Disclosed herein are methods and systems for using Lachnospiraceae to mitigate against radiation-induced hematopoietic/gastrointestinal injury and death, and promote cancer control by radiation.
Radiation-induced injury is not only a major side-effect that complicates radiotherapy in approximately 50% of patients with an abdominal or pelvic malignancy, but is also a major threat during accidental exposure or a targeted terror attack. Acute radiation syndrome (ARS) developing from whole-body or significant partial-body irradiation is associated with induction of hematopoietic (HP), gastrointestinal (GI) and cerebrovascular syndrome as well as cutaneous, pulmonary and cardiac toxicity. Damage to the HP component is known to play a major role in mortality, especially in weakening the immune system so that it cannot fend off infections. Another major source of damage stems primarily from GI damage. Collateral damage to GI epithelium can lead to acute radiation enteritis, which is associated with malabsorption, bleeding, pain, diarrhea and malnutrition.
These toxicities prevent optimal cancer treatment and can also lead to chronic complications in patients. The high prevalence of hematopoietic loss and acute radiation enteritis, coupled with the paucity of adequate preventative or therapeutic strategies, underscores the importance of further investigation in this field.
The gastrointestinal tract is inhabited by a large diverse microbial community, which is comprised of 10-100 trillion microorganisms and is collectively referred to as the gut microbiota. In recent years, there has been an explosive growth in the knowledge associating gut microbiome to multiple human diseases, such as inflammatory bowel disease (IBD), type 2 diabetes, intestinal vascular remodeling and neuronal homeostasis. More strikingly, emerging research has shown that cancer immunotherapies, such as anti-CTLA4 and anti-PD-L1 treatment, greatly rely on the gut microbiota. Although the protective role of commensal gut bacteria in human diseases is increasingly being appreciated, there remains a need for further development and understanding with respect to the relationship between microbiota and radiation-induced injury. Moreover, there remains a significant need for improved radiation and cancer therapies.
This summary lists several embodiments of the presently disclosed subject matter, and in many cases lists variations and permutations of these embodiments. This summary is merely exemplary of the numerous and varied embodiments. Mention of one or more representative features of a given embodiment is likewise exemplary. Such an embodiment can typically exist with or without the feature(s) mentioned; likewise, those features can be applied to other embodiments of the presently disclosed subject matter, whether listed in this summary or not. To avoid excessive repetition, this Summary does not list or suggest all possible combinations of such features.
Provided herein are methods of mitigating and/or preventing side effects from radiation therapy, including providing a subject to be treated with radiation therapy, and/or a subject already treated with radiation therapy, and administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing short chain fatty acids (SCFAs), wherein side effects from radiation therapy are mitigated and/or prevented in the subject.
Likewise, in some embodiments, provided herein are methods of treating a tumor and/or a cancer in a subject, the method comprising administering radiation therapy to a subject in need, and administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs, wherein the tumor and/or a cancer is treated, wherein the effectiveness of the treatment of the tumor and/or cancer is enhanced as compared to radiation therapy alone.
In some aspects, the bacterium comprises intestinal microbiota. In some aspects, the SCFAs produced by the bacterial strains comprise acetate, butyrate and propionate, optionally wherein the ratio of acetate to butyrate to propionate is about 1:5:50, optionally about 1:5:100. In some embodiments, the bacterium comprises strains selected from Lachnospiraceae, Enterococcus faecalis, Lactobacillus rhamonosusl, and combinations thereof. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM. In some aspects, the metabolite comprises one or more tryptophan metabolites.
In some aspects, the subject is suffering from acute radiation syndrome (ARS), hematopoietic (HP) injury, gastrointestinal (GI) injury, cerebrovascular syndrome, cutaneous toxicity, pulmonary toxicity, cardiac toxicity and/or combinations thereof. In some embodiments, administration of the bacterium and/or metabolite thereof effectively attenuates radiation-induced hematopoietic and/or gastrointestinal syndrome. In some aspects, the administration of the bacterium and/or metabolite to the subject occurs before or after radiation therapy. In some aspects, the bacterium and/or metabolite thereof is administered orally or by suppository. In some aspects, the subject is a human, optionally wherein the subject is suffering from a cancer, tumor or related condition.
Also provided are methods of treating and/or mitigating damage to a hematopoietic and/or gastrointestinal system in a subject, the method comprising administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs. In some embodiments, the administration of the bacterium and/or metabolite to the subject occurs before or after an event causing or potentially causing damage to the hematopoietic and/or gastrointestinal system of the subject. In some aspects, the event causing damage to the hematopoietic and/or gastrointestinal system includes radiation, chemotherapy and/or any event, therapy or exposure causing hematopoietic loss and/or acute radiation enteritis. Administration of the bacterium and/or metabolite thereof can effectively attenuate bone marrow loss due to exposure to radiation, chemotherapy or other therapy.
Correspondingly, also provided herein are adjuvant therapeutic compositions, the compositions comprising a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs, and a therapeutically acceptable carrier. In some aspects, the bacterium comprises intestinal microbiota. In some aspects, the SCFAs produced by the bacterial strains comprise acetate, butyrate and propionate, optionally wherein the ratio of acetate to butyrate to propionate is about 1:5:50, optionally about 1:5:100. In some embodiments, the bacterium comprises strains selected from Lachnospiraceae, Enterococcus faecalis, Lactobacillus rhamonosusl, and combinations thereof. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM. In some aspects, the metabolite comprises one or more tryptophan metabolites. The composition can be configured as an adjuvant to anti-cancer radiation therapy and/or anti-cancer chemotherapy, optionally wherein the composition is configured to treat and/or mitigate damage to a hematopoietic and/or gastrointestinal system in a subject to which it is administered.
Provided herein are also methods of screening bacterial strains for use as an anti-cancer adjuvant therapeutic, the methods comprising providing one or more bacterial strains to be screened, conducting a composite genomic analysis for enzymes required for SCFA synthesis, and identify those bacterial strains with a relatively high gene copy for SCFA producing enzymes. In some aspects, the genes for SCFA producing enzymes comprise mmdA, encoding methylmalonyl-CoA decarboxylase for the succinate pathway; lcdA, encoding lactoyl-CoA dehydratase for the acrylate pathway; pduP, encoding propionaldehyde dehydrogenase for the propanediol pathway; and BCoAT, encoding butyryl-CoA transferase for butyrate biosynthesis. The one or more bacterial strains comprises intestinal microbiota. The SCFA producing enzymes produce SCFAs selected from acetate, butyrate and propionate. The bacterial strains are selected from Lachnospiraceae, Enterococcus faecalis, Lactobacillus rhamonosusl, and combinations thereof.
These and other objects are achieved in whole or in part by the presently disclosed subject matter. Further, an object of the presently disclosed subject matter having been stated above, other objects and advantages of the presently disclosed subject matter will become apparent to those skilled in the art after a study of the following description, Drawings and Examples.
The presently disclosed subject matter can be better understood by referring to the following figures. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the presently disclosed subject matter (often schematically). In the figures, like reference numerals designate corresponding parts throughout the different views. A further understanding of the presently disclosed subject matter can be obtained by reference to an embodiment set forth in the illustrations of the accompanying drawings. Although the illustrated embodiment is merely exemplary of systems for carrying out the presently disclosed subject matter, both the organization and method of operation of the presently disclosed subject matter, in general, together with further objectives and advantages thereof, may be more easily understood by reference to the drawings and the following description. The drawings are not intended to limit the scope of this presently disclosed subject matter, which is set forth with particularity in the claims as appended or as subsequently amended, but merely to clarify and exemplify the presently disclosed subject matter.
For a more complete understanding of the presently disclosed subject matter, reference is now made to the following drawings in which:
The presently disclosed subject matter now will be described more fully hereinafter, in which some, but not all embodiments of the presently disclosed subject matter are described. Indeed, the presently disclosed subject matter can be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements.
The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the presently disclosed subject matter.
While the following terms are believed to be well understood by one of ordinary skill in the art, the following definitions are set forth to facilitate explanation of the presently disclosed subject matter.
All technical and scientific terms used herein, unless otherwise defined below, are intended to have the same meaning as commonly understood by one of ordinary skill in the art. References to techniques employed herein are intended to refer to the techniques as commonly understood in the art, including variations on those techniques or substitutions of equivalent techniques that would be apparent to one skilled in the art. While the following terms are believed to be well understood by one of ordinary skill in the art, the following definitions are set forth to facilitate explanation of the presently disclosed subject matter.
In describing the presently disclosed subject matter, it will be understood that a number of techniques and steps are disclosed. Each of these has individual benefit and each can also be used in conjunction with one or more, or in some cases all, of the other disclosed techniques.
Accordingly, for the sake of clarity, this description will refrain from repeating every possible combination of the individual steps in an unnecessary fashion. Nevertheless, the specification and claims should be read with the understanding that such combinations are entirely within the scope of the invention and the claims.
Following long-standing patent law convention, the terms “a”, “an”, and “the” refer to “one or more” when used in this application, including the claims. Thus, for example, reference to “a unit cell” includes a plurality of such unit cells, and so forth.
Unless otherwise indicated, all numbers expressing quantities of ingredients, reaction conditions, and so forth used in the specification and claims are to be understood as being modified in all instances by the term “about”. Accordingly, unless indicated to the contrary, the numerical parameters set forth in this specification and attached claims are approximations that can vary depending upon the desired properties sought to be obtained by the presently disclosed subject matter.
As used herein, the term “about,” when referring to a value or to an amount of a composition, mass, weight, temperature, time, volume, concentration, percentage, etc., is meant to encompass variations of in some embodiments ±20%, in some embodiments ±10%, in some embodiments ±5%, in some embodiments ±1%, in some embodiments ±0.5%, and in some embodiments ±0.1% from the specified amount, as such variations are appropriate to perform the disclosed methods or employ the disclosed compositions.
The term “comprising”, which is synonymous with “including” “containing” or “characterized by” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps. “Comprising” is a term of art used in claim language which means that the named elements are essential, but other elements can be added and still form a construct within the scope of the claim.
As used herein, the phrase “consisting of” excludes any element, step, or ingredient not specified in the claim. When the phrase “consists of” appears in a clause of the body of a claim, rather than immediately following the preamble, it limits only the element set forth in that clause; other elements are not excluded from the claim as a whole.
As used herein, the phrase “consisting essentially of” limits the scope of a claim to the specified materials or steps, plus those that do not materially affect the basic and novel characteristic(s) of the claimed subject matter.
With respect to the terms “comprising”, “consisting of”, and “consisting essentially of”, where one of these three terms is used herein, the presently disclosed and claimed subject matter can include the use of either of the other two terms.
As used herein, the term “and/or” when used in the context of a listing of entities, refers to the entities being present singly or in combination. Thus, for example, the phrase “A, B, C, and/or D” includes A, B, C, and D individually, but also includes any and all combinations and subcombinations of A, B, C, and D.
Summarily, the data herein show that after exposure to lethal dose total body irradiation (TBI), about 5-20% of C57BL/6J mice successfully recovered from radiation-induced damage. By using high-throughput gene-sequencing analysis of 16S rRNA, the microbiota composition in both the survivors and controls was identified. As shown herein, it was discovered that survivors harbored a gut microbiota with significantly higher diversity and distinct community composition relative to that in controls. Then two different fecal microbiota exchange experiments were conducted (i) by housing recipients in the dirty cages, which previously housed long-lived TBI survivors or age-matched non-TBI controls (donors) and contained fecal materials from these two donor groups; (ii) by transferring fecal microbiota from long-lived TBI survivors or age-matched non-TBI controls (donors) to recipients via oral gavage. Upon total body irradiation, recipients who received survivors' microbiota showed dramatically higher protection against TBI-induced injury and death. 16S rRNA sequencing analysis identified a significant decrease in abundance of Erysipelotrichaceae family as well as increases in the abundance of Bacteroidales and Clostridiales orders in survivor recipients compared with that in control recipients. Among these families, Lachnospiraceae was selected as a more abundant bacterium in the survivors group. To further examine the possibility of using Lachnospiraceae as a countermeasure against radiation-induced damage, these bacteria were cultured in vitro and reconstituted to SPF mice by oral gavage. Lachnospiraceae efficiently increased mice survival and decreased HP as well as GI syndromes in recipients post TBI. Furthermore, the function of butyrate, which is a commonly studied metabolite that is also produced by Lachnospiraceae, was detected and we found that this short chain fatty acid had radiomitigation properties albeit less than Lachnospiraceae strains. Moreover, we also found that Lachnospiraceae modestly improved the efficacy of localized radiotherapy by slowing down tumor growth as well as improving mice survival in a melanoma model. Taken together, we elucidated the role of the intestinal microbiota as an integrative point in the pathogenesis of acute radiation syndrome, and found a specific bacterium, Lachnospiraceae, that protects against radiation injury.
Currently, only one promising radiation countermeasure has been approved by the U.S. FDA as an effective countermeasure for ARS. In 2015, G-CSF was approved as a drug by the FDA for treating radiation-induced hematopoietic damage. It has also been approved by the Centers for Disease Control and Prevention for administration to victims exposed to a radiological nuclear incident. However, G-CSF has been shown to increase the survival of irradiated mice only when injected subcutaneously daily from day 1 to 16 (16 doses). The recommended dosage of commercial G-CSF (Filgrastim, Neupogen) in cancer patients undergoing bone marrow transplantation is 10 mcg/kg/day given as an intravenous infusion no longer than 24 hours and continue for several days until absolute neutrophil count increases beyond 10,000/mm3, which makes it quite costly, inconvenient to use and limits its clinical application. Furthermore, side effects are also a big concern. G-CSF administration may cause fever, myalgia, respiratory distress, hypoxia, splenomegaly, sickle cell crisis and incidences of Sweet's syndrome (acute febrile neutropenia dermatosis/skin plaques). Moreover, there are several lines of evidence showing that cancer patients who received G-CSF treatment had an increased risk of developing myelodysplasia (MDS) and acute myeloid leukemia (AML). On the other hand, Lachnospiraceae can be cultured in anaerobe culturing devices at a large scale, making it readily available and inexpensive. By using standard lyophilization method and encapsulation into enteric capsules, it is stable for easy handling, transporting, storage as well as oral administration with rapid reconstitution in the intestine. Here we show that Lachnospiraceae resulted in increased hematopoietic recovery and gastrointestinal wound repair. In addition, it is shown herein that the bacteria did not accelerate tumor growth, thus eliminating the possibility of this unintended consequence of using this bacteria strain to treat either accidental exposure to radiation or intentional exposure during radiation therapy for cancer. In contrast, the data herein unexpectedly showed that Lachnospiraceae and radiation provide better control of tumor growth, thus the bacteria may be used in conjunction with radiation to control cancer. Considering all these features, Lachnospiraceae and its metabolites represent appealing and cost-effective alternatives to conventional G-CSF or other radio-countermeasures for ARS caused by either radiotherapy or deliberate/accidental radiation release. Equally important, it might improve the outcome of radiation therapy to control cancer.
Thus, in some embodiments, provided herein are methods of mitigating and/or preventing side effects from radiation therapy. Such methods can comprise providing a subject to be treated with radiation therapy, and/or a subject already treated with radiation therapy, and administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing short chain fatty acids (SCFAs), wherein side effects from radiation therapy are mitigated and/or prevented in the subject. In some embodiments, the bacterium comprises intestinal microbiota. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM. In some embodiments, the subject is suffering from acute radiation syndrome (ARS), hematopoietic (HP) injury, gastrointestinal (GI) injury, cerebrovascular syndrome, cutaneous toxicity, pulmonary toxicity, cardiac toxicity and/or combinations thereof.
In some embodiments, administration of the bacterium and/or metabolite thereof effectively attenuates radiation-induced hematopoietic and/or gastrointestinal syndrome. In some embodiments, the administration of the bacterium and/or metabolite to the subject occurs before or after radiation therapy. In some embodiments, the bacterium and/or metabolite thereof is administered orally or by suppository. In some embodiments, the subject is a human, optionally wherein the subject is suffering from a cancer, tumor or related condition.
Also provided herein are methods of treating a tumor and/or a cancer in a subject, comprising administering radiation therapy to a subject in need, and administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs, wherein the tumor and/or a cancer is treated, wherein the effectiveness of the treatment of the tumor and/or cancer is enhanced as compared to radiation therapy alone. In some embodiments, the bacterium comprises intestinal microbiota. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM. In some embodiments, administration of the bacterium and/or metabolite thereof effectively attenuates radiation-induced hematopoietic and/or gastrointestinal syndrome. In some embodiments, the administration of the bacterium and/or metabolite to the subject occurs before or after radiation therapy. In some embodiments, the bacterium and/or metabolite thereof is administered orally or by suppository. In some embodiments, the subject is a human, optionally wherein the subject is suffering from a cancer, tumor or related condition.
Still yet, in some aspects, provided herein are methods of treating and/or mitigating damage to a hematopoietic and/or gastrointestinal system in a subject, the method comprising administering to the subject a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs. In some embodiments, the administration of the bacterium and/or metabolite to the subject occurs before or after an event causing or potentially causing damage to the hematopoietic and/or gastrointestinal system of the subject. In some embodiments, the event causing damage to the hematopoietic and/or gastrointestinal system includes radiation, chemotherapy and/or any event, therapy or exposure causing hematopoietic loss and/or acute radiation enteritis. In some embodiments, administration of the bacterium and/or metabolite thereof effectively attenuates bone marrow loss due to exposure to radiation, chemotherapy or other therapy. In some embodiments, the bacterium comprises intestinal microbiota. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM.
Also provided herein are adjuvant therapeutic compositions, comprising a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs, and a therapeutically acceptable carrier. In some embodiments, the bacterium comprises intestinal microbiota. In some embodiments, the bacterium comprises Lachnospiraceae strains, optionally wherein the Lachnospiraceae strains produce butyrate higher than about 120 μM and propionate higher than about 60 μM. In some embodiments, the composition is configured as an adjuvant to anti-cancer radiation therapy and/or anti-cancer chemotherapy, optionally wherein the composition is configured to treat and/or mitigate damage to a hematopoietic and/or gastrointestinal system in a subject to which it is administered.
Methods of screening bacterial strains for use as an anti-cancer adjuvant therapeutic are also provided herein. Such methods comprise providing one or more bacterial strains to be screened, conducting a composite genomic analysis for enzymes required for SCFA synthesis, and identify those bacterial strains with a relatively high gene copy for SCFA producing enzymes, e.g. at least 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 75% or 90% increased gene copy for SCFA producing enzymes as compared to other bacterial strains. In some embodiments, the genes for SCFA producing enzymes comprise mmdA, encoding methylmalonyl-CoA decarboxylase for the succinate pathway; lcdA, encoding lactoyl-CoA dehydratase for the acrylate pathway; pduP, encoding propionaldehyde dehydrogenase for the propanediol pathway; and BCoAT, encoding butyryl-CoA transferase for butyrate biosynthesis.
a. Pharmaceutical/Adjuvant Therapeutic Compositions
The compounds disclosed herein can be formulated in accordance with the routine procedures adapted for a desired administration route. Accordingly, in some embodiments, the presently disclosed subject matter provides an adjuvant therapeutic composition, or pharmaceutical composition, comprising a therapeutically effective amount of a compound as disclosed hereinabove (e.g., a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs). The therapeutically effective amount can be determined by testing the compounds in an in vitro or in vivo model and then extrapolating therefrom for dosages in subjects of interest, e.g., humans. The therapeutically effective amount should be enough to exert a therapeutically useful effect in the absence of undesirable side effects in the subject to be treated with the composition.
Pharmaceutically acceptable carriers are well known to those skilled in the art and include, but are not limited to, from about 0.01 to about 0.1M and preferably 0.05M phosphate buffer or 0.8% saline. Such pharmaceutically acceptable carriers can be aqueous or non-aqueous solutions, suspensions and emulsions. Examples of non-aqueous solvents suitable for use in the presently disclosed subject matter include, but are not limited to, propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate. Aqueous carriers suitable for use in the presently disclosed subject matter include, but are not limited to, water, ethanol, alcoholic/aqueous solutions, glycerol, emulsions or suspensions, including saline and buffered media. Oral carriers can be elixirs, syrups, capsules, tablets and the like.
Liquid carriers suitable for use in the presently disclosed subject matter can be used in preparing solutions, suspensions, emulsions, syrups, elixirs and pressurized compounds. The active ingredient can be dissolved or suspended in a pharmaceutically acceptable liquid carrier such as water, an organic solvent, a mixture of both or pharmaceutically acceptable oils or fats. The liquid carrier can contain other suitable pharmaceutical additives such as solubilizers, emulsifiers, buffers, preservatives, sweeteners, flavoring agents, suspending agents, thickening agents, colors, viscosity regulators, stabilizers or osmo-regulators.
Liquid carriers suitable for use in the presently disclosed subject matter include, but are not limited to, water (partially containing additives as above, e.g. cellulose derivatives, preferably sodium carboxymethyl cellulose solution), alcohols (including monohydric alcohols and polyhydric alcohols, e.g. glycols) and their derivatives, and oils (e.g. fractionated coconut oil and arachis oil). For parenteral administration, the carrier can also include an oily ester such as ethyl oleate and isopropyl myristate. Sterile liquid carriers are useful in sterile liquid form comprising compounds for parenteral administration. The liquid carrier for pressurized compounds disclosed herein can be halogenated hydrocarbon or other pharmaceutically acceptable propellent.
Solid carriers suitable for use in the presently disclosed subject matter include, but are not limited to, inert substances such as lactose, starch, glucose, methyl-cellulose, magnesium stearate, dicalcium phosphate, mannitol and the like. A solid carrier can further include one or more substances acting as flavoring agents, lubricants, solubilizers, suspending agents, fillers, glidants, compression aids, binders or tablet-disintegrating agents; it can also be an encapsulating material. In powders, the carrier can be a finely divided solid which is in admixture with the finely divided active compound. In tablets, the active compound is mixed with a carrier having the necessary compression properties in suitable proportions and compacted in the shape and size desired. The powders and tablets preferably contain up to 99% of the active compound. Suitable solid carriers include, for example, calcium phosphate, magnesium stearate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, polyvinylpyrrolidine, low melting waxes and ion exchange resins.
Parenteral carriers suitable for use in the presently disclosed subject matter include, but are not limited to, sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, lactated Ringer's and fixed oils. Intravenous carriers include fluid and nutrient replenishers, electrolyte replenishers such as those based on Ringer's dextrose and the like. Preservatives and other additives can also be present, such as, for example, antimicrobials, antioxidants, chelating agents, inert gases and the like.
Carriers suitable for use in the presently disclosed subject matter can be mixed as needed with disintegrants, diluents, granulating agents, lubricants, binders and the like using conventional techniques known in the art. The carriers can also be sterilized using methods that do not deleteriously react with the compounds, as is generally known in the art. The compounds disclosed herein can take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and can contain formulatory agents such as suspending, stabilizing and/or dispersing agents. The compounds disclosed herein can also be formulated as a preparation for implantation or injection. Thus, for example, the compounds can be formulated with suitable polymeric or hydrophobic materials (e.g., as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives (e.g., as a sparingly soluble salt). Alternatively, the active ingredient can be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen-free water, before use.
For example, formulations for parenteral administration can contain as common excipients sterile water or saline, polyalkylene glycols such as polyethylene glycol, oils of vegetable origin, hydrogenated naphthalenes and the like. In particular, biocompatible, biodegradable lactide polymer, lactide/glycolide copolymer, or polyoxyethylene-polyoxypropylene copolymers can be useful excipients to control the release of active compounds. Other potentially useful parenteral delivery systems include ethylene-vinyl acetate copolymer particles, osmotic pumps, implantable infusion systems, and liposomes. Formulations for inhalation administration contain as excipients, for example, lactose, or can be aqueous solutions containing, for example, polyoxyethylene-9-auryl ether, glycocholate and deoxycholate, or oily solutions for administration in the form of nasal drops, or as a gel to be applied intranasally. Formulations for parenteral administration can also include glycocholate for buccal administration, methoxysalicylate for rectal administration, or citric acid for vaginal administration.
Further, formulations for intravenous administration can comprise solutions in sterile isotonic aqueous buffer. Where necessary, the formulations can also include a solubilizing agent and a local anesthetic to ease pain at the site of the injection. Generally, the ingredients are supplied either separately or mixed together in unit dosage form, for example, as a dry lyophilized powder or water free concentrate in a hermetically sealed container such as an ampule or sachet indicating the quantity of active agent. Where the compound is to be administered by infusion, it can be dispensed in a formulation with an infusion bottle containing sterile pharmaceutical grade water, saline or dextrose/water. Where the compound is administered by injection, an ampule of sterile water for injection or saline can be provided so that the ingredients can be mixed prior to administration.
Suitable formulations further include aqueous and non-aqueous sterile injection solutions that can contain antioxidants, buffers, bacteriostats, bactericidal antibiotics and solutes that render the formulation isotonic with the bodily fluids of the intended recipient; and aqueous and non-aqueous sterile suspensions, which can include suspending agents and thickening agents.
Formulations of the compounds can contain minor amounts of wetting or emulsifying agents, or pH buffering agents. The formulations comprising the compound can be a liquid solution, suspension, emulsion, tablet, pill, capsule, sustained release formulation, or powder.
The compounds can be formulated as a suppository, with traditional binders and carriers such as triglycerides.
Oral formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, polyvinyl pyrollidone, sodium saccharine, cellulose, magnesium carbonate, etc.
In some embodiments, the pharmaceutical composition comprising the compound of the presently disclosed subject matter can include an agent which controls release of the compound, thereby providing a timed or sustained release compound.
b. Methods of Treatment
As described hereinabove, provided herein are methods of mitigating and/or preventing side effects from radiation therapy, and/or methods of treating a tumor and/or a cancer in a subject, comprising administering radiation therapy to a subject in need, and administering to the subject a bacterium and/or metabolite thereof. Also provided are methods of treating and/or mitigating damage to a hematopoietic and/or gastrointestinal system in a subject.
An effective amount of the compounds disclosed herein, e.g., a bacterium and/or metabolite thereof, wherein the bacterium comprises one or more bacterial strains capable of producing SCFAs, comprise amounts sufficient to produce a noticeable effect, such as, but not limited to, substantially preventing and/or mitigation hematopoietic loss and/or acute radiation enteritis caused by radiation, chemotherapy and/or any event, therapy or exposure causing such deleterious effects. In some embodiments, an effective amount of the compounds disclosed herein, e.g., a bacterium and/or metabolite thereof, comprises amounts sufficient to produce a noticeable effect, such as, but not limited to, substantially attenuating bone marrow loss due to exposure to radiation, chemotherapy or other therapy.
Actual dosage levels of active ingredients in a therapeutic compound of the presently disclosed subject matter can be varied so as to administer an amount of the active compound that is effective to achieve the desired therapeutic response for a particular subject and/or application. Preferably, a minimal dose is administered, and the dose is escalated in the absence of dose-limiting toxicity to a minimally effective amount. Determination and adjustment of a therapeutically effective dose, as well as evaluation of when and how to make such adjustments, are known to those of ordinary skill in the art.
The therapeutically effective amount of a compound can depend on a number of factors. For example, the species, age, and weight of the subject, the precise condition requiring treatment and its severity, the nature of the formulation, and the route of administration are all factors that can be considered.
A compound of the presently disclosed subject matter can also be useful as adjunctive, add-on or supplementary therapy for the treatment of the above-mentioned diseases/disorders, e.g. an adjuvant to radiation and/or chemotherapy for treating a cancer or tumor. Said adjunctive, add-on or supplementary therapy means the concomitant or sequential administration of a compound of the presently disclosed subject matter to a subject who has already received administration of, who is receiving administration of, or who will receive administration of one or more additional therapeutic agents for the treatment of the indicated conditions, for example, radiation and/or chemotherapy.
c. Subjects
The subjects treated, tested or from which a sample is taken, is desirably a human subject, although it is to be understood that the principles of the disclosed subject matter indicate that the compositions and methods are effective with respect to invertebrate and to all vertebrate species, including mammals, which are intended to be included in the term “subject”. Moreover, a mammal is understood to include any mammalian species in which screening is desirable, particularly agricultural and domestic mammalian species.
The disclosed methods are particularly useful in the treating, testing and/or screening of warm-blooded vertebrates. Thus, the presently disclosed subject matter concerns mammals and birds.
More particularly, provided herein is the testing, screening and/or treatment of mammals such as humans, as well as those mammals of importance due to being endangered (such as Siberian tigers), of economic importance (animals raised on farms for consumption by humans) and/or social importance (animals kept as pets or in zoos) to humans, for instance, carnivores other than humans (such as cats and dogs), swine (pigs, hogs, and wild boars), ruminants (such as cattle, oxen, sheep, giraffes, deer, goats, bison, and camels), and horses. Also provided is the treatment of birds, including the treatment of those kinds of birds that are endangered, kept in zoos, as well as fowl, and more particularly domesticated fowl, i.e., poultry, such as turkeys, chickens, ducks, geese, guinea fowl, and the like, as they are also of economic importance to humans. Thus, provided herein is the treatment of livestock, including, but not limited to, domesticated swine (pigs and hogs), ruminants, horses, poultry, and the like.
In some embodiments, the subject to be used in accordance with the presently disclosed subject matter is a subject in need of treatment and/or diagnosis. In some embodiments, a subject can be in need of, or currently receiving, a radiation therapy.
The following examples are included to further illustrate various embodiments of the presently disclosed subject matter. However, those of ordinary skill in the art should, in light of the present disclosure, appreciate that many changes can be made in the specific embodiments which are disclosed and still obtain a like or similar result without departing from the spirit and scope of the presently disclosed subject matter.
C57BL/6 mice are highly sensitive to a lethal dose of total body irradiation26, however approximately 5-20% of mice survived and recovered within 30 days and lived for more than 600 days (
Divergent factors, such as housing, diet and inflammation states, can dramatically affect enteric microbiota17,27,28. Therefore, to more stringently investigate the contribution of gut microbiota in radio-protection, a strategy was designed where cages which housed the super survivors were subsequently used to house mice which were scheduled for radiation later (
Total body exposure to 2 Gy or higher radiation induces severe damage in hematopoietic systems including bone marrow and spleen, which might lead to death from infection or hemorrhage within 30 days29. Replenishment of hematopoietic sites is critical for recovery following radiation exposure. In order to gain more insight into the gut microbiota's radio-protection function, histological studies were conducted in bone marrow and spleen samples at day 30 post TBI. Extensive stromal injury and cell death were observed in BM from microbiota recipients of control mice (
Next, studies were designed to investigate how the gut bacterial composition structure was altered in the dirty cage sharing experiment. To address this question, bacterial 16S rRNA genes were profiled in feces of control recipients and survivor recipients after 8 weeks of dirty cage sharing as shown in
To further determine if the transferred microbiota resulted in changes in specific bacteria, one-way analysis of variance (ANOVA) of all results from sequenced fecal bacteria identified by 16S rRNA gene sequencing both in donor and recipient groups was performed. Significant decreases in abundance of the Erysipelotrichaceae family as well as increases in abundance of Bacteroidales and Clostridiales orders were found in long-lived TBI survivors and survivor recipients compared with non-TBI controls and control recipients, respectively (
To consolidate the relevance between gut microbiota and radio-sensitivity, a fecal microbiota transplant (FMT) experiment was performed in which germ-free (GF) C57BL/6 mice were reconstituted with the microbiota from long-lived TBI survivors and age-matched non-TBI controls via oral gavage twice a week for 4 weeks, as previously described (
Consistent with the results obtained in dirty cage sharing experiment (
As shown in
To characterize the nature of Lachnospiraceae in radiation process, SPF C57BL/6 mice were inoculated with a mixture of 23 Lachnospiraceae strains (Lachno) by oral gavage twice a week for 9 weeks (
It is well established that Clostridiales and Lachnospiraceae bacterial groups produce short chain fatty acids (SCFAs) via fermentation of dietary polysaccharides32-34. SCFAs especially butyrate, which is the most commonly studied SCFA, are important substrates for maintaining intestinal epithelium and play a role in regulating immune system and inflammatory response. Increased abundance of Lachnospiraceae is expected to enhance the capability to produce SCFAs. To validate this hypothesis, the concentrations of lactate, propionate, isobutyrate and butyrate were detected in each individual Lachnospiraceae strain within the disclosed 23 stains pool. Here, for illustration and not intended to be limiting, six representative strains with three SCFAs high producers and three SCFAs low producers (
Radiotherapy, using high dose ionizing radiation, is one of the most successful and widely used non-surgical therapies for the treatment of localized solid cancers35. The success of radiotherapy in eradicating a tumor depends principally on the total radiation dose given. But high dose radiation will cause severe damage to normal tissues36,37 So, the key challenge in radiotherapy is to maximize radiation doses to cancer cells while decreasing side effects.
As the data herein showed a dramatic attenuation of radiation-induced damage by gut microbiota administration, efforts were undertaken to then investigate if microbiota and radiation combined therapy could successfully control tumor progress or at least does not affect the efficacy of radiotherapy. To this end, two strategies were employed, namely treating mice with Lachnospiraceae before or after tumor injection. As shown in FIG. 8A, SPF C57BL/6 mice were subcutaneously injected with B16 cells, a murine melanoma tumor cell line. Then, tumor-bearing mice were treated with Lachnospiraceae alone, BHI medium alone, Lachnospiraceae for 10 days followed by 10Gy X Ray localized radiation or BHI medium for 10 days followed by 10Gy X Ray localized radiation (
Radiation in tumor-bearing mice caused longer survival both in Lachnospiraceae and BHI treated groups. But there was no difference in survival rate nor tumor volume between Lachn-10 Gy X Ray group and BHI-10 Gy X Ray group, which indicated that Lachnospiraceae did not negatively affect radiation efficacy (
Because the B16 tumors were aggressive and grew very fast, there was a limited time interval for Lachnospiraceae transplantation. There was a concern that in this strategy, Lachnospiraceae did not have sufficient time to re-colonize the intestine. To overcome this problem, mice were treated with Lachnospiraceae before tumor injection for a longer period so that this bacterium could better colonize the intestine. As shown in
In some embodiments, disclosed herein are methods of screening strains to identify those that produce high levels of SCFAs. Such screening methods and systems can be useful in identifying strains that have similar mitigating and/or additive therapeutic effects as the exemplary strains disclosed herein.
Clostridiales and Lachnospiraceae bacterial groups produce SCFAs via fermentation of dietary polysaccharides (Atarashi et al., 2013; den Besten et al., 2013; Reichardt et al., 2014). Increased abundance of Lachnospiraceae is expected to enhance the capability to produce SCFAs. The Lachnospiraceae mixture produced the SCFAs butyrate and propionate, but not isobutyrate, compared to the BHI medium. Dietary hexose and fucose can be used to generate the SCFA propionate by three independent pathways: succinate, acrylate, and propanediol. Key enzymes from bacteria that are important in these pathways include mmdA, encoding methylmalonyl-CoA decarboxylase for the succinate pathway; lcdA, encoding lactoyl-CoA dehydratase for the acrylate pathway; and pduP, encoding propionaldehyde dehydrogenase for the propanediol pathway. Additionally, BCoAT, encoding butyryl-CoA transferase, is essential for butyrate biosynthesis. Reduced expression of these enzymes correlates with reduced propionate and butyrate (Reichardt et al., 2014). The colonic microbiota from Nlrp12−− on HFD showed significantly reduced copy numbers of these genes compared to similarly treated WT mice, while Lachnospiraceae treatment significantly increased these genes (
Thee data illustrate methods of screening strains producing relatively high levels of SCFA, and/or for markers of SCFA synthesis. Such screening methods and systems can comprise a composite analysis of the enzymes required for SCFA synthesis (
SCFA production was detected within 23 Lachnospiraceae strains, including 3 strains that were determined to produce high levels of SCFAs and 3 strains that produced low levels of SCFAs (
SPF C57BL/6 mice were treated with acetate, butyrate or propionate supplemented water for 8 weeks respectively, followed by a lethal dose TBI (
Acetate, butyrate and propionate were mixed by three different ratios and used to treat SPF C57BL/6 mice with these combinations for 8 weeks respectively, followed by a lethal dose TBI (
Two other bacteria strains (Enterococcus faecalis and Bacteroides fragilis) were tested, which were increased in elite-survivors detect by 16s rRNA sequencing, together with the well-known probiotics, Lactobacillus rhamonosus. These strains were cultured in vitro and separately transferred into SPF mice for 8 weeks, followed with lethal dose TBI and monitoring of the survival rate and clinical scores (
Besides propionate, a metabolomics approach was used to identify other metabolites with potentially protective or pathogenic consequences in an unbiased fashion (38, 39). An untargeted metabolomics of fecal samples from elite-survivors and AM-Ctrl on a high-resolution accurate mass (HRAM) mass spectrometry-based platform was performed (40). A total of 3787 ion features were detected as significantly altered (p<0.05, fold change>1.2) between elite-survivors and AM-Ctrl. Ion features of top 500 largest fold changes or of microbial relevance were fed into the chemoinformatic pipeline, resulting in 141 unique structures identified, including amino acids, fatty acids, steroid derivatives, acylcarnitines, saccharides, glycolytic and tricarboxylic acid cycle intermediates, and products of microbial metabolism, etc. Total ion chromatogram (TIC) metabolomic cloudplot and principal component analysis (PCA) score plot showed that the metabolite profiles were dramatically distinct between these two groups (
All references listed herein including but not limited to all patents, patent applications and publications thereof, scientific journal articles, and database entries (e.g., GENBANK® database entries and all annotations available therein) are incorporated herein by reference in their entireties to the extent that they supplement, explain, provide a background for, or teach methodology, techniques, and/or compositions employed herein.
It will be understood that various details of the presently disclosed subject matter may be changed without departing from the scope of the presently disclosed subject matter. Furthermore, the foregoing description is for the purpose of illustration only, and not for the purpose of limitation.
This application claims benefit of U.S. Provisional Patent Application Ser. No. 62/779,776, filed Dec. 14, 2018, herein incorporated by reference in its entirety.
This invention was made with government support under Grant No. AI067798 awarded by the National Institutes of Health. The government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
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PCT/US2019/066606 | 12/16/2019 | WO | 00 |
Number | Date | Country | |
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62779776 | Dec 2018 | US |