Patent Application
20200032207
This application claims priority to Singapore application No. 10201701009Q, filed 8 Feb. 2017, the contents of which are incorporated herein by reference.
The present invention relates to gamma delta T cells and their uses thereof, and a method of generating gamma delta T cells. More particularly, the present invention relates to gamma delta T cells having improved tumoricidal activity and their uses thereof, and a method of generating gamma delta T cells having improved tumoricidal activity.
The following discussion of the background to the invention is intended to facilitate understanding of the present invention. However, it should be appreciated that the discussion is not an acknowledgment or admission that any of the material referred to was published, known or a part of the common general knowledge in any jurisdiction as at the priority date of the application.
Gamma delta (γδ) T cells are a minor population in the peripheral blood (0.5-10% of T cells in healthy adults) that express γδ heterodimer of T cell receptor (TCR) chains and play an important role in linking innate and adaptive immune responses. The majority of peripheral blood γδ T cells express the variable-gene segments Vγ9 and Vδ2 (Vγ9Vδ2 T cells). In a non-major histocompatibility complex (MHC) restricted manner, γδ T cells can be activated by recognizing and interacting with a set of tumor-associated antigens, including phosphoantigens that are produced during metabolic dysregulation in tumour cells, lipids presented by CD1 family members, and cell stress markers. The activated γδ T cells release abundant inflammatory cytokines interferon (IFN)-γ and tumour necrosis factor (TNF)-α, and use both perforin and granzyme B secretory pathway and death receptor (Fas/Fas-ligand, TRAIL/TRAIL-receptor) pathway to execute the killing of tumor cells. γδ T cells have been indicated to be able to kill many different types of tumor cell lines and tumor in vivo and in vitro, including leukemia, neuroblastoma and various carcinomas. As such, the development of γδ T cells that are suitable for cancer treatment is desirable.
In addition to TCR, γδ T cells express the natural killer group 2D (NKG2D) receptor, killer-cell immunoglobulin-like receptors (KIRs), and many co-inhibitory receptors that can play either co-stimulatory or inhibitory roles to affect their tumoricidal activity. The balance between activating signals and inhibitory signals induced by their respective receptors has profound effects on the activation of γδ T cells.
The NKG2D receptor is an activating receptor expressed by human natural killer (NK) cells, γδ T cells, CD8+ T cells, and NKT cells. This receptor can interact with eight stress-induced ligands belonging to two families: two MHC class I chain-related proteins MICA and MICB and six HCMV UL16-binding proteins (ULBP1-6). The NKG2D ligands are not usually expressed on healthy tissues but can be up-regulated upon DNA damage, infection and transformation of cells, thus being commonly detected on hematopoietic tumors and carcinomas. Because of the tumour-associated over-expression, the NKG2D ligands have been a favourable therapeutic target for anticancer strategies.
Thus, there exists a need to develop γδ T cells and a method of augmenting the tumoricidal activity of γδ T cells to facilitate the use of γδ T cells for treatment of cancer.
The present invention seeks to address and/or ameliorate the problems in the prior art by providing a method of generating gamma delta T cells and augmenting and/or enhancing their functions.
In an aspect of the present invention, there is provided a method of generating γδ T cells having at least one down-regulated co-inhibitory receptor, the method comprising the steps of: (a) culturing a population of cells comprising γδ T cells with a phosphoantigen to expand the γδ T cells; and (b) culturing the expanded γδ T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody.
Preferably, the Fc receptor is CD64.
Preferably, the phosphoantigen is zoledronic acid or a salt thereof. More preferably, the phosphoantigen is added in an amount of 5 μM.
Preferably, the population of cells are peripheral blood mononuclear cells.
Preferably, the method does not require an initial depletion step to enrich the peripheral blood mononuclear cells.
Preferably, the γδ T cells are of the Vγ9Vδ2 subtype.
Preferably, step (a) is carried out for 7 days. More preferably, step (b) is carried out for 10 days. Even more preferably, the method comprises passaging the cells every 2 to 3 days.
Preferably, the artificial antigen-presenting cells are K562 cells. Preferably, the method further comprises irradiating the artificial antigen-presenting cells prior to step (b) using gamma irradiation.
Preferably, the anti-CD3 antibody is Muromonab-CD3.
Preferably, the co-inhibitory receptors are at least one co-inhibitory receptor selected from the group consisting of cytotoxic T lymphocyte (CTL)-associated antigen 4 (CTLA-4/CD152); programmed cell death protein 1 (PD-1/CD279); lymphocyte activation gene-3 (LAG-3); T cell immunoglobulin and immunoreceptor tyrosine-based inhibition motif (ITIM) domain (TIGIT); T-cell immunoglobulin and mucin-containing protein 3 (TIM3); and B and T lymphocyte attenuator (BTLA).
Preferably, another portion of the phosphoantigen is added simultaneously with step (b).
Preferably, the method further comprises modifying the γδ T cells having at least one down-regulated co-inhibitory receptor to express a chimeric antigen receptor (CAR). Preferably, the modified γδ T cells have at least one up-regulated activating receptor. More preferably, modifying the γδ T cells comprises transfecting the γδ T cells with an mRNA vector encoding the CAR. Preferably, transfecting the γδ T cells comprises RNA electroporation.
Preferably, the CAR comprises an extracellular antigen binding domain of natural killer group 2D (NKG2D). More preferably, the γδ T cells overexpresses NKG2D.
Preferably, the CAR comprises a signalling domain of CD3 zeta or DAP 12. More preferably, the CAR comprises an extracellular antigen binding domain of NKG2D and a signalling domain of DAP12.
In another aspect of the present invention, there is provided a γδ T cell having at least one down-regulated co-inhibitory receptor generated by a method according to an aspect of the present invention.
In another aspect of the present invention, there is provided a γδ T cell having at least one down-regulated co-inhibitory receptor and modified to express a chimeric antigen receptor (CAR), wherein the CAR comprises an extracellular antigen binding domain of NKG2D and a signalling domain of CD3 zeta or DAP 12. Preferably, the signalling domain is DAP12.
In another aspect of the present invention, there is provided a method of treating cancer comprising the step of administering a therapeutically effective amount of γδ T cells according to an aspect of the present invention. Preferably, the cancer is colorectal or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided a γδ T cell according to an aspect of the present invention for use in treating cancer.
In another aspect of the present invention, there is provided a γδ T cell according to an aspect of the present invention for use in the treatment of colorectal or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided a use of a γδ T cell according to an aspect of the present invention in the manufacture of a medicament for the treatment of cancer. Preferably, the cancer is colorectal cancer or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided a method of treating a patient with cancer comprising the steps of: administering to the patient, a therapeutically effective amount of γδ T cells having at least one down-regulated co-inhibitory receptor generated by a method comprising the steps of: (a) culturing a population of cells comprising γδ T cells with a phosphoantigen; (b) culturing the expanded γδ T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody. Preferably, said method comprises administering the γδ T cells having at least one down-regulated co-inhibitory receptor to the patient by intraperitoneal injection.
In another aspect of the present invention, there is provided a method of treating cancer in a patient, the method comprising the steps of: (a) obtaining peripheral blood mononuclear cells (PBMCs) comprising γδ T cells from the patient; (b) culturing the PBMCs with a phosphoantigen to expand the γδ T cells; (c) culturing the PBMCs with the expanded γδ T cells, with an artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody against CD3 to generate γδ T cells with at least one down-regulated co-inhibitory receptor; and (d) administering the γδ T cells with at least one down-regulated co-inhibitory receptor to the patient.
Preferably, the Fc receptor is CD64.
Preferably, the phosphoantigen is zoledronic acid or a salt thereof.
Preferably, the phosphoantigen is added in an amount of 5 μM.
Preferably, the method does not require an initial depletion step to enrich the peripheral blood mononuclear cells.
Preferably, the γδ T cells are of the Vγ9Vδ2 subtype.
Preferably, step (b) is carried out for 7 days.
Preferably, step (c) is carried out for 10 days.
Preferably, the method comprises passaging the cells every 2 to 3 days.
Preferably, the artificial antigen-presenting cells are K562 cells.
Preferably, the method further comprises irradiating the artificial antigen-presenting cells prior to step (c) using gamma irradiation.
Preferably, the anti-CD3 antibody is Muromonab-CD3.
Preferably, the at least one co-inhibitory receptor is selected from the group consisting of cytotoxic T lymphocyte (CTL)-associated antigen 4 (CTLA-4/CD152); programmed cell death protein 1 (PD-1/CD279); lymphocyte activation gene-3 (LAG-3); T cell immunoglobulin and immunoreceptor tyrosine-based inhibition motif (ITIM) domain (TIGIT); T-cell immunoglobulin and mucin-containing protein 3 (TIM3); and B and T lymphocyte attenuator (BTLA).
Preferably, the method further comprises modifying the γδ T cells having at least one down-regulated co-inhibitory receptor to express a chimeric antigen receptor (CAR).
Preferably, the modified γδ T cells have at least one up-regulated activating receptor.
Preferably, modifying the γδ T cells comprises transfecting the γδ T cells with an mRNA vector encoding the CAR.
Preferably, transfecting the γδ T cells comprises RNA electroporation.
Preferably, the CAR comprises an extracellular antigen binding domain of natural killer group 2D (NKG2D).
Preferably, the γδ T cells overexpresses NKG2D.
Preferably, the CAR comprises a signalling domain of CD3 zeta or DAP 12.
Preferably, the CAR comprises an extracellular antigen binding domain of NKG2D and a signalling domain of DAP12.
The invention will now be described, by way of example only, with reference to the accompanying drawings, in which:
Particular embodiments of the present invention will now be described with reference to the accompany drawings. The terminology used herein is for the purpose of describing particular embodiments only and is not intended to limit the scope of the present invention. Additionally, unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one or ordinary skill in the art to which the present invention belongs.
Throughout the specification, unless otherwise indicated to the contrary, the terms “comprising”, “consisting of”, and the like, are to be construed as non-exhaustive, or in other words, as meaning “including, but not limited to”.
Throughout the specification, unless the context requires otherwise, the word “comprise” or variations such as “comprises” or “comprising”, will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.
Throughout the specification, unless the context requires otherwise, the word “include” or variations such as “includes” or “including”, will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.
As used herein, the term “about” typically means +/−5% of the stated value, more typically +/−4% of the stated value, more typically +/−3% of the stated value, more typically +/−2% of the stated value, even more typically +/−1% of the stated value, and even more typically +/−0.5% of the stated value.
As used herein, the connotation “1E5”, “1E7”, “1E8” and “1E10” refer to 1×10{circumflex over ( )}5, 1×10{circumflex over ( )}7, 1×10{circumflex over ( )}8 and 1×10{circumflex over ( )}10 respectively. As used herein, the term “activating receptor” has ordinary meaning in the art, and would be understood to refer to a receptor which is capable of stimulating an activation signal upon binding of its corresponding ligand. For instance, the NKG2D receptor is an activating receptor.
As used herein, the term “augmenting” when used in the context of tumoricidal activity refers to improved tumor cell killing effects. For instance, improved tumor killing effects may be measured by an increase in the median survival time of a patient. As used herein, the terms “co-inhibitory receptor” and “inhibitory receptor” have ordinary meaning in the art and would be understood to refer to receptors that are capable of stimulating an inhibitory or blocking signal upon binding of their corresponding ligands. The terms “co-inhibitory receptor” and “inhibitory receptor” are used interchangeably in the specification herein.
As used herein, the term “co-stimulatory” refers to a molecule that binds to a receptor on a T cell that is involved in the activation of the T cell.
As used herein, the term “down-regulation” or “down-regulated” when used in the context of receptors refers to a decrease in the expression of the receptors. A non-limiting example is illustrated in
As used herein, the term “Fc receptor” or “FcR” is a receptor that binds to the Fc region of an immunoglobulin (Ig). Fc receptors are found on many cells which participate in immune responses. Among the human FcRs that have been identified so far are those which recognize IgG (designated FcyR), IgE (FceRI), IgA (FcaR), and polymerized IgM/A (FcεμR). FcRs are found in the following cell types: FceRI (mast cells), FceRII (many leukocytes), FcaR (neutrophils), and FcμR (glandular epithelium, hepatocytes). (Hogg Immunol. Today 9: 185-86 (1988)). The widely studied FcyRs are central in cellular immune defenses, and are responsible for stimulating the release of mediators of inflammation and hydrolytic enzymes involved in the pathogenesis of autoimmune disease. (Unkeless, Annu. Rev. Immunol. 6: 251-87 (1988)). The FcyRs provide a crucial link between effector cells and the lymphocytes that secrete Ig, since the macrophage/monocyte, polymorphonuclear leukocyte, and natural killer (NK) cell FcyRs confer an element of specific recognition mediated by IgG. Human leukocytes have at least three different receptors for IgG: hFcμRI (found on monocytes/macrophages), hFcyRII (on monocytes, neutrophils, eosinophils, platelets, possibly B cells, and the K562 cell line), and FcyIII (on NK cells, neutrophils, eosinophils, and macrophages).
As used herein, the term “median survival time” refers to a parameter that is commonly used for evaluating therapeutic effects and is the time after which 50% of a patient group with a particular condition are still living and 50% have died. For instance, the median survival time of a patient group with a particular condition, such as tumor-bearing mice, is 73 days after treatment with CAR-modified γδ T cells.
As used herein, the term “major histocompatibility complex” or “MHC” is a specific cluster of genes, many of which encode evolutionarily related cell surface proteins involved in antigen presentation, which are among the most important determinants of histocompatibility. Class I MHC, or MHC-I, function mainly in antigen presentation to CD8 T lymphocytes. Class II MHC, or MHC-II, function mainly in antigen presentation to CD4 T lymphocytes. The MHC gene, located on chromosome 6, includes HLA genes divided into distinct regions including Class I genes that encode for a heavy chain polypeptide located in the HLA-A, B and C regions; and Class II genes including the D region which is subdivided in three main regions, DP, DQ and DR, each containing genes for a number of α and β chains. A complete listing of current HLA specificities, any of which may be used in the present immunovaccines, and corresponding sequences, both nucleotide and amino acid, can be located at the IMGT/HLA Database at “http://www.ebi.ac.uk/imgt/hla” which provides a database for sequences of the human major histocompatibility complex (HLA) and includes the official sequences for the WHO Nomenclature Committee For Factors of the HLA System. The IMGT/HLA Database is part of the international ImMunoGeneTics project.
As used herein, the term “up-regulation” or “up-regulated” when used in the context of receptors refers to an increase in the expression of the receptors. A non-limiting example is illustrated in
As used herein, the term “treatment”, “treat” and “therapy”, and synonyms thereof refer to both therapeutic treatment and prophylactic or preventative measures, wherein the object is to prevent or slow down (lessen) a disease, for example cancer. Those in need of such treatment include those already with a disease as well as those prone to getting the disease or those in whom a disease is to be prevented.
As used herein, the term “therapeutically effective amount” of a compound will be an amount of active agent that is capable of preventing or at least slowing down (lessening) a disease, e.g. cancer. Dosages and administration of compounds, compositions and formulations of the present invention may be determined by one of ordinary skill in the art of clinical pharmacology or pharmacokinetics. See, for example, Mordenti and Rescigno, (1992) Pharmaceutical Research. 9:17-25; Morenti et al., (1991) Pharmaceutical Research. 8:1351-1359; and Mordenti and Chappell, “The use of interspecies scaling in toxicokinetics” in Toxicokinetics and New Drug Development, Yacobi et al. (eds) (Pergamon Press: NY, 1989), pp. 42-96. An effective amount of the active agent of the present invention to be employed therapeutically will depend, for example, upon the therapeutic objectives, the route of administration, and the condition of the patient. As used in the specification herein, the term “patient” includes humans and animals. Accordingly, it will be necessary for the therapist to titer the dosage and modify the route of administration as required to obtain the optimal therapeutic effect. A typical dosage per infusion may range from about 1E5 cells to up to 1E10 cells of the patient's body weight or more per day, preferably about 1E3 cells/kg/infusion to 1E8 cells/kg/infusion.
As used herein, a polynucleotide is said to “encode” a polypeptide if, in its native state or when manipulated by methods well known to those skilled in the art, it can be transcribed and/or translated to produce the mRNA for and/or the polypeptide or a fragment thereof. Polynucleotides include but are not limited to DNA (e.g. cDNA) and RNA (e.g. mRNA). The anti-sense strand is the complement of such a nucleic acid, and the encoding sequence can be deduced therefrom.
As used herein, a nucleic acid or fragment thereof is “substantially homologous” (“or substantially similar”) to another if, when optimally aligned (with appropriate nucleotide insertions or deletions) with the other nucleic acid (or its complementary strand), there is nucleotide sequence identity in at least about 60% of the nucleotide bases, usually at least about 70%, more usually at least about 80%, preferably at least about 90%, and more preferably at least about 95-98% of the nucleotide bases.
The term “polypeptide” refers to a polymer of amino acids and its equivalent and does not refer to a specific length of the product; thus, peptides, oligopeptides and proteins are included within the definition of a polypeptide. This term also does not refer to, or exclude modifications of the polypeptide, for example, glycosylations, acetylations, phosphorylations, and the like. Included within the definition are, for example, polypeptides containing one or more analogs of an amino acid (including, for example, natural amino acids, etc.), polypeptides with substituted linkages as well as other modifications known in the art, both naturally and non-naturally occurring.
A polypeptide “fragment”, “portion” or “segment” is a stretch of amino acid residues of at least about five to seven contiguous amino acids, often at least about seven to nine contiguous amino acids, typically at least about nine to 13 contiguous amino acids and, most preferably, at least about 20 to 30 or more contiguous amino acids.
In the context of the present invention, a homologous sequence is taken to include an amino acid sequence which is at least 60, 70, 80 or 90% identical, preferably at least 95 or 98% identical at the amino acid level over at least 20, 50, 100, 200, 300 or 400 amino acids with the amino acid sequences set out in sequence listings. In particular, homology should typically be considered with respect to those regions of the sequence known to be essential for the function of the protein rather than non-essential.
Although homology can also be considered in terms of similarity (i.e. amino acid residues having similar chemical properties/functions), in the context of the present invention it is also possible to express homology in terms of sequence identity. The terms “substantial homology” or “substantial identity”, when referring to polypeptides, indicate that the polypeptide or protein in question exhibits at least about 70% identity with an entire naturally-occurring protein or a portion thereof, usually at least about 80% identity, and preferably at least about 90 or 95% identity.
Homology comparisons can be conducted by eye, or more usually, with the aid of readily available sequence comparison programs. These commercially available computer programs can calculate % homology between two or more sequences.
Percentage (%) homology may be calculated over contiguous sequences, i.e. one sequence is aligned with the other sequence and each amino acid in one sequence directly compared with the corresponding amino acid in the other sequence, one residue at a time. This is called an “ungapped” alignment. Typically, such ungapped alignments are performed only over a relatively short number of residues (for example less than 50 contiguous amino acids).
Although this is a very simple and consistent method, it fails to take into consideration that, for example, in an otherwise identical pair of sequences, one insertion or deletion will cause the following amino acid residues to be put out of alignment, thus potentially resulting in a large reduction in % homology when a global alignment is performed. Consequently, most sequence comparison methods are designed to produce optimal alignments that take into consideration possible insertions and deletions without penalising unduly the overall homology score. This is achieved by inserting “gaps” in the sequence alignment to try to maximise local homology.
However, these more complex methods assign “gap penalties” to each gap that occurs in the alignment so that, for the same number of identical amino acids, a sequence alignment with as few gaps as possible—reflecting higher relatedness between the two compared sequences—will achieve a higher score than one with many gaps. “Affine gap costs” are typically used that charge a relatively high cost for the existence of a gap and a smaller penalty for each subsequent residue in the gap. This is the most commonly used gap scoring system. High gap penalties will of course produce optimised alignments with fewer gaps. Most alignment programs allow the gap penalties to be modified. However, it is preferred to use the default values when using such software for sequence comparisons. For example when using the GCG Wisconsin Bestfit package (see below) the default gap penalty for amino acid sequences is −12 for a gap and −4 for each extension.
The present invention provides for polyclonal and/or monoclonal antibodies and fragments thereof, and immunologic binding equivalents thereof, which are capable of specifically binding to a polypeptide target and fragments thereof. Such antibodies thus include for example, but are not limited to polyclonal, monoclonal, chimeric, single chain, Fab fragments, and a Fab expression library.
A “monoclonal antibody” refers to an antibody having only one species of antibody combining site capable of immunoreacting with a particular antigen. A monoclonal antibody thus typically displays a single binding affinity for any antigen with which it immunoreacts. A monoclonal antibody may therefore contain an antibody molecule having a plurality of antibody combining sites, each immunospecific for a different antigen; e.g., a bi-specific (chimeric) monoclonal antibody.
Throughout this disclosure, certain embodiments may be disclosed 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 a limitation on the scope of the disclosed ranges. Accordingly, the description of a range should be considered to have specifically disclosed all the possible sub-ranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed sub-ranges such as from 1 to 3, from 1 to 4, from 1 to 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, 3, 4, 5, and 6. Ranges are not limited to integers, and can include decimal measurements. This applies regardless of the breadth of the range.
In an aspect of the present invention, there is provided a method of generating γδ T cells having at least one down-regulated co-inhibitory receptor, the method comprising the steps of: (a) culturing a population of cells comprising γδ T cells with a phosphoantigen to expand the γδ T cells; and (b) culturing the expanded γδ T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody. Consequently, the expression of at least one co-stimulatory and/or inhibitory receptors of γδ T cells are manipulated, particularly by the manipulation of the expression of functional receptors expressed on the surface of γδ T cells, thereby facilitating the use of γδ T cells for treatment of cancer. Advantageously, there may be up-regulated expression of activating receptors and down-regulated expression of co-inhibitory receptors in the γδ T cells. Preferably, there is an up-regulation of the expression of at least one co-inhibitory receptor during the step of culturing the population of cells comprising γδ T cells with a phosphoantigen to expand the γδ T cells; and there is a down-regulation of the expression of at least one co-inhibitory receptor during the step of culturing the expanded γδ T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody.
Advantageously, the method of the present invention makes use of γδ TCRs that recognize cancer-associated antigens in an HLA (human leukocyte antigen)-independent manner. In contrast, αβ TCRs do not recognize cancer-associated antigens in an HLA-independent manner. As such, γδ T cells generated in the present invention may be used in the development of “off-the-shelf” therapeutics. Importantly, for cancer treatment, γδ T cells are capable of infiltrating a range of human malignancies, a capacity required critically for them to interact with and kill cancer cells. These malignances include renal, bladder, ovarian, colorectal, breast and nasopharyngeal carcinomas.
More advantageously, the method of the present invention is less time consuming, less complicated and at least as effective as prior art methods. For instance, methods of modifying γδ T cells such as CRISPR/Cas9, which makes use of a gene editing nuclease, are time consuming and complicated.
In various embodiments, the γδ T cells are Vγ9Vδ2 T cells, preferably pure Vγ9Vδ2 T cells. Certain earlier studies relate to expansion of polyclonal γδ T cells, not a single subtype of γδ T cells, meaning that the polyclonal γδ T cell population generated may contain a mixture of many subtypes of γδ T cells. Various problems may arise from the use of other methods in view of the following considerations:
In a preferred embodiment, the method of the present invention relates to the manipulation of the expression of functional receptors expressed on the surface of Vγ9Vδ2 T cells. Advantageously, there may be up-regulated expression of activating receptors and down-regulated expression of co-inhibitory receptors in the Vγ9Vδ2 T cells. Preferably, there is an up-regulation of the expression of at least one co-inhibitory receptor during the step of culturing the population of cells comprising Vγ9Vδ2 T cells with a phosphoantigen to expand the Vγ9Vδ2 T cells; and there is a down-regulation of the expression of at least one co-inhibitory receptor during the step of culturing the expanded Vγ9Vδ2 T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody.
Inhibitory receptors (or co-inhibitory receptors), also named as immune checkpoint receptors, can down-regulate immune responses to avoid excessive immune activation, providing a critical role in the maintenance of immune homeostasis. The co-inhibitory receptors expressed on γδ T cells include cytotoxic T lymphocyte (CTL)-associated antigen 4 (CTLA-4, CD152), programmed cell death protein 1 (PD-1, CD279), lymphocyte activation gene-3 (LAG-3), T-cell immunoglobulin and mucin-containing protein (TIM-3), T cell immunoglobulin and immunoreceptor tyrosine-based inhibition motif (ITIM) domain (TIGIT), and B and T lymphocyte attenuator (BTLA). Advantageously, the method of the present invention led to down-regulation or reduced expression of co-inhibitory receptors, thereby leading to improved tumor killing effects. In particular, the method of the present invention led to the reduced expression of at least one inhibitory receptor selected from the group consisting of CTLA-4, CD152, PD1, LAG-3, TIGIT, TIM3 and BTLA. In a preferred embodiment, the method of the present invention led to the reduced expression of two, three, four, five or six co-inhibitory receptors. In a more preferred embodiment, the method of the present invention led to the reduced expression of six co-inhibitory receptors.
In addition to TCR, γδ T cells express the natural killer group 2D (NKG2D) receptor, killer-cell immunoglobulin-like receptors (KIRs), and many co-inhibitory receptors that can play either co-stimulatory or inhibitory roles to affect their tumoricidal activity. The balance between activating signals and inhibitory signals induced by their respective receptors has profound effects on the activation of γδ T cells. The NKG2D receptor is an activating receptor expressed by human natural killer (NK) cells, γδ T cells, CD8+ T cells, and NKT cells. This receptor can interact with eight stress-induced ligands belonging to two families: two MHC class I chain-related proteins MICA and MICB and six HCMV UL16-binding proteins (ULBP1-6). The NKG2D ligands are not usually expressed on healthy tissues but can be up-regulated upon DNA damage, infection and transformation of cells, thus being commonly detected on hematopoietic tumors and carcinomas. Because of the tumour-associated over-expression, the NKG2D ligands have been a favourable therapeutic target for anticancer strategies. Advantageously, the method of the present invention led to the reduced expression of co-inhibitory receptors without obvious effects on NKG2D expression.
In various embodiments, the γδ T cells, in particular, Vγ9Vδ2 T cells, may be expanded from peripheral blood mononuclear cells (PBMCs), cord blood mononuclear cells (CBMCs) or tissue derived cells in a chemically defined culture medium which can include, but is not limited to, RPMI, TexMACS, IMDM, CTS OpTmizer or AIM-V media. In a preferred embodiment, the Vγ9Vδ2 T cells are expanded from PBMCs seeded in AIM-V media. Isolated PBMCs may be freshly isolated or cryopreserved prior to expansion in the culture medium. In a more preferred embodiment, the PBMCs are seeded in AIM-V media at a density of 2E6. As such, in various embodiments, the method further comprises seeding the PBMCs in a serum-free lymphocyte-activation medium, such as AIM-V media.
In various embodiments, the cell culture medium may be supplemented with fetal calf serum (FCS), human AB serum, autologous plasma, human platelet lysate or a chemically defined serum replacement substitutes. In various embodiments, the serum/plasma/substitute may be added in an amount of about 0.1 to about 20% (v/v), about 1 to about 10% (v/v), or about 1 to about 5% (v/v) to the culture solution. In a preferred embodiment, human AB serum is added in about 5% v/v.
In various embodiments, the method comprises passaging the cells every day, every 2 days, every 3 days or every 4 days, preferably every 2 to 3 days.
Because of their infrequent nature, Vγ9Vδ2 T cells need to be expanded from PBMCs for adoptive T cell therapy. In various embodiments, step (a) further comprises adding the phosphoantigen into the sample of PBMCs. In various embodiments, the population of cells comprising γδ T cells is cultured with the phosphoantigen to expand the γδ T cells for about 5 days to about 10 days, preferably about 7 days. In various embodiments, the phosphoantigen is added in an amount of about 0.1 to about 10 μM, about 1 to about 10 μM or about 1 to about 5 μM. In a preferred embodiment, the phosphoantigen is zoledronic acid or zoledronate (Zometa) or salts thereof. The formula for zoledronate is as follows.
The phosphoantigen may be a synthetic antigen such as isopentenyl pyrophosphate (IPP), phosphostim/bromohydrin pyrophosphate (BrHPP), (E)-4-Hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBPP) or DMAPP.
In a more preferred embodiment, Zometa is added in an amount of 5 μM. Advantageously, a small amount (1 μM or 5 μM) of Zometa leads to vigorous proliferation of Vγ9Vδ2 T cells in vitro in response to the phosphoantigen, Zometa, which is an FDA-approved, commercially available bisphosphonate drug that has been used to treat patients with postmenopausal osteoporosis. Zometa can inhibit farnesyl pyrophosphate synthase, an enzyme acting downstream of isopentenyl pyrophosphate (IPP) in the mevalonate pathway, thus profoundly increasing intracellular levels of IPP.
In various embodiments, the cytokine IL-2 is also added with the phosphoantigen. In various embodiments, IL-2 is added in a concentration of about 50 IU/ml to about 1000 IU/ml, about 100 IU/ml to about 500 IU/m or about 200 IU/ml to about 400 IU/ml. In a preferred embodiment, IL-2 is added in a concentration of about 300 IU/ml.
In various embodiments, the method does not require an initial depletion step to enrich the sample of PBMCs. As such, the method of the present invention leads to a savings in time and money because the PBMCs can be expanded without undergoing an initial depletion step.
In various embodiments, the Vγ9Vδ2 T cells are activated by using an artificial antigen-presenting cell (aAPC) and an antibody against CD3, homologous peptides, or a portion or a polypeptide fragment thereof. In various embodiments, the expanded γδ T cells is cultured with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody between about 10 days to about 21 days or longer, preferably between about 10 days to about 14 days. The anti-CD3 antibody may be a monoclonal and/or polyclonal antibody or fragments thereof, or immunologic binding equivalents thereof capable of binding CD3, homologous peptides, or a portion or a polypeptide fragment thereof. Surprisingly, the inventors found that co-inhibitory receptors were up-regulated on Vγ9Vδ2 T cells when expanding Vγ9Vδ2 T cells in the sample of peripheral blood mononuclear cells using the phosphoantigen. Advantageously, activating the Vγ9Vδ2 T cells using the artificial antigen-presenting cell together with an antibody against CD3 led to down-regulation of the co-inhibitory receptor expression on Vγ9Vδ2 T cells. In addition, there was improved tumor cell killing effects as compared with Vγ9Vδ2 T cells collected after treatment with the phophoantigen. Without being bound by theory, it is believed that conformational change of the CD3 co-receptor on T cells and aAPCs, in particular K562-based aAPCs, advantageously affect the tumor killing activity of Vγ9Vδ2 T cells. As such, the combination of expanding Vγ9Vδ2 T cells in the sample of PBMCs using a phosphoantigen and activating the Vγ9Vδ2 T cells using an artificial antigen-presenting cell together with an antibody against CD3 led to an unexpected technical advantage. In particular, the Vγ9Vδ2 T cells were effectively expanded and augmented to exhibit enhanced tumor cell killing activity.
As used herein, artificial antigen presenting cells (aAPCs) are mimetic cells that are modelled after antigen presenting cells, and provide T cell stimulation signals. In various embodiments, the aAPC is derived from a human erythroleukemia cell line, such as the K562 cell line. Advantageously, K562 cells expresses neither endogenous HLA class I and II molecules, nor co-stimulatory molecules such as CD86, CD83, 4-1BBL, OX40L, ICOSL (B7H2, B7RP1) or CD40L, thereby minimizing unintended allogeneic responses. Among three human IgG Fc receptors, K562 cells endogenously expresses a high level of CD32 but not CD16 or CD64. K562 cells also express adhesion molecules CD54 (ICAM-1) and CD58 (LFA-3), which enhances K562 cells interactions with T cells and improves T cell stimulation. Furthermore, K562 cells can be easily manipulated for stable expression of transgenes and have been found safe in clinical trials when used as feeder cells for T cell expansion. In a preferred embodiment, the aAPC expresses CD64 (SEQ ID NO: 1), homologous polypeptides, or a portion or a polypeptide fragment thereof.
In various embodiments, the method further comprises irradiating the aAPC prior to step (b) using gamma irradiation.
In various embodiments, the antibody against CD3 (SEQ ID NO: 2) is Muromonal-CD3 (tradename OKT3; light chain SEQ ID NO: 3; heavy chain SEQ ID NO: 4). Without being bound by theory, it is believed that the antigen-binding sites of OKT3 can interact with CD3 on the γδ T cell surface to induce the conformational change of the co-receptor. Advantageously, the Fc-portion of OKT-3 can attach to CD64 expressed on the K562 cells because of the high affinity between the Fc-portion of OKT-3 for CD64. As such, down-regulation of the co-inhibitory receptors was observed, thereby leading to improved tumor killing effects.
In various embodiments, the method further comprises modifying the γδ T cells using a chimeric antigen receptor (CAR). Advantageously, the method led to further enhanced tumor killing. In various embodiments, treatment with CAR-modified γδ T cells resulted in the increase of the median survival time of tumor-bearing mice. The median survival time of such mice increased from 41 to 51 days in the control groups, to 73 days after treatment with CAR-modified Vγ9Vδ2 T cells (
In various embodiments, the CAR comprises an extracellular antigen binding domain of NKG2D (SEQ ID NO: 5), homologous polypeptides, or a portion or a polypeptide fragment thereof. As such, γδ T cells with an up-regulated NKG2D function are obtained. The NKG2D extracellular domain acts as the target recognition domain to bind the NKG2D ligands on tumor cells. Consequently, the interaction activates γδ cells through the intracellular signaling motif, thereby leading to enhanced tumor killing.
In various embodiments, the CAR comprises a signalling domain of CD3 zeta or DAP 12 (NKG2Dz or NKG2Dp, respectively; CD3 zeta SEQ ID NO: 6; DAP 12 SEQ ID NO: 7), homologous polypeptides, or a portion or a polypeptide fragment of CD3 zeta or DAP 12. Advantageously, the tumor-killing efficacy of the Vγ9Vδ2 T cells can be further enhanced. In particular, the tumor-killing efficacy of the Vγ9Vδ2 T cells is enhanced through the modification of the effector cells with gene transfer of NKG2Dz.
In various embodiments, the CAR comprises a transmembrane domain of CD8-α (CD8-β) chain (SEQ ID NO: 8), homologous polypeptides, or a portion or a polypeptide fragment thereof.
In a preferred embodiment, the CAR comprises an extracellular antigen binding domain of NKG2D and an intracellular signalling domain of DAP12, homologous polypeptides, or a portion or a polypeptide fragment of NKG2D or DAP 12.
In another aspect of the present invention, there is provided a γδ T cell having at least one down-regulated co-inhibitory receptor generated by a method according to an aspect of the present invention.
In another aspect of the present invention, there is provided a γδ T cell having at least one down-regulated co-inhibitory receptor and modified to express a chimeric antigen receptor (CAR), wherein the CAR comprises an extracellular antigen binding domain of NKG2D and an intracellular signalling domain of CD3 zeta or DAP 12. Preferably the signalling domain is DAP12.
In another aspect of the present invention, there is provided a method of treating cancer comprising administering a therapeutically effective amount of γδ T cells according to an aspect of the present invention. Preferably, the cancer is colorectal or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided a γδ T cell according to an aspect of the present invention for use in treating cancer. Preferably, the cancer is colorectal cancer or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided use of a γδ T cell according to an aspect of the present invention in the manufacture of a medicament for the treatment of cancer. Preferably, the cancer is colorectal cancer or ovarian cancer or any other cancer expressing NKG2D ligands.
In another aspect of the present invention, there is provided a method of treating a patient with cancer comprising: administering to the patient, a therapeutically effective amount of γδ T cells having at least one down-regulated co-inhibitory receptor generated by a method comprising the steps of: (a) culturing a population of cells comprising γδ T cells with a phosphoantigen; (b) culturing the expanded γδ T cells with artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody. Preferably, said method comprises administering the γδ T cells having at least one down-regulated co-inhibitory receptor to the patient by intraperitoneal injection.
In another aspect of the present invention, there is provided a method of treating cancer in a patient, the method comprising the steps of: (a) obtaining peripheral blood mononuclear cells (PBMCs) comprising γδ T cells from the patient; (b) culturing the PBMCs with a phosphoantigen to expand the γδ T cells; (c) culturing the PBMCs with the expanded γδ T cells, with an artificial antigen-presenting cells expressing a Fc receptor, and an anti-CD3 antibody against CD3 to generate γδ T cells with at least one down-regulated co-inhibitory receptor; and (d) administering the γδ T cells with at least one down-regulated co-inhibitory receptor to the patient.
Other aspects of the invention will become apparent to those of ordinary skill in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying figures.
Human PBMC were isolated from fresh buffy coat of healthy donors by density gradient centrifugation using Ficoll-Paque (GE Healthcare, Milwaukee, Wis.). Human myelogenous leukemia cell line K562 (ATCC) and a K562-based aAPC cell line genetically engineered for stable expression of EGFP, CD86, CD64 and 4-1BBL (Du et al., 2016) were cultured in IMDM (Lonza Biotech, Basel, Switzerland) supplemented with 10% FBS. Other tumor cell lines used in the present invention were cultured in DMEM supplemented with 10% FBS.
For Vγ9Vδ2 T cell activation and expansion, PBMCs were seeded at a density of 2E6 cells/ml in AIM-V (Life Technologies) supplemented with 5% human AB serum (Valley Biomedical, Winchester, Va.). Zometa (5 μM, Sigma Aldrich, St. Louis, Mo.) and IL-2 (300 IU/ml) were added on day 0, followed by adding 50 ng/ml anti-CD3 antibody (OKT3 clone, eBioscience, San Diego, Calif.), gamma irradiated K562 aAPCs at a 100:1 ratio, 300 IU/ml IL-2, and 5 μM Zometa from day 7 onwards. 5 μM Zometa and 300 IU/ml IL-2 on day 0 and the anti-CD3/CD28-dynabead method (Life Technologies). The culture medium was refreshed every 2 to 3 days. In other words, the cells were passaged every 2 to 3 days.
Construction of NKG2D CAR Vectors and Generation of mRNA CAR T Cells
To generate NKG2D mRNA CAR vectors, a synthetic sequence containing the T7 promoter, 5′UTR, with Kozak sequence, a multiple cloning site, the GM-CSF signal peptide encoding sequence and the alpha-globin 3′UTR sequence was synthesized and inserted into pFastbacl vector (Life Technologies) to construct the basal backbone vector pFBCMV-T7. The extracellular domain of human NKG2D (NKG2D-ED, uniprot P26718-1, amino acids 83-216) was amplified by PCR from a PMBC cDNA library using the primers 5′-gcgcgcatgccttcaaccaagaagttcaaattcc-3′ (forward primer with SphI site (SEQ ID NO: 9)) and 5′-acgaagctagccacagtcctttgcatacagatgtacgtatttggag-3′ (reverse primer with NheI site (SEQ ID NO: 10)). NKG2D chimeric proteins were constructed by fusing NKG2D-ED to the CD8a hinge and transmembrane region (CD8 H-TM, uniprot P01732 (SEQ ID NO: 8), amino acids 128-210) and CD3 (SEQ ID NO: 6) or DAP12 (SEQ ID NO: 7) signalling moiety, and then subcloned into pFBCMV-T7 with EcoRI and SalI. The mGFP control vector was generated by replacing the NKG2D ED part of the NKG2Dz vector with GFP encoding sequence (the start codon removed) by SphI and NheI.
To generate mRNA molecules encoding the NKG2D chimeric proteins, PCR was performed using the above pFBCMV-T7 vectors as DNA templates, a forward primer CMV-F (5′-atccgctcgagtagttattaatagtaatcaattacggggtc-3′) (SEQ ID NO: 11) and reverse primer T150-R (SEQ ID NO: 12). Capped mRNA was generated through in vitro transcription of the PCR DNA templates using the mMESSAGE mMACHINE T7 ULTRA transcription kit (Invitrogen, Carlsbad, Calif.) or the mScript™ RNA system (Epicentre, Madison, Wis.). For mRNA transfection, Vγ9Vδ2 T cells were mixed with the generated mRNA molecules and electroporated in a 2-mm cuvette (Bio-Rad, Hercules, Calif.) using a NEPA21 electroporator (Nepagene, Chiba, Japan) with the following parameters: voltage 240 V, pulse length 4 ms, pulse once. The electroporated T cells were rested for 3 hours and stored at −80° C. until use.
The cytolytic activity of CAR-modified Vγ9Vδ2 T cells was examined with a non-radioactive method (DELFIA EuTDA Cytotoxicity Reagents kit, PerkinElmer, MA). Time-resolved fluorescence was measured in Victor3 multilabel plate counter (PerkinElmer). The effector to target (E:T) ratios used ranged from 20:1 to 2.5:1. Control groups were set up to measure spontaneous release (only target cells added), maximum release (target cells added with 10 μl lysis buffer), and medium background (no cell added). Killing efficacy was calculated by using the following formula:
Non-obese diabetic/severe combined immunodeficiency/IL-2Rycnull (NSG) mice (6-8 weeks old, female) were used in the present invention. Mice were inoculated via intraperitoneal (i.p.) injection of 1E7 SKOV3-Luc cells. On day 7 post-tumor inoculation, tumor engraftment was confirmed by live bioluminescent imaging (BLI) monitored using an IVIS Spectrum Imaging platform with Living Image software (PerkinElmer). Mice with similar BLI signal intensity were randomly divided into different groups. For treatment, 1E7 modified Vγ9Vδ2 T cells or PBS cells were i.p. injected into the tumor-bearing mice, twice a week for 3 weeks. Tumor progression was monitored by BLI. All luminescent signals and images were acquired and analysed with the Xenogen living image software v2.5. Behaviour and survival of the mice were monitored closely. Humane endpoints were used and mice were euthanized by cervical dislocation under sodium pentobarbital anaesthesia upon signs of severe distress such as swollen belly due to tumor ascites formation, seizures, tremors, laboured or difficulty in breathing, significant weight loss (>15% body weight), signs of emaciation (i.e. prominent skeletal structures), impaired ambulation, inability to remain upright or evidence of moribund condition. The survival curves were established based on the dates when mice were found dead or euthanized.
Data are presented as mean±standard deviation (SD). All statistics were performed using GraphPad Prim 5.0 (San Diego, Calif.). P values <0.05 were considered significant.
Vγ9Vδ2 T cells were efficiently expanded by treating PBMCs using 5 μM of Zometa. The Vγ9Vδ2 T-cell population was amplified from −4% in PBMCs on day 0 to close to 90% by day 7, together with a concurrent increase of the NKG2D-positive cell population (
On the other hand, the decrease in the proportion of αβ T cells to less than 10% and NK cells to less than 3% was observed on day 7. In view of the important roles of co-inhibitory receptors in cancer therapy, the expression of six of them, namely, CTLA-4, PD1, LAG3, TIGIT, TIM3, and BTLA, on the Zometa-expanded Vγ9Vδ2 T cells was examined using flow cytometry (
Given the findings that the tumor killing activity of γδ T cells can be regulated by the conformational change of the CD3 co-receptor on T cells and that K562-based aAPCs can be used to activate and propagate the proliferation of polyclonal γδ T cells, the inventors tested whether the combined use of the two treatments can affect the expression of co-inhibitory receptors on γδ T cells.
After the initial treatment of PBMCs with Zometa for 7 days, an anti-CD3 (OKT3 clone) antibody and gamma-irradiated CD64-expressing K562 aAPCs, as well as another portion of Zometa, were added to the culture and the cells were further cultured for another 10 days. Without being bound by theory, it is believed that the Fc-portion of OKT-3 can attach to CD64 (the high affinity human IgG receptor FcγRI) expressed on K562 cells, whereas the antigen-binding sites of OKT3 can interact with CD3 on the γδ T cell surface to induce the conformational change of the co-receptor. This cell-cell interaction between CD3+ γδ T cells and CD64+ K562 aAPCs provides co-stimulatory signal-2, leading to γδ T cell activation and proliferation, likely without triggering their anergy or apoptosis. Advantageously, numerical expansion of T cells were observed after this combined treatment for 10 days and Vγ9Vδ2 T cells were expanded more than 1000-fold during the co-culture period. Importantly, down-regulation of all 6 examined co-inhibitory receptors on γδ T cells was observed, without obvious effects on NKG2D expression (
To further improve the tumor cell killing activity of Vγ9Vδ2 T cells obtained with the co-cultured method of the present invention, the inventors proceeded to test equipping Vγ9Vδ2 T cells by over-expressing an activating receptor on their surface. In particular, electroporation of mRNA encoding an activating receptor into the expanded Vγ9Vδ2 T cells was carried out.
Two NKG2D chimeric proteins containing the extracellular domain of NKG2D fused with CD3 zeta (NKG2Dz) or DAP12 (NKG2Dp) were synthesized. An mRNA electroporation approach was adopted to facilitate fast evaluation of the two constructs. mRNA electroporation was optimized in Vγ9Vδ2 T cells using EGHP mRNA, which provided almost 99% transfection efficiency. While the electroporation of Vγ9Vδ2 T cells with EGFP fused with CD3 zeta (mGFP), a control structure with EGFP to replace the extracellular domain of NKG2D, did not increase NKG2D expression, the increased NKG2D expression was observed after the electroporation of Vγ9Vδ2 T cells with NKG2Dz or NKG2Dp (
Zometa treatment was used because Zometa can increase intracellular levels of IPP, thereby increasing the sensitivity of tumor cells to Vγ9Vδ2 T cells. Subsequently, the inventors tested whether tumor cell killing efficacy can be improved by using NKG2Dz-modified Vγ9Vδ2 T cells to kill Zometa pre-treated tumor cells at an effector to target ratio of 10:1 (
It was found that without Zometa pre-treatment of tumor cells, Vγ9Vδ2 T cells or mGFP-modified Vγ9Vδ2 T cells did not kill the 4 tested tumor cell lines, namely, SW480 human colon carcinoma cells, HepG2 human hepatocarcinoma cells, U87 human glioblastoma cells and SKOV3 human ovarian cancer cells. However, NKG2Dz-modified Vγ9Vδ2 T cells were able to kill these tumor cells that were not pre-treated with Zometa, with the efficiency varying from 20 to 80%. The sensitivity of SW480, U87 and SKOV3 cells, but not HepG2 cells, towards Vγ9Vδ2 T cells were significantly increased by Zometa pre-treatment. Moreover, consistent tumor cell killing efficiencies across the 4 tested tumor cell lines were achieved when NKG2Dz-modified Vγ9Vδ2 T cells were used to kill Zometa pre-treated tumor cells. These findings indicate that while Vγ9Vδ2 T cells plus Zometa pre-treatment were able to effectively kill some types of tumor cells, the tumor-killing efficacy can be further enhanced through the modification of the effector cells with gene transfer of NKG2Dz.
To demonstrate the in vivo tumor killing effect of the NKG2Dz-modified Vγ9Vδ2 T cells, an ovarian cancer mouse model was established by inoculating via intraperitoneal (i.p.) injection of 1E7 SKOV3-Luc cells into NSG mice. 7 days post-tumor cell injection, the tumor-bearing mice were randomized into three groups (n=6) and given three different treatments intraperitoneally twice a week for 3 weeks: PBS was used as a negative control, Vγ9Vδ2 T cells (1E7 per dose) transfected with the control gene mGFP plus Zometa i.p. injection before cell injection (γδT-Z) and the NKG2Dz-modified Vγ9Vδ2 T cells (1E7 per dose) plus Zometa (NKG2D-γδ-T-Z or CAR−Vγ9Vδ2 T-cell+Zometa). Non-invasive whole-body bioluminescent imaging (BLI) of SKOV3-Luc cells were performed to monitor tumor growth.
It should be further appreciated by the person skilled in the art that variations and combinations of features described above, not being alternatives or substitutes, may be combined to form yet further embodiments falling within the intended scope of the invention.
| Number | Date | Country | Kind |
|---|---|---|---|
| 10201701009Q | Feb 2017 | SG | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/SG2018/050055 | 2/8/2018 | WO | 00 |
