administered together.
The nucleic acids encoding the polypeptide(s) useful within the disclosure may be used in gene therapy protocols for the treatment of the diseases or disorders contemplated herein. The improved construct encoding the polypeptide(s) can be inserted into the appropriate gene therapy vector and administered to a patient to treat or prevent the diseases or disorder of interest.
Vectors, such as viral vectors, have been used in the prior art to introduce genes into a wide variety of different target cells. Typically, the vectors are exposed to the target cells so that transformation can take place in a sufficient proportion of the cells to provide a useful therapeutic or prophylactic effect from the expression of the desired polypeptide (e.g., a receptor). The transfected nucleic acid may be permanently incorporated into the genome of each of the targeted cells, providing long lasting effect, or alternatively the treatment may have to be repeated periodically. In certain embodiments, the (viral) vector transfects liver cells in vivo with genetic material encoding the polypeptide(s) of the disclosure.
A variety of vectors, both viral vectors and plasmid vectors are known in the art (see for example U.S. Pat. No. 5,252,479 and WO 93/07282). In particular, a number of viruses have been used as gene transfer vectors, including papovaviruses, such as SV40, vaccinia virus, herpes viruses including HSV and EBV, and retroviruses. Many gene therapy protocols in the prior art have employed disabled murine retroviruses. Several recently issued patents are directed to methods and compositions for performing gene therapy (see for example U.S. Pat. Nos. 6,168,916; 6,135,976; 5,965,541 and 6,129,705). Each of the foregoing patents is incorporated by reference in its entirety herein. Hence, genetic material such as a polynucleotide comprising an NPP1 or an NPP3 sequence can be introduced to a mammal in order to treat VSMC proliferation.
Certain modified viruses are often used as vectors to carry a coding sequence because after administration to a mammal, a virus infects a cell and expresses the encoded protein. Modified viruses useful according to the disclosure are derived from viruses which include, for example: parvovirus, picornavirus, pseudorabies virus, hepatitis virus A, B or C, papillomavirus, papovavirus (such as polyoma and SV40) or herpes virus (such as Epstein-Barr Virus, Varicella Zoster Virus, Cytomegalovirus, Herpes Zoster and Herpes Simplex Virus types 1 and 2), an RNA virus or a retrovirus, such as the Moloney murine leukemia virus or a lentivirus (i.e. derived from Human Immunodeficiency Virus, Feline Immunodeficiency Virus, equine infectious anemia virus, etc.). Among DNA viruses useful according to the disclosure are: Adeno-associated viruses adenoviruses, Alphaviruses, and Lentiviruses.
A viral vector is generally administered by injection, most often intravenously (by IV) directly into the body, or directly into a specific tissue, where it is taken up by individual cells. Alternately, a viral vector may be administered by contacting the viral vector ex vivo with a sample of the patient's cells, thereby allowing the viral vector to infect the cells, and cells containing the vector are then returned to the patient. Once the viral vector is delivered, the coding sequence expressed and results in a functioning protein. Generally, the infection and transduction of cells by viral vectors occur by a series of sequential events as follows: interaction of the viral capsid with receptors on the surface of the target cell, internalization by endocytosis, intracellular trafficking through the endocytic/proteasomal compartment, endosomal escape, nuclear import, virion uncoating, and viral DNA double-strand conversion that leads to the transcription and expression of the recombinant coding sequence interest. (Colella et al., Mol Ther Methods Clin Dev. 2017 Dec. 1; 8:87-104.).
Adeno-Associated Viral Vectors According to the Disclosure
AAV refers to viruses belonging to the genus Dependovirus of the Parvoviridae family. The AAV genome is approximately 4.7 kilobases long and is composed of linear single-stranded deoxyribonucleic acid (ssDNA) which may be either positive- or negative-sensed. The genome comprises inverted terminal repeats (ITRs) at both ends of the DNA strand, and two open reading frames (ORFs): rep and cap. The rep frame is made of four overlapping genes encoding non-structural replication (Rep) proteins required for the AAV life cycle. The cap frame contains overlapping nucleotide sequences of structural VP capsid proteins: VP1, VP2 and VP3, which interact together to form a capsid of an icosahedral symmetry.
The terminal 145 nucleotides are self-complementary and are organized so that an energetically stable intramolecular duplex forming a T-shaped hairpin may be formed. These hairpin structures function as an origin for viral DNA replication, serving as primers for the cellular DNA polymerase complex. Following wild type AAV infection in mammalian cells the rep genes (i.e. Rep78 and Rep52) are expressed from the P5 promoter and the P19 promoter, respectively, and both Rep proteins have a function in the replication of the viral genome. A splicing event in the rep ORF results in the expression of actually four Rep proteins (i.e. Rep78, Rep68, Rep52 and Rep40). However, it has been shown that the unspliced mRNA, encoding Rep78 and Rep52 proteins, in mammalian cells are sufficient for AAV vector production. Also in insect cells the Rep78 and Rep52 proteins suffice for AAV vector production.
AAV is a helper-dependent virus, that is, it requires co-infection with a helper virus (e.g., adenovirus, herpesvirus, or vaccinia virus) in order to form functionally complete AAV virions. In the absence of co-infection with a helper virus, AAV establishes a latent state in which the viral genome inserts into a host cell chromosome or exists in an episomal form, but infectious virions are not produced. Subsequent infection by a helper virus “rescues” the integrated genome, allowing it to be replicated and packaged into viral capsids, thereby reconstituting the infectious virion. While AAV can infect cells from different species, the helper virus must be of the same species as the host cell. Thus, for example, human AAV replicates in canine cells that have been co-infected with a canine adenovirus.
To produce infectious recombinant AAV (rAAV) containing a heterologous nucleic acid sequence, a suitable host cell line can be transfected with an AAV vector containing the heterologous nucleic acid sequence, but lacking the AAV helper function genes, rep and cap. The AAV-helper function genes can then be provided on a separate vector. Also, only the helper virus genes necessary for AAV production (i.e., the accessory function genes) can be provided on a vector, rather than providing a replication-competent helper virus (such as adenovirus, herpesvirus, or vaccinia).
Collectively, the AAV helper function genes (i.e., rep and cap) and accessory function genes can be provided on one or more vectors. Helper and accessory function gene products can then be expressed in the host cell where they will act in trans on rAAV vectors containing the heterologous nucleic acid sequence. The rAAV vector containing the heterologous nucleic acid sequence will then be replicated and packaged as though it were a wild-type (wt) AAV genome, forming a recombinant virion. When a patient's cells are infected with the resulting rAAV virions, the heterologous nucleic acid sequence enters and is expressed in the patient's cells.
Because the patient's cells lack the rep and cap genes, as well as the accessory function genes, the rAAV cannot further replicate and package their genomes. Moreover, without a source of 5 rep and cap genes, wtAAV cannot be formed in the patient's cells.
The AAV vector typically lacks rep and cap frames. Such AAV vectors can be replicated and packaged into infectious viral particles when present in a host cell that has been transfected with a vector encoding and expressing rep and cap gene products (i.e. AAV Rep and Cap proteins), and wherein the host cell has been transfected with a vector which encodes and expresses a protein from the adenovirus open reading frame E4orf6.
Delivery of a protein of interest to the cells of a mammal is accomplished by first generating an AAV vector comprising DNA encoding the protein of interest and then administering the vector to the mammal. Thus, the disclosure should be construed to include AAV vectors comprising DNA encoding the polypeptide(s) of interest. Once armed with the present disclosure, the generation of AAV vectors comprising DNA encoding this/these polypeptide(s)s will be apparent to the skilled artisan.
In one embodiment, the disclosure relates to an adeno-associated viral (AAV) expression vector comprising a sequence encoding mammal ENPP1 or mammal ENPP3, and upon administration to a mammal the vector expresses an ENPP1 or ENPP3 precursor in a cell, the precursor including an Azurocidin signal peptide fused at its carboxy terminus to the amino terminus of ENPP1 or ENPP3. The ENPP1 or ENPP3 precursor may include a stabilizing domain, such as an IgG Fc region or human albumin. Upon secretion of the precursor from the cell, the signal peptide is cleaved off and enzymatically active soluble mammal ENPP1 or ENPP3 is provided extracellularly.
An AAV expression vector may include an expression cassette comprising a transcriptional regulatory region operatively linked to a nucleotide sequence comprising a transcriptional regulatory region operatively linked to a recombinant nucleic acid sequence encoding a polypeptide comprising a Azurocidin signal peptide sequence and an ectonucleotide pyrophosphatase/phosphodiesterase (ENPP1) polypeptide sequence.
In some embodiments, the expression cassette comprises a promoter and enhancer, the Kozak sequence GCCACCATGG, a nucleotide sequence encoding mammal NPP1 protein or a nucleotide sequence encoding mammal NPP3 protein, other suitable regulatory elements and a polyadenylation signal.
In some embodiments, the AAV recombinant genome of the AAV vector according to the disclosure lacks the rep open reading frame and/or the cap open reading frame.
The AAV vector according to the disclosure comprises a capsid from any serotype. In general, the AAV serotypes have genomic sequences of significant homology at the amino acid and the nucleic acid levels, provide an identical set of genetic functions, and replicate and assemble through practically identical mechanisms. In particular, the AAV of the present disclosure may belong to the serotype 1 of AAV (AAV1), AAV2, AAV3 (including types 3A and 3B), AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAVrh10, AAV11, avian AAV, bovine AAV, canine AAV, equine AAV, or ovine AAV.
Examples of the sequences of the genome of the different AAV serotypes may be found in the literature or in public databases such as GenBank. For example, GenBank accession numbers NC 001401.2 (AAV2), NC 001829.1 (AAV4), NC 006152.1 (AAV5), AF028704.1 (AAV6), NC 006260.1 (AAV7), NC 006261.1 (AAV8), AX753250.1 (AAV9) and AX753362.1 (AAV10).
In some embodiments, the adeno-associated viral vector according to the disclosure comprises a capsid derived from a serotype selected from the group consisting of the AAV2, AAV5, AAV7, AAV8, AAV9, AAV10 and AAVrhl 0 serotypes. In another embodiment, the serotype of the AAV is AAV8. If the viral vector comprises sequences encoding the capsid proteins, these may be modified so as to comprise an exogenous sequence to direct the AAV to a particular cell type or types, or to increase the efficiency of delivery of the targeted vector to a cell, or to facilitate purification or detection of the AAV, or to reduce the host response.
In certain embodiments, the rAAV vector of the disclosure comprises several essential DNA elements. In certain embodiments, these DNA elements include at least two copies of an AAV ITR sequence, a promoter/enhancer element, a transcription termination signal, any necessary 5′ or 3′ untranslated regions which flank DNA encoding the protein of interest or a biologically active fragment thereof. The rAAV vector of the disclosure may also include a portion of an intron of the protein on interest. Also, optionally, the rAAV vector of the disclosure comprises DNA encoding a mutated polypeptide of interest.
In certain embodiments, the vector comprises a promoter/regulatory sequence that comprises a promiscuous promoter which is capable of driving expression of a heterologous gene to high levels in many different cell types. Such promoters include but are not limited to the cytomegalovirus (CMV) immediate early promoter/enhancer sequences, the Rous sarcoma virus promoter/enhancer sequences and the like. In certain embodiments, the promoter/regulatory sequence in the rAAV vector of the disclosure is the CMV immediate early promoter/enhancer. However, the promoter sequence used to drive expression of the heterologous gene may also be an inducible promoter, for example, but not limited to, a steroid inducible promoter, or may be a tissue specific promoter, such as, but not limited to, the skeletal a-actin promoter which is muscle tissue specific and the muscle creatine kinase promoter/enhancer, and the like.
In certain embodiments, the rAAV vector of the disclosure comprises a transcription termination signal. While any transcription termination signal may be included in the vector of the disclosure, in certain embodiments, the transcription termination signal is the SV40 transcription termination signal.
In certain embodiments, the rAAV vector of the disclosure comprises isolated DNA 5 encoding the polypeptide of interest, or a biologically active fragment of the polypeptide of interest. The disclosure should be construed to include any mammalian sequence of the polypeptide of interest, which is either known or unknown. Thus, the disclosure should be construed to include genes from mammals other than humans, which polypeptide functions in a substantially similar manner to the human polypeptide. Preferably, the nucleotide sequence comprising the gene encoding the polypeptide of interest is about 50% homologous, more preferably about 70% homologous, even more preferably about 80% homologous and most preferably about 90% homologous to the gene encoding the polypeptide of interest.
Further, the disclosure should be construed to include naturally occurring variants or recombinantly derived mutants of wild type protein sequences, which variants or mutants render the polypeptide encoded thereby either as therapeutically effective as full-length polypeptide, or even more therapeutically effective than full-length polypeptide in the gene therapy methods of the disclosure.
The disclosure should also be construed to include DNA encoding variants which retain the polypeptide's biological activity. Such variants include proteins or polypeptides which have been or may be modified using recombinant DNA technology, such that the protein or polypeptide possesses additional properties which enhance its suitability for use in the methods described herein, for example, but not limited to, variants conferring enhanced stability on the protein in plasma and enhanced specific activity of the protein. Analogs can differ from naturally occurring proteins or peptides by conservative amino acid sequence differences or by modifications which do not affect sequence, or by both. For example, conservative amino acid changes may be made, which although they alter the primary sequence of the protein or peptide, do not normally alter its function.
The disclosure is not limited to the specific rAAV vector exemplified in the experimental examples; rather, the disclosure should be construed to include any suitable AAV vector, including, but not limited to, vectors based on AAV-1, AAV-3, AAV-4 and AAV-6, and the like. Also included in the disclosure is a method of treating a mammal having a disease or disorder in an amount effective to provide a therapeutic effect.
The method comprises administering to the mammal an rAAV vector encoding the polypeptide of interest. Preferably, the mammal is a human. Typically, the number of viral vector genomes/mammal which are administered in a single injection ranges from about 1×108 to about 5×1016. Preferably, the number of viral vector genomes/mammal which are administered in a single injection is from about 1×1010 to about 1×1015; more preferably, the number of viral vector genomes/mammal which are administered in a single injection is from about 5×1010 to about 5×1015; and, most preferably, the number of viral vector genomes which are administered to the mammal in a single injection is from about 5×1010 to about 5×1014.
When the method of the disclosure comprises multiple site simultaneous injections, or several multiple site injections comprising injections into different sites over a period of several hours (for example, from about less than one hour to about two or three hours) the total number of viral vector genomes administered may be identical, or a fraction thereof or a multiple thereof, to that recited in the single site injection method.
For administration of the rAAV vector of the disclosure in a single site injection, in certain embodiments a composition comprising the virus is injected directly into an organ of the subject (such as, but not limited to, the liver of the subject).
For administration to the mammal, the rAAV vector may be suspended in a pharmaceutically acceptable carrier, for example, HEPES buffered saline at a pH of about 7.8. Other useful pharmaceutically acceptable carriers include, but are not limited to, glycerol, water, saline, ethanol and other pharmaceutically acceptable salt solutions such as phosphates and salts of organic acids. Examples of these and other pharmaceutically acceptable carriers are described in Remington's Pharmaceutical Sciences (1991, Mack Publication Co., New Jersey). The rAAV vector of the disclosure may also be provided in the form of a kit, the kit comprising, for example, a freeze-dried preparation of vector in a dried salts formulation, sterile water for suspension of the vector/salts composition and instructions for suspension of the vector and administration of the same to the mammal
The published application, US 2017/0290926—Smith et al., the contents of which are incorporated by reference in their entirety herein, describes in detail the process by which AAV vectors are generated, delivered and administered.
The present disclosure provides compositions and methods for the production and delivery of recombinant double-stranded RNA molecules (dsRNA that encode ENPP1 or ENPP3 polypeptides described herein. The double stranded RNA particle (dsRP) can contain a dsRNA molecule enclosed in a capsid or coat protein. The dsRNA molecule can be a viral genome or portion of a genome, which can be derived from a wild-type viral genome. The RNA molecule can encode an RNA-dependent RNA polymerase (RDRP) and a polyprotein that forms at least part of a capsid or coat protein. The RNA molecule can also contain an RNA sub-sequence that encodes an ENPP1 or ENPP3 polypeptides that are translated by the cellular components of a host cell. When the dsRP is transfected into a host cell the sub-sequence can be translated by the cellular machinery of the host cell to produce the ENPP1 or ENPP3 polypeptides.
In another aspect the disclosure provides a method of producing a protein product in a host cell. The method includes transfecting a host cell with a dsRP having a recombinant double-stranded RNA molecule (dsRNA) and a capsid or coat protein. The RNA molecule can encode an RNA-dependent RNA polymerase and a polyprotein that forms at least part of the capsid or coat protein, and the dsRP can be able to replicate in the host cell. The RNA molecule has at least one RNA sub-sequence that encodes ENPP1 or ENPP3 polypeptides that is translated by cellular components of the host cell.
In another aspect the disclosure provides an RNA molecule translatable by a host cell. The RNA molecule can be any RNA molecule that encodes the ENPP1 or ENPP3 polypeptides described herein. In one embodiment the RNA molecule encodes an RNA-dependent RNA polymerase and a polyprotein that forms at least part of a capsid or coat protein of a dsRP and, optionally, can have at least one sub-sequence of RNA that encodes an additional protein product.
Production of dsRP
A dsRP of the disclosure can also be produced by presenting to a host cell a plasmid or other DNA molecule encoding a dsRP of the disclosure or encoding the genes of the dsRP. The plasmid or DNA molecule containing nucleotide sequences encoding desired protein such as ENPP1 or ENPP3 polypeptide is then transfected into the host cell and the host cell begins producing the dsRP of the disclosure. The dsRP can also be produced in the host cell by presenting to the host cell an RNA molecule encoding the genes of the dsRP. The RNA molecule can be (+)-strand RNA.
Once the dsRP of the disclosure has been presented to the host cell (or a plasmid encoding the genes of the dsRP of the disclosure, or an RNA molecule encoding the genes of the dsRP), the dsRP will be produced within the host cell using the cellular components of the host cell. The dsRP of the disclosure is therefore self-sustaining within the host cell and is propagated within the host cell. The host cell can be any suitable host cell such as, for example, a eukaryotic cell, a mammalian cell, a fungal cell, a bacterial cell, an insect cell, or a yeast cell. The host cell can propagate a recombinant dsRP after a recombinant dsRNA molecule of the disclosure or a DNA molecule encoding a dsRP of the disclosure is presented to and taken up by the host cell.
Methods of Producing a dsRNA Virus or dsRP
The disclosure also provides methods of producing a dsRP of the disclosure. A double-stranded or single-stranded RNA or DNA molecule can be presented to a host cell. The amplification of the dsRNA molecules in the host cell utilizes the natural production and assembly processes already present in many types of host cells (e.g., yeast). The disclosure can thus be applied by presenting to a host cell a single-stranded or double-stranded RNA or DNA molecule of the disclosure, which is taken up by the host cell and is utilized to produce the recombinant dsRP and protein or peptide encoded by the RNA sub-sequence using the host cell's cellular components. The disclosure can also be applied by providing to the host cell a linear or circular DNA molecule (e.g., a plasmid or vector) containing one or more sequences coding for an RNA-dependent RNA polymerase, a polyprotein that forms at least part of the capsid or coat protein of the dsRP, and a sub-sequence encoding the protein of interest such as ENPP1 or ENPP3 polypeptides as disclosed herein.
The presentation of a dsRNA or ssRNA molecule of the disclosure can be performed in any suitable way such as, for example, by presenting an RNA molecule of the disclosure directly to the host cell as “naked” or unmodified single-stranded or double-stranded RNA. The RNA molecule can be transfected (or transformed) into a yeast, bacterial, or mammalian host cell by any suitable method, for example by electroporation, exposure of the host cell to calcium phosphate, or by the production of liposomes that fuse with the cell membrane and deposit the viral sequence inside. It can also be performed by a specific mechanism of direct introduction of dsRNA from killer viruses or heterologous dsRNA into the host cell. This step can be optimized using a reporter system, such as red fluorescent protein (RFP), or by targeting a specific constitutive gene transcript within the host cell genome. This can be done by using a target with an obvious phenotype or by monitoring by quantitative reverse transcriptase PCR (RT-PCR).
In some embodiments a DNA molecule (e.g., a plasmid or other vector) that encodes an RNA molecule of the disclosure is introduced into the host cell. The DNA molecule can contain a sequence coding for the RNA molecule of a dsRP of the disclosure. The DNA molecule can code for an entire genome of the dsRP, or a portion thereof. The DNA molecule can further code for the at least one sub-sequence of RNA that produces the additional (heterologous) protein product. The DNA sequence can also code for gag protein or gag-pol protein, and as well as any necessary or desirable promoters or other sequences supporting the expression and purpose of the molecule. The DNA molecule can be a linear DNA, a circular DNA, a plasmid, a yeast artificial chromosome, or may take another form convenient for the specific application.
In one embodiment the DNA molecule can further comprise T7 ends for producing concatamers and hairpin structures, thus allowing for propagation of the virus or dsRP sequence in the host cell. The DNA molecule can be transfected or transformed into the host cell and then, using the host cellular machinery, transcribed and thus provide the dsRNA molecule having the at least one sub-sequence of RNA to the host cell. The host cell can then produce the encoded desired ENPP1 or ENPP3 polypeptide. The dsRNA can be packaged in the same manner that a wild-type virus would be, using the host cell's metabolic processes and machinery. The ENPP1 or ENPP3 polypeptide is also produced using the host cell's metabolic processes and cellular components.
The patent, U.S. Ser. No. 10/266,834 by Brown et al., the contents of which are incorporated by reference in their entirety herein, describes in detail the process by which dsRNA particles that encode polypeptides are generated, delivered and administered
The disclosure provides pharmaceutical compositions comprising a polypeptide of the disclosure within the methods described herein. Such a pharmaceutical composition is in a form suitable for administration to a subject, or the pharmaceutical composition may further comprise one or more pharmaceutically acceptable carriers, one or more additional ingredients, or some combination of these. The various components of the pharmaceutical composition may be present in the form of a physiologically acceptable salt, such as in combination with a physiologically acceptable cation or anion, as is well known in the art.
In an embodiment, the pharmaceutical compositions useful for practicing the method of the disclosure may be administered to deliver a dose of between 1 ng/kg/day and 100 mg/kg/day. In other embodiments, the pharmaceutical compositions useful for practicing the disclosure may be administered to deliver a dose of between 1 ng/kg/day and 500 mg/kg/day.
The relative amounts of the active ingredient, the pharmaceutically acceptable carrier, and any additional ingredients in a pharmaceutical composition of the disclosure will vary, depending upon the identity, size, and condition of the subject treated and further depending upon the route by which the composition is to be administered. By way of example, the composition may comprise between about 0.1% and about 100% (w/w) active ingredient.
Pharmaceutical compositions that are useful in the methods of the disclosure may be suitably developed for inhalational, oral, rectal, vaginal, parenteral, topical, transdermal, pulmonary, intranasal, buccal, ophthalmic, intrathecal, intravenous or another route of administration. Other contemplated formulations include projected nanoparticles, liposomal preparations, resealed erythrocytes containing the active ingredient, and immunologically-based formulations. The route(s) of administration is readily apparent to the skilled artisan and depends upon any number of factors including the type and severity of the disease being treated, the type and age of the veterinary or human patient being treated, and the like.
The formulations of the pharmaceutical compositions described herein may be prepared by any method known or hereafter developed in the art of pharmacology. In general, such preparatory methods include the step of bringing the active ingredient into association with a carrier or one or more other accessory ingredients, and then, if necessary or desirable, shaping or packaging the product into a desired single- or multi-dose unit.
As used herein, a “unit dose” is a discrete amount of the pharmaceutical composition comprising a predetermined amount of the active ingredient. The amount of the active ingredient is generally equal to the dosage of the active ingredient that would be administered to a subject or a convenient fraction of such a dosage such as, for example, one-half or one-third of such a dosage. The unit dosage form may be for a single daily dose or one of multiple daily doses (e.g., about 1 to 4 or more times per day). When multiple daily doses are used, the unit dosage form may be the same or different for each dose.
The regimen of administration may affect what constitutes an effective amount. For example, several divided dosages, as well as staggered dosages may be administered daily or sequentially, or the dose may be continuously infused, or may be a bolus injection. Further, the dosages of the therapeutic formulations may be proportionally increased or decreased as indicated by the exigencies of the therapeutic or prophylactic situation. In certain embodiments, administration of the compound of the disclosure to a subject elevates the subject's plasma PPi to a level that is close to normal, where a normal level of PPi in mammals is 1-3 μM. “Close to normal” refers to 0 to 1.2 μM or 0-40% below or above normal, 30 nM to 0.9 μM or 1-30% 15 below or above normal, 0 to 0.6 μM or 0-20% below or above normal, or 0 to 0.3 μM or 0-10% below or above normal.
Administration of the compositions of the present disclosure to a patient, such as a mammal, such as a human, may be carried out using known procedures, at dosages and for periods of time effective to treat a disease or disorder in the patient. An effective amount of the therapeutic compound necessary to achieve a therapeutic effect may vary according to factors such as the activity of the particular compound employed; the time of administration; the rate of excretion of the compound; the duration of the treatment; other drugs, compounds or materials used in combination with the compound; the state of the disease or disorder, age, sex, weight, condition, general health and prior medical history of the patient being treated, and like factors well-known in the medical arts. Dosage regimens may be adjusted to provide the optimum therapeutic response. Dosage is determined based on the biological activity of the therapeutic compound which in turn depends on the half-life and the area under the plasma time of the therapeutic compound curve. The polypeptide according to the disclosure is administered at an appropriate time interval of every 2 days, or every 4 days, or every week or every month so as to achieve a continuous level of plasma PPi that is either close to the normal (1-3 μM) level or above (30-50% higher than) normal levels of PPi. Therapeutic dosage of the polypeptides of the disclosure may also be determined based on half-life or the rate at which the therapeutic polypeptide is cleared out of the body. The polypeptide according to the disclosure is administered at appropriate time intervals of either every 2 days, or every 4 days, every week or every month so as to achieve a constant level of enzymatic activity of ENPP1 or ENPP3 polypeptides.
For example, several divided doses may be administered daily, or the dose may be proportionally reduced as indicated by the exigencies of the therapeutic situation. A non-limiting example of an effective dose range for a therapeutic compound of the disclosure is from about and 50 mg/kg of body weight/per day. In certain embodiments, the effective dose range for a therapeutic compound of the disclosure is from about 50 ng to 500 ng/kg, preferably 100 ng to 300 ng/kg of bodyweight. One of ordinary skill in the art would be able to study the relevant factors and make the determination regarding the effective amount of the therapeutic compound without undue experimentation.
The compound can be administered to a patient as frequently as several times daily, or it may be administered less frequently, such as once a day, once a week, once every two weeks, once a month, or even less frequently, such as once every several months or even once a year or less. It is understood that the amount of compound dosed per day may be administered, in non-limiting examples, every day, every other day, every 2 days, every 3 days, every 4 days, or every days. For example, with every other day administration, a 5 mg per day dose may be initiated on Monday with a first subsequent 5 mg per day dose administered on Wednesday, a second subsequent 5 mg per day dose administered on Friday, and so on. The frequency of the dose is readily apparent to the skilled artisan and depends upon any number of factors, such as, but not limited to, the type and severity of the disease being treated, and the type and age of the patient. Actual dosage levels of the active ingredients in the pharmaceutical compositions of this disclosure may be varied so as to obtain an amount of the active ingredient that is effective to achieve the desired therapeutic response for a particular patient, composition, and mode of administration, without being toxic to the patient.
A medical doctor, e.g., physician, having ordinary skill in the art may readily determine and prescribe the effective amount of the pharmaceutical composition required. For example, the physician or veterinarian could start doses of the compounds of the disclosure employed in the pharmaceutical composition at levels lower than that required in order to achieve the desired therapeutic effect and gradually increase the dosage until the desired effect is achieved.
In certain embodiments, the compositions of the disclosure are administered to the patient in dosages that range from one to five times per day or more. In other embodiments, the compositions of the disclosure are administered to the patient in range of dosages that include, but are not limited to, once every day, every two, days, every three days to once a week, and once every two weeks. The frequency of administration of the various combination compositions of the disclosure varies from subject to subject depending on many factors including, but not limited to, age, disease or disorder to be treated, gender, overall health, and other factors. Thus, the disclosure should not be construed to be limited to any particular dosage regime and the precise dosage and composition to be administered to any patient will be determined by the attending physical taking all other factors about the patient into account.
In certain embodiments, the present disclosure is directed to a packaged pharmaceutical composition comprising a container holding a therapeutically effective amount of a compound of the disclosure, alone or in combination with a second pharmaceutical agent; and instructions for using the compound to treat, prevent, or reduce one or more symptoms of a disease or disorder in a patient.
Routes of administration of any of the compositions of the disclosure include inhalational, oral, nasal, rectal, parenteral, sublingual, transdermal, transmucosal (e.g., sublingual, lingual, (trans)buccal, (trans)urethral, vaginal (e.g., trans- and perivaginally), (intra)nasal, and (trans)rectal), intravesical, intrapulmonary, intraduodenal, intragastrical, intrathecal, subcutaneous, intramuscular, intradermal, intra-arterial, intravenous, intrabronchial, inhalation, and topical administration.
Suitable compositions and dosage forms include, for example, tablets, capsules, caplets, pills, gel caps, troches, dispersions, suspensions, solutions, syrups, granules, beads, transdermal patches, gels, powders, pellets, magmas, lozenges, creams, pastes, plasters, lotions, discs, suppositories, liquid sprays for nasal or oral administration, dry powder or aerosolized formulations for inhalation, compositions and formulations for intravesical administration and the like. The formulations and compositions that would be useful in the present disclosure are not limited to the particular formulations and compositions that are described herein.
“Parenteral administration” of a pharmaceutical composition includes any route of administration characterized by physical breaching of a tissue of a subject and administration of the pharmaceutical composition through the breach in the tissue. Parenteral administration thus includes, but is not limited to, administration of a pharmaceutical composition by injection of the composition, by application of the composition through a surgical incision, by application of the composition through a tissue-penetrating non-surgical wound, and the like. In particular, parenteral administration is contemplated to include, but is not limited to, subcutaneous, intravenous, intraperitoneal, intramuscular, intrasternal injection, and kidney dialytic infusion techniques.
The present disclosure is further exemplified by the following examples. The examples are for illustrative purpose only and are not intended, nor should they be construed as limiting the disclosure in any manner.
Allograft vasculopathy remains one of the main complications hindering long-term graft survival, thus representing a major risk factor for mortality in patients subjected to solid organ transplantation. The aim of the example is to evaluate the efficacy of an ENPP1-Fc fusion protein or ENPP1 protein in a mouse model for aortic allografts. Therapeutic effects of the ENPP1 or ENPP1-Fc fusion protein are assessed with respect to the ability to inhibit stenosis after solid organ transplant.
Female DBA/2 (H-2d) and C57BL/6J (H-2b) mice ages of 5-6 weeks are used as donor and recipient mice respectively. (Bickerstaff et al, Murine renal allografts: spontaneous acceptance is associated with regulated T cell-mediated immunity, 2001, J. Immunol. 167, 4821-4827). Descending thoracic aortae of DBA/2 mice are transplanted into C57CL/6 mice in the infrarenal position, as already described. (Seppelt et al., Loss of Endothelial Barrier in Marfan Mice (mgR/mgR) Results in Severe Inflammation after Adenoviral Gene Therapy, 2016, PLoS ONE 11, e0148012.)
Donor mice are euthanized with CO2. The thoracic cavity is opened, left ventricle is punctured, and the arterial circulatory system is perfused with 5 mL NaCl (4° C., 0.9%). The descending aorta is harvested and transplanted into the recipient mice to create the model for aortic allografts. Alternatively, the entire heart of the donor mice can be harvested and transplanted into the recipient mice as shown in
Recipient C57BL/6J mice are anesthetized by inhalation of 5% isoflurane. Novalgin (500 mg/mL; 200 mg/kg body weight) and Carprieve (50 mg/mL carprofen, 5 mg/kg body weight) are injected intraperitoneally. The abdominal cavity of recipient mice is opened and the infrarenal aorta was dissected. Titanium clips are applied, and the aorta was transected. Grafts are connected to recipient aorta with two end-to-end anastomoses (Prolene 11-0, nylon black, S&T, Neuhausen, Switzerland). After removal of the clips the graft was re-perfused. (Remes et al., Molecular Therapy: Methods & Clinical Development Vol. 15 Dec. 2019).
A control subset of recipient mice containing the transplanted aorta (n=5) is treated with tris buffered saline and the experimental subset of recipient mice with the transplanted aorta (n=5) is treated with ENPP1 or ENPP1-Fc to determine the effect of ENPP1 or ENPP1-Fc on vascular smooth muscle cell proliferation in the allografts. ENPP1 or ENPP1-Fc treatment (ENPP1 or ENPP1-Fc at 10 mg/kg body weight subcutaneously injected every day) is initiated after the aortic transplant in the experimental mice group and continued for 28 days until the transplanted aorta is harvested. Similarly, the control mice group are treated with Tris buffered saline, pH 7.4 after aortic transplant by subcutaneous injection every day continued for 28 days until the transplanted aorta is harvested. The arteries are then fixed with 4% paraformaldehyde in PBS for morphological analyses.
Serial sections (sections of 5 μm each) are collected. 5-μm thick frozen aortic sections (Microtom, HM 500 O) are randomly chosen from various intervals throughout the transplanted grafts and are stained by using Elastica van Gieson stain (Roth, Karlsruhe, Germany). ImageJ software is used to measure the circumference of the external elastic lamina, the internal elastic lamina and the luminal border. Afterward, ImageJ (Fiji version 1.51p, NIH, USA) is used to measure neointimal and medial areas with two investigators blinded toward the treatment regimen. The ratio of the two analyzed parameters is used as a measure of lumen obstruction. The medial area, the intimal area and the intima/media ratio (I/M ratio) were calculated.
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that control non-treated mice developed vascular lesions and intense remodeling, accompanied by high degrees of vessel lumen obstruction.
In experimental mice treated with ENPP1 or ENPP1-Fc post transplantation, the degree of intimal hyperplasia is compared to control mice which received no ENPP1 or ENPP1-Fc. Quantitative analyses of sequential sections of transplanted aorta from untreated control mice are expected to exhibit significantly increased neointimal proliferation and this also is compared to ENPP1 or ENPP1-Fc treated mice at or after 28 days post-transplant. Control mice are expected to show thickening of arterial intima and this is compared to treated mice. Correspondingly, the I/M ratios of control and treated mice are compared.
The same experiment as described in Example 1 is modified to determine the prophylactic effect of ENPP1 or ENPP1-Fc in preventing or reducing allograft vasculopathy by administering ENPP1 or ENPP1-Fc to the experimental group one week prior to aortic transplantation, as shown in
The same experiment as described in Example 1 can be performed using a rat model instead of a mouse model. A rat model for transplantation is described in Bogossian et al. (2016) Cardiovasc Ther 34(4):183. ENPP1 or ENPP1-Fc treated rats and control rats (receiving Tris buffer saline) having aortic allograft transplants are compared at 28 days after transplant surgery.
The selection of donor-recipient pairs is based upon major histocompatibility complex incompatibility by mixed lymphocyte reaction (MLR). The stimulation index (SI) is calculated through the following formula: (mean cpm of allogeneic MLR)/(mean cpm of autologous MLR). The donor heart is heterotopically transplanted into the recipient swine abdomen by infrarenal allografting. The selected transplant donors and recipients are anesthetized using Zoletil (tiletamine plus zolazepam, 5 mg/kg), succinylcholine (1.1 mg/kg), and atropine (0.6 mg/kg,), and they are maintained under anesthesia using isoflurane (3%/1.5 L/min) administered through a ventilator after intubation. The recipient is placed in the left decubitus position, and vascular access was established for the administration of immunosuppressive drugs.
A right flank incision is created, and through a retroperitoneal approach, the infrarenal aorta and inferior vena cava are isolated (See
The beating rate of cardiac allograft was monitored daily through palpation, and electrocardiography is performed twice per week. When the beating rate of the allograft decreased, echocardiography is performed to assess systolic function. Follow-up is continued to the time of allograft arrest or the study end date (150 days).
A control subset of recipient pigs containing the transplanted heart (n=12) is treated with tris buffered saline and the experimental subset of recipient pigs with the transplanted heart (n=12) is treated with ENPP1 or ENPP1-Fc to determine the effect of ENPP1 on vascular smooth muscle cell proliferation in the solid organ transplants. ENPP1 or ENPP1-Fc treatment (ENPP1-Fc or ENPP1 at 10 mg/kg body weight subcutaneously injected every four days) is initiated after the heart transplant in the experimental pigs group and continued for 150 days until the transplanted heart is harvested. Similarly, the control pig group are treated with Tris buffered saline, pH 7.4 after heart transplant by intraperitoneal injection every 4 days is continued for 150 days until the transplanted heart is harvested.
Formalin-fixed cardiac specimens are embedded in paraffin, cross-sectioned, deparaffinized, rehydrated, and then subjected to hematoxylin and eosin (HE) or orcein staining. Intimal hyperplasia of the vascular grafts is examined using a Zeiss microscope and determined from computer images of orcein-stained cross sections. The area surrounded by the internal elastic lamina (IELA) and the luminal area (LA) are calculated using an image analysis program (Image J, Version 1.46r, NIH Image). The severity of intimal hyperplasia is calculated using the following formula: [(IELA−LA)/IELA]×100%. After calculation, the severity of intimal hyperplasia for each graft is evaluated in 3 randomly chosen fields per coronary section for 5 cross sections in a blinded manner, and the evaluated severity levels are averaged for statistical analysis.
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that control non-treated pigs developed vascular lesions and intense remodeling, accompanied by high degrees of vessel lumen obstruction.
In experimental pigs treated with ENPP1 or ENPP1-Fc post transplantation, the degree of intimal hyperplasia is determined for control and ENPP1 or ENPP1-treated pigs by performing quantitative and qualitative analyses of sequential sections. Control pigs are expected to exhibit significantly increased neointimal proliferation at 150 days post-transplant. Control pigs are expected to show thickening of arterial intima and treated pigs are compared to control. Correspondingly, the I/M ratios of control and treated pigs are compared. Median survival time also is determined for the control and ENPP1 or ENPP1-treated groups. Graft survival time also is determined for control and ENPP1 or ENPP1-treated groups.
Female DBA/2 (H-2d) and C57BL/6J (H-2b) mice ages of 5-6 weeks are used as donor and recipient mice respectively. (Bickerstaff et al, Murine renal allografts: spontaneous acceptance is associated with regulated T cell-mediated immunity, 2001, J. Immunol. 167, 4821-4827). Descending thoracic aortae of DBA/2 mice are transplanted into C57CL/6 mice in the infrarenal position, as already described. (Seppelt et al., Loss of Endothelial Barrier in Marfan Mice (mgR/mgR) Results in Severe Inflammation after Adenoviral Gene Therapy, 2016, PLoS ONE 11, e0148012.)
Donor mice are euthanized with CO2. The thoracic cavity is opened, left ventricle is punctured, and the arterial circulatory system is perfused with 5 mL NaCl (4° C., 0.9%). The descending aorta is harvested and transplanted into the recipient mice to create the model for aortic allografts. Alternatively, the entire heart of the donor mice can be harvested and transplanted into the recipient mice as shown in
Recipient C57BL/6J mice are anesthetized by inhalation of 5% isoflurane. Novalgin (500 mg/mL; 200 mg/kg body weight) and Carprieve (50 mg/mL carprofen, 5 mg/kg body weight) are injected intraperitoneally. The abdominal cavity of recipient mice is opened and the infrarenal aorta was dissected. Titanium clips are applied, and the aorta was transected. Grafts are connected to recipient aorta with two end-to-end anastomoses (Prolene 11-0, nylon black, S&T, Neuhausen, Switzerland). After removal of the clips the graft was re-perfused. (Remes et al., Molecular Therapy: Methods & Clinical Development Vol. 15 Dec. 2019).
A control subset of recipient mice containing the transplanted aorta (n=5) is treated with tris buffered saline and the experimental subset of recipient mice with the transplanted aorta (n=5) is treated with ENPP3 or ENPP3-Fc to determine the effect of ENPP3-Fc on vascular smooth muscle cell proliferation in the allografts. ENPP3-Fc treatment (ENPP3-Fc at 10 mg/kg body weight subcutaneously injected every day) is initiated after the aortic transplant in the experimental mice group and continued for 28 days until the transplanted aorta is harvested. Similarly, the control mice group are treated with Tris buffered saline, pH 7.4 after aortic transplant by subcutaneous injection every day continued for 28 days until the transplanted aorta is harvested. The arteries are then fixed with 4% paraformaldehyde in PBS for morphological analyses.
Serial sections (sections of 5 μm each) are collected. 5-μm thick frozen aortic sections (Microtom, HM 500 O) are randomly chosen from various intervals throughout the transplanted grafts and are stained by using Elastica van Gieson stain (Roth, Karlsruhe, Germany). ImageJ software is used to measure the circumference of the external elastic lamina, the internal elastic lamina and the luminal border. Afterward, ImageJ (Fiji version 1.51p, NIH, USA) is used to measure neointimal and medial areas with two investigators blinded toward the treatment regimen. The ratio of the two analyzed parameters is used as a measure of lumen obstruction. The medial area, the intimal area and the intima/media ratio (UM ratio) were calculated.
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that control non-treated mice developed vascular lesions and intense remodeling, accompanied by high degrees of vessel lumen obstruction.
In experimental mice treated with ENPP3 or ENPP3-Fc post transplantation, the degree of intimal hyperplasia is compared to control mice which received no ENPP3 or ENPP3-Fc. Quantitative analyses of sequential sections of transplanted aorta from untreated control mice are expected to exhibit significantly increased neointimal proliferation and this also is compared to ENPP3 or ENPP3-Fc treated mice at or after 28 days post-transplant. Control mice are expected to show thickening of arterial intima and this is compared to treated mice. Correspondingly, the TIM ratios of control and treated mice are compared.
The same experiment as described in Example 5 is modified to determine the prophylactic effect of ENPP3 or ENPP3-Fc in preventing or reducing allograft vasculopathy by administering ENPP3 or ENPP3-Fc to the experimental group one week prior to aortic transplantation, as shown in
The same experiment as described in Example 5 can be performed using a rat model instead of a mouse model. A rat model for transplantation is described in Bogossian et al. (2016) Cardiovasc Ther 34(4):183. ENPP3 or ENPP3-Fc treated rats and control rats (receiving Tris buffer saline) having aortic allograft transplants are compared at 28 days after transplant surgery.
CAV remains the leading cause of allograft failure 1 year after transplantation. Cardiac allograft vasculopathy manifests as accelerated, diffuse coronary arteriosclerosis that has different pathogenesis than conventional native coronary artery disease (CAD). The efficacy of an ENPP3 or ENPP3-Fc fusion protein is evaluated in a large animal model of an organ transplant—specifically, heart transplant of domestic (Yorkshire) swine. Therapeutic effects of the ENPP3 or ENPP3-Fc fusion protein were assessed with respect to the ability to inhibit stenosis after heart transplant in Yorkshire swine.
The selection of donor-recipient pairs is based upon major histocompatibility complex incompatibility by mixed lymphocyte reaction (MLR). The stimulation index (SI) is calculated through the following formula: (mean cpm of allogeneic MLR)/(mean cpm of autologous MLR). The donor heart is heterotopically transplanted into the recipient swine abdomen by infrarenal allografting. The selected transplant donors and recipients are anesthetized using Zoletil (tiletamine plus zolazepam, 5 mg/kg), succinylcholine (1.1 mg/kg), and atropine (0.6 mg/kg,), and they are maintained under anesthesia using isoflurane (3%/1.5 L/min) administered through a ventilator after intubation. The recipient is placed in the left decubitus position, and vascular access was established for the administration of immunosuppressive drugs.
A right flank incision is created, and through a retroperitoneal approach, the infrarenal aorta and inferior vena cava are isolated (See
The beating rate of cardiac allograft was monitored daily through palpation, and electrocardiography is performed twice per week. When the beating rate of the allograft decreased, echocardiography is performed to assess systolic function. Follow-up is continued to the time of allograft arrest or the study end date (150 days).
A control subset of recipient pigs containing the transplanted heart (n=12) is treated with tris buffered saline and the experimental subset of recipient pigs with the transplanted heart (n=12) is treated with ENPP3 or ENPP3-Fc to determine the effect of ENPP3 polypeptides on vascular smooth muscle cell proliferation in the solid organ transplants. ENPP3 or ENPP3-Fc treatment (ENPP3 or ENPP3-Fc at 10 mg/kg body weight subcutaneously injected every four days) is initiated after the heart transplant in the experimental pigs group and continued for 150 days until the transplanted heart is harvested. Similarly, the control pig group are treated with Tris buffered saline, pH 7.4 after heart transplant by intraperitoneal injection every 4 days is continued for 150 days until the transplanted heart is harvested.
Formalin-fixed cardiac specimens are embedded in paraffin, cross-sectioned, deparaffinized, rehydrated, and then subjected to hematoxylin and eosin (HE) or orcein staining. Intimal hyperplasia of the vascular grafts is examined using a Zeiss microscope and determined from computer images of orcein-stained cross sections. The area surrounded by the internal elastic lamina (IELA) and the luminal area (LA) are calculated using an image analysis program (Image J, Version 1.46r, NIH Image). The severity of intimal hyperplasia is calculated using the following formula: [(IELA−LA)/IELA]×100%. After calculation, the severity of intimal hyperplasia for each graft is evaluated in 3 randomly chosen fields per coronary section for 5 cross sections in a blinded manner, and the evaluated severity levels are averaged for statistical analysis.
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that control non-treated pigs developed vascular lesions and intense remodeling, accompanied by high degrees of vessel lumen obstruction.
In experimental pigs treated with ENPP3 or ENPP3-Fc post transplantation, the degree of intimal hyperplasia is determined for control and ENPP3-treated pigs by performing quantitative and qualitative analyses of sequential sections. Control pigs are expected to exhibit significantly increased neointimal proliferation at 150 days post-transplant. Control pigs are expected to show thickening of arterial intima and treated pigs are compared to control. Correspondingly, the TIM ratios of control and treated pigs are compared. Median survival time also is determined for the control and ENPP3-treated groups. Graft survival time also is determined for control and ENPP3-treated groups.
The efficacy of an ENPP1-Fc fusion protein was evaluated in large animal model of peripheral vascular injury—specifically, in-stent restenosis lesions in the peripheral vasculature of domestic (Yorkshire) swine. Therapeutic effects of the ENPP1-Fc fusion protein were assessed with respect to the ability to inhibit stenosis after angioplasty in previously injured and stented peripheral arteries of Yorkshire swine.
Four peripheral arterial sites were created for induction of neointimal response in each animal; one site was selected in each of four arteries (bilateral profunda and superficial femoral arteries).
All target sites were injured on Day 0 to create the in-stent restenosis model, 10 days prior to the first dose of ENPP1-Fc or a vehicle only control, and 14 days before repeat injury. The four peripheral artery sites were mapped using quantitative vascular angiography (QVA) in order to select the treatment site and correctly sized balloon and stent. The injury was created by overstretch of the artery with a standard angioplasty balloon catheter at a target 130% overstretch; three inflations were performed. Immediately following injury, a bare metal stent was deployed. Peripheral stents were self-expandable, targeting approximately a 120% overstretch.
ENPP1-Fc treatment occurred systemically starting on Day 10 and was dosed every 4 days subcutaneously until termination. On Day 14, all vessels were assessed by angiography and Optical Coherence Tomography (OCT). Then the previously injured and stented artery sites were subjected to a re-injury event consisting of overstretch of the artery with a single inflation of a standard angioplasty balloon catheter at the same pressure/diameter as the original pre-stent injury was done (130% of the baseline reference diameter). Following re-injury interventions, final post-procedural angiography and OCT were also recorded for select peripheral sites.
Four weeks following the re-injury event on Day 14, arteries underwent repeat imaging with angiography and endovascular imaging (OCT). The treated peripheral segments were explanted and stored in 10% neutral buffered formalin.
As shown in
Tables 1 and 2 (below) summarizes the mean OCT values in all profunda arteries by treatment group.
As set forth in the Table, the profunda arteries of animals treated with ENPP1-Fc had a higher lumen area at day 42 compared to the vehicle control group. The stent area was similar between both groups. Neointimal thickness and neointimal area were also reduced at day 42 in animals treated with ENPP1-Fc relative to the vehicle control animals. In additional, animals treated with ENPP1-Fc had a markedly lower % area of stenosis as compared to the vehicle control group (see
The efficacy of an ENPP3-Fc fusion protein is evaluated in a large animal model of peripheral vascular injury—specifically, in-stent restenosis lesions in the peripheral vasculature of domestic (Yorkshire) swine. Therapeutic effects of the ENPP3-Fc fusion protein are assessed with respect to the ability to inhibit stenosis after angioplasty in previously injured and stented peripheral arteries of Yorkshire swine.
Four peripheral arterial sites are created for induction of neointimal response in each animal; one site is selected in each of four arteries (bilateral profunda and superficial femoral arteries).
All target sites are injured on Day 0 to create the in-stent restenosis model, 10 days prior to the first dose of ENPP3-Fc or a vehicle only control, and 14 days before repeat injury. The four peripheral artery sites are mapped using quantitative vascular angiography (QVA) in order to select the treatment site and correctly sized balloon and stent. The injury is created by overstretch of the artery with a standard angioplasty balloon catheter at a target 130% overstretch; three inflations are performed. Immediately following injury, a bare metal stent is deployed. Peripheral stents are self-expandable, targeting approximately a 120% overstretch.
ENPP3-Fc treatment will be systemically starting on Day 10 and dosed every 4 days subcutaneously until termination. On Day 14, all vessels are assessed by angiography and Optical Coherence Tomography (OCT). Then the previously injured and stented artery sites are subjected to a re-injury event consisting of overstretch of the artery with a single inflation of a standard angioplasty balloon catheter at the same pressure/diameter as the original pre-stent injury (130% of the baseline reference diameter). Following re-injury interventions, final post-procedural angiography and OCT are also recorded for select peripheral sites.
Four weeks following the re-injury event on Day 14, arteries will be subject to repeat imaging with angiography and endovascular imaging (OCT). The treated peripheral segments will be explanted and stored in 10% neutral buffered formalin.
Moyamoya is a cerebrovascular disorder characterized by progressive stenosis of the intracranial internal carotid arteries leading to both hemorrhagic and ischemic strokes Restriction of blood flow through the ICA leads to eventual development of new blood vessels resembling a “puff of smoke” (moyamoya in Japanese) in the subcortical region. The aim of the example is to evaluate the efficacy of an ENPP1-Fc fusion protein or ENPP1 for treatment in a mouse model for MMD. Therapeutic effects of the ENPP1-Fc fusion protein or ENPP1 are assessed with respect to the ability to inhibit vascular smooth muscle cell proliferation in MMD and reduce or prevent cerebral occlusions.
Generation of MMD Phenotype
C57Bl/6 male mice (5-6 weeks old) obtained from Jackson Laboratories are anesthetized with a cocktail of ketamine and xylazine using a weight based ratio. Once the mice are anesthetized their cervical region are shaved, and the mouse is placed in the supine position with their head, forepaws and tail restrained (
With the ICA isolated, the 6±0 suture is used as an anchor for coil placement. Fine tipped forceps are used to grasp the coil at one end and place it at an angle to the ICA so that the vessel inserts into the last rung of the coil. With the vessel in the last rung of the coil, the coil is inverted so that it is parallel to the ICA. Using the 6±0 suture, the vessel is gently rotated around the coil so that a length of vessel is placed in each rung of the coil. Vessel placement is assessed to ensure that it is not skipping a rung; if so, the vessel is uncoiled and repositioned until the coil completely encompassed the vessel. Thus, the MMD phenotype in both control and experimental subset of mice is induced by following the procedures discussed in Roberts et al. ((Roberts et al., Internal carotid artery stenosis: A novel surgical model for moyamoya syndrome, PLoS One. 2018; 13(1): e0191312.)
A control subset of MMD model mice (n=5) is treated with tris buffered saline and the experimental subset of MMD mice (n=5) is treated with ENPP1 or ENPP1-Fc post induction of MMD phenotype to determine the effect of ENPP1 or ENPP1-Fc on vascular smooth muscle cell proliferation and cerebral occlusions in the brain of the MMD mice. ENPP1 or ENPP1-Fc treatment (ENPP1 or ENPP1-Fc at 10 mg/kg body weight, subcutaneously injected every day) is initiated after the induction of MMD phenotype by surgery as described above in the experimental mice group and ENPP1 or ENPP1-Fc administration is continued for 28 days until the cerebral artery is harvested.
Similarly, the control mice group are treated with Tris buffered saline, pH 7.4 after the induction of MMD phenotype by surgery as described and Tris buffered saline is administered via subcutaneous injection every day and continued for 28 days until the cerebral artery is harvested. The arteries of both control and experimental group mice with MMD are then fixed with 4% paraformaldehyde in PBS for morphological analyses.
Visualization of Cerebrovasculature
To visualize the cerebrovasculature, all animals from each group are perfused with the fluorescent dye Di I (Li et al., Direct labeling and visualization of blood vessels with lipophilic carbocyanine dye Dd. Nat Protoc. 2008; 3(11):1703±8). Mice are subjected to a transcardial perfusion using a perfusion pump (set to 1 ml/min) to perfuse (room temperature) 5 ml of PBS, immediately followed by 10 ml of Di I working solution and then 10 ml of 10% buffered formalin. Brains are carefully removed from the skull ensuring that the Circle of Willis (CoW) remained intact.
The extracted brain is then post-fixed overnight at 4° C. with 10% buffered formalin. The brains are then transferred into PBS for long-term storage at 4° C. and protected from light. Fluorescently labelled brains were imaged using a 1×microscope (Nikon Eclipse E800/Nikon DS-Ril). Images of the cortical vasculature are taken to examine anastomoses and images of the CoW were used to measure vessel diameter. Image analysis is performed using Nikon NES Analysis software to measure vessel diameter (μm).
Diameter measurements are taken approximately 20 μm from the bifurcation of the supraclinoid internal carotid artery, M1 segment of the middle cerebral artery, and the A1 segment of the anterior cerebral artery. Anastomoses analysis is performed by counting the number of anastomoses (circle placed over each connection point on a magnified image) between the ACA and the MCA of both the ipsilateral and contralateral hemispheres. Diameters of the ICA, ACA and MCA vessels are examined by measuring the width of each vessel near the bifurcation point on both the ipsilateral and contralateral sides to determine if there was any difference in size between the experimental and control groups.
Morphological Analysis
Serial sections (sections of 5 μm each) of cerebral arteries such as MCA, ACA and ICA are collected for both control and experimental group. 5-μm thick frozen aortic sections (Microtome, HM 500 O) are stained by using Elastica van Gieson stain (Roth, Karlsruhe, Germany). ImageJ software is used to measure the circumference of the external elastic lamina, the internal elastic lamina and the luminal border. Afterward, ImageJ (Fiji version 1.51p, NIH, USA) is used to measure neointimal and medial areas with two investigators blinded toward the treatment regimen. The ratio of the two analyzed parameters is used as a measure of lumen obstruction. The medial area, the intimal area and the intima/media ratio (FM ratio) were calculated. (See
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that the control non-treated mice with MMD phenotype develop vascular lesions, occlusions and narrowing accompanied by high degrees of vessel lumen obstruction.
In experimental mice treated with ENPP1 or ENPP1-Fc post induction of MMD phenotype, the degree of intimal hyperplasia is compared to control mice which received no ENPP1 or ENPP1-Fc. Quantitative analyses of cerebral arteries from untreated control mice with MMD phenotype are expected to exhibit significantly increased neointimal proliferation and this also is compared to ENPP1 or ENPP1-Fc treated mice at or after 28 days post-surgery. Control mice are expected to exhibit thickening of arterial intima and this is compared to treated mice. Correspondingly, the I/M ratios of control and treated mice are also compared.
The same experiment as described in Example 11 is modified to determine the prophylactic effect of ENPP1 or ENPP1-Fc in preventing or reducing vascular smooth muscle proliferation and cerebral occlusions by administering ENPP1 or ENPP1-Fc to the experimental group one week prior to induction of MMD phenotype, as shown in
Morphological analysis is expected to show that the intimal area of experimental mice with MMD phenotype receiving subcutaneous ENPP1 or ENPP1-Fc is expected to be significantly reduced compared to control mice, whereas the medial area, between the external and internal lamina remains constant. The I/M ratio is expected to decrease in ENPP1 or ENPP1-Fc treated experimental mice compared to vehicle-treated control mice. The prophylactic treatment of ENPP1 or ENPP1-Fc prior to induction of MMD phenotype is expected to confer protective effect by lowering the level of VSMC proliferation.
Moyamoya is a cerebrovascular disorder characterized by progressive stenosis of the intracranial internal carotid arteries leading to both hemorrhagic and ischemic strokes Restriction of blood flow through the ICA leads to eventual development of new blood vessels resembling a “puff of smoke” (moyamoya in Japanese) in the subcortical region. The aim of the example is to evaluate the efficacy of an ENPP3-Fc fusion protein or ENPP3 for treatment in a mouse model for MMD. Therapeutic effects of the ENPP3-Fc fusion protein or ENPP3 are assessed with respect to the ability to inhibit vascular smooth muscle cell proliferation in MMD and reduce or prevent cerebral occlusions.
Generation of MMD Phenotype
C57Bl/6 male mice (5-6 weeks old) obtained from Jackson Laboratories are anesthetized with a cocktail of ketamine and xylazine using a weight based ratio. Once the mice are anesthetized their cervical region are shaved, and the mouse is placed in the supine position with their head, forepaws and tail restrained (
With the ICA isolated, the 6±0 suture is used as an anchor for coil placement. Fine tipped forceps are used to grasp the coil at one end and place it at an angle to the ICA so that the vessel inserts into the last rung of the coil. With the vessel in the last rung of the coil, the coil is inverted so that it is parallel to the ICA. Using the 6±0 suture, the vessel is gently rotated around the coil so that a length of vessel is placed in each rung of the coil. Vessel placement is assessed to ensure that it is not skipping a rung; if so, the vessel is uncoiled and repositioned until the coil completely encompassed the vessel. Thus, the MMD phenotype in both control and experimental subset of mice is induced by following the procedures discussed in Roberts et al. ((Roberts et al., Internal carotid artery stenosis: A novel surgical model for moyamoya syndrome, PLoS One. 2018; 13(1): e0191312.)
A control subset of MMD model mice (n=5) is treated with tris buffered saline and the experimental subset of MMD mice (n=5) is treated with ENPP3-Fc or ENPP3 post induction of MMD phenotype to determine the effect of ENPP3-Fc or ENPP3 on vascular smooth muscle cell proliferation and cerebral occlusions in the brain of the MMD mice. ENPP3-Fc treatment (ENPP3 or ENPP3-Fc at 10 mg/kg body weight, subcutaneously injected every day) is initiated after the induction of MMD phenotype by surgery as described above in the experimental mice group and ENPP3-Fc or ENPP3 administration is continued for 28 days until the cerebral artery is harvested.
Similarly, the control mice group are treated with Tris buffered saline, pH 7.4 after the induction of MMD phenotype by surgery as described and Tris buffered saline is administered via subcutaneous injection every day and continued for 28 days until the cerebral artery is harvested. The arteries of both control and experimental group mice with MMD are then fixed with 4% paraformaldehyde in PBS for morphological analyses.
Visualization of Cerebrovasculature
To visualize the cerebrovasculature, all animals from each group are perfused with the fluorescent dye Di I (Li et al., Direct labeling and visualization of blood vessels with lipophilic carbocyanine dye DiI. Nat Protoc. 2008; 3(11): 1703±8). Mice are subjected to a transcardial perfusion using a perfusion pump (set to 1 ml/min) to perfuse (room temperature) 5 ml of PBS, immediately followed by 10 ml of Di I working solution and then 10 ml of 10% buffered formalin. Brains are carefully removed from the skull ensuring that the Circle of Willis (CoW) remained intact.
The extracted brain is then post-fixed overnight at 4° C. with 10% buffered formalin. The brains are then transferred into PBS for long-term storage at 4° C. and protected from light. Fluorescently labelled brains were imaged using a 1×microscope (Nikon Eclipse E800/Nikon DS-Ril). Images of the cortical vasculature are taken to examine anastomoses and images of the CoW were used to measure vessel diameter. Image analysis is performed using Nikon NES Analysis software to measure vessel diameter (μm).
Diameter measurements are taken approximately 20 μm from the bifurcation of the supraclinoid internal carotid artery, M1 segment of the middle cerebral artery, and the A1 segment of the anterior cerebral artery. Anastomoses analysis is performed by counting the number of anastomoses (circle placed over each connection point on a magnified image) between the ACA and the MCA of both the ipsilateral and contralateral hemispheres. Diameters of the ICA, ACA and MCA vessels are examined by measuring the width of each vessel near the bifurcation point on both the ipsilateral and contralateral sides to determine if there was any difference in size between the experimental and control groups.
Measurements of the distal ICA and proximal ACA in control mice with MMD phenotype are expected to exhibit severe narrowing of vessel diameter post-surgery, and this is compared with the vessel diameter of ENPP3 or ENPP3-Fc treated mice with MMD phenotype.
Morphological Analysis
Serial sections (sections of 5 μm each) of cerebral arteries such as MCA, ACA and ICA are collected for both control and experimental group. 5-μm thick frozen aortic sections (Microtome, HM 500 O) are stained by using Elastica van Gieson stain (Roth, Karlsruhe, Germany). ImageJ software is used to measure the circumference of the external elastic lamina, the internal elastic lamina and the luminal border. Afterward, ImageJ (Fiji version 1.51p, NIH, USA) is used to measure neointimal and medial areas with two investigators blinded toward the treatment regimen. The ratio of the two analyzed parameters is used as a measure of lumen obstruction. The medial area, the intimal area and the intima/media ratio (FM ratio) were calculated. (See
Statistical analyses are performed using Student's t test (unpaired two-sample testing for means). Comparisons of multiple groups used one-way ANOVA, followed by the Bonferroni's post hoc test, are performed with GraphPad Prism software version 7. Probability values of p<0.05 are considered significant. Morphometric analysis shows that the control non-treated mice with MMD phenotype develop vascular lesions, occlusions and narrowing accompanied by high degrees of vessel lumen obstruction.
In experimental mice treated with ENPP3 or ENPP3-Fc post induction of MMD phenotype, the degree of intimal hyperplasia is compared to control mice which received no ENPP3 or ENPP3-Fc. Quantitative analyses of cerebral arteries from untreated control mice with MMD phenotype are expected to exhibit significantly increased neointimal proliferation and this also is compared to ENPP3 or ENPP3-Fc treated mice at or after 28 days post-surgery. Control mice are expected to exhibit thickening of arterial intima and this is compared to treated mice. Correspondingly, the I/M ratios of control and treated mice are also compared.
The same experiment as described in Example 13 is modified to determine the prophylactic effect of ENPP3 or ENPP3-Fc in preventing or reducing vascular smooth muscle proliferation and cerebral occlusions by administering ENPP3 or ENPP3-Fc to the experimental group one week prior to induction of MMD phenotype, as shown in
Morphological analysis is expected to show that the intimal area of experimental mice with MMD phenotype receiving subcutaneous ENPP3 or ENPP3-Fc is expected to be significantly reduced compared to control mice, whereas the medial area, between the external and internal lamina remains constant. The I/M ratio is expected to decrease in ENPP3 or ENPP3-Fc treated experimental mice compared to vehicle-treated control mice. The prophylactic treatment of ENPP3 or ENPP3-Fc prior to induction of MMD phenotype is expected to confer protective effect by lowering the level of VSMC proliferation.
Failure
The efficacy of an ENPP1 or ENPP1-Fc fusion protein is evaluated in a mouse model of arterio-venous fistula failure as described in, e.g., Wong et al. (2014) J Vasc Surg 59:192-201. Unilateral AVFs are created between the external jugular vein and common carotid artery in male C57bl6 mice. The mice are divided into four cohorts: (1) mice that receive chronic subcutaneous treatment with an ENPP1-Fc fusion protein or ENPP1 prior to and after the AVF is created; (2) mice that receive a vehicle control treatment subcutaneously prior to and after the AVF is created; (3) mice that begin chronic subcutaneous treatment with an ENPP1-Fc fusion protein or ENPP1 following AVF creation; and (4) mice that receive a vehicle control treatment subcutaneously after the AVF creation.
The mice are followed over time and euthanized at various time points (such as one, two, and/or three weeks after AVF creation). Histological analysis is performed on sections of blood vessels at or promixal to the site of AVF.
It is anticipated that the extent of intimal hyperplasia in the AVF adjacent vessels of mice treated with ENPP1-Fc fusion protein will be markedly reduced as compared to those mice receiving the vehicle control.
The efficacy of an ENPP3-Fc fusion protein or ENPP3 is evaluated in a mouse model of arterio-venous fistula failure as described in, e.g., Wong et al. (2014) J Vasc Surg 59:192-201. Unilateral AVFs are created between the external jugular vein and common carotid artery in male C57bl6 mice. The mice are divided into four cohorts: (1) mice that receive chronic subcutaneous treatment with an ENPP3-Fc fusion protein or ENPP3 prior to and after the AVF is created; (2) mice that receive a vehicle control treatment subcutaneously prior to and after the AVF is created; (3) mice that begin chronic subcutaneous treatment with an ENPP3-Fc fusion protein or ENPP3 following AVF creation; and (4) mice that receive a vehicle control treatment subcutaneously after the AVF creation.
The mice are followed over time and euthanized at various time points (such as one, two, and/or three weeks after AVF creation). Histological analysis is performed on sections of blood vessels at or proximal to the site of AVF.
It is anticipated that the extent of intimal hyperplasia in the AVF adjacent vessels of mice treated with ENPP3-Fc fusion protein will be markedly reduced as compared to those mice receiving the vehicle control.
A human adult heart allograft recipient is identified by a medical practitioner as having CAV. The recipient administers or is administered chronically a pharmaceutical composition comprising a fusion protein comprising a soluble form of ENPP1 fused to a Fc region. Medical professionals monitor the recipient over time for cessation of unwanted intimal proliferation in one or more vessels of the allografted heart and/or partial or full resolution over time of vessel occlusion in the allografted heart. Treatment with the fusion protein is expected to halt or substantially reduce unwanted intimal proliferation in one or more vessels of the allografted heart and/or partially or fully resolve over time vessel occlusion in the allografted heart.
In another example, a pharmaceutical composition comprising a fusion protein comprising a soluble form of ENPP1 fused to a Fc region is chronically administered to the recipient of a cardiac allograft beginning at or around the time of transplantation to prevent, lessen the likelihood of occurrence of, or reduce the extent of unwanted intimal proliferation in one or more vessels of the allografted heart. Medical professionals monitor the recipient over time for the presence and/or level of unwanted intimal proliferation in one or more vessels of the allografted heart. Treatment with the fusion protein is expected to halt or substantially reduce unwanted intimal proliferation in one or more vessels of the allografted heart.
A human adult patient is identified by a medical practitioner as having Moyamoya disease. The recipient administers or is administered chronically a pharmaceutical composition comprising a fusion protein comprising a soluble form of ENPP1 fused to a Fc region. Medical professionals monitor the recipient over time for cessation of unwanted intimal proliferation in one or more vessels feeding the brain and/or partial or full resolution over time of the occlusion of such vessel or vessels. Treatment with the fusion protein is expected to halt or substantially reduce unwanted intimal proliferation in one or more vessels and/or partially or fully resolve over time vessel occlusion.
A pharmaceutical composition comprising a fusion protein comprising a soluble form of ENPP1 fused to a Fc region is chronically administered to a hemodialysis patient at or around the time that a hemodialysis shunt is placed in the subject to thereby prevent, lessen the likelihood of occurrence of, or reduce the extent of unwanted intimal proliferation in one or more vessels connected to or involved in the shunt. Medical professionals monitor the recipient over time for the presence and/or level of unwanted intimal proliferation in one or more of the vessels. Treatment with the fusion protein is expected to halt or substantially reduce unwanted intimal proliferation in one or more of the vessels.
The disclosure of each and every U.S. and foreign patent and pending patent application and publication referred to herein is specifically incorporated herein by reference in its entirety, as are the contents of Sequence Listing and Figures.
Those skilled in the art will recognize or be able to ascertain using no more than routine experimentation, many equivalents of the specific embodiments described herein. Such equivalents are intended to be encompassed by the following claims. Any combination of the embodiments disclosed in the any plurality of the dependent claims or Examples is contemplated to be within the scope of the disclosure.
From the foregoing description, it will be apparent that variations and modifications may be made to the disclosure described herein to adopt it to various usages and conditions, including the use of different signal sequences to express functional variants of ENPP1 or ENPP3 or combinations thereof in different viral vectors having different promoters or enhancers or different cell types known in art to treat any diseases characterized by the presence of pathological calcification or ossification are within the scope according to the disclosure. Other embodiments according to the disclosure are within the following claims.
Recitation of a listing of elements in any definition of a variable herein includes definitions of that variable as any single element or combination (or sub combination) of listed elements. Recitation of an embodiment herein includes that embodiment as any single embodiment or in combination with any other embodiments or portions thereof.
All publications and patent applications mentioned in the specification are indicative of the level of skill of those skilled in the art to which this disclosure pertains. All publications and patent applications are herein incorporated by reference to the same extent as if each individual publication or patent application was specifically and individually indicated to be incorporated by reference.
Other embodiments are within the following claims.
This U.S. patent application is a continuation of International Patent Application No. PCT/US2021/040356, filed Jul. 2, 2021, which claims priority to the following provisional applications, U.S. Application No. 63/047,793 filed on Jul. 2, 2020, U.S. Application No. 63/047,877 filed on Jul. 2, 2020, U.S. Application No. 63/047,865 filed on Jul. 2, 2020, and U.S. Application No. 63/047,848 filed on Jul. 2, 2020, the contents of each of which is herein incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63047877 | Jul 2020 | US | |
| 63047848 | Jul 2020 | US | |
| 63047865 | Jul 2020 | US | |
| 63047793 | Jul 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US21/40356 | Jul 2021 | US |
| Child | 18148888 | US |
