METHODS OF SUPPRESSING DELIVERY OF EXOSOMES TO LIVER AND SPLEEN

Abstract
The instant application describes improved methods and compositions for the systemic delivery of therapeutic exosomes to a subject in need thereof. In certain embodiments, the current invention reduces the amount of exosomes delivered to liver, spleen and combinations thereof to allow greater distribution to other areas of the body such as, but not limited to, the brain, pancreas, lung, kidney, muscle. In certain embodiments, the methods involve the injection of one or multiple doses of non-therapeutic exosomes prior to the injection of a suitable therapeutic dose of exosomes with a therapeutic payload. Also included are methods to improve immune clearance of exosomes in subjects by inhibiting phagocytosis.
Description
BACKGROUND OF THE INVENTION
Field of the Invention

The instant application relates to methods and compositions for introducing exosomes to a subject in need thereof. In certain embodiments, the methods involve the injection of one or multiple doses of non-therapeutic exosomes prior to the injection of a suitable therapeutic dose of exosomes harboring a therapeutic payload. In certain embodiments, the methods are designed to partially block uptake of therapeutic exosomes in the liver and/or spleen so as to enable systemic delivery to other organs and tissues.


Description of the Related Art

Studies in mice have shown that the majority of injected exosomes in normal or diseased mice are deposited in the liver and spleen (Wiklander, O. et al. Extracellular vesicle in vivo biodistribution is determined by cell source, route of administration and targeting. Journal of Extracellular Vesicles. Apr. 20, 2015). The preferential biodistribution of exosomes to these organs may lead to reduced delivery of exosomes to other tissues of interest or lead to toxic off-target side-effects. Therefore, there is a need for methods and compositions that reduce the amount of exosomes delivered to the liver and spleen to allow greater distribution of exosomes to targets located at other locations and tissue types in the body.


SUMMARY OF THE INVENTION

Disclosed herein are methods and compositions for the delivery of exosomes to a subject in need thereof. In certain aspects are methods of introducing exosomes to a subject, the method comprising, administering to the subject a first dose comprising non-therapeutic exosomes and administering to the subject a second dose comprising therapeutic exosomes. In an embodiment, the therapeutic exosomes optionally comprise a receiver. In certain embodiments, the non-therapeutic and therapeutic exosomes are optionally administered separately. In certain embodiments, the second dose is optionally administered at a period of time which is 15 minutes or greater after administration of the first dose. In certain embodiments, the second dose is administered at a period of time which is three hours or less after administration of the first dose. In certain aspects, the first dose optionally comprises an exosome quantity that is different from an exosome quantity of the second dose. In some aspects, the first dose optionally comprises an exosome quantity that is greater than an exosome quantity of the second dose.


In certain embodiments, the first and second doses are optionally administered parenterally. In some embodiments, the administration is optionally intravenous administration. In certain embodiments, the first dose is optionally a bolus dose comprising an exosome quantity that is greater than an exosome quantity of the second dose, and wherein the second dose is administered as a continuous infusion. In certain embodiments, the first dose is optionally a bolus dose comprising an exosome quantity that is greater than an exosome quantity of the second dose, and the second dose is administered in a plurality of repeated administration steps. In certain embodiments, the first dose is administered in a plurality of repeated administration steps. In some embodiments, the second dose is administered in a time period ranging from 15 minutes to 3 hours after completion of the plurality of repeated administration steps.


In certain embodiments, the non-therapeutic exosomes, the therapeutic exosomes or both the non-therapeutic and therapeutic exosomes optionally comprise an imaging agent. In some embodiments, the imaging agent is a fluorescent compound. In some embodiments, the imaging agent is a radioactive compound. In certain embodiments, the methods further comprise imaging the subject after administration of the non-therapeutic exosomes, the therapeutic exosomes or both the non-therapeutic and therapeutic exosomes and thereby detecting the location of the exosomes in the subject. In some embodiments, the imaging comprises magnetic resonance imaging.


In certain embodiments, the therapeutic exosomes optionally comprise RNA. In certain embodiments, the therapeutic exosomes comprise microRNA (miRNA). In certain embodiments, the therapeutic exosomes comprise siRNA. In certain embodiments, the therapeutic exosomes optionally comprise DNA. In certain embodiments, the therapeutic exosomes optionally comprise a polypeptide. In certain embodiments, the therapeutic exosomes optionally comprise a small molecule. In certain embodiments, the therapeutic exosomes optionally comprise a large molecule biologic.


In certain embodiments, the therapeutic exosomes optionally comprise more than one distinct payload. In certain embodiments, the payload comprises more than one type of payload selected from the group consisting of: peptide, protein, DNA, RNA, siRNA, miRNA, shRNA, lncRNA, small molecule, large molecule biologic, polysaccharide, lipid, toxin and combinations thereof.


In certain embodiments, the therapeutic exosomes optionally comprise a payload labeled with a detectable moiety.


In certain embodiments, the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are synthetic. In certain embodiments, the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are derived from a producer cell.


In certain embodiments, the exosomes are optionally contacted with sialyltransferase prior to administration.


In certain embodiments, the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are optionally co-administered either concurrently or sequentially, with an agent that inhibits phagocytosis of the exosomes.


In certain embodiments, the first dose, the second dose or both the first and second doses harbor a plurality of distinct exosomes, wherein the distinct exosomes harbor distinct payloads.


In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 500 nm. In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 200 nm. In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 100 nm.


In certain embodiments, administration of the first dose comprising non-therapeutic exosomes causes reduced delivery of the therapeutic exosomes to an organ selected from the group consisting of: the liver and spleen, or combinations thereof, compared to delivery of the therapeutic exosomes administered at the same dose, but without prior administration of the first dose comprising non-therapeutic exosomes. In certain embodiments, administration of the non-therapeutic exosomes causes increased delivery of the therapeutic exosomes to a target cell or tissue, compared to delivery of therapeutic exosomes administered at the same dose, but without prior administration of the first dose comprising non-therapeutic exosomes.


In certain aspects, are methods comprising administering to the subject a first dose comprising non-therapeutic exosomes and administering to the subject a second dose comprising therapeutic exosomes, wherein administering to the subject the first dose comprises accumulating the non-therapeutic exosomes in the liver or spleen, or any combination thereof, of the subject.


Included with the invention, are kits comprising a first pharmaceutical composition comprising non-therapeutic exosomes, and a second pharmaceutical composition comprising therapeutic exosomes.


In certain aspects, are methods of introducing exosomes to a subject, the method comprising administering to the subject a dose of therapeutic exosomes, wherein the therapeutic exosomes are modified, the modification causing increased delivery of the therapeutic exosomes to a target cell or tissue as compared to delivery of unmodified therapeutic exosomes that have been obtained by identical methods. In certain embodiments, the exosomes are optionally modified by contacting with sialyltransferase prior to administration. In certain embodiments, the exosomes are optionally administered either concurrently or sequentially with an agent that inhibits phagocytosis of the exosomes. In certain embodiments, the exosomes optionally comprise an imaging agent. In some embodiments, the imaging agent is a fluorescent compound. In some embodiments, the imaging agent is a radioactive compound. In certain embodiments, the methods optionally further comprise imaging the subject after administration of the exosomes and thereby detecting the location of the exosomes in the subject. In some embodiments, the imaging comprises magnetic resonance imaging. In certain embodiments, the therapeutic exosomes optionally comprise RNA. In certain embodiments, the therapeutic exosomes comprise microRNA (miRNA). In certain embodiments, the therapeutic exosomes comprise siRNA. In certain embodiments, the therapeutic exosomes optionally comprise DNA. In certain embodiments, the therapeutic exosomes optionally comprise a polypeptide. In certain embodiments, the therapeutic exosomes optionally comprise a small molecule. In certain embodiments, the therapeutic exosomes optionally comprise a large molecule biologic. In certain embodiments, the therapeutic exosomes optionally comprise more than one distinct payload. In certain embodiments, the payload optionally comprises more than one type of payload selected from the group consisting of: peptide, protein, DNA, RNA, siRNA, miRNA, shRNA, lncRNA, small molecule, large molecule biologic, polysaccharide, lipid, toxin and combinations thereof. In certain embodiments, the exosomes optionally comprise a payload labeled with a detectable moiety. In certain embodiments, the exosomes are optionally synthetic. In certain embodiments, the exosomes are optionally derived from a producer cell. In certain embodiments, the exosomes are optionally contacted with sialyltransferase prior to administration. In certain embodiments, the exosomes, are optionally co-administered either concurrently or sequentially, with an agent that inhibits phagocytosis of the exosomes. In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 500 nm. In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 200 nm. In certain embodiments, the exosomes comprise a largest diameter ranging from 30 nm to 100 nm. In certain embodiments, the exosomes optionally comprise a receiver. In certain embodiments, the administration of the modified exosomes causes reduced delivery of the exosomes to an organ selected from the group consisting of: the liver and spleen, or combinations thereof, compared to delivery of unmodified exosomes that have been obtained by identical methods and administered at the same dose.





BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

These and other features, aspects, and advantages of the present invention will become better understood with regard to the following description, and accompanying drawings, where:



FIG. 1 shows whole-body PET/CT images of mice injected solely with 89Zr-DFO-labeled exosomes at four hours and 24 hours post-injection.



FIG. 2 shows whole-body PET/CT images of mice injected first with unlabeled exosomes, followed by injection with 89Zr-DFO-labeled exosomes at four hours and 24 hours post-injection.



FIG. 3 is a chart showing the amount of 89Zr-DFO taken up by various mouse tissues 48 hours after treatment with either 89Zr-DFO-labeled exosomes (Control) or unlabeled exosomes followed by 89Zr-DFO-labeled exosomes (Blocked). 89Zr-DFO levels are shown in percent injected dose per gram of organ weight. The chart at right shows the same data replotted after removing liver and spleen levels.



FIG. 4 is a chart showing the amount of 89Zr-DFO taken up by various mouse tissues 48 hours after treatment with either 89Zr-DFO-labeled exosomes (Control) or unlabeled exosomes followed by 89Zr-DFO-labeled exosomes (Blocked). 89Zr-DFO levels are shown as percent of total injected dose. The chart at right shows the same data replotted after removing kidney and spleen levels.





DETAILED DESCRIPTION OF THE INVENTION

Advantages and Utility


Briefly, and as described in more detail below, described herein are improved methods for the delivery of therapeutic exosomes to a subject in need thereof. Therapeutic exosomes can confer therapeutic benefits by interacting with, signaling to, or delivering therapeutic molecules to a target cell, tissue or molecule within a subject. It is known in the art that when administered intravenously, exosomes are deposited and accumulate in the liver and/or spleen of mice, leading to unwanted toxicity and/or decreased delivery of exosomes to other targets of interest. Therefore, the in vivo pharmacokinetics and off-target deposition of exosomes needs to be improved for the treatment of tissues and organs other than the liver and spleen. The instant application describes improved methods and compositions for the systemic delivery of therapeutic exosomes to targets of interest. In some embodiments, the current invention reduces the amount of therapeutic exosomes delivered to liver, spleen and combinations thereof to allow greater distribution to other areas in the body such as, but not limited to, the brain, pancreas, lung, kidney and muscle. Also included, are methods to improve immune clearance of exosomes in subjects by inhibiting phagocytosis.


Definitions

Terms used in the claims and specification are defined as set forth below unless otherwise specified.


The term “exosome” refers to cell-derived phospholipid membrane bound vesicles with a diameter between 30 and 500 nm that are present in biological fluids, including blood, urine and cultured medium of cell cultures. Exosomes are either released from the cell when multivesicular bodies fuse with the plasma membrane or they are released directly from the plasma membrane. Exosomes may also be synthetic exosomes. A synthetic exosome refers to an exosome that is not naturally occurring.


The term “exosome delivery” or “delivery of exosomes” refers to the administration and localization of exosomes to target tissues and/or organs of the subject. In some embodiments, the payload can be delivered to the cytoplasm of a target cell. In other embodiments, the payload is delivered to the membrane of the target cell. In some embodiments, the membrane of the exosome fuses with a membrane of a target cell.


The term “non-therapeutic exosome” refers to exosomes that do not harbor at least one therapeutic payload as compared to a therapeutic exosome that is administered to a subject either concurrently or following the administration of the non-therapeutic exosome.


The term “therapeutic exosome” refers to exosomes that harbor at least one therapeutic payload or have been modified to have a desired therapeutic effect as compared to a non-therapeutic exosome that is administered to a subject concurrently or prior to the administration of the therapeutic exosome.


A “therapeutic agent” or “therapeutic molecule” includes a compound or molecule that, when present in an effective amount, produces a desired therapeutic effect, pharmacologic and/or physiologic effect on a subject in need thereof. It includes any compound, e.g., a small molecule drug, or a biologic (e.g., a polypeptide drug or a nucleic acid drug) that when administered to a subject has a measurable or conveyable effect on the subject, e.g., it alleviates or decreases a symptom of a disease, disorder or condition.


The term “payload” refers to an agent delivered by an exosome. A “therapeutic payload” is a “payload” comprising a therapeutic agent. A therapeutic payload can comprise, but is not limited to, a therapeutic polypeptide, nucleic acid (including DNA, RNA, mRNA, miRNA, shRNA, siRNA, dsDNA, lncRNA, siRNA) or other polynucleotide, polysaccharide or glycan, lipid or fatty acid, large molecule biologic, small molecule or toxin.


The term “nucleic acid,” refers to any compound and/or substance that is or can be incorporated into an oligonucleotide chain Exemplary nucleic acids for use in accordance with the present invention include, but are not limited to, one or more of DNA, RNA, hybrids thereof, RNAi-inducing agents, RNAi agents, siRNAs, shRNAs, miRNAs, antisense RNAs, ribozymes, catalytic DNA, RNAs that induce triple helix formation, aptamers, vectors, etc., described in detail herein.


The term “receiver” refers to a molecule that directs the exosome to a target and/or promotes the interaction of exosome with the target in the subject. In some embodiments, the receiver is a polypeptide. In some embodiments, the receiver is capable of increasing the concentration of the payload in the tissue of the subject. Examples of receivers include, but are not limited to, examples listed in Table 5.


The term “target” refers to, a cell, a pathogen, a metabolite, a polypeptide complex or any molecule or structure that resides in a tissue or circulates in the circulatory system or lymphatic system of the subject. Examples of targets include, but are not limited to, examples listed in Table 6.


The terms “administration,” “administering” and variants thereof refer to introducing a composition, such as an exosome, or agent into a subject and includes concurrent and sequential introduction of a composition or agent. The introduction of a composition or agent into a subject is by any suitable route, including orally, pulmonarily, intranasally, parenterally (intravenously, intramuscularly, intraperitoneally, or subcutaneously), rectally, intralymphatically, intrathecally or topically. Administration includes self-administration and the administration by another. A suitable route of administration allows the composition or the agent to perform its intended function. For example, if a suitable route is intravenous, the composition is administered by introducing the composition or agent into a vein of the subject.


As used herein, the term “antibody” encompasses an immunoglobulin whether natural or partly or wholly synthetically produced, and fragments thereof. The term also covers any protein having a binding domain that is homologous to an immunoglobulin binding domain. These proteins can be derived from natural sources, or partly or wholly synthetically produced. “Antibody” further includes a polypeptide comprising a framework region from an immunoglobulin gene or fragments thereof that specifically binds and recognizes an antigen. Use of the term antibody is meant to include whole antibodies, polyclonal, monoclonal and recombinant antibodies, fragments thereof, and further includes single-chain antibodies, humanized antibodies; murine antibodies; chimeric, mouse-human, mouse-primate, primate-human monoclonal antibodies, anti-idiotype antibodies, antibody fragments, such as, e.g., scFv, (scFv)2, Fab, Fab′, and F(ab′)2, F(ab1)2, Fv, dAb, and Fd fragments, diabodies, and antibody-related polypeptides. Antibody includes bispecific antibodies and multispecific antibodies so long as they exhibit the desired biological activity or function.


The term “antigen binding fragment” used herein refers to fragments of an intact immunoglobulin, and any part of a polypeptide including antigen binding regions having the ability to specifically bind to the antigen. For example, the antigen binding fragment can be a F(ab′)2 fragment, a Fab′ fragment, a Fab fragment, a Fv fragment, or a scFv fragment, but is not limited thereto. A Fab fragment has one antigen binding site and contains the variable regions of a light chain and a heavy chain, the constant region of the light chain, and the first constant region CH1 of the heavy chain. A Fab′ fragment differs from a Fab fragment in that the Fab′ fragment additionally includes the hinge region of the heavy chain, including at least one cysteine residue at the C-terminal of the heavy chain CH1 region. The F(ab′)2 fragment is produced whereby cysteine residues of the Fab′ fragment are joined by a disulfide bond at the hinge region. A Fv fragment is the minimal antibody fragment having only heavy chain variable regions and light chain variable regions, and a recombinant technique for producing the Fv fragment is well known in the art. Two-chain Fv fragments can have a structure in which heavy chain variable regions are linked to light chain variable regions by a non-covalent bond. Single-chain Fv (scFv) fragments generally can have a dimer structure as in the two-chain Fv fragments in which heavy chain variable regions are covalently bound to light chain variable regions via a peptide linker or heavy and light chain variable regions are directly linked to each other at the C-terminal thereof. The antigen binding fragment can be obtained using a protease (for example, a whole antibody is digested with papain to obtain Fab fragments, and is digested with pepsin to obtain F(ab′)2 fragments), and can be prepared by a genetic recombinant technique. A dAb fragment consists of a VH domain. Single-chain antibody molecules can comprise a polymer with a number of individual molecules, for example, dimmer, trimer or other polymers.


The term “imaging agent” refers to molecules that serve as positive markers that can be used to visibly monitor over time the number or concentration of exosomes in vivo and/or in vitro.


The term “fluorescent compound” refers to imaging agents that produce a fluorescent signal upon excitation. Fluorescent compounds include those that are approved by the Food & Drug Administration for human use including, but not limited to, fluorescein, indocyanin green, and rhodamine B.


The term “detectable moiety” refers to any positive marker that can be used by any means to monitor over time the number or concentration of exosomes in vivo and/or in vitro.


The term “synthetic” when used to modify “exosome” refers to an exosome that is not naturally occurring.


The term “producer cell” refers to a parental cell that produces the exosomes. The producer cells can me mammalian, human or non-mammalian. Parent producer cells can include, but are not limited to, reticulocytes, erythrocytes, megakaryocytes, leukocytes, platelets, neutrophils, mesenchymal stem cells, connective tissue cells, neural cells and tumor cells. In some embodiments, the extracts comprising exosomes are derived from a plurality of donor cell types (e.g. 2, 3, 4, 5, 6, 7, 8, 9, 10, 50, 100, 500, 1000, 5000, or 10000 donor cell types) and are combined or pooled. Producer cells include mammalian cell lines and primary cells. Producer cells include cells grown in culture or cells isolated directly from a donor tissue or subject.


The term “in vivo” refers to processes that occur in a living organism.


The term “mammal” as used herein includes both humans and non-humans mammals.


The term “sufficient amount” means an amount sufficient to produce a desired effect, e.g., an amount sufficient to modulate a condition in the subject.


The term “therapeutically effective amount” is an amount that is effective to ameliorate a symptom of a disease. A therapeutically effective amount can be a “prophylactically effective amount” as prophylaxis can be considered therapy.


As used herein, the term “modulate,” “modulating”, “modify,” and/or “modulator” generally refers to the ability to alter, by increase or decrease, e.g., directly or indirectly promoting/stimulating/upregulating or interfering with/inhibiting/downregulating a specific concentration, level, expression, function or behavior, such as, e.g., to act as an antagonist or agonist. In some instances a modulator can increase and/or decrease a certain concentration, level, activity or function relative to a control, or relative to the average level of activity that would generally be expected or relative to a control level of activity.


The term “pharmaceutically-acceptable” and grammatical variations thereof, refers to compositions, carriers, diluents and reagents capable of administration to or upon a subject without the production of undesirable physiological effects to a degree that would prohibit administration of the composition.


As used herein, the term “substantially” or “substantial” refers, e.g., to the presence, level, or concentration of an entity in a particular space, the effect of one entity on another entity, or the effect of a treatment. For example, an activity, level or concentration of an entity is substantially increased if the increase is 2-fold, 3-fold, 4-fold, 5-fold, 10-fold, 50-fold, 100-fold, or 1000-fold relative to a baseline. An activity, level or concentration of an entity is also substantially increased if the increase is 5%, 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 200%, or 500% relative to a baseline.


Abbreviations used in this application include the following: “miRNA” refers to microRNA, “siRNA” refers to small interfering RNA, “shRNA” refers to small or short hairpin RNA and “lncRNA” refers to long non-coding RNA.


It must be noted that, as used in the specification and the appended claims, the singular forms “a,” “an” and “the” include plural referents unless the context clearly dictates otherwise.


Exosomes

In some embodiments, the exosome comprises a membrane that forms a particle that has a diameter of 30-100 nm, 30-200 nm or 30-500 nm. In some embodiments, the exosome comprises a membrane that forms a particle that has a diameter of 10-100 nm, 20-100 nm, 30-100 nm, 40-100 nm, 50-100 nm, 60-100 nm, 70-100 nm, 80-100 nm, 90-100 nm, 100-200 nm, 100-150 nm, 150-200 nm, 100-250 nm, 250-500 nm, or 10-1000 nm. In some embodiments, the membrane comprises lipids and fatty acids. In some embodiments, the membrane comprises one or more of phospholipids, glycolipids, fatty acids, sphingolipids, phosphoglycerides, sterols, cholesterols, and phosphatidylserine. In some embodiments, the lipid or fatty acid can be one or more of those listed in Table 3. In addition, the membrane can comprise one or more polypeptides and one or more polysaccharides, such as glycans.


In some embodiments, the exosome is generated by a producer cell (or parental cell), such as, e.g., a mammalian cell. In some embodiments, the membrane of the exosome comprises one or more molecules derived from the producer cell. The exosome can be generated in a cell culture system and isolated (e.g., by separating the exosome from the producer cell). Separation can be achieved by sedimentation. For example, the exosome can have a specific density between 0.5-2.0, 0.6-1.0, 0.7-1.0, 0.8-1.0, 0.9-1.0, 1.0-1.1, 1.1-1.2, 1.2-1.3, 1.4-1.5, 1.0-1.5, 1.5-2.0, and 1.0-2.0 kg/m3.


In some embodiments, the exosome is synthetic. For example, the exosome can comprise a payload, such as, e.g., a therapeutic polypeptide, nucleic acid (such as DNA or RNA) or other polynucleotide, polysaccharide or glycan, lipid or fatty acid, large biologic, small molecule or toxin such that the exosome is not naturally occurring. In some embodiments, the exosome is modified (e.g., by introducing a payload or otherwise modifying the content of the complex, such as by changing the protein, lipid or glycan content of the membrane). For example, exosomes are first isolated from a producer cell and then modified as desired, thereby generating synthetic exosomes. In some embodiments, the producer cell is modified. For example, an exogenous nucleic acid, an exogenous polypeptide or small molecule or toxin can be introduced into to the producer cell. Alternatively or in addition, the producer cell can otherwise be modified (e.g., by modifying the cellular or membrane content, such as by changing the lipid or glycan content of the cell membrane). Exosomes generated from the modified producer cells comprise one or more of the modifications of the producer cell. The process produces synthetic exosomes. In some embodiments, both the producer cell and the exosome isolated from the producer cell are modified as described herein.


In some embodiments, the exosome delivers the payload (therapeutic agent) to a target. The payload is a therapeutic agent that acts on a target (e.g., a target cell) that is contacted with the exosome. Contacting can occur (e.g., in vitro) or in a subject. Payloads that can be introduced into an exosome and/or a producer cell include therapeutic agents such as, nucleotides (e.g., nucleotides comprising a detectable moiety or a toxin or that disrupt transcription), nucleic acids (e.g., DNA or mRNA molecules that encode a polypeptide such as an enzyme, or RNA molecules that have regulatory function such as miRNA, dsDNA, lncRNA, siRNA), amino acids (e.g., amino acids comprising a detectable moiety or a toxin or that disrupt translation), polypeptides (e.g., enzymes), lipids, carbohydrates, and small molecules (e.g., small molecule drugs and toxins). The payload can comprise nucleotides (e.g., nucleotides that are labeled with a detectable or cytotoxic moiety, such as a radiolabel).


In some embodiments, the exosome comprises nucleotides and/or polynucleotides (e.g., nucleic acids). For example, the exosome can comprise RNA, DNA, mRNA, miRNA, dsDNA, lncRNA, siRNA, or singular nucleotides. In some embodiments, the exosome comprises one or more of the miRNAs listed in Table 7. In some embodiments, the nucleotides and polynucleotides are synthetic. For example, an exogenous nucleic acid can be introduced into the exosome and/or the producer cell. In some embodiments, the nucleic acid is DNA that can be transcribed into an RNA (e.g., a siRNA or mRNA) and in the case of an mRNA can be translated into a desired polypeptide. In some embodiments, the nucleic acid is an RNA (e.g., an siRNA or mRNA) and in the case of an mRNA can be translated into a desired polypeptide.


In some embodiments, the exosome comprises a nucleic acid, such as a RNA, DNA mRNA, miRNA, siRNA, dsDNA, lncRNA or siRNA. The nucleic acid is delivered to a target cell as a payload. The target cell can transcribe a DNA payload into an RNA such as a siRNA. In case a mRNA is transcribed by the target cell from the DNA payload, the cell can translate the mRNA into a polypeptide (e.g., therapeutic polypeptide). The target cell can also translate a delivered mRNA payload into a polypeptide.


In some embodiments, the producer cell comprises a nucleic acid that can be transcribed (e.g., a DNA can be transcribed into a siRNA or mRNA), and in certain embodiments, mRNA is made the mRNA can be translated by the producer cell into a polypeptide. The producer cell can also be modified with a non-translatable RNA (e.g., siRNA) or mRNA. In case an mRNA is transferred the producer cell can translate the mRNA into a polypeptide. Exosomes derived from the producer cell can then carry the non-translatable RNA, the transcribed RNA or the translated polypeptide as a payload.


The exosome can interact with the target cell via membrane fusion and deliver payloads (e.g., therapeutic agents) in an exosome composition to the surface or cytoplasm of a target cell. In some embodiments, membrane fusion occurs between the exosome and the plasma membrane of a target cell. In other embodiments, membrane fusion occurs between the exosome and an endosomal membrane of a target cell.


In some embodiments, the exosome comprises polypeptides on its surface selected from CD47, CD55, CD40, CD63, CD9, CD81, CD133 and CD59. In some embodiments, the exosome is modified to contain the one or more polypeptides. In some embodiments, the producer cell is modified to contain the one or more polypeptides. In some embodiments, the producer cell naturally contains the one or more polypeptides and exosomes derived therefrom also contain the polypeptides. The levels of any desired surface marker can be modified directly on the exosome (e.g., by contacting the complex with recombinantly produced polypeptides to bring about insertion in or conjugation to the membrane of the complex). Alternatively or in addition, the levels of any desired surface marker can be modified directly on the producer cell (e.g., by contacting the complex with recombinantly produced polypeptides to bring about insertion in or conjugation to the membrane of the cell). Alternatively, the producer cell can be modified by transducing an exogenous nucleic acid into the producer cell to express a desired surface marker. The surface marker can already be naturally present on the producer cell, in which case the exogenous construct can lead to overexpression of the marker and increased concentration of the marker in or on the producer cell. Alternatively, a naturally expressed surface marker can be removed from the producer cell (e.g., by inducing gene silencing in the producer cell). The polypeptides can confer different functionalities to the exosome (e.g., specific targeting capabilities, delivery functions (e.g., fusion molecules), enzymatic functions, increased or decreased half-life in vivo, etc). In some embodiments, the polypeptides include, but are not limited to CD47, CD55, CD49, CD40, CD133, CD59, glypican-1, CD9, CD63, CD81, integrins, selectins, lectins, and cadherins.


In some embodiments, the exosome comprises a receiver polypeptide. The receiver polypeptide can be synthetic. In some embodiments, the receiver polypeptide is introduced into the producer cell (e.g., an exogenous nucleic acid that encodes the receiver polypeptide is introduced into the producer cell) or a recombinant receiver polypeptide that is made outside the producer cell (e.g., synthesized by a protein expression system). In some embodiments, the receiver polypeptide (e.g., a recombinantly produced polypeptide) is introduced into the exosome directly (e.g., after the exosome is isolated from the producer cell). In some embodiments, the receiver polypeptide can be on the surface of the exosomes. In some embodiments, the receiver polypeptide is capable of targeting the exosome to a specific target (e.g., a target such as a pathogen, a metabolite, a polypeptide complex or a cell such as non-functional cell or cancer cell) that circulates in the circulatory system of the subject, such as the blood, or a target that resides in a tissue (such as a diseased tissue).


Membrane Compositions of the Exosomes

Exosomes, exosome-like vesicles, matrix vesicles, microparticles, nanovesicles, oncosomes, prostasomes, secreted vesicles, microvesicles, ectosomes, and apoptotic bodies have been found to mediate interaction between cells, mediate non-classical protein secretion, facilitating processes such as antigen presentation, in trans signaling to neighboring cells and transfer of RNAs and protein. These vesicles are secreted by different cell types/tissues and harbor a common set of molecules that are essential for their structure and trafficking apart from distinct subsets of proteins/RNA, which, presumably, reflect the biological function of the producer cell. (Mathivanan, S et al. Exocarta—A compendium of exosomal proteins and RNA, Proteomics (2009)).


In some embodiments, exosome compositions are comprised of proteins, lipids, sugars, and nucleotides. In some embodiments, exosomes have a cholesterol-rich lipid membrane comprising one or more of sphingomyelin, ceramide, lipid rafts and exposed phosphatidylserine.


Exosome compositions can comprise adhesion molecules, signaling molecules, soluble proteins, T-cell stimulating molecules, transmembrane molecules, membrane trafficking proteins, cytoskeleton components, chaperones, lipid rafts, or nucleotides.


1. Lipids


In an embodiment, the exosome comprises a membrane that sediments at approximately 1,000-200,000×g and comprises a density of approximately 0.8-1.4 g/ml. In some embodiments, exosomes have a density in sucrose of about 1.10 to 1.19 g/ml, sedimented at 100,000×g, or about 1.0 to 1.3 g/ml. The mass of the membrane component can be assessed by separating it from the remainder of the complex using hypotonic solutions of mildly alkaline buffer (see e.g., protocols in Dodge et al 1963, Arch Biochem Biophys 100:119).


The exosome comprises a membrane. In some embodiments, the membrane comprises phosphatidylcholine, sphingomyelin, lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, or phosphatidic acid. In some embodiments, the membrane is a cell membrane.


In an embodiment, the exosome comprises lipid molecules of the class of choline phospholipids, acidic phospholipids, and phosphatidylethanolamine.


In an embodiment, the exosome comprises phosphatidylcholine, sphingomyelin, lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, or phosphatidic acid.


In some embodiments exosome comprises ceramine, lipid rafts, exposed phosphatidylserine, or diaclglycerol.


In some embodiments exosomes comprise lipids.


In an embodiment, the exosome comprises choline phospholipids in an approximate amount of 50%, 51%, 52%, 53%, 54%, 55%, 56%, 57%, 58%, 59%, 60%, 61%, 62%, 63%, 64%, or 65% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises acidic phospholipids in an approximate amount of 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, or 20% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises phosphatidylcholine in an amount greater than 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%. 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, or greater than 50% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises sphingomyelin in an amount greater than 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%. 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, or greater than 50% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises lysophosphatidylcholine in an amount greater than 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 1.5%, 2%, 2.5%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, or greater than 10% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises phosphatidylethanolamine in an amount greater than 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%. 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, or greater than 50% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises phosphatidylserine in an amount greater than 1%, 1.5%, 2%, 2.5%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19%, 20%, 21%, 22%, 23%, 24%, 25%, 26%, 27%, 28%, 29%, 30%, 31%, 32%, 33%, 34%, 35%, 36%, 37%, 38%. 39%, 40%, 41%, 42%, 43%, 44%, 45%, 46%, 47%, 48%, 49%, 50%, or greater than 50% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises phosphatidylinositol in an amount greater than 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 1.5%, 2%, 2.5%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, or greater than 10% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises phosphatidic acid in an amount greater than 0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 0.6%, 0.7%, 0.8%, 0.9%, 1%, 1.5%, 2%, 2.5%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, or greater than 10% relative to the total lipid content of the complex.


In an embodiment, the exosome comprises molecules from at least one, two, or three, of the following classes of molecules, including, but not limited to, choline phospholipids, acidic phospholipids, and phosphatidylethanolamine.


In an embodiment, the molar ratio of choline phospholipids to acidic phospholipids in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the molar ratio of choline phospholipids to phosphatidyl ethanolamine in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the molar ratio of phosphatidylethanolamine to acidic phospholipids in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the exosome comprises molecules from at least one, two, three, four, five, six, or seven of the following classes of molecules, including, but not limited to, phosphatidylcholine, sphingomyelin, lysophosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidylinositol, or phosphatidic acid.


In an embodiment, the exosome comprises at least one lipid selected from Table 3.


The lipid composition of the exosome can be experimentally measured using methods known in the art including, e.g., gas-liquid chromatography or thin layer chromatography, see for example, Dodge & Phillips, J Lipid Res 1967 8:667.


In an embodiment, the exosome comprises a lipid bilayer composed of an inner leaflet and an outer leaflet. The composition of the inner and outer leaflet can be determined by transbilaycr distribution assays known in the art, see e.g., Kuypers et al. Biohim Biophys Acta 1985 819:170. In an embodiment, the composition of the outer leaflet is between approximately 70-90% choline phospholipids, between approximately 0-15% acidic phospholipids, and between approximately 5-30% phosphatidylethanolamine. In an embodiment, the composition of the inner leaflet is between approximately 15-40% choline phospholipids, between approximately 10-50% acidic phospholipids, and between approximately 30-60% phosphatidylethanolamine.


2. Cholesterol


In an embodiment, the exosome comprises cholesterol. In an embodiment, the cholesterol content is between approximately 3.0-5.5 nmol cholesterol per 10{circumflex over ( )}7 complexes. In an embodiment, the cholesterol content is between approximately 1.8-3.5 nmol cholesterol per 10{circumflex over ( )}7 complexes. In an embodiment, the cholesterol content accounts for >5 mol % of membrane lipids. In an embodiment, the molar ratio of cholesterol to phospholipids in the complex is between approximately 0.5-1.5. In an embodiment the molar ratio of cholesterol to phospholipids is between approximately 0.8-1.2. In an embodiment the molar ratio of cholesterol to phospholipids is between approximately 0.84-0.9. In an embodiment the molar ratio of cholesterol to phospholipids is between approximately 0.5-0.75. In an embodiment the molar ratio of cholesterol to phospholipids is between approximately 0.55-0.6.


3. Lipids, Proteins, and Carbohydrates


In an embodiment, approximately 52% of the membrane mass is protein, approximately 40% is lipid, and approximately 8% is carbohydrate. In an embodiment, approximately 7% of the carbohydrate content is comprised of glycosphingolipids and approximately 93% of the carbohydrate content is comprised of O-linked and N-linked oligosaccharides on membrane-associated polypeptides.


In an embodiment, the mass ratio of lipid to protein in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the mass ratio of lipid to carbohydrate in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the mass ratio of carbohydrate to protein in the exosome is less than 1:1000, approximately 1:1000, approximately 1:500, approximately 1:250, approximately 1:100, approximately 1:50, approximately 1:25, approximately 1:10, approximately 1:9, approximately 1:8, approximately 1:7, approximately 1:6, approximately 1:5, approximately 1:4, approximately 1:3, approximately 1:2, approximately 1:1, approximately 2:1, approximately 3:1, approximately 4:1, approximately 5:1, approximately 6:1, approximately 7:1, approximately 8:1, approximately 9:1, approximately 10:1, approximately 25:1, approximately 50:1, approximately 100:1, approximately 250:1, approximately 500:1, approximately 1000:1, or greater than approximately 1000:1.


In an embodiment, the area occupancy of protein in the exosome is approximately 23% and the area occupancy of lipid in the exosome is approximately 77%.


Exosomes do not contain a random sampling of their producer cell's cytoplasm, but are enriched in specific mRNA, miRNA and proteins (Bobrie, et al., Traffic 12:1665-1668, 2011). Some exosomes express surface markers e.g., MHC-II, MHC-I, CD86 and ICAM-1. Some exosomes express molecules with biologic activity (such as Fas ligand, PD-1, MICA/B, mdr1, MMPs, CD44, and autoreactive antigens). This cargo is protected from degradation by proteases and RNases while the complex is in the interstitial space, and retains bioactivity once taken up by a recipient cell. In this way, exosomes facilitate the transfer of interactive signaling and enzymatic activities that would otherwise be restricted to individual cells based on gene expression (Lee, et al, Semin Immunopathol 33:455-467, 2011).


In an embodiment, the exosome comprises a polypeptide selected from the following list, including but not limited to, spectrin, myosin-like polypeptide, band 3, SLC4A1, actin, actin-like polypeptide, glyceraldehyde 3-P dehydrogenase (G3PD), tetraspanins, Alix and TSG101, integrins, selectins, CR1, TNFRI, proteolytic enzymes, glycosylphosphatidylinositol (GPI)-linked proteins or histones.


In an embodiment, the exosome comprises at least one polypeptide selected from Table 4.


In an embodiment, the exosome comprises at least one, two, three, four, five, six, or seven of the polypeptides selected from the following list, including but not limited to, spectrin, myosin-like polypeptide, band 3, SLC4A1, actin, actin-like polypeptide, glyceraldehyde 3-P dehydrogenase (G3PD), tetraspanins, Alix and TSG101, integrins, selectins, CR1, TNFRI, proteolytic enzymes, glycosylphosphatidylinositol (GPI)-linked proteins or histones.


Payloads

Exosomes can comprise payloads such as peptides, proteins, DNA, RNA, siRNA and other macromolecules (e.g., small therapeutic molecules). In some embodiments, the payload is transferred to a producer cell by applying controlled injury to the cell for a predetermined amount of time in order to cause perturbations in the cell membrane such that the payload can be delivered to the inside of the cell (e.g., the cytoplasm). In some embodiments the payload is transferred to an exosome isolated from a producer cell by applying controlled injury to the exosome for a predetermined amount of time in order to cause perturbations in the complex membrane such that the payload can be delivered to the inside of the exosome. In some embodiments the payload of the exosome can be loaded within the membrane or interior portion of the exosome.


The payload can be a therapeutic agent selected from a variety of known small molecule pharmaceuticals. Alternatively, the payload can be a therapeutic agent selected from a variety of macromolecules, such as, e.g., an inactivating peptide nucleic acid (PNA), an RNA or DNA oligonucleotide aptamer, an interfering RNA (iRNA), a peptide or a protein.


In some embodiments, the payload that can be delivered to a target by an exosome includes, but is not limited to, RNA, DNA, siRNA, mRNA, lncRNA, iRNA, polypeptides, enzymes, cytokines, antibodies, antibody fragments, small molecules, chemotherapeutics, metals, viral particles, imaging agents and plasmids.


In some embodiment, the exosome comprises a payload of siRNA capable of interfering with the expression of an oncogene or other dysregulating polypeptide. In some embodiments, the siRNA is capable of interfering with the expression of BCR-ABL, clusterin, survivin, B-catenin, CXCR4, BRCA-1 or BRCA-2.


In another embodiment, the exosome comprises a payload of antibodies, scFv, or nanobody that have intracellular targets including, but not limited to, tau, amyloid beta, WT1, LMP2, HPV E6 E7, MAGE A3, p53, NY-ESO-1, MelanA/MART1, Ras, gp100, proteinase 3, bcr-abl, tyrosinase, surviving, hTERT and ML-IAP.


In another embodiment, the exosome comprises a payload of proteins, antibodies, polypeptides, or mRNAs encoding a polypeptides that include IL-1, IL-2, insulin, erythropoietin, anti-TNFalpha, glucocerebrosidase, interferon beta 1a, interferon beta 1b, agalsidase beta, velaglucerase alfa, dornase alfa, alpha galactosidase A, idursulfase, adalimumab, etancercept, rituximab, infliximab, trastuzumab, bevacizumab, filgrastim and ranibizumab.


In another embodiment, the exosome comprises a payload of miRNA, including, but not limited to, let-7a, let-7b, let-7c, mir-34, miR-101, miR-215 or miR-16.


In another embodiment, the exosome comprises a payload of small molecules, including, but is not limited to, doxorubicin, daunorubicin, docetaxel, irinotecan, taxanes, topoisomerase inhibitors, cyclophosphamide, vinca alkaloids, cisplatin, retinoids, nucleotide analogs and kinase inhibitors.


In some embodiments the payload of the exosome is a nucleic acid molecule, e.g., mRNA or DNA, and the exosome targets the payload to the cytoplasm of the recipient or target cell, such that the nucleic acid molecule can be translated (if mRNA) or transcribed and translated (if DNA) and thus produce the polypeptide encoded by the payload nucleic acid molecule within the target cell. In an embodiment, the polypeptide encoded by the payload nucleic acid molecule is secreted by the target cell, thus modulating the systemic concentration or amount of the polypeptide encoded by the payload nucleic acid molecule in the subject. In an embodiment, the polypeptide encoded by the payload nucleic acid molecule is not secreted by the target cell, thus modulating the intracellular concentration or amount of the polypeptide encoded by the payload nucleic acid molecule in the subject. In an embodiment, the polypeptide encoded by the payload nucleic acid molecule is toxic to the target cell or to other cell or tissue in the subject, e.g., toxic to a cancer cell. In an embodiment, the polypeptide encoded by the payload nucleic acid molecule is not toxic to the target cell or other cell or tissue in the subject, e.g., is therapeutically beneficial or corrects a disease phenotype.


The mRNA can be naked or modified, as desired. mRNA modification that improve mRNA stability and/or decrease immunogenicity include, e.g., ARCA: anti-reverse cap analog (m27,3′-OGP3G), GP3G (Un methylated Cap Analog), m7GP3G (Monomethylated Cap Analog), m32.2.7GP3G (Trimethylated Cap Analog), m5CTP (5′-methyl-cytidine triphosphate), m6ATP (N6-methyl-adenosine-5′-triphosphate), s2UTP (2-thio-uridine triphosphate) and Ψ (pseudouridine triphosphate).


In some embodiments, the payload of the exosome is a miRNA or pre-miRNA molecule, and the exosome targets the payload to the cytoplasm of the target cell, such that the miRNA molecule can silence a native mRNA in the target cell. miRNAs are small non-coding RNAs that are about 17 to about 25 nucleotide bases (nt) in length in their biologically active form. miRNAs post-transcriptionally regulate gene expression by repressing target mRNA translation. It is thought that miRNAs function as negative regulators. There are three forms of miRNAs existing in vivo, primary miRNAs (pri-miRNAs), premature miRNAs (pre-miRNAs), and mature miRNAs. Primary miRNAs (pri-miRNAs) are expressed as stem-loop structured transcripts of about a few hundred bases to over 1 kb. The pri-miRNA transcripts are cleaved in the nucleus by an RNase II endonuclease called Drosha that cleaves both strands of the stem near the base of the stem loop. Drosha cleaves the RNA duplex with staggered cuts, leaving a 5′ phosphate and 2 nt overhang at the 3′ end. The cleavage product, the premature miRNA (pre-miRNA) is about 60 to about 110 nt long with a hairpin structure formed in a fold-back manner. Pre-miRNA is transported from the nucleus to the cytoplasm by Ran-GTP and Exportin-5. Pre-miRNAs are processed further in the cytoplasm by another RNase II endonuclease called Dicer. Dicer recognizes the 5′ phosphate and 3′ overhang, and cleaves the loop off at the stem-loop junction to form miRNA duplexes. The miRNA duplex binds to the RNA-induced silencing complex (RISC), where the antisense strand is preferentially degraded and the sense strand mature miRNA directs RISC to its target site. It is the mature miRNA that is the biologically active form of the miRNA and is about 17 to about 25 nt in length. MicroRNAs function by engaging in base pairing (perfect or imperfect) with specific sequences in their target genes' messages (mRNA). The miRNA degrades or represses translation of the mRNA, causing the target genes' expression to be post-transcriptionally down-regulated, repressed, or silenced. In animals, miRNAs do not necessarily have perfect homologies to their target sites, and partial homologies lead to translational repression, whereas in plants, where miRNAs tend to show complete homologies to the target sites, degradation of the message (mRNA) prevails. MicroRNAs are widely distributed in the genome, dominate gene regulation, and actively participate in many physiological and pathological processes. For example, the regulatory modality of certain miRNAs is found to control cell proliferation, differentiation, and apoptosis; and abnormal miRNA profiles are associated with oncogenesis.


In an embodiment, the exosome comprises as a receiver synaptobrevin, as a payload an mRNA molecule encoding ricin toxin, and is useful for targeting the payload mRNA to tumor cells such that the mRNA is translated and the cells are killed.


In an embodiment, the exosome comprises as a receiver mannose, as a payload an mRNA molecule encoding glucocerebrosidase, and is useful for targeting the payload mRNA to macrophages in a subject with Gaucher's disease such that the mRNA is translated and the restorative enzyme is expressed, thus rescuing the recipient macrophage.


In some embodiments, the payload can be engineered for specific trafficking from the producer cell into the exosome. In some embodiments, the receiver or payload can be directed for trafficking by an addition of a molecule to the payload (e.g., conjugation or fusion of another molecule). In certain embodiments, the additional molecule can be appended via a linker. In certain embodiments, the payload can be directed for trafficking by modifying the payload composition (e.g., a nucleotide change for nucleic acid payloads or amino acid change for polypeptide payloads). In some embodiments a receiver can be directed for trafficking by modifying the payload sequence to share increased homology with part or all of a lipid listed in Table 3, or a nucleic acid listed in Table 7.


In some embodiments, a nucleic acid payload can be engineered for specific trafficking from the producer cell into the exosome. In certain embodiments, a nucleic acid payload (e.g., mRNA or miRNA) can comprise a sequence in the coding or noncoding region that targets the nucleic acid to the exosome. In certain embodiments, the noncoding region can include a 3′ UTR or 5′ UTR.


In some embodiments the payload of the exosome can be a membrane protein delivered to the plasma membrane or endosomal membrane of the recipient cell.


Exosomes can comprise two or more payloads, including mixtures, fusions, combinations and conjugates, of atoms, molecules, etc. as disclosed herein, for example including but not limited to, a nucleic acid combined with a polypeptide; two or more polypeptides conjugated to each other; a protein conjugated to a biologically active molecule (which can be a small molecule such as a prodrug); and the like.


Suitable payloads include, without limitation, pharmacologically active drugs and genetically active molecules, including antineoplastic agents, anti-inflammatory agents, hormones or hormone antagonists, ion channel modifiers, and neuroactive agents. Examples of suitable payloads of therapeutic agents include those described in, “The Pharmacological Basis of Therapeutics,” Goodman and Gilman, McGraw-Hill, New York, N.Y., (1996), Ninth edition, under the sections: Drugs Acting at Synaptic and Neuroeffector Junctional Sites; Drugs Acting on the Central Nervous System; Autacoids: Drug Therapy of Inflammation; Water, Salts and Ions; Drugs Affecting Renal Function and Electrolyte Metabolism; Cardiovascular Drugs; Drugs Affecting Gastrointestinal Function; Drugs Affecting Uterine Motility; Chemotherapy of Parasitic Infections; Chemotherapy of Microbial Diseases; Chemotherapy of Neoplastic Diseases; Drugs Used for Immunosuppression; Drugs Acting on Blood-Forming organs; Hormones and Hormone Antagonists; Vitamins, Dermatology; and Toxicology, all incorporated herein by reference. Suitable payloads further include toxins, and biological and chemical warfare agents, for example, see Somani, S. M. (ed.), Chemical Warfare Agents, Academic Press, New York (1992)).


In some embodiments, the payload is a therapeutic agent, such as a small molecule drug or a large molecule biologic. Large molecule biologics include, but are not limited to, a protein, polypeptide, or peptide, including, but not limited to, a structural protein, an enzyme, a cytokine (such as an interferon and/or an interleukin), a polyclonal or monoclonal antibody, or an effective part thereof, such as an Fv fragment, which antibody or part thereof, can be natural, synthetic or humanized, a peptide hormone, a receptor, or a signaling molecule.


Large molecule biologics are immunoglobulins, antibodies, Fv fragments, etc., that are capable of binding to antigens in an intracellular environment. These types of molecules are known as “intrabodies” or “intracellular antibodies.” An “intracellular antibody” or an “intrabody” includes an antibody that is capable of binding to its target or cognate antigen within the environment of a cell, or in an environment that mimics an environment within the cell. Selection methods for directly identifying such “intrabodies” include the use of an in vivo two-hybrid system for selecting antibodies with the ability to bind to antigens inside mammalian cells. Such methods are described in PCT/GB00/00876, incorporated herein by reference. Techniques for producing intracellular antibodies, such as anti-β-galactosidase scFvs, have also been described in Martineau et al., J Mol Biol 280:117-127 (1998) and Visintin et al., Proc. Natl. Acad. Sci. USA 96:11723-1728 (1999).


Large molecule biologics include but is not limited to, at least one of a protein, a polypeptide, a peptide, a nucleic acid, a virus, a virus-like particle, an amino acid, an amino acid analogue, a modified amino acid, a modified amino acid analogue, a steroid, a proteoglycan, a lipid and a carbohydrate or a combination thereof (e.g., chromosomal material comprising both protein and DNA components or a pair or set of effectors, wherein one or more convert another to active form, for example catalytically).


A large molecule biologic can include a nucleic acid, including, but not limited to, an oligonucleotide or modified oligonucleotide, an antisense oligonucleotide or modified antisense oligonucleotide, an aptamer, a cDNA, genomic DNA, an artificial or natural chromosome (e.g., a yeast artificial chromosome) or a part thereof, RNA, including an siRNA, a shRNA, mRNA, tRNA, rRNA or a ribozyme, or a peptide nucleic acid (PNA); a virus or virus-like particles; a nucleotide or ribonucleotide or synthetic analogue thereof, which can be modified or unmodified.


The large molecule biologic can also be an amino acid or analogue thereof, which can be modified or unmodified or a non-peptide (e.g., steroid) hormone; a proteoglycan; a lipid; or a carbohydrate. If the large molecule biologic is a polypeptide, it can be loaded directly into a producer cell according to the methods described herein. Alternatively, an exogenous nucleic acid encoding a polypeptide, which sequence is operatively linked to transcriptional and translational regulatory elements active in a producer cell at a target site, can be loaded.


Small molecules, including inorganic and organic chemicals, can also be used as payloads of the exosomes described herein.


In some embodiments, the small molecule is a pharmaceutically active agent. Useful classes of pharmaceutically active agents include, but are not limited to, antibiotics, anti-inflammatory drugs, angiogenic or vasoactive agents, growth factors and chemotherapeutic (anti-neoplastic) agents (e.g., tumour suppressers).


If a prodrug is loaded into the exosome in an inactive form it is often useful that the exosome further comprises an activating polypeptide which converts the inactive prodrug to active drug form. In an embodiment, activating polypeptides include, but are not limited to, viral thymidine kinase (encoded by Genbank Accession No. J02224), carboxypeptidase A (encoded by Genbank Accession No. M27717), α-galactosidase (encoded by Genbank Accession No. M13571), β-glucuronidase (encoded by Genbank Accession No. M15182), alkaline phosphatase (encoded by Genbank Accession No. J03252 J03512), or cytochrome P-450 (encoded by Genbank Accession No. D00003 N00003), plasmin, carboxypeptidase G2, cytosine deaminase, glucose oxidase, xanthine oxidase, β-glucosidase, azoreductase, t-gutamyl transferase, β-lactamase and penicillin amidase.


Either the activating polypeptide or the exogenous gene encoding it can be transduced into a producer cell to generate a exosome. Both the prodrug and the activating polypeptide can be encoded by genes on the same exogenous nucleic acid. Furthermore, either the prodrug or the activating polypeptide of the prodrug can be transgenically expressed in a producer cell.


In an embodiment, the prodrug and/or the activating polypeptide of the prodrug are expressed in a target cell.


Imaging Agents

In certain embodiments, the exosomes are also be labeled with one or more positive markers that can be used to monitor over time the number or concentration of exosomes in vivo. Suitable fluorescent compounds include those that are approved by the Food & Drug Administration for human use including but not limited to fluorescein, indocyanin green, and rhodamine B. For example, producer cells or exosomes can be non-specifically labeled with fluorescein isothiocyanate (FITC; Bratosin et al., Cytometry 46:351-356 (2001)). For example, a solution of FITC-labeled lectins in phosphate buffered saline (PBS) with 0.2 mM phenylmethysulfonyl fluoride (PMSF) is added to an equal volume of producer cells or isolated exosomes in the same buffer. The cells or complexes are incubated with the FITC-labeled lectins for 1 h at 4° C. in the dark. The lectins bind to sialic acids and beta-galactosyl residues on the surface of the producer cells or exosomes.


Other dyes can be useful for tracking exosomes in vivo. A number of reagents can be used to non-specifically label an exosome. For example, producer cells or exosomes are optionally labeled with PKH26 Red (See, e.g., Bratosin, et al., (1997) Cytometry 30:269-274). Producer cells (e.g. 1-3×107 cells) are suspended in 1 ml of diluent and rapidly added to 1 ml or 2 μM PKH26 dissolved in the same diluent. The mixture is mixed by gentle pipetting and incubated at 25° C. for 2-5 min with constant stirring. The labeling can be stopped by adding an equal volume of human serum or compatible protein solution (e.g., 1% bovine serum albumin). After an additional minute, an equal volume of cell culture medium is added and the cells are isolated by centrifugation at 2000×g for 5 min. Cells or complexes are washed three times by repeated suspension in cell culture medium and centrifugation. PHK26-labeled exosomes can be monitored with a maximum excitation wavelength of 551 nm and a maximum emission wavelength of 567 nm.


Exosomes are optionally tracked in vivo using VivoTag 680 (VT680; VisEn Medical, Woburn, Mass., USA), a near-infrared fluorochrome with a peak excitation wavelength of 670±5 nm and a peak emission wavelength of 688±5 nm. VT680 also contains an amine reactive NHS ester which enables it to cross-link with proteins and peptides. The surface of producer cells or exosomes is optionally labeled with VT680 (See, e.g., Swirski, et al., (2007) PloS ONE 10:e1075). For example, 4×106 cells/ml are incubated with VT680 diluted in complete culture medium at a final concentration of 0.3 to 300 μg/ml for 30 min at 37° C. The cells are washed twice with complete culture medium after labeling. Cells or complexes can be non-specifically labeled based on proteins expressed on the surface of the producer cell or the exosome. Alternatively, a specific surface polypeptide (e.g., a receiver polypeptide) can be labeled with VT680. In some embodiments, a protein or peptide can be directly labeled with VT680 ex vivo and subsequently either attached to the surface of the cell or incorporated into the interior of the cell or complex using methods described herein. In vivo monitoring can, for example, be performed using the dorsal skin fold. Laser scanning microscopy can be performed using, for example, an Olympus IV 100 in which VT680 is excited with a red laser diode of 637 nm and detected with a 660/LP filter. Alternatively, multiphoton microscopy can be performed using, for example, a BioRad Radiance 2100 MP centered around an Olympus BX51 equipped with a 20×/0.95 NA objective lens and a pulsed Ti:Sapphire laser tuned to 820 nm. The latter wavelength is chosen because VT680 has a peak in its two-photon cross-section at 820 nm.


Alternatively or in addition, an exosome can be labeled with other red and/or near-infrared dyes including, for example, cyanine dyes such as Cy5, Cy5.5 and Cy7 (Amersham Biosciences, Piscataway, N.J., USA) and/or a variety of Alexa Fluor dyes including Alexa Fluor 633, Alexa Fluor 635, Alexa Fluor 647, Alexa Fluor 660, Alexa Fluor 680, Alexa Fluor 700 and Alexa Fluor 750 (Molecular Probes-Invitrogen, Carlsbad, Calif., USA). Additional suitable fluorophores include IRD41 and IRD700 (LI-COR, Lincoln, Nebr., USA), NIR-1 and 1C5-OSu (Dejindo, Kumamotot, Japan), LaJolla Blue (Diatron, Miami, Fla., USA), FAR-Blue, FAR-Green One, and FAR-Green Two (Innosense, Giacosa, Italy), ADS 790-NS and ADS 821-NS (American Dye Source, Montreal, Calif.). Quantum dots (Qdots) of various emission/excitation properties can also be used for labeling exosomes (See, e.g., Jaiswal et al., Nature Biotech. 21:47-51 (2003)). Many of these fluorophores are available from commercial sources either attached to primary or secondary antibodies or as amine-reactive succinimidyl or monosuccinimidyl esters, for example, ready for conjugation to a protein or proteins either on the surface or inside the exosome.


Magnetic nanoparticles are optionally used to track exosomes in vivo using high resolution MRI (Montet-Abou et al., Molecular Imaging 4:165-171 (2005)). Magnetic particles can be internalized by several mechanisms. Magnetic particles can be taken up by a producer cell or by an exosome through fluid-phase pinocytosis or phagocytosis. Alternatively, the magnetic particles can be modified to contain a surface agent such as, for example, a membrane translocating HIV TAT peptide which promotes internalization. In some instances, a magnetic nanoparticle such as, for example, Feridex IV®, an FDA approved magnetic resonance contrast reagent, are optionally internalized into a producer cell or exosome in conjunction with a transfection agent such as, for example, protamine sulfate (PRO), polylysine (PLL), and lipofectamine (LFA).


Surface Molecules or Markers

In some embodiments, the exosome comprises polypeptides on its surface selected from CD47, CD55, CD40, CD63, CD9, CD81, CD133 and CD59. In some embodiments, the exosome is modified to contain the one or more polypeptides. In some embodiments, the producer cell is modified to contain the one or more polypeptides. In some embodiments, the producer cell naturally contains the one or more polypeptides and exosomes derived therefrom also contain the polypeptides. The surface polypeptides can confer different functionalities to the exosome, e.g., specific targeting capabilities, delivery functions (e.g., fusion molecules), enzymatic functions, increased or decreased half-life in vivo, etc.


In some embodiments, the surface polypeptide can, e.g., stabilize the exosome, target the exosome to particular cells and tissues, engage the reticulo-endothelial system, protect the exosome from macrophages and other phagocytic cells, and/or evade other components of the innate immune system. Suitable polypeptides include, e.g., complement regulatory polypeptides, inhibitors of cell-mediated degradation (e.g., CD47, CD55, CD40, CD63, CD9, CD133 and CD59), and anti-inflammatory polypeptides. Alternatively or in addition, such polypeptides can shorten or control the half-life of the complex, including targeting to macrophages or other phagocytic cells. Suitable polypeptides can promote apoptosis or otherwise trigger opsonization.


For example, CD40 is a costimulatory protein found on antigen presenting cells and is required for their activation; CD63 is a cell surface glycoprotein that forms a complex with integrins; CD133 is thought to act as an organizer of cell membrane topology; and CD9 is a member of the transmembrane 4 superfamily, also known as the tetraspanin family that mediates signal transduction events.


As many drugs are systemically delivered to the blood circulatory system, the answer to the problem of effective drug delivery often focuses on maintaining the drug in the blood for extended periods of time. Thus, the development of long-circulating (long half-life) therapeutics that remain biologically available in the blood for extended time periods is an unmet need. The exosomes described herein can be modified to increase or decrease their half-life in circulation. In some embodiments, the half-life of the payload in circulation can be modified by altering the half-life of the exosome. In some instances, the half-life is increased and the increase can be, for instance from about 1.5-fold to 20-fold for a therapeutic agent payload maintained in the exosome when compared to a therapeutic agent not contained in the exosome and the half-life being measured in a serum-containing solution.


Residency of the exosome and/or the payload in the circulatory system, in certain embodiments, is determined by the presence or absence of certain polypeptides on the exosome. For example, the exosome can comprise a CD47, CD55, or CD59 polypeptide or a functional fragment thereof.


CD47 is a membrane protein that interacts with the myeloid inhibitory immunoreceptor SIRPα (also termed CD172a or SHPS-1) that is present, e.g., on macrophages. Engagement of SIRPα by CD47 provides a down-regulatory signal that inhibits host cell phagocytosis. For example, high levels of CD47 allow cancer cells to avoid phagocytosis despite the presence pro-phagocytic signals, such as high levels of calreticulin. CD47 also has further roles in cell adhesion, e.g., by acting as an adhesion receptor for THBS1 on producer cells and in the modulation of integrins. CD47 interaction with SIRPα further prevents maturation of immature dendritic cells, inhibits cytokine production by mature dendritic cells. CD47 interaction with SIRPγ mediates cell-cell adhesion, enhances superantigen-dependent T-cell-mediated proliferation and co-stimulates T-cell activation.


CD47 is a 50 kDa membrane receptor that has extracellular N-terminal IgV domain, five transmembrane domains, and a short C-terminal intracellular tail. There are four alternatively spliced isoforms of CD47 that differ only in the length of their cytoplasmic tail. In some embodiments, the exosome can comprise a CD47 or a functional fragment thereof comprising one or more of: the extracellular N-terminal IgV domain, one, two, three, four, or five transmembrane domains, and/or the short C-terminal intracellular tail. The cytoplasmic tail can be found as four different splice isoforms ranging from 4 to 36 amino acids. The 16 amino acid form 2 is expressed in all cells of hematopoietic origin and in endothelial and epithelial cells. The 36 amino acid form 4 is expressed primarily in neurons, intestine, and testis. The 4 amino acid form 1 is found in epithelial and endothelial cells. The expression pattern of the 23 amino acid form 3 resembles that of form 4. In some embodiments, the exosome comprises CD47 or a functional fragment thereof that is of one of form 1, from 2, form 3, or from 4. In some embodiments, the exosome does not comprise form 2. In some embodiments, the exosome comprises a modified CD47, such as a conformational change. For example, a conformational change in CD47 is introduced so that the modified CD47 is capable of interacting with TSP-1. In an embodiment, the modified CD47 comprising the conformational change creates a different binding site for SIRPα. In some embodiments, the exosome comprises a modified CD47 polypeptide or a functional polypeptide fragment thereof comprising a conformational change. In certain embodiments, the exosome comprises a fusion of a CD47 isoform to the extracellular domain of a native producer cell polypeptide. For example, the N- or C-terminus of a native polypeptide of a producer cell can be fused to the CD47 polypeptide or functional fragment thereof, which can lead to a reduction of the SIRPα-mediated signal to macrophages to phagocytose the exosome.


In some embodiments, the producer cells naturally express CD47. In some embodiments, the natural levels of CD47 are altered in the producer cell, e.g., by overexpression or inhibition of CD47 expression using any suitable method, such as the introduction of exogenous nucleic acids (e.g., expression vectors, CD47 mRNA, CD47 siRNA and the like).


For example, exosomes that are administered to a subject can comprise elevated CD47 levels when compared to native levels of a suitable control. Elevated CD47 levels can be achieved, e.g., by exogenous expression by the producer cell line of CD47 from an exogenous nucleic acid, by loading of CD47 mRNA into the producer cell or directly into the exosome, or by conjugating CD47 polypeptide to the surface of the producer cell or directly to the surface of the exosome. Elevated CD47 levels are useful to increase the half-life of the population of exosomes in the circulatory system of the subject. The exosomes comprise a payload (such as a therapeutic agent) and optionally a receiver and increasing the half-life of the exosome can increase the half-life of the payload in circulation. This potentially increases the therapeutic window in which payload is active. In one instance, a population of 1011 exosomes comprises an adenosine deaminase payload and an exogenous CD47 polypeptide on its surface. When administered to a subject with an enzyme deficiency, such as ADA-SCID, the half-life of the exosome is extended beyond that of a complex not comprising exogenous CD47 polypeptide and the subject requires less frequent dosing. Half-life extension is a particular advantage when compared to current enzyme therapies not involving exosomes.


In some embodiments, CD47 is altered by heparin and/or chondroitin sulfate glycosaminoglycan (GAG) chains. In some embodiments, the exosome comprises CD47 as a proteoglycan. In some embodiments, the exosome comprises a CD47 proteoglycan that is conjugated to the complex. In an embodiment, the CD47 proteoglycan comprises heparin and/or chondroitin sulfate glycosaminoglycan (GAG) chains. In an embodiment, that CD47 proteoglycan has a size of greater than 150 kDa, 200 kDa or greater than 250 kDa. In an embodiment, CD47 comprises one or more GAG chains at Ser64.


In some embodiments, the residency of an exosome generated using producer cells can be further modulated by changing the amount or number of oxidized lipids on the membrane of the exosome. In an embodiment, the exosome comprises oxidized lipids in an amount effective to shorten its half-life. In some embodiments, the amount of oxidized lipids in the membrane are altered such that mobility of CD47 is increased or decreased, thereby aiding or hindering, respectively the ability of CD47 to cluster on the membrane. (See, Olsson, Department of Integrative Medical Biology, Section for Histology and Cell Biology, Umea University, Umea, Sweden, 2008).


CD55, also known as complement decay-accelerating factor or DAF, is a 70 kDa membrane protein. CD55 recognizes C4b and C3b fragments of the complement system that are created during C4 (classical complement pathway and lectin pathway) and C3 (alternate complement pathway) activation. It is thought that interaction of CD55 with cell-associated C4b and C3b proteins interferes with their ability to catalyze the conversion of C2 and factor B to active C2a and Bb and thereby prevents the formation of C4b2a and C3bBb, the amplification convertases of the complement cascade. CD55 is thought to block the formation of membrane attack complexes. CD55 can prevent lysis by the complement cascade. In some embodiments, the exosome comprises CD55 polypeptide or a functional polypeptide fragment thereof. In some embodiments, the exosome comprises an exogenous CD55 polypeptide and an exogenous CD47 polypeptide or functional polypeptide fragments thereof.


CD59 glycoprotein also known as MAC-inhibitory protein (MAC-IP), membrane inhibitor of reactive lysis (MIRL), protectin, or HRF is a protein that attaches to host cells via a glycophosphatidylinositol (GPI) anchor. When complement activation leads to deposition of C5b678 on host cells, CD59 can prevent C9 from polymerizing and forming the complement membrane attack complex. CD59 can prevent lysis by the complement cascade. In some embodiments, the exosome comprises CD59 polypeptide or a functional polypeptide fragment thereof. In some embodiments, the exosome comprises an exogenous CD59 polypeptide and an exogenous CD47 polypeptide or functional polypeptide fragments thereof.


In some embodiments, the exosome comprises one or more of an exogenous CD55 polypeptide, an exogenous CD59 polypeptide and/or an exogenous CD47 polypeptide or functional polypeptide fragments thereof in a desired amount, copy number and/or ratio sufficient to regulate the residency of the exosome in circulation.


Effective amounts of CD47, CD55, and CD59 include 102, 103, 104, 105, 106, 107, 109 polypeptides per exosome. Alternatively, an effective amount is the amount capable of extending the exosome's half-life by 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 200%, 400%, 800%, 1,000%, or 10,000% relative to the half-life that the exosome would exhibit without the polypeptides.


Receivers

Optionally, the exosome comprises a receiver. In some embodiments, a receiver polypeptide comprises or consists essentially of a polypeptide. In some embodiments, a receiver comprises or consists essentially of a carbohydrate, a nucleic acid, a lipid, a small molecule or a combination thereof. In some embodiments, the receiver is synthetic. For example, the receiver is an exogenous polypeptide or molecule or is expressed from an exogenous nucleic acid.


In some embodiments, the receiver functions to “target”, e.g., aggregate around, concentrate itself in, home to, undergo a transformation near, or otherwise engage a target molecule, cell or tissue of interest. In some embodiments, a receiver is capable of interacting with a target, e.g., to associate with, bind to, or fuse with a target, such as a target cell in sufficient proximity and for a sufficient duration for the exosome to bring about delivery of the payload to the target.


In some embodiments, the interaction of the receiver with a target comprises altering an activity of the target. In some embodiments, the interaction of the receiver with a target comprises altering the composition of the target. In some embodiments, the interaction of the complex with a target comprises reducing an activity of the target. In some embodiments, the interaction of the complex with a target comprises inactivating the target.


In some embodiments, the interaction of the receiver with a target comprises altering the RNA composition of the target. In some embodiments, the interaction of the complex with a target comprises inducing translation in the target of a payload RNA.


In some embodiments, receivers comprise polypeptides. Receiver polypeptides can range in size from 6 amino acids to 3000 amino acids and can exceed 6, 10, 15, 20, 25, 30, 35, 40, 50, 60, 70, 80, 90, 100, 150, 200, 300, 400 or can exceed 500 amino acids. Receiver polypeptides can range in size from about 20 amino acids to about 500 amino acids, from about 30 amino acids to about 500 amino acids or from about 40 amino acids to about 500 amino acids.


In some embodiments, the receiver polypeptide comprises a chimeric or fusion protein which can comprise two or more distinct protein domains. These chimeric receivers are heterologous or exogenous in the sense that the various domains are derived from different sources, and as such, are not found together in nature and can be encoded e.g., by exogenous nucleic acids. Receiver polypeptides can be produced by a number of methods, many of which are well known in the art and also described herein. For example, receiver polypeptides can be obtained by extraction (e.g., from isolated cells), by expression of an exogenous nucleic acid encoding the receiver polypeptide, or by chemical synthesis. Receiver polypeptides can be produced by, for example, recombinant technology, and expression vectors encoding the polypeptide introduced into host cells (e.g., by transformation or transfection) for expression of the encoded receiver polypeptide.


There are a variety of conservative changes that can generally be made to an amino acid sequence without altering activity. These changes are termed conservative substitutions or mutations; that is, an amino acid belonging to a grouping of amino acids having a particular size, charge or other characteristic can be substituted for another amino acid. Substitutions for an amino acid sequence can be selected from other members of the class to which the amino acid belongs. For example, the nonpolar (hydrophobic) amino acids include alanine, leucine, isoleucine, valine, proline, phenylalanine, tryptophan, methionine, and tyrosine. The polar neutral amino acids include glycine, serine, threonine, cysteine, tyrosine, asparagine and glutamine. The positively charged (basic) amino acids include arginine, lysine and histidine. The negatively charged (acidic) amino acids include aspartic acid and glutamic acid. Such alterations are not expected to substantially affect apparent molecular weight as determined by polyacrylamide gel electrophoresis or isoelectric point. Conservative substitutions also include substituting optical isomers of the sequences for other optical isomers, specifically D amino acids for L amino acids for one or more residues of a sequence. Moreover, all of the amino acids in a sequence can undergo a D to L isomer substitution. Exemplary conservative substitutions include, but are not limited to, Lys for Arg and vice versa to maintain a positive charge; Glu for Asp and vice versa to maintain a negative charge; Ser for Thr so that a free ˜OH is maintained; and Gln for Asn to maintain a free NH2. Moreover, point mutations, deletions, and insertions of the polypeptide sequences or corresponding nucleic acid sequences can in some cases be made without a loss of function of the polypeptide or nucleic acid fragment. Substitutions can include, e.g., 1, 2, 3, or more residues. Any teaching of a specific amino acid sequence or an exogenous nucleic acid encoding the polypeptide or teaching of the name of the name thereof includes any conservative substitution point mutations, deletions, and insertions of those polypeptide sequences or corresponding nucleic acid sequences and any sequence deposited for the protein or gene in a database that can be made without a loss of function of the polypeptide or nucleic acid fragment.


Any of the methods described herein can be used to generate any of the polypeptides described herein (e.g., therapeutic polypeptides and surface or maker polypeptides) and application of these methods is not restricted to receiver polypeptides.


In some embodiments, the receiver polypeptide is associated with the membrane of the exosome. In other embodiments, the receiver polypeptide is not associated with the membrane of the exosome.


In an embodiment, the receiver comprises a polypeptide that comprises an amino acid sequence derived from an antibody. The antibody receiver can be expressed as a full-length protein or a fragment thereof. In an embodiment, the receiver comprises an antibody amino acid sequence that is specific for a desired target. In some embodiments, the antibody is a scFv. In other embodiments, the antibody is a nanobody.


In an embodiment, the receiver comprises a polypeptide that comprises an amino acid sequence derived from a scFv antibody. The scFv antibody receiver can be expressed as a full-length protein or a fragment thereof. The scFv antibody can be expressed as a fusion protein. Suitable scFv receiver polypeptides include, but are not limited to, those listed in Table 5.


The production of scFvs is known in the art. The scFv receiver can be made specific to any target molecule including, but not limited to, those in Table 6.


In certain embodiments, the receiver comprises a camelid-derived nanobody. Nanobodies are usually 12-15 kDa. They are considerably smaller than antibodies and scFv. Nanobodies can thus be easier to transfect, and the nanobody receiver will be more easily expressed, translated and or transported to the cell surface in a producer cell and ultimately the exosome derived therefrom. In certain embodiments, nanobody receivers are employed to minimize immunogenic effects caused by a specific receiver. Nanobodies because of their small size will offer reduced immunogenic potential. In certain embodiments, receiver nanobodies are employed because they have an increased ability to recognize hidden or uncommon epitopes compared to standard antibodies. For example, they can bind to small enzymatic cavities of a target and modulate the molecular behavior of the target.


In some embodiments, receivers comprise a protein-binding partner or a receptor on the surface of the exosome, which functions to target the exosome to a specific tissue space or to interact with a specific moiety on a target cell, either in vivo or in vitro. Suitable protein-binding partners include antibodies and functional fragments thereof, scaffold proteins, or peptides.


In some embodiments, the receiver is a molecule that promotes endocytosis in the target cell, e.g., by engaging receptors that stimulate receptor-mediated endocytosis. Suitable receivers for this purpose include, but are not limited to, transferrin, insulin, growth factors, epidermal growth factor, ligands for receptor tyrosine kinases, mannose, somatostatin, hormones and ligands of scavenger receptors.


In some embodiments, the receiver can be a molecule that promotes exosome fusion to the target cell, e.g., the target cell plasma membrane, the endosomal membrane or the lysosomal membrane, thus transferring the payload to the cytoplasm of the target cell. In some embodiments, the receiver is a coat protein, e.g., clathrin, coat protein complex (COP)1, COP2; or a soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE), e.g., synaptobrevin, syntaxin, Tlg1p, SNAP-25, Vam3p, Vam7p; or a membrane fusion protein, e.g., a bacterial membrane fusion protein, a dynamin, DynA of Bacillus subtilis, HlyD; or a cell-penetrating polypeptide, e.g., a microbial pore forming protein, a poly-arginine polypeptide, an anti-microbial peptide, a microbial exotoxin or a microbial endotoxin.


In other embodiments, the receiver that promotes membrane fusion is an adhesion molecule (e.g., ICAM1), integrins (e.g., beta1 and beta2 integrins), tetraspanins (e.g., transferrin), phosphatidylserine or MFGE.


In some embodiments, the receiver mediates tissue targeting of the exosome. In some embodiments, the receiver mediates extravasation, intravasation or tissue penetration of the exosome. In certain embodiments, the receiver that mediates tissue targeting is a small peptide. In other embodiments, the receiver mediates tissue or cell penetration of the exosome.


In some embodiments, the receiver is a targeting molecule. In certain embodiments the targeting molecule can be an aptamer, a scFV, an antibody, a nanobody, a homing peptide, a folic acid, a cyclodextrin, a transferrin, a luteinizing hormone-releasing hormone or a glycoprotein.


In some embodiments, the receiver mediates exosome chemotaxis. In this aspect, the exosome is able to migrate to target tissue in response to cytokine or chemokine gradients.


In some embodiments, the receiver mediates angiogenesis. In some embodiments, angiogenesis mediated by the receiver enables improved tissue distribution or Pharmacokinetics of the exosome.


Targets

A suitable receiver can be chosen to interact with a specific target. Suitable targets include entities that are associated with a specific disease, disorder or condition. However, targets can also be chosen independent of a specific disease, disorder or condition.


In certain embodiments, suitable targets include, but are not limited to, those listed in Table 6.


In certain embodiments, the target is associated with a specific disease, disorder or condition such as those listed in Table 8 and Table 9.


In some embodiments, the exosome does not comprise a receiver and the exosome is capable of interacting with a target in the absence of a receiver.


In some embodiments, the target is a bacterium, for example Enterococcus, Streptococcus, or Mycobacteria, Rickettsia, Mycoplasma, Neisseria meningitides, Neisseria gonorrheoeae, Legionella, Vibrio cholerae, Streptococci, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Corynobacteria diphtheriae, Clostridium spp., enterotoxigenic Escherichia coli, and Bacillus anthracis. Other pathogens for which bacteremia has been reported at some level include the following: Rickettsia, Bartonella henselae, Bartonella quintana, Coxiella burnetii, chlamydia, Mycobacterium leprae, Salmonella; shigella; Yersinia enterocolitica; Yersinia pseudotuberculosis; Legionella pneumophila; Mycobacterium tuberculosis; Listeria monocytogenes; Mycoplasma spp.; Pseudomonas fluorescens; Vibrio cholerae; Haemophilus influenzae; Bacillus anthracis; Treponema pallidum; Leptospira; Borrelia; Corynebacterium diphtheriae; Francisella; Brucella melitensis; Campylobacter jejuni; Enterobacter; Proteus mirabilis; Proteus; and Klebsiella pneumoniae.


In some embodiments, the target is a virus, including but limited to, those whose infection involves injection of genetic materials into host cells upon binding to cell surface receptors, viruses whose infection is mediated by cell surface receptors. Non-limiting examples of these viruses can be selected from Paramyxoviridae (e.g., pneumovirus, morbillivirus, metapneumovirus, respirovirus or rubulavirus), Adenoviridae (e.g., adenovirus), Arenaviridae (e.g., arenavirus such as lymphocytic choriomeningitis virus), Arteriviridae (e.g., porcine respiratory and reproductive syndrome virus or equine arteritis virus), Bunyaviridae (e.g., phlebovirus or hantavirus), Caliciviridae (e.g., Norwalk virus), Coronaviridae (e.g., coronavirus or torovirus), Filoviridae (e.g., Ebola-like viruses), Flaviviridae (e.g., hepacivirus or flavivirus), Herpesviridae (e.g., simplexvirus, varicellovirus, cytomegalovirus, roseolovirus, or lymphocryptovirus), Orthomyxoviridae (e.g., influenza virus or thogotovirus), Parvoviridae (e.g., parvovirus), Picomaviridae (e.g., enterovirus or hepatovirus), Poxviridae (e.g., orthopoxvirus, avipoxvirus, or leporipoxvirus), Retroviridae (e.g., lentivirus or spumavirus), Reoviridae (e.g., rotavirus), Rhabdoviridae (e.g., lyssavirus, novirhabdovirus, or vesiculovirus), and Togaviridae (e.g., alphavirus or rubivirus). Specific examples of these viruses include human respiratory coronavirus, influenza viruses A-C, hepatitis viruses A to G and herpes simplex viruses 1-9.


In some embodiments, the target is a parasite, including but not limited to, for example, intestinal or blood-borne parasites, protozoa, trypanosomes; haemoprotozoa and parasites capable of causing malaria; enteric and systemic cestodes including taeniid cestodes; enteric coccidians; enteric flagellate protozoa; filarial nematodes; gastrointestinal and systemic nematodes and hookworms.


In some embodiments, the target is a fungus, including but not limited to, for example, Candida albicans, Candida glabrata, Aspergillus, T. glabrata, Candida tropicalis, C. krusei and C. parapsilosis.


In some embodiments, the target is a lipid, lipid complex or proteolipid complex.


In some embodiments, the target is a LFA (e.g., lymphocyte function-associated antigen 1), intercellular adhesion molecules (e.g., ICAM1), extracellular matrix proteins (e.g., fibronectin), phosphatidylserine receptors (e.g., T cell immunoglobulin domain, mucin domain proteins, TIM1/TIM4), lactaherin or integrins (e.g., avb3 or avb5).


In some embodiments, the target is an inflammatory molecule, a cytokine or a chemokine.


In some embodiments, the target is a carbohydrate, polysaccharide or amino acid.


In some embodiments, the target is a virus, a viral antigen, an envelope antigen or a capsid antigen.


In some embodiments, the target is a bacterium, a bacterial antigen, a bacterial surface antigen, a secreted bacterial toxin or a secreted bacterial antigen.


In some embodiments, the target is a fungus, a fungal antigen, a fungal cell surface antigen, a secreted fungal toxin or a secreted fungal antigen.


In some embodiments, the target is DNA or RNA.


In some embodiments, the target is a circulating cell, an inflammatory cell, a tumor cell or a metastatic cancer cell.


In some embodiments, the target is a mammalian cell, including but not limited to, for example, a human cell, a circulating cell, an immune cell, a neutrophil, an eosinophil, a basophil, a lymphocyte, a monocyte, a B cell, a T cell, a CD4+ T cell, a CD8+ T cell, a gamma-delta T cell, a regulatory T cell, a natural killer cell, a natural killer T cell, a macrophage, a Kupffer cell, a dendritic cell, a cancer cell, a cancer stem cell, a circulating tumor cell, a cancer cell from one of the following cancers including, but not limited to, ACUTE lymphoblastic leukemia (ALL), ACUTE myeloid leukemia (AML), anal cancer, bile duct cancer, bladder cancer, bone cancer, bowel cancer, brain tumours, breast cancer, cancer of unknown primary, cancer spread to bone, cancer spread to brain, cancer spread to liver, cancer spread to lung, carcinoid, cervical cancer, choriocarcinoma, chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), colon cancer, colorectal cancer, endometrial cancer, eye cancer, gallbladder cancer, gastric cancer, gestational trophoblastic tumours (GTT), hairy cell leukemia, head and neck cancer, Hodgkin lymphoma, kidney cancer, laryngeal cancer, leukemia, liver cancer, lung cancer, lymphoma, melanoma skin cancer, mesothelioma, men's cancer, molar pregnancy, mouth and oropharyngeal cancer, myeloma, nasal and sinus cancers, nasopharyngeal cancer, non-Hodgkin's lymphoma (NHL), oesophageal cancer, ovarian cancer, pancreatic cancer, penile cancer, prostate cancer, rare cancers, rectal cancer, salivary gland cancer, secondary cancers, skin cancer (non melanoma), soft tissue sarcoma, stomach cancer, testicular cancer, thyroid cancer, unknown primary cancer, uterine cancer, vaginal cancer and vulval cancer.


In some embodiments, the target is a non-circulating cell or tissue. In some embodiments, the target is a specific tissue including, but not limited to, endothelial tissues, connective tissues, muscle tissue, nervous tissue, and epithelial tissue. In some embodiments, the target is a specific organ systems based on an affinity for ligands associated with the tissues therein, including, but not limited to, the brain, liver, kidneys, gastrointestinal system, pancreas, spleen and lungs.


Pharmaceutical Compositions of the Invention


Aspects of the invention relate to use of preparations of exosomes for use as a medicament. In some embodiments, the exosomes are formulated for intravenous administration to the circulatory system of a mammalian subject. The methods of the invention include administering a therapeutically effective amount of exosomes. The exosomes of the invention can be formulated in pharmaceutical compositions. In some embodiments, the exosomes are formulated for intravenous administration to the circulatory system of a mammalian subject. The pharmaceutical compositions can comprise, in addition to one or more of the exosomes, a pharmaceutically acceptable excipient, carrier, buffer, stabiliser or other materials well known to those skilled in the art. Such materials should be non-toxic and should not interfere with the efficacy of the active ingredient. The precise nature of the carrier or other material can depend on the route of administration, e.g., oral, intravenous, cutaneous or subcutaneous, nasal, intramuscular, intrathecal or intraperitoneal routes.


For intravenous, cutaneous or subcutaneous injection, or injection at the site of affliction, the active ingredient will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability. Those of relevant skill in the art are well able to prepare suitable solutions using, for example, isotonic vehicles such as Sodium Chloride Injection, Ringer's Injection, Lactated Ringer's Injection. Preservatives, stabilisers, buffers, antioxidants and/or other additives can be included, as required.


Pharmaceutical compositions suitable for injectable use include sterile aqueous solutions (if water soluble) or dispersions and sterile powders. For intravenous administration, suitable carriers include physiological saline, bacteriostatic water, Cremophor EL™ (BASF, Parsippany, N.J.) or phosphate buffered saline (PBS). The composition is generally sterile and fluid to the extent that easy syringeability exists. The carrier can be a solvent or dispersion medium containing, e.g., water, ethanol, polyol (e.g., glycerol, propylene glycol, and liquid polyethylene glycol, and the like), and suitable mixtures thereof. The proper fluidity can be maintained, e.g., by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersion and by the use of surfactants. Prevention of the action of microorganisms can be achieved by various antibacterial and antifungal compounds, e.g., parabens, chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. If desired, isotonic compounds, e.g., sugars, polyalcohols such as manitol, sorbitol, sodium chloride can be added to the composition. Prolonged absorption of the injectable compositions can be brought about by including in the composition a compound which delays absorption, e.g., aluminum monostearate and gelatin.


Sterile injectable solutions can be prepared by incorporating the exosomes in an effective amount and in an appropriate solvent with one or a combination of ingredients enumerated herein, as desired. Generally, dispersions are prepared by incorporating the exosomes into a sterile vehicle that contains a basic dispersion medium and any desired other ingredients. In the case of sterile powders for the preparation of sterile injectable solutions, methods of preparation are vacuum drying and freeze-drying that yields a powder of the active ingredient plus any additional desired ingredient from a previously sterile-filtered solution thereof. In certain embodiments, exosomes are administered in the form of a depot injection or implant preparation which can be formulated in such a manner to permit a sustained or pulsatile release of the exosomes.


Systemic administration of compositions comprising exosomes can also be by transmucosal or transdermal means. For transmucosal or transdermal administration, penetrants appropriate to the barrier to be permeated are used in the formulation. Such penetrants are generally known in the art, and include, e.g., for transmucosal administration, detergents, bile salts, and fusidic acid derivatives. Transmucosal administration can be accomplished through the use of nasal sprays or suppositories. For transdermal administration, the modified exosomes are formulated into ointments, salves, gels, or creams as generally known in the art.


The exosomes can also be prepared as pharmaceutical compositions in the form of suppositories (e.g., with conventional suppository bases such as cocoa butter and other glycerides) or retention enemas for rectal delivery.


In an embodiment, the pharmaceutical composition comprising exosomes is administered intravenously into a subject that would benefit from the pharmaceutical composition. In other embodiments, the composition is administered to the lymphatic system, e.g., by intralymphatic injection or by intranodal injection (See e.g., Senti et al., 2008 PNAS 105(46):17908), or by intramuscular injection, by subcutaneous administration, by direct injection into the thymus or into the liver.


In an embodiment, the pharmaceutical composition comprises exosomes and is administered as a liquid suspension. In an embodiment, the pharmaceutical composition is administered as a formulation that is capable of forming a depot following administration, and in a preferred embodiment, exosomes are slowly released into circulation or remain in depot form.


Typically, pharmaceutically acceptable compositions are highly purified to be free of contaminants, are biocompatible and not toxic, and are suited to administration to a subject. If water is a constituent of the carrier, the water is highly purified and processed to be free of contaminants, e.g., endotoxins.


The pharmaceutically acceptable carrier can be lactose, dextrose, sucrose, sorbitol, mannitol, starch, gum acacia, calcium phosphate, alginates, gelatin, calcium silicate, micro-crystalline cellulose, polyvinylpyrrolidone, cellulose, water, syrup, methyl cellulose, methylhydroxy benzoate, propyl hydroxy benzoate, talc, magnesium stearate and/or mineral oil, but is not limited thereto. The pharmaceutical composition can further include a lubricant, a wetting agent, a sweetener, a flavor enhancer, an emulsifying agent, a suspension agent and/or a preservative.


The pharmaceutical compositions described herein comprise an exosome and optionally a pharmaceutically active or therapeutic agent. The therapeutic agent can be a biological agent, a small molecule agent, or a nucleic acid agent.


Dosage forms are provided that comprise a pharmaceutical composition comprising an exosome described herein. In some embodiments, the dosage form is formulated as a liquid suspension for intravenous injection.


Medical devices are provided that comprise a container holding a pharmaceutical composition comprising an exosome described herein and an applicator for intravenous injection of the pharmaceutical composition to a subject.


Medical kits are provided that comprise a pharmaceutical composition comprising an exosome described herein and a medical device for intravenous injection of the pharmaceutical composition to a subject.


In an embodiment, pharmaceutically acceptable suspensions of exosomes are packaged in a volume of approximately 1 ml to approximately 500 ml. In an embodiment, the packaging is a syringe or an IV bag suitable for transfusions. Administration of the suspension is carried out, e.g., by intravenous or intra-arterial injection, optionally using a drip from an IV bag or the like. The administration is typically carried out intravenously in the arm or via a central catheter. For administrations exceeding 50 ml, use of a drip is preferred.


In certain embodiments, pharmaceutical compositions for oral administration are in tablet, capsule, powder or liquid form. In certain embodiments, a tablet includes a solid carrier such as gelatin or an adjuvant. Liquid pharmaceutical compositions generally include a liquid carrier such as water, petroleum, animal or vegetable oils, mineral oil or synthetic oil. Physiological saline solution, dextrose or other saccharide solution or glycols such as ethylene glycol, propylene glycol or polyethylene glycol can be included.


In some embodiments, the pharmaceutical composition comprises one or more therapeutic agents and the exosomes described herein. In some embodiments, the exosomes are co-administered with of one or more separate therapeutic agents, wherein co-administration includes administration of the separate therapeutic agent before, after or concurrent with administration of the exosome.


In certain embodiments, supplementary therapeutic agents are incorporated into the compositions.


The pharmaceutically useful compound according to the present invention that is to be given to an individual, administration is preferably in a “therapeutically effective amount” or “prophylactically effective amount” (as the case can be, although prophylaxis can be considered therapy), this being sufficient to show benefit to the individual. The dosages of the exosomes, therapeutic exosomes and non-therapeutic exosomes are any dose that yields therapeutic benefit in the subject. The actual amount administered, and rate and time-course of administration, will depend on the nature and severity of the condition being treated. Prescription of treatment, e.g., decisions on dosage etc, is within the responsibility of general practitioners and other medical doctors, and typically takes account of the disorder to be treated, the condition of the individual patient, the site of delivery, the method of administration and other factors known to practitioners. Examples of the techniques and protocols mentioned above can be found in Remington's Pharmaceutical Sciences, 16th edition, Osol, A. (ed), 1980.


In certain embodiments, the dosages of either the non-therapeutic exosomes, therapeutic exosomes or both the non-therapeutic exosomes and therapeutic exosomes is between 1 ng to 10 ng, 10 ng to 100 ng, 100 ng to 1.0 μg, 1 μg to 5 μg, 5 μg to 10 μg, 10 μg-50 μg, 50 μg to 75 μg, 75 μg to 100 μg, 100 μg to 150 μg, 150 μg to 200 μg, 200 μg to 300 μg, 300 μg to 500 μg, 500 μg to 1 mg, or 1 mg to 10 mg.


In certain embodiments, the dosage of the non-therapeutic exosome is greater than the dosage of the therapeutic exosomes. In certain embodiments, the dosage of the non-therapeutic exosome is the same as the therapeutic exosomes. In some embodiments, the dosage of the non-therapeutic exosome is between 1.1-fold to 1.5-fold, 1.0-fold to 2.0-fold, 2.0-fold to 3.0-fold, 3.0-fold to 4.0-fold, 4.0-fold to 5.0-fold, 5.0-fold to 10.0-fold, 10.0-fold to 20.0-fold, 10.0-fold to 100-fold or 100-fold to 1,000-fold greater than the dosage of the therapeutic exosomes. In certain embodiments, the dosage of the non-therapeutic exosome is less than the dosage of the therapeutic exosome. In certain embodiments, the dosage of the non-therapeutic exosomes is between 1.1-fold to 1.5-fold, 1.0-fold to 2.0-fold, 2.0-fold to 3.0-fold, 3.0-fold to 4.0-fold, 4.0-fold to 5.0-fold, 5.0-fold to 10.0-fold, 10.0-fold to 20.0-fold, 10.0-fold to 100-fold or 100-fold to 1,000-fold less than the dosage of the therapeutic exosomes.


A composition can be administered alone or in combination with other treatments, either simultaneously or sequentially dependent upon the condition to be treated.


Methods of Making Exosomes

Provided herein are methods for producing isolated exosomes and pharmaceutical preparations thereof.


In some embodiments, the methods comprise: a) providing a producer cell capable of generating an exosome, b) obtaining from the producer cell the exosome, c) modifying the exosome with a payload, and d) isolating the modified exosome.


In some embodiments, the methods comprise: a) providing a producer cell capable of generating an exosome, b) modifying the producer cell with a payload, c) obtaining from the producer cell the exosomes, and d) isolating the modified exosomes.


Optionally, the isolated exosomes can be formulated into a pharmaceutical composition described herein. If desired, the activity of the pharmaceutical composition is tested or analyzed. Testing can include one or more of: i) analyzing the presence or activity of the payload, ii) analyzing the potency of the exosome in a phenotypic or functional assay iii) detecting the presence or absence of one or more biomarkers from the producer cell, iv) analyzing the size distribution of the exosomes, and/or v) analyzing the membrane composition of the exosomes.


If desired, the producer cell can be modified to comprise a receiver. Alternatively or in addition, the exosome is modified to comprise a receiver.


In some embodiments, the exosomes are released by the producer cells into a culture medium. The exosomes can be generated through a variety of cellular mechanisms including the endosomal sorting complexes required for transport I and II (ESCRT I and II), alternate endosome production pathways derived thereof, or mechanistic perturbation or disruption of the producer cell membrane, such as microfluidic compression or lysis, exposure to chemical stresses such as pH or apoptosis.


In some embodiments, the producer cell is a mammalian cell that is isolated or derived from a mammalian cell line. The exosomes can be derived from various cell lines, including eukaryotes, prokaryotes, archae, fungi and protists.


In some embodiments, generating an exosome comprises using isolated optionally cultured producer cells that are autologous and/or allogeneic to the subject in which the exosome is administered.


The producer cell can be cultured. Cultured producer cells can be scaled up from bench-top scale to bioreactor scale. For example, the producer cells are cultured until they reach saturation density, e.g., 1×105, 1×106, 1×107 or greater than 1×107 per ml. Optionally, upon reaching saturation density, the producer cells can be transferred to a larger volume of fresh medium. The producer cells can be cultured in a bioreactor, such as, e.g., a Wave-type bioreactor, a stirred-tank bioreactor. Various configurations of bioreactors are known in the art and a suitable configuration can be chosen as desired. Configurations suitable for culturing and/or expanding populations of producer cells can easily be determined by one of skill in the art without undue experimentation. The bioreactor can be oxygenated. The bioreactor can optionally contain one or more impellers, a recycle stream, a media inlet stream, and control components to regulate the influx of media and nutrients or to regulate the outflux of media, nutrients, and waste products.


In some embodiments, the bioreactor is a Wave bioreactor or a impeller-driven agitator. The bioreactor can be aerated by means of a sparger. In an embodiment, the bioreactor is disposable. In an embodiment, the bioreactor is CIP (cleaned in place). The final number of producer cells that can be obtained in a bioreactor setting as described herein can be greater than 109, 1010, 1011, 1012, 1013 or greater than 1013 cells. The density of producer cells can be monitored during culture by measuring cell density by hemacytometer counting or by optical density reading at 600 nm. Optionally, the culture process is monitored for pH levels, oxygenation, agitation rate and/or recycle rate.


In some embodiments, the producer cells can be treated with chemicals, hormones, metabolites, nucleic acids, proteins, enzymes, lipids, nutrients, micronutrients or any other molecule to affect the cell's phenotype or profile of exosomes.


In some embodiments, the producer cells can be treated with a molecule, e.g., a DNA molecule, an RNA molecule, a mRNA, an siRNA, a microRNA, a lncRNA, a shRNA, a hormone or a small molecule, that activates or inhibits expression of one or more genes.


Producer cell inputs, including but not limited to, nutrients, micronutrients, metabolites, amino acids, sugars, and fatty acids can be increased or decreased. For example, producer cells can be grown in hypoxic conditions prior to and during isolation of exosomes.


The producer cells can be treated with physical stimuli, including but not limited to, irradiation, pressure, shear stress, mixing, turbulence, and shaking.


In an embodiment, the producer cell is differentiated from a starter or precursor cell. In this embodiment, the differentiation state of the producer cell is assessed by an in vitro assay. Suitable in vitro assays include measuring the number of cells, protein content or expression level, e.g., of a biomarker (e.g., differentiation marker), mRNA content or expression level, e.g., of a biomarker (e.g., a differentiation marker), lipid content, partition of a substrate, catalytic activity, or metabolic activity.


In some embodiments, the producer cells are cultured and the differentiation state of the cells and/or resulting exosomes is assessed at multiple time points over the course of the culture process.


In certain embodiments, a producer cell expresses (naturally or upon modification) a polypeptide (e.g., a receiver polypeptide, a therapeutic polypeptide and/or a surface marker polypeptide). In some embodiments, exosomes derived from the producer cells comprise the polypeptide that is expressed by the producer cell. The polypeptide can be exhibited on the surface of the exosome or can reside within the interior space of the exosome.


In certain embodiments, the polypeptide (e.g., a receiver polypeptide, a therapeutic polypeptide and/or a surface marker polypeptide) is conjugated to the producer cell or the exosome. The polypeptide usually is conjugated to the surface of the producer cell or exosome. Conjugation can be achieved chemically or enzymatically, by methods known in the art.


In certain embodiments, the polypeptide (e.g. a receiver polypeptide, a therapeutic polypeptide and/or a surface marker polypeptide) is loaded into the producer cell or exosome. In some embodiments, the polypeptide is not loaded into or onto the producer cell or exosome.


In some embodiments, the exosome comprises a polypeptide (e.g. a receiver polypeptide, a therapeutic polypeptide and/or a surface marker polypeptide) that is optionally i) expressed in the producer cell from an exogenous nucleic acid, ii) conjugated to the producer cell or the exosome, iii) loaded into or onto the producer cell or the exosome, and any combination of i), ii) and iii).


A non-polypeptide payload (e.g., a nucleic acid, such as an RNA, e.g., siRNA, miRNA, shRNA, etc., a therapeutic small molecule or a toxin) can be i) expressed in the producer cell from an exogenous nucleic acid, ii) conjugated to the producer cell or the exosome, iii) loaded into or onto the producer cell or the exosome, and any combination of i), ii) and iii), as applicable for the respective payload.


In some embodiments, the exosome is generated by contacting a suitable producer cell with an exogenous nucleic acid encoding the payload, receiver of surface marker. In some embodiments, the nucleic acid is a DNA. In some embodiments, the nucleic acid is a RNA.


A payload, receiver or surface marker can be expressed by a producer cell from a transgene or mRNA introduced into a producer cell by electroporation, chemical or polymeric transfection, viral transduction, mechanical membrane disruption, or other method. The producer cells can be modified e.g., by transfection of single or multiple copies of genes, transduction with a virus, or electroporation in the presence of DNA or RNA. In some embodiments, the exosome derived from the producer cell comprises the payload, receiver or surface marker that is expressed by the producer cell.


A payload can be expressed by a target cell from a transgene or mRNA introduced into an exosome by electroporation, chemical or polymeric transfection, viral transduction, mechanical membrane disruption, or other method when the target cell is contacted with the exosome.


In some instances, the exogenous nucleic acid is an RNA molecule, or a DNA molecule that encodes for an RNA molecule, that silences or represses the expression of a target gene. For example, the molecule can be a small interfering RNA (siRNA), an antisense RNA molecule or a short hairpin RNA (shRNA) molecule.


Messenger RNA can be derived from in vitro transcription of a cDNA plasmid construct containing the coding sequence corresponding to the payload, surface marker or receiver polypeptide. For example, the cDNA sequence corresponding to the polypeptide (e.g., a receiver polypeptide, a therapeutic polypeptide and/or a surface marker polypeptide) can be inserted into a cloning vector containing a promoter sequence compatible with specific RNA polymerases. For example, the cloning vector ZAP Express® pBK-CMV (Stratagene, La Jolla, Calif., USA) contains T3 and T7 promoter sequence compatible with T3 and T7 RNA polymerase, respectively. For in vitro transcription of sense mRNA, the plasmid is linearized at a restriction site downstream of the stop codon(s) corresponding to the end of the coding sequence of the receiver polypeptide. The mRNA is transcribed from the linear DNA template using a commercially available kit such as, for example, the RNAMaxx® High Yield Transcription Kit (from Stratagene, La Jolla, Calif., USA). In some instances, it can be desirable to generate 5′-m7GpppG-capped mRNA. As such, transcription of a linearized cDNA template can be carried out using, for example, the mMESSAGE mMACHINE High Yield Capped RNA Transcription Kit from Ambion (Austin, Tex., USA). Transcription can be carried out in a reaction volume of 20-100 μl at 37° C. for 30 min to 4 h. The transcribed mRNA is purified from the reaction mix by a brief treatment with DNase I to eliminate the linearized DNA template followed by precipitation in 70% ethanol in the presence of lithium chloride, sodium acetate or ammonium acetate. The integrity of the transcribed mRNA can be assessed using electrophoresis with an agarose-formaldehyde gel or commercially available Novex pre-cast TBE gels (e.g., Novex, Invitrogen, Carlsbad, Calif., USA).


Methods for transferring expression vectors into producer cells that are suitable to produce the exosomes described herein include, but are not limited to, viral mediated gene transfer, liposome mediated transfer, transformation, gene guns, transfection and transduction, e.g., viral mediated gene transfer such as the use of vectors based on DNA viruses such as adenovirus, adenoassociated virus and herpes virus, as well as retroviral based vectors. Examples of modes of gene transfer include e.g., naked DNA, CaPO4 precipitation, DEAE dextran, electroporation, protoplast fusion, lipofection and cell microinjection.


Viral gene transfer can be used to transfect the producer cells with DNA encoding a payload (e.g., polypeptide or RNA), surface marker polypeptide or receiver polypeptide. A number of viruses can be used as gene transfer vehicles including Moloney murine leukemia virus (MMLV), adenovirus, adeno-associated virus (AAV), herpes simplex virus (HSV), lentiviruses such as human immunodeficiency virus 1 (HIV 1) and spumaviruses such as foamy viruses, for example (See, e.g., Osten et al., HEP 178:177-202 (2007)). Retroviruses, for example, efficiently transduce mammalian cells including human cells and integrate into chromosomes, conferring stable gene transfer.


Optionally, a fluorescent tracking molecule such as, for example, green fluorescent protein (GFP) can be transfected using a viral-based approach (Tao et al., Stem Cells 25:670-678 (2007)). Ecotopic retroviral vectors containing DNA encoding the enhanced green fluorescent protein (EGFP) or a red fluorescent protein (e.g., DsRed-Express) are packaged using a packaging cell such as, for example, the Phoenix-Eco cell line (distributed by Orbigen, San Diego, Calif.). Packaging cell lines stably express viral proteins needed for proper viral packaging including, for example, gag, pol, and env. Supernatants from the Phoenix-Eco cells into which viral particles have been shed are used to transduce producer cells. In this instance, the percentage of cells expressing EGFP or DsRed-Express can be assessed by FACS. Other reporter genes that can be used to assess transduction efficiency include, for example, beta-galactosidase, chloramphenicol acetyltransferase, and luciferase as well as low-affinity nerve growth factor receptor (LNGFR), and the human cell surface CD24 antigen (Bierhuizen et al., Leukemia 13:605-613 (1999)).


Nonviral vectors can be used to introduce genetic material into suitable producer cell to generate exosomes. Nonviral-mediated gene transfer differs from viral-mediated gene transfer in that the plasmid vectors contain no proteins, are less toxic and easier to scale up, and have no host cell preferences. A number of delivery methods can be used to transfer nonviral vectors into suitable producer cells including chemical and physical methods.


Nonviral vectors can be introduced into suitable producer cells using synthetic macromolecules such as cationic lipids and polymers (Papapetrou et al., Gene Therapy 12:S118-S130 (2005)). Cationic liposomes, for example form complexes with DNA through charge interactions. The positively charged DNA/lipid complexes bind to the negative cell surface and are taken up by the cell by endocytosis. For example, the plasmid DNA (approximately 0.5 μg in 25-100 μL of a serum free medium, such as, for example, OptiMEM (Invitrogen, Carlsbad, Calif.)) is mixed with a cationic liposome (approximately 4 μg in 25 μL of serum free medium) such as the commercially available transfection reagent Lipofectamine™ (Invitrogen, Carlsbad, Calif.) and allowed to incubate for at least 20 min to form complexes. The DNA/liposome complex is added to suitable producer cell and allowed to incubate for 5-24 h, after which time transgene expression can be assayed. Alternatively, other commercially available liposome transfection agents can be used (e.g., in vivo Gene SHUTTLE™, Qbiogene, Carlsbad, Calif.).


Alternatively or in addition, a cationic polymer such as, for example, polyethylenimine (PEI) can be used to transfect producer cells. Plasmid DNA is incubated with branched or linear PEIs varying in size from 0.8 K to 750 K (Sigma Aldrich, Saint Louis, Mo., USA; Fermetas, Hanover, Md., USA). PEI is prepared as a stock solution at 4.2 mg/ml distilled water and slightly acidified to pH 5.0 using HCl. The DNA can be combined with the PEI for 30 min at room temperature at various nitrogen/phosphate ratios based on the calculation that 1 μg of DNA contains 3 nmol phosphate and 1 μl of PEI stock solution contains 10 nmol amine nitrogen. The producer cells are seeded with the DNA/cationic complex, centrifuged at 280×g for 5 min and incubated in culture medium for 4 or more hours until transgene expression is assessed.


A plasmid vector can be introduced into a producer cell or an exosome using a physical method such as particle-mediated transfection, “gene gun”, biolistics, or particle bombardment technology (Papapetrou, et al., (2005) Gene Therapy 12:S118-S130). In this instance, exogenous nucleic acid is absorbed onto gold particles and administered to cells or complexes by a particle gun. A reporter gene such as, for example, beta-galactosidase, chloramphenicol acetyltransferase, luciferase or green fluorescent protein can be used to assess efficiency of transfection.


Optionally, electroporation methods can be used to introduce a plasmid vector into suitable producer cell or exosome. Electroporation creates transient pores in the cell membrane, allowing for the introduction of various molecules into the cells and complexes including, for example, DNA and RNA as well as polypeptides and non-polypeptide therapeutic agents (e.g., therapeutic small molecules). Electroporation can be done using, for example, an ECM 600 electroporator (Genetronics, San Diego, Calif., USA). A number of alternative electroporation instruments are commercially available and can be used for this purpose (e.g., Gene Pulser Xcell™, BioRad, Hercules, Calif.; Cellject Duo, Thermo Science, Milford, Mass.).


In some embodiments, an episomal vector which can persist in the host nucleus as autonomously replicating genetic units without integration into chromosomes (Papapetrou et al., Gene Therapy 12:S118-S130 (2005)) can be used to modify producer cells. These vectors exploit genetic elements derived from viruses that are normally extrachromosomally replicating in cells upon latent infection such as, for example, EBV, human polyomavirus BK, bovine papilloma virus-1 (BPV-1), herpes simplex virus-1 (HSV) and Simian virus 40 (SV40). Mammalian artificial chromosomes can also be used for nonviral gene transfer (Vanderbyl et al., Exp. Hematol. 33:1470-1476 (2005)).


Exogenous nucleic acids encoding payloads, receiver or surface molecules can be assembled into expression vectors by standard molecular biology methods known in the art, e.g., restriction digestion, overlap-extension PCR and Gibson assembly.


In some embodiments, the exosome comprises a payload, receiver or surface marker that is chemically conjugated. Chemical conjugation can be accomplished by covalent bonding of the payload, receiver or surface marker to another molecule, with or without use of a linker. The formation of such conjugates is within the skill of artisans and various techniques are known for accomplishing the conjugation, with the choice of the particular technique being guided by the materials to be conjugated. The addition of amino acids to the polypeptide (C- or N-terminal) which contain ionizable side chains, e.g., aspartic acid, glutamic acid, lysine, arginine, cysteine, histidine, or tyrosine, and are not contained in the active portion of the polypeptide sequence, serve in their unprotonated state as a potent nucleophile to engage in various bioconjugation reactions with reactive groups attached to polymers, e.g., homo- or hetero-bi-functional PEG (e.g., Lutolf and Hubbell, Biomacromolecules 2003; 4:713-22, Hermanson, Bioconjugate Techniques, London. Academic Press Ltd; 1996). Conjugation is not restricted to polypeptides but is applicable also for non-polypeptides, e.g., lipids, carbohydrates, nucleic acids, and small molecules.


In an embodiment, the payload, receiver or surface marker can be bound to the surface of an exosome through a biotin-streptavidin bridge. Any surface membrane proteins of an exosome can be biotinylated using an amine reactive biotinylation reagent such as, for example, EZ-Link Sulfo-NHS-SS-Biotin (sulfosuccinimidyl 2-(biotinamido)-ethyl-1,3-dithiopropionate; Pierce-Thermo Scientific, Rockford, Ill., USA; See, e.g., Jaiswal et al., Nature Biotech. 21:47-51 (2003)). For example, exosomes can be incubated for 30 min at 4° C. in 1 mg/ml solution of sulfo-NHS-SS in phosphate-buffered saline. Excess biotin reagent is removed by washing the complexes with Tris-buffered saline. The biotinylated complexes are then reacted with the biotinylated payload, receiver or surface marker in the presence of streptavidin to form the conjugated exosome.


In some embodiments, the exosome comprises a payload, receiver or surface marker that is enzymatically conjugated, including using transpeptidases, sortases, and isopeptidases. These methods include enzymatic strategies such as, e.g., transpeptidase reaction mediated by a sortase enzyme to connect one polypeptide containing the acceptor sequence LPXTG or LPXTA with a polypeptide containing the N-terminal donor sequence GGG, see e.g., Swee et al., PNAS 2013. The methods also include combination methods, such as e.g., sortase-mediated conjugation of Click Chemistry handles (an azide and an alkyne), respectively, followed by a cyclo-addition reaction to chemically bond the antigen to the cell, see e.g., Neves et al., Bioconjugate Chemistry, 2013.


In certain embodiments, the payload, receiver or surface marker is loaded into the producer cell or exosome. A number of methods can be used to load a payload, receiver or surface marker into a producer cell or exosome. Suitable methods include, for example, hypotonic lysis, hypotonic dialysis, osmosis, osmotic pulsing, osmotic shock, ionophoresis, electroporation, sonication, microinjection, calcium precipitation, membrane intercalation, lipid mediated transfection, detergent treatment, viral infection, diffusion, receptor mediated endocytosis, use of protein transduction domains, particle firing, membrane fusion, freeze-thawing, mechanical disruption and filtration. Any one such method or a combination thereof can be used to load exosomes or producer cells.


Generally, any method that induces controlled injury can be used to load an agent, e.g., a payload, receiver or surface marker into or onto a producer cell or exosome. The controlled injury of the membrane of the producer cell or exosome can be caused by, for example, pressure induced by mechanical strain or shear forces, subjecting the cell to deformation, constriction, rapid stretching, rapid compression or pulse of high shear rate. The controlled injury leads to uptake of material, e.g., a payload, receiver or surface marker into the interior of the exosome or the cytoplasm of the producer cell from the surrounding cell medium. Any suitable controlled injury method can be used to generate the exosomes described herein.


Controlled cell injury as used herein includes: i) virus-mediated transfection (e.g., Herpes simplex virus, Adeno virus, Adeno-associated virus, Vaccinia virus, or Sindbis virus), ii) chemically-mediated transfection, e.g., cationic polymer, calcium phosphate, cationic lipid, polymers, and nanoparticles, such as cyclodextrin, liposomes, cationic liposomes, DEAE-dextran, polyethyleneimine, dendrimer, polybrene, calcium phosphate, lipofectin, DOTAP, lipofectamine, CTAB/DOPE, DOTMA; and iii) physically-mediated transfection, including direct injection, biolistic particle delivery, electroporation, laser-irradiation, sonoporation, magnetic nanoparticles, and controlled deformation (e.g., cell squeezing), as exemplified by micro-needle, nano-needle, femtosyringe, atomic-force microscopy (AFM) tip, gene gun (e.g., gold nanoparticles), Amaxa Nucleofector, phototransfection (multi-photon laser), impalefection, and magnetofection and other suitable methods known in the art.


For hypotonic lysis, producer cells or exosomes are exposed to low ionic strength buffer causing them to burst allowing loading of an agent, e.g., a payload, receiver or surface marker. Alternatively, controlled dialysis against a hypotonic solution to swell the cells or complexes and create pores in the cell or complex membrane is used. The cells or complexes are subsequently exposed to conditions that allow resealing of the membrane.


For electroporation, producer cells or exosomes are exposed to an electrical field which causes transient holes in the cell or complex membrane, allowing loading of an agent, e.g., a payload, receiver or surface marker.


For sonication, producer cells or exosomes are exposed to high intensity sound waves, causing transient disruption of the cell or complex membrane allowing loading of an agent, e.g., a payload, receiver or surface marker.


For detergent treatment, producer cells or exosomes are treated with a mild detergent which transiently compromises the cell or complex membrane by creating holes allowing loading of an agent, e.g., a payload, receiver or surface marker. After cells or complexes are loaded, the detergent is washed away thereby resealing the membrane.


For receptor mediated endocytosis, producer cells or exosomes that have a surface receptor which upon binding of the receiver or payload (e.g., therapeutic agent) induces internalization of the receptor and the associated receiver or payload.


For mechanical firing, producer cells or exosomes can be bombarded with a payload, receiver or surface marker attached to a heavy or charged particle such as, for example, gold microcarriers and are mechanically or electrically accelerated such that they traverse the cell membrane. Microparticle bombardment can be achieved using, for example, the Helios Gene Gun (from e.g., Bio-Rad, Hercules, Calif., USA).


In some embodiments, producer cells or exosomes can be loaded with a payload, receiver or surface marker by fusion with a synthetic vesicle such as, for example, a liposome. In this instance, the vesicles themselves are loaded with the payload, receiver or surface marker using one or more of the methods described herein or known in the art. Alternatively, the payload, receiver or surface marker can be loaded into the vesicles during vesicle formation. The loaded vesicles are then fused with the producer cells or exosomes under conditions that enhance membrane fusion. Fusion of a liposome, for example, can be facilitated using various inducing agents such as, for example, proteins, peptides, polyethylene glycol (PEG), and viral envelope proteins or by changes in medium conditions such as pH.


For filtration, producer cells or exosomes and the payload, receiver or surface marker can be forced through a filter of pore size smaller than the cell or complex causing transient disruption of the cell membrane and allowing the payload, receiver or surface marker to enter the cell or complex.


For freeze/thawing, producer cells or exosomes are subjected to several freeze thaw cycles, resulting in cell membrane disruption allowing loading of an agent, e.g., a payload, receiver or surface marker.


In certain embodiments, generating an exosome comprises the step of contacting an isolated membrane derived from a producer cell with a payload (e.g., a therapeutic agent). In some embodiments, generating an exosome comprises the step of contacting an isolated membrane derived from a producer cell with a receiver. In some embodiments, generating an exosome comprises the step of contacting an isolated membrane derived from a producer cell with a payload (e.g., a therapeutic agent) and a receiver


Methods of Isolating Exosomes

The exosomes can be isolated from the producer cells. It is contemplated that all known manners of isolation of exosomes are deemed suitable for use herein. For example, physical properties of exosomes can be employed to separate them from a medium or other source material, including separation on the basis of electrical charge (e.g., electrophoretic separation), size (e.g., filtration, molecular sieving, etc), density (e.g., regular or gradient centrifugation) and Svedberg constant (e.g., sedimentation with or without external force, etc). Alternatively, or additionally, isolation can be based on one or more biological properties, and include methods that can employ surface markers (e.g., for precipitation, reversible binding to solid phase, FACS separation, specific ligand binding, non-specific ligand binding, etc.). In yet further contemplated methods, the exosomes can also be fused using chemical and/or physical methods, including PEG-induced fusion and/or ultrasonic fusion.


Isolation (and enrichment) can be done in a general and non-selective manner (typically including serial centrifugation). Alternatively, isolation and enrichment can be done in a more specific and selective manner (e.g., using producer cell-specific surface markers). For example, specific surface markers can be used in immunoprecipitation, FACS sorting and bead-bound ligands for magnetic separation etc.


In some embodiments, size exclusion chromatography can be utilized to isolate the exosomes. Size exclusion chromatography techniques are known in the art. Exemplary, non-limiting techniques are provided herein. In some embodiments, a void volume fraction is isolated and comprises the exosomes of interest. Further, in some embodiments, the exosomes can be further isolated after chromatographic separation by centrifugation techniques (of one or more chromatography fractions), as is generally known in the art. In some embodiments, for example, density gradient centrifugation can be utilized to further isolate the exosomes. Still further, in some embodiments, it can be desirable to further separate the producer cell-derived exosomes from exosomes of other origin. For example, the producer cell-derived exosomes can be separated from non-producer cell-derived exosomes by immunosorbent capture using an antigen antibody specific for the producer cell


In some embodiments, the isolation of exosomes can involve combinations of methods that include, but are not limited to, differential centrifugation, size-based membrane filtration, concentration and/or rate zonal centrifugation.


Methods of Characterizing Exosomes

In some embodiments, exosomes are isolated and characterized by metrics including, but not limited to, size, shape, morphology, or molecular compositions such as nucleic acids, proteins, metabolites and lipids.


Exosomes can be assessed by methods known in the art including, but not limited to, transcriptomics, sequencing, proteomics, mass spectrometry or HPLC. Exosomes can further be assessed by methods that include, but are not limited to, electron microscopy, flow cytometry and Western blotting.


The composition of nucleotides associated with an isolated exosome composition (including RNAs and DNAs) can be measured using a variety of techniques that are well known to those of skill in the art (e.g., quantitative or semi-quantitative RT-PCR, Northern blot analysis and solution hybridization detection). In a particular embodiment, the level of at least one RNA is measured by reverse transcribing RNA from the exosome composition to provide a set of target oligodeoxynucleotides, hybridizing the target oligodeoxynucleotides to one or more RNA-specific probe oligonucleotides (e.g., a microarray that comprises RNA-specific probe oligonucleotides) to provide a hybridization profile for the exosome composition and comparing the exosome composition hybridization profile to a hybridization profile generated from a control sample. An alteration in the signal of at least one RNA in the test sample relative to the control sample is indicative of the RNA composition.


Also, a microarray can be prepared from gene-specific oligonucleotide probes generated from known RNA sequences. The array can contain two different oligonucleotide probes for each RNA, one containing the active, mature sequence and the other being specific for the precursor of the RNA (for example miRNA and pre-miRNAs). The array can also contain controls, such as one or more mouse sequences differing from human orthologs by only a few bases, which can serve as controls for hybridization stringency conditions. tRNAs and other RNAs (e.g., rRNAs, mRNAs) from both species can also be printed on the microchip, providing an internal, relatively stable, positive control for specific hybridization. One or more appropriate controls for non-specific hybridization can also be included on the microchip. For this purpose, sequences are selected based upon the absence of any homology with any known RNAs.


The microarray can be fabricated using techniques known in the art. For example, probe oligonucleotides of an appropriate length, e.g., 40 nucleotides, are 5′-amine modified at position C6 and printed using commercially available microarray systems, e.g., the GeneMachine OmniGrid™ 100 Microarrayer and Amersham CodeLink™ activated slides. Labeled cDNA oligomer corresponding to the target RNAs is prepared by reverse transcribing the target RNA with labeled primer. Following first strand synthesis, the RNA/DNA hybrids are denatured to degrade the RNA templates. The labeled target cDNAs thus prepared are then hybridized to the microarray chip under hybridizing conditions, e.g., 6×SSPE/30% formamide at 25° C. for 18 hours, followed by washing in 0.75×TNT at 37° C. for 40 minutes. At positions on the array where the immobilized probe DNA recognizes a complementary target cDNA in the sample, hybridization occurs. The labeled target cDNA marks the exact position on the array where binding occurs, allowing automatic detection and quantification. The output consists of a list of hybridization events, indicating the relative abundance of specific cDNA sequences, and therefore the relative abundance of the corresponding complementary RNAs, in the exosome preparation. According to an embodiment, the labeled cDNA oligomer is a biotin-labeled cDNA, prepared from a biotin-labeled primer. The microarray is then processed by direct detection of the biotin-containing transcripts using, e.g., Streptavidin-Alexa647 conjugate, and scanned utilizing conventional scanning methods. Image intensities of each spot on the array are proportional to the abundance of the corresponding RNA in the exosomes.


The identity of the producer cells or exosomes can be assessed by in vitro assays. For example, the identity of the producer cells or exosomes is assessed by counting the number of cells or complexes in a population, e.g., by microscopy, by flow cytometry, or by hemacytometry. Alternatively or in addition, the identity of the producer cells or exosomes is assessed by analysis of protein content of the cell or complex, e.g., by flow cytometry, Western blot, immunoprecipitation, fluorescence spectroscopy, chemiluminescence, mass spectrometry, or absorbance spectroscopy. In an embodiment, the protein content assayed is a surface protein, e.g., a differentiation marker, a receptor, a co-receptor, a transporter, a glycoprotein. In some embodiments, the identity of the producer cells or exosomes is assessed by analysis of the receiver content of the cell or complex, e.g., by flow cytometry, Western blot, immunoprecipitation, fluorescence spectroscopy, chemiluminescence, mass spectrometry or absorbance spectroscopy. For example, the identity of the producer cells or exosomes can be assessed by the mRNA content of the cells or complexes, e.g., by RT-PCR, flow cytometry or northern blot. The identity of the producer cells can be assessed by nuclear material content, e.g., by flow cytometry, microscopy, or southern blot, using, e.g., a nuclear stain or a nucleic acid probe. Alternatively or in addition, the identity of the producer cells or exosomes is assessed by lipid content of the cells or complexes, e.g., by flow cytometry, liquid chromatography or by mass spectrometry.


Methods of Using Exosomes

Provided are compositions, methods, kits, and reagents for treatment or prevention of diseases or conditions in humans and other mammals. In some embodiments, pharmaceutical compositions comprising exosomes can be used for therapeutic purposes, such as the treatment or prevention of disease, disorder or condition.


Provided herein are methods of targeting a cell or tissue to treat or prevent a disease, disorder or condition. The subject can suffer from the disease, disorder or condition or can be at risk of developing the disease, disorder or condition. The methods provided herein include the administration of suitable exosomes described herein in an amount effective to substantially deliver the payload to the target cell or tissue, thereby preventing or treating the disease, disorder or condition. In some embodiments, the exosome is formulated as a pharmaceutical composition. In some embodiments, the pharmaceutical composition is formulated for intravenous injection to the subject. The compositions can be administered once to the subject. Alternatively, multiple administrations can be performed over a period of time. For example, two, three, four, five, or more administrations can be given to the subject. In some embodiments, administrations can be given as needed, e.g., for as long as symptoms associated with the disease, disorder or condition persist. In some embodiments, repeated administrations can be indicated for the remainder of the subject's life. Treatment periods can vary and could be, e.g., no longer than a year, six months, three months, two months, one month, two weeks, one week, three days, two days, or no longer than one day.


In some embodiments, the pharmaceutical composition is administered at a frequency sufficient to effectively increase the concentration of payload in the target cell or tissue above a level that is associated with a symptom of the disease, disorder or condition.


In some embodiments, the time interval between repeated administrations within a treatment period is no longer than the period in which the number of exosomes in circulation is reduced to less than about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or 95% of the number of exosomes present in the administered pharmaceutical composition.


In certain embodiments, the non-therapeutic exosome is administered separately to and at a different dosage than the therapeutic exosomes. In certain embodiments, the dosage of the non-therapeutic exosome is greater than the dosage of the therapeutic exosome. In certain embodiments, the dosage of the non-therapeutic exosome is the same as the therapeutic exosome. In some embodiments, the dosage of the non-therapeutic exosome is between 1.1-fold to 1.5-fold, 1.0-fold to 2.0-fold, 2.0-fold to 3.0-fold, 3.0-fold to 4.0-fold, 4.0-fold to 5.0-fold, 5.0-fold to 10.0-fold, 10.0-fold to 20.0-fold, 10.0-fold to 100-fold or 100-fold to 1,000-fold greater than the dosage of the therapeutic exosome. In certain embodiments, the dosage of the non-therapeutic exosome is less than the dosage of the therapeutic exosome. In certain embodiments, the dosage of the non-therapeutic exosome is between 1.1-fold to 1.5-fold, 1.0-fold to 2.0-fold, 2.0-fold to 3.0-fold, 3.0-fold to 4.0-fold, 4.0-fold to 5.0-fold, 5.0-fold to 10.0-fold, 10.0-fold to 20.0-fold, 10.0-fold to 100-fold or 100-fold to 1,000-fold less than the dosage of the therapeutic exosome.


In certain embodiments, the non-therapeutic exosome is administered concurrently to the therapeutic exosome. In certain embodiments, the non-therapeutic exosomes and the therapeutic exosomes are co-formulated as a single pharmaceutical composition.


In certain embodiments, the non-therapeutic exosomes are administered between 1 minute and 48 hours prior to the administration of the therapeutic exosomes. In particular embodiments, the non-therapeutic exosomes are administered 1 min to 5 min, 5 min to 10 min, 10 min to 15 min, 15 min to 20 min, 20 min to 25 min, 25 min to 30 min, 30 min to 45 min, 45 min to 60 min, 60 min to 120 min, 2 h to 3 h, 3 h to 5 h, 5 h to 10 h, 2 h to 12 h, 12 h to 18 h, 18 h to 24 h, 24 h to 48 h or 48 h to one week prior to administration of the therapeutic exosomes.


In certain embodiments, the non-therapeutic exosomes, the therapeutic exosomes or both the non-therapeutic exosomes and therapeutic exosomes are administered as repeated administration steps.


In certain embodiments, a plurality of distinct exosomes harboring distinct receivers, payloads or both distinct receivers or payloads are administered either concurrently or separately.


An effective amount of the composition is provided based, at least in part, on the target tissue, target cell type, means of administration, physical characteristics of the exosome (e.g., size, and in some cases the extent of molecules to be delivered) and other determinants. In general, an effective amount of the composition provides efficient cellular response of the target cell. Increased efficiency can be demonstrated by increased cell transfection (i.e., the percentage of cells transfected with the exosome constituents), increased cellular response or reduced innate immune response of the host subject.


The dosing and frequency of the administration of the exosomes and pharmaceutical compositions thereof can be determined, e.g., by the attending physician based on various factors such as the severity of disease, the patient's age, sex and diet, the severity of any inflammation, time of administration and other clinical factors. In an example, an intravenous administration is initiated at a dose which is minimally effective, and the dose is increased over a pre-selected time course until a positive effect is observed. Subsequently, incremental increases in dosage are made limiting to levels that produce a corresponding increase in effect while taking into account any adverse effects that can appear.


In certain embodiments, doses of exosomes are administered at intervals such as once daily, every other day, once weekly, twice weekly, once monthly or twice monthly.


In some embodiments, the compositions are administered at least twice over a treatment period such that the disease, disorder or condition is treated, or a symptom thereof is ameliorated. In some embodiments, the compositions are administered at least twice over a treatment period such that the disease, disorder or condition is treated or a symptom thereof is prevented. In some embodiments, the pharmaceutical composition is administered a sufficient number of times over a treatment period such that a sufficient amount of payload is delivered to the target cell or tissue during the treatment period. In some embodiments, the pharmaceutical composition is administered a sufficient number of times over a treatment period such that a sufficient amount of payload is delivered to the target cell or tissue during the treatment period such that one or more symptoms of the disease, disorder or condition is prevented, decreased, ameliorated or delayed. In some embodiments, increasing the payload concentration in the target cell or tissue includes increasing the peak concentration, while in others it includes increasing the average concentration. In some embodiments, a substantial increase during the treatment period can be determined by comparing a pretreatment or post-treatment period in the human subject, or by comparing measurements made in a population undergoing treatment with a matched, untreated control population.


In some embodiments, the pharmaceutical composition is administered a sufficient number of times per treatment period such that the concentration of payload in the target cell or tissue is increased for at least about one week, two weeks, three weeks, four weeks, one month, two months, three months, four months, five months, six months or greater than six months. In some embodiments, the pharmaceutical composition is administered a sufficient number of times per treatment period such that the concentration of payload in the target cell or tissue is increased for a period of time at least as long as the treatment period.


In some embodiments, the exosomes are administered, e.g., intravenously to the circulatory system or a tissue of a mammalian subject, such as a human. In some embodiments, the exosomes provide a natural barrier between a payload (e.g., therapeutic agent) and the immune system. In some embodiments, the exosomes are capable of residing in the circulatory system or tissue of a subject for an extended period of time allowing delivery of a more efficient therapeutic effect than what can be achieved by delivery through other methods currently used.


In certain embodiments, the exosomes are optionally modified by contacting with sialyltransferase prior to administration. Sialyltransferases are enzymes that transfer sialic acid to nascent oligosaccharide. Each sialyltransferase is specific for a particular sugar substrate. Sialyltransferases add sialic acid to the terminal portions of the sialylated glycolipids (gangliosides) or to the N- or O-linked sugar chains of glycoproteins. In certain embodiments, contacting exosomes with sialyl transferase prevents removal of the exosomes by the liver. In certain embodiments, contacting exosomes with sialyl transferase prevents removal of the exosomes by the liver by modulation of the binding of exosomes and liver cells that is mediated through asialoglycoprotein receptor.


In certain embodiments, the exosomes are optionally administered either concurrently or sequentially with an agent that inhibits phagocytosis by inhibiting, impeding or preventing the phagocytosis of exosomes by phagocytes. Agents that inhibit phagocytosis include but are not limited to, CD47 on the exosome surface.


Exosomes can interact with a target cell in a tissue or circulatory system of the subject. In some embodiments, the composition or phenotype of the target cell is modified subsequent to its interaction with the complex. In some embodiments, the modification of the target cell leads to a reduction in disease burden, can alleviate a symptom of the disease or has some other treatment effect.


In some embodiments, exosomes interact with a target cell and increase the concentration of a therapeutic agent in the target cell. In some embodiments, a therapeutic agent is delivered to the cytoplasm of the target cell. In some embodiments, the therapeutic agent is a functional mRNA which can be translated in the cytoplasm of the target cell. A resulting polypeptide can be functional and modulate signaling or regulatory behavior, morphology or growth of the target cell.


Provided are methods of treating a disease, disorder or condition comprising administering to a subject in need thereof a pharmaceutical composition comprising the exosomes described herein, optionally in form of the dosage form described herein, in an amount effective to treat the disease, disorder or condition.


In some embodiments, the preparations comprise exosomes comprising a payload that is capable, upon contact, of killing or restoring the functionality of an infected, impaired or dysregulated cell or tissue that is associated with the disease, disorder or condition. In some embodiments, the exosome facilitates the contacting of the infected, impaired or dysregulated cell or tissue with the payload in sufficient proximity and for a sufficient duration to bring about the killing or restoring the functionality of the infected, impaired or dysregulated cell or tissue. In some embodiments, an infected or dysregulated cell or tissue is killed thereby treating the disease, disorder or condition. In other embodiments an impaired or dysregulated cell or tissue is restored thereby treating the disease, disorder or condition. For example, an impaired enzyme function can be restored or a dysregulated enzyme function regulated.


In some embodiments, pharmaceutical compositions comprising exosomes can be used for treatment of any of a variety of diseases, disorders, and/or conditions, including but not limited to one or more of the following: autoimmune disorders (e.g., diabetes, lupus, multiple sclerosis, psoriasis, rheumatoid arthritis); inflammatory disorders (e.g., arthritis, pelvic inflammatory disease); infectious diseases (e.g., viral infections (e.g., HIV, HCV, RSV), bacterial infections, fungal infections, sepsis); neurological disorders (e.g., Alzheimer's disease, Huntington's disease; autism; Duchenne muscular dystrophy); cardiovascular disorders (e.g., atherosclerosis, hypercholesterolemia, thrombosis, clotting disorders, angiogenic disorders such as macular degeneration); proliferative disorders (e.g., cancer, benign neoplasms); respiratory disorders (e.g., chronic obstructive pulmonary disease); digestive disorders (e.g. inflammatory bowel disease, ulcers); musculoskeletal disorders (e.g. fibromyalgia, arthritis); endocrine, metabolic, and nutritional disorders (e.g., diabetes, osteoporosis); urological disorders (e.g., renal disease); psychological disorders (e.g., depression, schizophrenia); skin disorders (e.g., wounds, eczema); and blood and lymphatic disorders (e.g., anemia, hemophilia).


In an embodiment, the exosome is administered to a subject in need thereof to treat cancers. Such cancers include, but are not limited to, pancreatic cancers, biliary tract cancer, liver cancer, breast cancer, glioma, lung cancer, leukemias, gastrointestinal cancers, neuroendocrine tumors, throat cancers, melanoma, colon cancer, prostate cancer, ovarian cancer, testicular cancer, ocular cancer and kidney cancer.


In an embodiment, the exosome is administered to a subject in need thereof treat autoimmune disease. Such autoimmune diseases include, but are not limited to, multiple sclerosis, peripheral neuritis, Sjogren's syndrome, rheumatoid arthritis, graft versus host disease, alopecia, Autoimmune pancreatitis, Behcet's disease, Bullous pemphigoid, Celiac disease, Devic's disease (neuromyelitis optica), Glomerulonephritis, IgA nephropathy, assorted vasculitides, scleroderma, diabetes, arteritis, vitiligo, ulcerative colitis, irritable bowel syndrome, psoriasis, uveitis and systemic lupus erythematosus.


In an embodiment, the exosome is administered to a subject in need thereof to treat neurodegenerative diseases and brain-related conditions. Such indications include, but are not limited to, Parkinson's disease, Alzheimer's, stroke, aneurysms, neuroencephalitis and ALS.


In an embodiment, the exosome is administered to a subject in need thereof to treat a disease, disorder or condition selected from Table 8 and Table 9.


Diseases, disorders and conditions associated with target cells or tissues that can be treated or prevented by administering exosomes include, but are not limited to: diseases associated with infectious agents or pathogens (e.g., bacterial, fungal, viral, parasitic infections), disease associated with toxic proteins, diseases associated with the accumulation of lipids, diseases associated with apoptotic, necrotic, aberrant or oncogenic mammalian cells and metabolic diseases.


In some embodiments, provided are methods of treating diseases, including, but not limited to, metabolic diseases, cancers, clotting and anti-clotting diseases. The methods include administering to a subject in need thereof a pharmaceutical composition of exosomes in an amount sufficient to treat the metabolic disease, the cancer, the clotting disease or anti-clotting disease of the subject.


Diseases, disorders and conditions associated with targets in the circulatory system that can be treated or prevented by administering exosomes are described herein.


Diseases, disorders and conditions associated with targets in the circulatory system that can be treated or prevented by administering exosomes include, but are not limited to: diseases associated with infectious agents or pathogens (e.g., bacterial, fungal, viral, parasitic infections), diseases associated with apoptotic, necrotic, aberrant or oncogenic mammalian cells and metabolic diseases.


Provided herein, in some embodiments, are methods for the treatment or prevention of diseases or conditions that are associated with molecules or entities that reside, at least in part, in specific target cells or tissues. The methods comprise, in certain embodiments, administering to a subject in need thereof exosomes in an amount effective to treat or prevent the disease or condition that is associated with molecules or entities that reside, in specific target cells or tissues.


Provided herein are methods of inducing in vivo delivery of exosomes in a mammalian subject in need thereof. Therein, an effective amount of a composition containing an exosome is administered to the subject using the delivery methods described herein. The exosome is provided in an amount such that the exosome is localized into a cell of the subject. The cell in which the exosome is localized, or the tissue in which the cell is present, can be targeted with one or more than one rounds of exosome administration.


Provided herein are methods of transplanting cells containing or producing exosomes to a mammalian subject. Administration of cells to mammalian subjects is known to those of ordinary skill in the art, such as local implantation (e.g., topical or subcutaneous administration), organ delivery or systemic injection (e.g., intravenous injection or inhalation), as is the formulation of cells in pharmaceutically acceptable carrier.


Provided are methods of inducing a cellular response using the exosomes described herein. Such response can be in vivo, ex vivo, in culture, or in vitro. For example, a target cell population is contacted with an effective amount of a composition containing an exosome. The population is contacted under conditions such that the exosome is localized into one or more cells of the cell population.


In an embodiment, the exosome is administered as part of a treatment regimen that further includes administration of a second, standard-of-care therapy.


In certain embodiments, the administered exosome directs up-regulation of (via expression in the cell, delivery in the cell, or induction within the cell) of one or more polypeptides that provide a functional activity which is substantially absent in the target cell to which the polypeptide is delivered. For example, the missing functional activity can be enzymatic, structural, or gene regulatory in nature. In related embodiments, the administered exosome directs up-regulation of one or more polypeptides that increases (e.g., synergistically) a functional activity which is present but substantially deficient in the target cell in which the polypeptide is up-regulated.


In certain embodiments, the administered exosome directs up-regulation of (via expression in the cell, delivery in the cell, or induction within the cell) of one or more polypeptides that replace a polypeptide (or multiple polypeptides) that is substantially absent in the target cell in which the polypeptide is up-regulated. Such absence can be due to genetic mutation of the encoding gene or regulatory pathway thereof. In some embodiments, the polypeptide increases the level of an endogenous protein in the cell to a desirable level; such an increase can bring the level of the endogenous protein from a subnormal level to a normal level, or from a normal level to a super-normal level.


Alternatively, the polypeptide functions to antagonize the activity of an endogenous protein present in, on the surface of, or secreted from the cell. Usually, the activity of the endogenous protein is deleterious to the subject, for example, due to mutation of the endogenous protein resulting in altered activity or localization. Additionally, the polypeptide antagonizes, directly or indirectly, the activity of a biological moiety present in, on the surface of or secreted from the cell. Examples of antagonized biological moieties include lipids (e.g., cholesterol), a lipoprotein (e.g., low density lipoprotein), a nucleic acid, a carbohydrate, a protein toxin such as shiga and tetanus toxins or a small molecule toxin such as botulinum, cholera and diphtheria toxins. Additionally, the antagonized biological molecule can be an endogenous protein that exhibits an undesirable activity, such as a cytotoxic or cytostatic activity.


Modulation of Cell Fate


Provided are methods of inducing an alteration in cell fate in a target mammalian cell. The target mammalian cell can be a precursor cell and the alteration can involve driving differentiation into a lineage, or blocking such differentiation. Alternatively, the target mammalian cell can be a differentiated cell, and the cell fate alteration includes driving de-differentiation into a pluripotent precursor cell, or blocking such de-differentiation, such as the dedifferentiation of cancer cells into cancer stem cells. In situations where a change in cell fate is desired, effective amounts of exosomes encoding a cell fate inductive molecule or signal as a payload is introduced into a target cell under conditions such that an alteration in cell fate is induced. In some embodiments, the exosomes are useful to reprogram a subpopulation of cells from a first phenotype to a second phenotype. Such a reprogramming can be temporary or permanent. Optionally, the reprogramming induces a target cell to adopt an intermediate phenotype.


Additionally, the methods can be used to generate induced pluripotent stem cells (iPS cells). The use of iPS cells generated using the methods described herein is expected to have a reduced incidence of teratoma formation.


Also provided are methods of reducing cellular differentiation in a target cell population. For example, a target cell population containing one or more precursor cell types is contacted with a composition having an effective amount of an exosome composition, under conditions such that the exosome reduces the differentiation of the precursor cell. In non-limiting embodiments, the target cell population contains injured tissue in a mammalian subject or tissue affected by a surgical procedure. The precursor cell is, e.g., a stromal precursor cell, a neural precursor cell or a mesenchymal precursor cell.


Targeting Diseased Cells


Provided herein are methods for targeting pathogenic or diseased cells or tissues, including cancer cells, using exosomes that deliver cytotoxic or cytostatic molecules. The molecule can be delivered into the target pathogenic cell exclusively or preferentially to reduce off-target effects of the therapeutic. Receivers described herein can be used that are capable of targeting the exosomes preferentially to the target pathogenic cell.


Methods of Gene Silencing


The exosome compositions described herein are useful to silence (e.g., prevent or substantially reduce) expression of one or more target genes in a target cell population. An exosome containing or encoding a polypeptide capable of directing sequence-specific histone H3 methylation is introduced into the target cells under conditions such that the polypeptide is translated and reduces gene transcription of a target gene via histone H3 methylation and subsequent heterochromatin formation. In some embodiments, the silencing mechanism is performed on a cell population present in a mammalian subject. By way of non-limiting example, a useful target gene is a mutated Janus Kinase-2 family member, wherein the mammalian subject expresses the mutant target gene suffers from a myeloproliferative disease resulting from aberrant kinase activity.


Administration of exosomes carrying siRNAs are also provided herein. As has been previously demonstrated in yeast, sequence-specific trans-silencing is an effective mechanism for altering cell function. While this mechanism functions in cis- with centromeric regions of DNA, sequence-specific trans silencing is possible through co-transfection with double-stranded siRNAs for specific regions of DNA and concomitant RNAi-directed silencing of the siRNA ribonuclease Eri1 (Buhler et al. Cell 2006, 125, 873-886).


Modulation of Biological Pathways


The efficient delivery of molecules (payloads) via exosomes into cells provides a desirable mechanism of modulating target biological pathways. Such modulation includes antagonism or agonism of a given pathway. In an embodiment, a method is provided for antagonizing a biological pathway in a target cell by contacting the cell with an effective amount of an exosome composition comprising a polypeptide or comprising a functional nucleic acid (e.g., mRNA) which encodes a polypeptide, under conditions such that the peptide is localized into the target cell or the polypeptide is capable of being translated in the cell from the nucleic acid, wherein the polypeptide inhibits the activity of another polypeptide functional in the biological pathway. Exemplary biological pathways are those defective in an autoimmune or inflammatory disorder such as multiple sclerosis, rheumatoid arthritis, psoriasis, lupus erythematosus, ankylosing spondylitis colitis, or Crohn's disease; in particular, antagonism of the IL-12 and IL-23 signaling pathways are of particular utility. (See Kikly K, Liu L, Na S, Sedgwick J D (2006) Curr. Opin. Immunol. 18 (6): 670-5). Further, provided are modified nucleic acids encoding an antagonist for chemokine receptors; chemokine receptors CXCR-4 and CCR-5 are required for, e.g., HIV entry into host cells (Arenzana-Seisdedos F et al. (1996) Nature 383:400).


Alternatively, provided are methods of agonizing a biological pathway in a target cell. Exemplary agonized biological pathways include pathways that modulate cell fate determination. Such agonization is reversible or, alternatively, irreversible.


In some embodiments, contacting a target cell with an exosome modulates a biological pathway that causes a cytotoxic cellular response. In some embodiments, the polypeptide is a protein cytotoxic to the target cell.


In some embodiments, exosomes can similarly carry metabolites, lipids, or small molecules that modulate the activity of a biological pathway. Such molecules can be recombinant, synthesized or natively isolated.


Methods of Nucleic Acid Delivery


Methods are provided to enhance nucleic acid delivery from exosomes into a cell population, in vivo, ex vivo, or in culture. For example, a cell culture containing a plurality of target cells (e.g., eukaryotic cells such as yeast or mammalian cells) is contacted with a composition comprising an exosome having at least one nucleic acid, which optionally has a translatable region. The nucleic acid within the exosome composition exhibits enhanced retention in the target cell relative to a corresponding free nucleic acid. The retention of the nucleic acid within the exosome composition is greater than the retention of the free nucleic acid. In some embodiments, it is at least about 50%, 75%, 90%, 95%, 100%, 150%, 200% or more than 200% greater than the retention of the free nucleic acid. Such retention advantage can be achieved by one round of transfection with the nucleic acid within an exosome composition, or can be obtained following repeated rounds of transfection.


In some embodiments, the nucleic acid within the exosome composition is delivered to a target cell population with one or more additional nucleic acids. Such delivery can be at the same time, or the nucleic acid within the exosome composition is delivered prior to delivery of the one or more additional nucleic acids. The additional one or more nucleic acids can be within the same or within a separate exosome composition or free nucleic acids. It is understood that the initial presence of the nucleic acid within an exosome composition does not substantially induce an innate immune response of the target cell population and, moreover, that the innate immune response will not be activated by the later presence of the additional nucleic acids. In this regard, the nucleic acid within the exosome composition cannot itself contain a translatable region, if the protein desired to be present in the target cell population is translated from the additional nucleic acid.


The nucleic acid within the exosome composition can have at least one nucleoside modification or can be unmodified.


Examples

Below are examples of specific embodiments for carrying out the present invention. The examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way. Efforts have been made to ensure accuracy with respect to numbers used (e.g., dosages, amounts, temperatures, dosing schedules etc.), but some experimental error and deviation should, of course, be allowed for.


The practice of the present invention will employ, unless otherwise indicated, conventional methods of protein chemistry, biochemistry, recombinant DNA techniques and pharmacology, within the skill of the art. Such techniques are explained fully in the literature. See, e.g., T. E. Creighton, Proteins: Structures and Molecular Properties (W.H. Freeman and Company, 1993); A. L. Lehninger, Biochemistry (Worth Publishers, Inc., current addition); Sambrook, et al., Molecular Cloning: A Laboratory Manual (2nd Edition, 1989); Methods In Enzymology (S. Colowick and N. Kaplan eds., Academic Press, Inc.); Remington's Pharmaceutical Sciences, 18th Edition (Easton, Pa.: Mack Publishing Company, 1990); Carey and Sundberg Advanced Organic Chemistry 3rd Ed. (Plenum Press) Vols A and B (1992).


Methods

Production, isolation and formulation of exosomes for intravenous injection are performed as described above. Methods described herein can be carried out as known in the art and described in PCT Application No. PCT/US14/65304 SYNTHETIC MEMBRANE-RECEIVER COMPLEXES incorporated in its entirety by reference herein.


Example 1: Administration of Unlabeled Exosomes Prior to Labeled Exosomes to Determine Alterations in Tissue-Specific Uptake

To determine whether exosome pre-treatment could lead to increased uptake in tissues beyond the liver and spleen, the following experiment was performed. Conditioned culture media from 293T cells was collected and centrifuged at 300-800×g for 5 minutes at room temperature to remove cells and large debris. Media supernatant was then supplemented with 1000 U/L Benzonase® and incubated at 37° C. for 1 hour in a water bath. Supernatant was collected and centrifuged at 16,000×g for 30 minutes at 4° C. to remove residual cell debris and other large contaminants. Supernatant was then ultracentrifuged at 133,900×g for 3 hours at 4° C. to pellet the exosomes. Supernatant was discarded and residual media was aspirated from the bottom of the tube. The pellet was then resuspended in 200-1000 μL PBS (−Ca −Mg).


To further enrich exosome populations, the pellet was processed via sucrose density gradient purification as defined in Table 1 below:









TABLE 1







Sucrose Density Gradient:












65%




Working
Stock Vol.
Milli-Q



Percentage (%)
(mL)
Vol. (mL)







50
3.85
1.15



40
3.08
1.92



25
1.92
3.08



10
0.46
2.54










The gradient was spun at 200,000×g for 16 hours at 4° C. in a 12 mL Ultra-Clear™ (Beckman Coulter catalogue #344059) tube placed in a SW 41 Ti rotor to separate the exosome fraction.


The exosome layer was gently removed from the top layer and diluted in ˜32.5 mL PBS in a 38.5 mL Ultra-Clear™ (Beckman Coulter catalogue #344058) tube and ultracentrifuged again at 133,900×g for 3 hours at 4° C. to pellet the purified exosomes. The resulting pellet was resuspended in a minimal volume of PBS (˜200 μL) and stored at 4° C.


To radiolabel the purified exosomes for in vivo imaging, 1×1011 purified exosomes in 100 μL were diluted with HEPES (200 μL, 0.1 M, pH 8.5) and conjugated to p-SCN-Bn-DFO (5 μg) for one hour at 37° C. followed by overnight incubation at 4° C., separately. DFO-exosomes were incubated with 89Zr (7.5 mCi) diluted in HEPES (100 μL, 1 M, pH 7.3) for one hour at 37° C. and purified on a qEv column. This resulted in a total yield (0.4 mCi of 89Zr-DFO-exosomes in up to 0.8 mL PBS at 100 μCi/1×1010 exosomes. Quality control (HPLC) was performed prior to release to ensure >95% RCP.


In Vitro Stability


Exosomes (20 μCi/2×1010) were incubated at room temperature in:


a. Formulation buffer


b. Mouse serum (10% v/v exosome solution in serum, if possible)


2 hours after initiation of incubation solutions were injected into HPLC to determine stability of tracer.


In Vivo Imaging


Mice (SKH-1, n=8, age 5-8 weeks) were randomized into two groups, weighed and injected (with the second group injected immediately after the first group's dynamic scan was over) with 1×1010/g exosomes to give a minimum radioactive dose of 100 μCi/mouse. Both groups are injected intravenously. Group 1 was injected with the radiolabeled exosomes only while group 2 was injected first with unlabeled 293SF exosomes and 5 minutes later with the radiolabeled exosomes (Table 2).


Mice received a whole body PET/CT scan in a 4-mouse hotel using the following schedule: static imaging at 4 h (20 min), 24 h (Thursday, 20 min). Each imaging time point was followed by CT for anatomical reference.


After the last imaging time point, mice were euthanized and the following organs were collected, weighed and counted in the gamma counter: Blood, lung (both), liver (lobe), spleen, pancreas, kidney (both), stomach (whole, emptied), small intestine (whole, emptied), large intestine (whole, emptied) muscle, brain and tail.


Organs were allowed to decay for 2-3 days when counts were extremely high, and were counted again.









TABLE 2







In Vivo Imaging












Group (mouse


Injection

Imaging time


# and type)
Blocking
Tracer
route
Imaging
points





1 (n = 4, SKH-1)
N/A

89Zr-DFO-exosomes

IV
Whole body
4 h and 24 h


2 (n = 4, SKH-1)
293SF
(293T, 100 μCi,

PET/CT
(20 min)



exosomes
<150 μL)

using a 4




(1 × 1012, <100


mouse hotel




μL) 5 minutes







before tracer









Results

The two cohorts of treated mice were imaged 4 hours, 24 hours, and 48 hours after treatment. Whole body PET/CT imaging revealed robust delivery to the livers of all mice analyzed (FIGS. 1 and 2). Organs were dissected and analyzed by radiographic gamma counter, which revealed a marked increase in exosome uptake by nearly all tissues in mice that were pre-treated with unlabeled exosomes (FIGS. 3 and 4). Notably, exosomes were taken up to a much greater extent by lung, small intestine, large intestine, stomach and pancreas when mice were pre-treated with unlabeled exosomes (FIGS. 3 and 4). These results demonstrate that an in vivo bolus dose of exosomes facilitates bypass of liver and spleen, and allows for an increased uptake of downstream tissues.


Example 2: Administration of Unlabeled, Non-Therapeutic Exosomes Prior to Labeled Exosomes in Mice to Determine Localization to Endothelium and Delivery of RNA

The exosome populations are intravenously administered to mice via tail-vein injections using a syringe. Unlabeled exosomes are diluted to a density of 106 exosomes/ml and DiI-C16-labeled exosomes harboring Cy3-labeled GAPDH siRNA are diluted to a density of 105 exosomes/ml using standard saline buffer at 37° C. such that 1 ml of volume, are delivered per tail vein injection. The exosome solutions are loaded into a 5 cc syringe, 26 gauge needle and injected into the subject through the tail vein.


At 8 weeks of age, mice received tail-vein injections of unlabeled exosomes and DiI-C16-labeled exosomes harboring Cy3-labeled GAPDH siRNA or DiI-C16-labeled exosomes harboring Cy3-labeled GAPDH siRNA alone. 1 mL or 106 exosomes of unlabeled exosomes are injected 15, 30 or 60 minutes prior to injection of 1 mL or 105 exosomes of DiI-C16-labeled exosomes harboring Cy3-labeled GAPDH siRNA. 6, 12 or 24 hours after injection of the DiI-C16-labeled exosomes harboring Cy3-labeled GAPDH siRNA, murine thoracic aorta endothelium is isolated, washed with PBS five times to remove contaminated exosomes, and then viewed under fluorescence microscopy. For measurement of GAPDH RNA levels, total RNA is extracted from thoracic aorta by using TRIzol Reagent (Invitrogen) according to the manufacturer's instructions. RNA samples are then subjected to TaqMan miRNA assays and real-time PCR.


Example 3: Administration of Exosomes Containing Let-7a miRNA in a Human Tumor Xenograft Model for Tracking Tissue Distribution of Exosomes and Tumor Growth

Platelets are transfected with synthetic Let-7a. Fluorescently-labeled exosomes containing Let-7a, and exosomes from untransfected platelets are purified from culture supernatants according to methods described above. Luciferase-expressing HCC70 cells (2×106) are injected subcutaneously into the mammary fat pads of 5-week-old RAG2−/− mice. Four weeks after transplantation, tumors were sized using an IVIS (Xenogen, Hopkinton, Mass.). Experimental mice with mammary fat pad transplanted luciferase-expressing HCC70 cells are intravenously injected with 150 μg of purified exosomes lacking Let-7a, and after 60 minutes, 150 μg of purified fluorescently-labeled exosomes expressing Let-7a are administered intravenously. Control mice with mammary fat pad transplanted luciferase-expressing HCC70 cells are intravenously injected with saline, and after 60 minutes, 150 μg of purified fluorescently-labeled exosomes expressing Let-7a are administered intravenously. Administration of either purified exosomes lacking Let-7a followed by administration of purified exosomes expressing Let-7a for experimental mice and administration of saline, followed by administration of 150 μg of purified exosomes expressing Let-7a for control mice is performed thrice per week for 4 weeks. Let-7a levels in the exosome samples are evaluated using TaqMan miRNA assays and real-time PCRs. Mice are handled according to the Ethical Guidelines of our institution. Tumor size is monitored every other day using an IVIS. Five weeks post-administration of the first dose of exosomes, mice are euthanized and mammary tumor samples are subjected to immunohistochemistry, TaqMan miRNA assays and real-time PCR.


In Vivo Imaging of Xenograft Tumors

Mice are anesthetized via isoflurane inhalation, and intraperitoneally injected with 100 μl of 7.5 mg/ml luciferin solution (Promega). Bioluminescence imaging is initiated with an IVIS (Xenogen) 10 minutes post injection. The region of interest was defined manually, and bioluminescence data are expressed as photon flux values (photons/s/cm2/steradian). Background photon flux is defined using an area of the tumor that did not receive an intraperitoneal injection of luciferin. All bioluminescence data is collected and analyzed using an IVIS.


In Vivo Imaging of Fluorescently Labeled Exosomes

A stock solution of the lipophilic near-infrared dye XenoLight DiR (Caliper Life Sciences, Hopkinton, Mass.) is prepared in ethanol. A 300-μmol/l working solution is prepared in diluent-C solution (Sigma-Aldrich). Exosomes isolated from culture supernatant-derived platelets are incubated with 2 μmol/l DiR for 30 minutes. The exosomes are then washed with 10 ml of phosphate-buffered saline, subjected to ultracentrifugation, and injected intravenously into RAG2−/− mice (4 μg of exosomes/mouse). Migration of fluorescently labeled exosomes in murine organs is detected using an IVIS 24 hours post injection.


Example 4: Targeting Exosomes to the Brain In Vivo

Exosomes are engineered by modifying a parent cell with a receiver that targets the complex to a specific tissue for payload delivery. In this example, a parent cell is transfected with a receiver comprising a membrane protein linked to a neuron-specific peptide, which targets isolated exosomes (generated by the parent cell) to the brain tissue. Recipient neurons specifically receive a functional RNA payload (either BACE1 siRNAs or GAPDH siRNA) that is contacted with the exosome prior to administration.


Exosomes with encapsulated siRNA are prepared by electroporation of 150 μg of Cy3-labeled scrambled siRNA or 150 μg each of two Cy3-labeled BACE1 siRNAs. siRNA-transfection reagent complexes are prepared with cationic liposome-based in vivo transfection reagent as per manufacturer's protocol (Altogen Biosystems). Exosomes for in vivo experiments are spun down and resuspended in 80 μl of 5% glucose immediately before tail vein injection. 150 μg of exosomes with encapsulated 150 μg of Cy3-labeled scrambled siRNA or 150 μg of exosomes with encapsulated Cy3-labeled BACE1 siRNAs are injected per animal.


Alternatively, animals are injected with exosomes lacking Cy3-labeled GAPDH siRNA and exosomes harboring Cy3-labeled GAPDH siRNA, or injected with exosomes harboring Cy3-labeled GAPDH siRNA only. For the experimental cohort, receiving both exosomes lacking Cy3-labeled GAPDH siRNA and exosomes harboring Cy3-labeled GAPDH siRNA, 150 μg of exosomes lacking Cy3-labeled GAPDH siRNA is injected between 5 minutes and 2 hours prior to injection of 150 μg exosomes harboring Cy3-labeled GAPDH siRNA. The control cohort, receiving only the exosomes harboring Cy3-labeled GAPDH siRNA, is injected with saline (at the same volume as the exosome injections) 5 minutes to 2 hours prior to injection of 150 μg of the exosomes. Animals of both cohorts are euthanized 12 h later for immunohistochemical analysis of brain tissue sections.


Immunohistochemistry

Brain coronal sections (10 μM) are cut with a cryostat for the histopathological assessment. Slices are washed with PBS and fixed with 4% paraformaldehyde. Slices are treated with blocking solution (PBS containing 10% NGS and 0.05% Triton X-100). Slices are incubated overnight at 4° C. with the primary antibodies: mouse anti-BACE1 (Sigma), mouse anti-GAPDH (1:250, Abeam); mouse anti-NeuN (1:100, Sigma), rabbit anti-glial fibrillary acidic protein (GFAP) (1:250, Sigma), rabbit anti-Iba1 (1:250, Dakocytomation), rabbit anti-OP1 (1:250, Abeam) and rabbit anti-oligodendrocyte specific protein (OSP) (1:205, Abeam). Slices are washed three times with PBS and were incubated with a secondary antibody of the appropriate species; Alexa 488 goat anti-mouse (1:200) and Alexa 488 goat anti-rabbit. The microscope analyses are performed using an epifluorescence microscope (Zeiss).


5′ Rapid Amplification of cDNA Ends


RNA is harvested from cortical sections of the brain of mice injected with BACE1 siRNAs encapsulated in exosomes, as mentioned previously. 5′ RACE is performed with Invitrogen GeneRacer kit as per manufacturer's instruction on 10 μg of total RNA. Briefly, an RNA linker (5′-CGACUGGAGCACGAGGACACUGACAUGGACUGAAGGAGUAGAAA-3′) is ligated to the unprotected phosphorylated 5′ end of RNA and the product is reverse transcribed using a specific primer against BACE1 (5′-CGACAAGAGCATTGTGGACAGTGGGAC-3′) using New England Biolabs ThermoPol Taq polymerase. Using a specific primer for the 5′ linker and the specific BACE1 primer, the cDNA is amplified and TA-cloned into a vector and sequenced.


Example 5: Administration of Non-Therapeutic Exosomes Prior to Therapeutic Exosomes to Human Patients for the Treatment of Breast Cancer

Exosome populations are intravenously administered via a syringe. The exosomes are formulated as described above. Non-therapeutic exosomes and therapeutic exosomes harboring Let-7 miRNA are diluted to a density of 10{circumflex over ( )}7 exosomes/ml using standard saline buffer at 37° C. such that 100 ml of volume, or 109 cells, are delivered. Breast cancer patients are administered 150 μg of purified, non-therapeutic exosomes lacking Let-7a, and after 60 minutes, 150 μg of purified therapeutic exosomes harboring Let-7a are administered intravenously. Exosome formulations are prepared as described above. The exosome solutions are loaded into a 150 cc syringe, 20 gauge needle and injected into the patient through the basilic vein at 5 cc/min. During injection, the patient's vitals are monitored for any immunogenic or clotting reactions. Administration of 150 μg purified exosomes lacking Let-7a followed by administration of 150 μg purified exosomes expressing Let-7a is performed thrice per week for 12 weeks. Patients are monitored for tumor size and disease progression at 6-weeks and 12-weeks by Positron Emission Tomography and Computed Tomography (PET-CT) imaging.


While the invention has been particularly shown and described with reference to a preferred embodiment and various alternate embodiments, it will be understood by persons skilled in the relevant art that various changes in form and details can be made therein without departing from the spirit and scope of the invention.


All references, issued patents and patent applications cited within the body of the instant specification are hereby incorporated by reference in their entirety, for all purposes.









TABLE 3





Exosome Lipids
















Lysobisphosphatidic acid
Ganglioside GM3 24:1


Sphingomyelin (SM)
Ganglioside GM3 16:0


Ganglioside GM3
PE40:5


Phosphatidylserine (PS)
PE40:6


Phosphatidylinositol (PI)
PE38:3


Phosphatidylcholine (PC)
PE38:4


Phosphatidylethanolamine (PE)
PE36:1


Lysophosphatidylcholine (LPC)
PE36:2


Cholesterol (Chol)
PE34:1


Diacylglycerol (DG)
PE34:2


PI18:0/20:3
PE-ether38:5


PI18:0/20:4
PE-ether38:6


PI18:0/18:1
PE-ether34:1


PI18:1/18:1
PE-ether34:2


PI18:0/16:0
PC34:1


PA18:0/18:1
PC36:4


PS18:0/18:1
PC34:3


BMP 18:0/18:1
PC32:0


BMP 18:1/18:1
PC30:0


BMP 18:1/16:0
SM24:1


CL(18:1)3/16:1
SM16:0


CL(18:1)2/(16:1)2
Dihydrosphingomyelin16:0
















TABLE 4





Exosome polypeptides


















ACLY
TCP1
ACTR1A
LY75


ACTB
PRDX2
THOC4
ABCC1


ACTG1
TSPAN6
INADL
MYO1E


ALB
CCT3
CTDSPL
NACA


ALDOA
TSTA3
ZMPSTE24
NAP1L4


ALDOB
TUBA3C
DNAJA2
NCL


AKR1B1
HIST1H2AK
NDRG1
NEDD8


AMBP
HIST1H2AJ
RAPGEF3
YBX1


ANPEP
HIST1H2AB
SPON2
PA2G4


ANXA2
HIST2H2AC
UBAC1
PECAM1


ANXA3
IFITM1
N4BP2L2
PFAS


ANXA4
PDXK
CAP1
SERPINB9


ANXA5
LIN7A
VAT1
PI4KA


ANXA6
BUB3
NEBL
PLAT


ANXA7
MAP4K4
DCTN2
PLCG2


ANXA11
EDIL3
ARPC1A
PPA1


ATP1A1
ATP6AP2
C6orf108
PPP2CA


CAPZB
PSME3
SMC2
PRKCB


CD63
TUBB3
AHSA1
PSMA6


CD81
IFITM3
STAMBP
PSMA7


CKB
ACAA2
PMVK
PSMB8


CLU
CCT7
GIPC1
PSMB9


CLIC1
CCT4
HBS1L
PSMD7


TPP1
1FITM2
NCKAP1
PSME1


CLTC
GNA13
ALDH1L1
PTPRA


CNP
RUVBL2
FTCD
RAC2


COL6A1
PRSS23
FGL2
RPL3


CR1
ACOT7
CFHR3
RPL4


CTNND1
CCT5
MMP24
RPL5


ACE
DIP2C
COPS8
RPL11


DDT
ASCC3L1
CKAP4
RPL22


DEFA1
TNIK
C10orf116
RPL24


DEFA3
NEDD4L
SLC27A2
RPL27


DNAH8
NCSTN
MID2
RPL30


DPEP1
TSPAN15
KIF3A
RPL28


DPP4
PLXNB2
NUDT5
RPL31


EEF1A1
SDCBP2
TREH
RPL34


EEF2
IGKV1-5
CEP250
RPL35A


EGF
IGHV4-31
PDCD10
RPL37A


EIF5A
IGKV3-20
PADI2
RPS2


ENO1
IGKV2-24
PACSIN2
RPS3A


ENO3
MINK1
CHP
RPS5


ENPEP
IGK@
SNF8
RPS9


STOM
VPS36
DDX19B
RPS19


EPS8
DERA
SCN11A
RPS25


FABP3
GOLGA7
LYPLA2
RPS26


FGA
KRT76
PARK7
RPS28


MLANA
EIF3EIP
COBLL1
RPS29


FN1
LSR
CNKSR2
RSU1


FTL
TUBA8
ENPP4
SARS


FUS
RAB4B
RAB3GAP1
SLAMF1


GAA
SETD4
AKR7A3
SLC1A4


GAPDH
TOLLIP
SPEN
SLC2A3


GDI2
PLEKHB2
GANAB
SNRPD2


GGT1
VPS37C
MGRN1
SPINK1


GLB1
LIN7C
CUX2
SPN


GLG1
H2AFJ
DNAJC13
STK10


GNA11
CAND1
ZCCHC11
STXBP3


GNAI1
PLSCR3
PHF15
TALDO1


GNAI2
KIAA1199
KIAA0841
TNFAIP3


GNAI3
GNB4
ARHGEF12
TPM3


GNAS
MYH14
COTL1
TPM4


GNB1
TSPAN14
ANGPTL2
TYK2


GNB2
NCALD
DDAH2
VIM


GNG7
REG4
HEBP2
WARS


SFN
VPS25
CD2AP
WAS


GPI
TUBB6
PLD3
LAT2


GSTA1
TUBA1C
TMEM2
HIST1H2BL


GSTA2
TNKS1BP1
SH3BP4
STX7


GSTA3
FAM125B
BHMT2
CPNE1


GSTM3
LRSAM1
GCA
RPL14


GSTP1
HIST3H2A
MXRA5
PDCD5


GUSB
TUBA3E
AHCTF1
SYNGR2


HIST1H2AD
TUBA3D
PTPN23
RPL23


HLA-A
DCD
DAK
RAB9A


HLA-B
HIST4H4
ACOT11
IGSF2


HLA-DQB1
ALDH16A1
APPL1
EEF1E1


HLA-DRA
RPS4Y2
PHGDH
SCAMP2


HLA-DRB1
MYL6B
TIAM2
SCAMP3


HLA-DRB5
BRI3BP
KCNG2
DPP3


HPGD
AGR3
CYFIP2
ARPC1B


HRAS
EEF1AL3
GHITM
PDIA6


HSPA1A
KRT28
C11orf54
WASF2


HSPA1B
KRT24
DBNL
ANP32B


HSPA8
RPLP0-like
ATAD2
PAICS


HSP90AA1
RPSAP15
PHPT1
AHCYL1


ITGA4
RANP1
C16orf80
VAMP5


KRT1
PCSK9
OLA1
41891


KRT9
METRNL
ZDHHC1
HSPH1


KRT10
LOC284889
SNX12
SUB1


LDHA
KRT6C
PSAT1
CDC37


LDHB
KRT79
NT5C
CORO1A


TACSTD1
RAB43
EHD2
CD300A


MCAM
KRT27
TAX1BP3
TMC6


MDH1
ACTBL2
CRNN
RFTN1


MEP1A
RP11-631M21.2
NOX3
SCRIB


MSN
TUBB2B
ATP6V0A4
SERBP1


2-Sep
KRT77
ITSN2
TTLL3


PGAM1
AGRN
GEMIN4
CACYBP


PGK1
RAB15
LAP3
SIT1


PKM2
LOC388524
CRYL1
SLC43A3


PPP1CA
LOC388720
MYO15A
PILRA


PTGFRN
HSP90AB2P
ATP6V1D
RPL26L1


PTPRC
ACTBL3
SNX9
MPP6


RAN
LOC442497
PCYOX1
GNG2


RDX
A26C1A
ANKFY1
TMED9


SDCBP
HIST2H4B
UFC1
DOCK10


STX3
hCG_1757335
FAM49B
C3orf10


STXBP1
HLA-A29.1
CUTA
MYO1G


STXBP2
LOC653269
ATP6V1H
FLJ21438


TPI1
A26C1B
VPS24
SLC38A1


EZR
LOC100128936
CMPK1
FERMT3


YWHAE
LOC100130553
UPB1
ITFG3


TUBA1A
LOC100133382
CLIC5
HIST1H2AH


WDR1
LOC100133739
MUPCDH
SLAMF6


PDCD6IP
AP2A2
CLIC6
TMC8


GPA33
ALDH3B1
SIAE
LOC153364


TUBA1B
FASLG
CPVL
SVIP


TUBB2C
ATP4A
RHOF
TMEM189-





UBE2V1


CAPN7
CAPS
ARL15
hCG_16001


DDAH1
COL12A1
ZNHIT6
FABP5L7


PGLS
DMBT1
GIPC2
Del(X)1Brd


SAMM50
DSP
PCDH24
ABP1


CLIC4
EGFR
VPS13C
ACTN3


CHMP2B
EPHA5
CC2D1A
AFM


ULK3
EPHB1
EPS8L1
AKT1


RNF11
FAT
C10orf18
ALDH3A2


VPS4A
HSD17B4
CHCHD3
ALOX12P2


ARFIP1
L1CAM
C2orf18
ANXA2P1


CHMP2A
LAMA5
C17orf80
KRT33B


SMPDL3B
MUC4
EPN3
MYOC


PACSIN3
NOTCH1
UACA
SERPINE1


EHD4
PPP2R1B
VPS13D
PIK3CA


EHD3
PTPRF
APPL2
NRP1


HEBP1
SORT1
ARL8B
SPRY1


VPS28
SERPINB3
DDX19A
EMILIN1


DCXR
SELP
NAGK
LRG1


RHCG
FSCN1
ITLN1
AZGP1P1


CHMP5
TGFB1
CCDC132
LOC728533


VTA1
CLTCL1
OTUB1
ALDH7A1


RAB14
CHST1
CDK5RAP2
AXL


GPRC5B
EIF3I
MBD5
CFB


CAB39
TNFSF10
SLC22A11
C1S


RAB8B
MAP7
SUSD2
CAT


TM7SF3
COPB2
SUCNR1
CD47


MXRA8
HEPH
BDH2
CD151


C11orf59
BASP1
NIT2
CDH13


MOBKL1B
CIB1
RPL23AP13
CFTR


UEVLD
SLC34A2
FAM20C
CEACAM8


TSNAXIP1
SLC6A14
SLC12A9
AP1S1


GPRC5C
DIP2A
RAB25
CLTA


GNG12
TNPO3
SMURF1
CNGB1


BAIAP2L1
FER1L3
TMEM27
COL1A1


MUC13
CNTLN
RAB22A
COL1A2


CHMP1B
TUBB4Q
NDRG3
COL2A1


SLC44A2
KIF15
ERMN
COL3A1


CPNE5
SERINC1
TAOK1
COL4A1


TMBIM1
PDIA2
KIAA1529
COL4A2


EPS8L3
EPS8L2
RNF213
COL4A3


MMRN2
PLVAP
WIZ
COL5A1


TTYH3
MYADM
ACE2
COL5A2


SLC44A4
MUC16
PLEKHA1
COL7A1


RAB1B
KRT25
SCPEP1
COMP


RAB33B
SERINC5
AASDHPPT
CPS1


RBP5
LOC440264
FIGNL1
CSF1


C5orf32
AGT
PBLD
VCAN


ABHD14B
ALPP
KIF9
SLC25A10


MOBKL1A
APOA2
LEPRE1
CTBP2


ARRDC1
APOB
RAB17
CTNNA2


IGSF8
APOE
IKZF5
DCTN1


FAM125A
SERPING1
MMP25
DECR1


SNX18
C1QB
MPP5
DNASE1L1


CHMP4B
C1R
TEKT3
ENG


MITD1
C4A
ALDH8A1
STX2


S100A16
C4B
SLC13A3
ETFB


CPNE8
C4BPA
DUSP26
F2R


C1orf58
C4BPB
GGCT
F8


GLIPR2
CD5L
TMEM38A
ACSL1


TUBB
FCN1
C1orf116
FAP


ATP6V1C2
FCN2
GDPD3
FBLN1


FTLL1
FGB
OR2A4
FBN1


PEF1
FGG
FAM65A
FBN2


SERPINA3
GRIN1
NARG1L
FEN1


ACP2
MSH6
CHMP6
FLT1


ACPP
HBA1
DYNC2H1
FUCA2


ACTA2
HBA2
PRKRIP1
GAS6


ACTC1
ITGA2B
GSTCD
GDI1


ACTG2
PPARG
PIP4K2C
GLDC


ACY1
PDLIM7
CYBRD1
GNAL


APCS
CD274
FUZ
GRM2


APOD
A1BG
ARMC9
GRM3


APRT
ACAT1
NAT13
GRM7


AQP1
ACO1
COASY
GSTM1


AQP2
ADCY1
UBXN6
GSTM5


ARF1
ADFP
COL18A1
H2AFX


ARF3
ADH5
BHLHB9
HBE1


ARF4
ADH6
WNT5B
HMGCS2


ARF5
PARP4
CAB39L
TNC


ARF6
AHSG
ITM2C
IDH3B


RHOA
AK1
LOC81691
IFRD1


ARL3
ALAD
AMN
ITGA5


ASAH1
ALCAM
SH3BGRL3
ITGB5


ASS1
ALDH2
C9orf58
ITPR2


FXYD2
ALDH9A1
BCL2L12
KRT84


BHMT
ALDOC
RAB34
LAMB1


BST2
ALK
TBC1D10A
LCN1


C3
ALOX12
GPR98
LGALS8


CA2
ALPL
HDHD2
LMNA


CA4
ANXA13
ARL6
LOXL2


CALB1
AOX1
IQCG
LTBP2


CALR
APAF1
C2orf16
MAP1A


CD9
APOA4
PARD6B
MAT1A


CD59
SHROOM2
TXNDC17
MC1R


HSPA5
RHOB
ABCC11
MCC


HSPA6
ARHGAP1
FAM40A
ME1


HSP90AB1
ARHGDIB
SCIN
MECP2


HSPD1
ARSE
SCRN2
MAP3K1


IDH1
ARSF
ZNF486
MFAP4


KNG1
ASL
ACY3
SCGB2A1


KRAS
ASNA1
C11orf52
ALDH6A1


LAMP1
ATIC
CRB3
MOS


LGALS3BP
ATP6V1A
C20orf114
CITED1


LRP2
ATP6V1B1
NAPRT1
NEFH


MAN1A1
ATP6V1B2
RG9MTD2
OPRM1


RAB8A
ATP6V0C
SAT2
OTC


MIF
ATP6V1C1
KIF12
OXTR


MME
ATP6V1E1
MAL2
PAPPA


MUC1
ATP6V0A1
OSBPL1A
PC


MYH9
ATP6AP1
VASN
PCOLCE


NAGLU
AZU1
SLC22A12
PDGFRB


NONO
BCR
ACSM1
PFKFB3


NPM1
BGN
TTC18
PGAM2


NRAS
BLMH
GSTO2
SERPINE2


P2RX4
BLVRA
CLRN3
PLP2


P4HB
BLVRB
LRRK2
PPP1CC


PEBP1
BPI
C12orf59
SRGN


SERPINA5
BTG1
LOC124220
MAP2K6


PFN1
BTN1A1
SLC5A10
PSMB7


PFN2
TSPO
CCDC105
PSMB10


ABCB1
C1QC
C1orf93
PTK7


SERPINA1
CAPN5
ARL8A
PTPRK


PIGR
C5
LOC128192
PZP


PIK3C2B
C9
GALM
RAD21


PKD1
PTTG1IP
LRRC15
RASA1


PLSCR1
CACNA2D1
LOC131691
RDH5


PODXL
CALML3
H1FOO
RPL18


CTSA
CAMK4
ENPP6
RPL29


PPIA
CAMP
CMBL
RPS10


PSAP
CAPG
MUM1L1
RPS24


PSMB3
CAPN1
C20orf117
S100A13


PTBP1
CAPN2
SIRPA
SAA4


PTPRJ
CAPZA2
PLEKHA7
ATXN1


RAB1A
CD14
A2ML1
CLEC11A


RAB2A
CD80
C16orf89
SDC2


RAB3B
CD36
TOM1L2
SMARCA4


RAB5A
SCARB2
KIF18B
SPOCK1


RAB5B
CD40
C19orf18
STAT1


RAB13
CDC2
PM20D1
STC1


RAB27B
CEL
PROM2
SURF4


RAB5C
CETP
GPR155
SYT1


RAC1
CTSC
SLC36A2
TAGLN


RALB
AP2M1
VPS37D
TCN1


RAP1B
CSN1S1
SLC5A12
TERF1


RBM3
CSN2
SLC5A8
TGFB2


RNASE2
CSN3
EML5
TSPAN4


S100A6
ACSL3
TBC1D21
TSN


S100A11
FOLR1
ZNF114
TSNAX


S100P
B4GALT1
ANO6
COL14A1


SLC1A1
GNAQ
SLC5A9
WNT5A


SLC2A5
HBB
CRTC2
ZNF134


SLC12A1
HBD
C20orf106
PXDN


SLC12A3
CFH
TMEM192
SMC1A


SNCG
HLA-G
ARMC3
OFD1


SNRPD1
HP
NAPEPLD
COPS3


SOD1
HPR
C10orf30
STC2


SRI
IGHA1
ATP6V0D2
ADAM9


TF
IGJ
STXBP4
CREG1


THBS1
IGLC1
C17orf61
CDK5R2


THY1
IGLC2
TXNDC8
TNFSF18


TMPRSS2
IGLC3
LRRC57
MPZL1


TSG101
LAMC1
HSPA12A
SEMA5A


TUBB2A
LPA
MAGI3
CLDN1


UBE2N
LPL
C11orf47
RGN


UMOD
LRP1
SLC39A5
SLC16A3


UPK2
LTF
C12orf51
ARHGEF1


VTN
TACSTD2
SLC46A3
LRRFIP2


EIF4H
MBL2
VMO1
TAAR2


YWHAB
MYH8
SLC26A11
CRIPT


YWHAG
NEB
LOC284422
ENTPD4


YWHAZ
PON1
CRB2
IFT140


NPHS2
PKN2
HIST2H2AB
RNF40


RAB7A
PROS1
FAM151A
RB1CC1


PSCA
MASP1
SLC6A19
PSMD6


CUBN
RELN
PKD1L3
MRC2


BBOX1
PTX3
LOC342897
HDAC5


RAB11A
RARS
EGFL11
RASA4


NAPA
SILV
SERINC2
SLC25A13


PROM1
THBS2
PDDC1
PSMD14


FCGBP
TLR2
SLCO4C1
TFG


CPNE3
TTN
SFT2D2
CDIPT


MGAM
TTR
C9orf169
CRTAP


GPRC5A
TYRP1
LOC377711
UNC13B


RAB11B
VWF
OR11L1
ARL6IP5


VAMP3
CLIP2
RAB19
TGOLN2


SLC9A3R1
XDH
LOC440335
POSTN


ITM2B
APOL1
HIST2H2BF
CLPX


NAPSA
FCN3
LOC441241
TSPAN9


VPS4B
SELENBP1
KPRP
TMED10


RAB3D
SMC3
HSP90AB6P
SLC38A3


PRDX6
DDX21
LOC643751
IL1RAPL1


KIAA0174
CCPG1
LOC651536
GALNT5


PDCD6
ABCG2
LOC652968
PRR4


ARPC4
SFI1
AEBP1
ITGA11


TSPAN1
MVP
AMY1A
CLASP2


PDZK1IP1
AKAP9
AMY1B
EPB41L3


NUTF2
PRG4
AMY1C
KIAA0467


FLOT1
AKR1A1
AMY2A
DULLARD


HRSP12
ABCA7
ANGPT1
NOMO1


A2M
COLEC10
APLP2
KIAA0146


ACP1
GNB5
APP
SLC39A14


ACTA1
MMRN1
AQP5
DNPEP


ACTN4
CLASP1
AZGP1
CASP14


ACTN1
SYNE1
CEACAM1
STX12


ACTN2
NIPBL
BMP3
BRMS1


ADAM10
CHRDL2
CA6
ABI3BP


AHCY
HSPB8
DDR1
PLEKHG3


ALDH1A1
ANGPTL4
CAPNS1
FBXW8


SLC25A4
NIN
COL6A2
GAPDHS


SLC25A5
ZNF571
COPA
GREM1


SLC25A6
LRP1B
CPD
DKK3


ANXA1
CNDP2
DLD
SRPX2


ANXA2P2
DNAH7
ETFA
IGHV3-11


APOA1
HCN3
GLUD1
IGHV3-7


ARHGDIA
EXOC4
HSD17B10
IGLV4-3


ARVCF
SNX25
IMPDH2
IGLV3-21


ATP1A2
TC2N
HTATIP2
IGLV1-40


ATP1A3
HAPLN3
MARVELD2
ST6GALNAC6


ATP1B1
CD163L1
CST4
COPS4


ATP5A1
HRNR
CST5
HERC5


ATP5B
P704P
CTSB
NUSAP1


ATP5I
CD24
DAG1
PLUNC


ATP5O
COL6A3
DSG2
PPME1


B2M
COL15A1
TOR1A
MBD3


CALM1
COMT
ECM1
SLC38A2


CALM2
CP
EIF4G1
FAM64A


CALM3
CPN2
EXT2
GTPBP2


CANX
CRABP2
FAT2
DIRAS2


CAPZA1
CRK
GPC4
DCHS2


CD2
CRYAB
FOLH1
QPCTL


CD247
CRYM
FUT2
PARP16


CD86
CSE1L
FUT3
TMEM51


CD37
CSK
FUT6
MCM10


CD44
CSTB
FUT8
CHST12


CD53
CTH
GLRX
LYAR


CDC42
CTNS
GPC1
ODZ3


CDH1
CTSD
GPX3
WDR52


CFL1
CTSG
IGHA2
ASH1L


CFL2
DDB1
IGHV@
UNC45A


COX4I1
DDC
IGL@
SLC7A10


COX5B
DDX3X
IVL
PNO1


CLDN3
DDX5
KRT12
CD248


CSPG4
CFD
LAMA4
AHRR


CSRP1
DNM2
LAMB2
ZBTB4


CST3
DPYS
LGALS7
SPTBN4


CTNNA1
DSC2
LMAN1
LGR6


CTNNB1
DSG3
LPO
RNF123


NQO1
ECE1
LTBP3
PRDM16


DYNC1H1
MEGF8
DNAJB9
PARVG


EEF1A2
ELA2
MEST
RMND5A


EFNB1
SERPINB1
MGAT1
FAT4


CTTN
EPHX2
MGP
FLJ13197


EPHB4
FBL
MUC5AC
TREML2


ERBB2
EVPL
MUC7
SVEP1


F5
F11
NEU1
OBFC1


FASN
FABP1
NUCB1
ZNF614


FKBP1A
ACSL4
NUCB2
FLJ22184


FLNA
FAH
FURIN
DBF4B


FLNB
EFEMP1
PAM
CD276


G6PD
FBP1
PLG
CMIP


GCNT2
FKBP4
FXYD3
ADAMTS12


PDIA3
FKBP5
PLOD2
SPACA1


GSN
FRK
PLTP
VANGL1


HADHA
FTH1
PON3
SPRY4


HLA-DMB
FUCA1
PPP1CB
HYI


HLA-E
GABRB2
PRELP
FAM108A1


HNRNPA2B1
GALK1
DNAJC3
TMEM47


HNRNPH2
GBE1
HTRA1
MYCBPAP


HSPA1L
GDF2
RARRES1
RAB6C


HSPA2
GFRA1
SAA1
FAM71F1


HSPA4
GK2
SAA2
ZNF503


HSPA7
GLO1
SEPP1
PARP10


HSPA9
GLUL
SFRP1
SHANK3


HSP90AA4P
GM2A
ST3GAL1
LACRT


HSP90AA2
GNG5
SLC5A5
TRIM41


HSP90AB3P
GOT1
SLC9A1
OXNAD1


HSPE1
GPD1
SLC20A2
LDHAL6B


HSPG2
GPM6A
SLPI
LOC92755


ICAM1
GPT
SRPR
CACNA2D4


ITGA6
GPX4
STAU1
ARHGAP18


ITGA2
GRB2
HSPA13
AHNAK2


ITGAV
GRID1
TGFBI
RPLP0P2


ITGB1
GSR
TGM1
PGLYRP2


ITGB2
GSS
TGM3
RAB39B


ITGB4
GSTM2
YES1
GYLTL1B


JUP
HGD
HIST2H2AA3
KRT74


CD82
HINT1
HIST2H2BE
SLAIN1


KPNB1
HNMT
GALNT4
LOC122589


KRT2
HNRNPL
B4GALT3
NLRP8


KRT5
HPD
TNFSF13
PODN


KRT8
HPX
TNFSF12
C5orf24


KRT13
HRG
ANGPTL1
CD109


KRT14
DNAJA1
GCNT3
TRIM40


KRT15
HSPB1
TM9SF2
GPR112


KRT16
DNAJB1
DDX23
KRT72


KRT18
CFI
ADAMTS3
VTI1A


KRT19
IGF2R
GPR64
SYT9


LAMP2
IGFALS
LHFPL2
KRT80


LGALS4
IL1RN
ST3GAL6
CCDC64B


LYZ
IRF6
PRDX4
ATP8B3


MARCKS
ITGA1
MAN1A2
C1orf84


MFGE8
EIF6
OS9
LOC149501


MMP7
ITGB8
MGAT4A
LOC150786


MYH10
ITIH4
TWF2
WDR49


MYL6
KHK
CLCA4
NEK10


MYO1C
KIFC3
TXNDC4
STOML3


MYO1D
KLK1
PLCB1
SASS6


NME1
LBP
CES3
DCLK2


NME2
LCN2
B3GAT3
FREM3


PRDX1
LCP1
TOR1B
C9orf91


PCBP1
LTA4H
IGHV3OR16-13
TREML2P


CHMP1A
BCAM
IGLV2-11
CCDC129


SERPINF1
MAN2A1
IGLV1-44
PAN3


PHB
MDH2
IGKV3D-15
MAMDC2


PPIB
MFI2
IGKV4-1
RCOR2


PRKAR2A
MLLT3
C1GALT1C1
LOC283412


PRKDC
MLLT4
RACGAP1
LOC283523


PSMA2
MNDA
EFEMP2
NOMO2


QSOX1
MPO
DUOX2
SEC14L4


PYGB
MPST
SDF4
LCN1L1


RAB6A
MYO1B
CYB5R1
LOC286444


RALA
MSRA
ERAP1
TAS2R60


RAP1A
MTAP
NUDT9
KRT18P19


RPL6
MTHFD1
FAM3B
LOC343184


RPL8
MYH3
FAM20A
LOC345041


RPLP1
MYO5B
FAM55D
GNAT3


RPLP2
MYO6
ANO1
POLN


RPN1
NID1
LRRC16A
LOC376693


RPS3
NKX6-1
TTC17
ARMS2


RPS7
NQO2
PDGFC
LOC387867


RPS13
NP
PCDHGB5
LOC388339


RPS14
NPC1
CCL28
FLG2


RPS15A
NPHS1
UGCGL1
LOC388707


RPS18
NRF1
SEMA3G
LOC389141


RPS20
NT5E
CORO1B
LOC390183


RPS21
PAFAH1B1
NDRG2
KRT8P9


RPS27A
PAFAH1B2
KIAA1324
LOC391777


RRAS
PCBD1
TXNDC16
LOC391833


S100A10
PCK1
ARHGAP23
LOC399942


SDC1
PDCD2
MUTED
LOC400389


SDC4
PDE8A
TINAGL1
LOC400578


SLC1A5
ENPP3
TOR3A
LOC400750


SLC2A1
SLC26A4
VWA1
LOC400963


SLC3A2
PDZK1
CHID1
FLJ21767


SLC12A2
PEPD
TMEM109
LOC401817


SLC16A1
PFKL
GAL3ST4
NOMO3


SPTBN1
PGD
THSD4
LOC439953


SSBP1
PGM1
UXS1
RPL12P6


SSR4
SLC25A3
TXNDC5
LOC440589


TBCA
SERPINA4
CRISPLD1
LOC440917


TCEB1
SERPINB6
LOXL4
LOC440991


TFRC
SERPINB13
GNPTG
LOC441876


TKT
PIK3C2A
SCGB3A1
LOC442308


TSPAN8
PIP
CHST14
DIPAS


TPM1
PKD2
C1QTNF1
LOC643300


HSP90B1
PKLR
C1QTNF3
LOC643358


TUBA4A
PKHD1
SLC26A9
LOC643531


TUFM
PLCD1
FAM129A
RPSAP8


TXN
PLOD1
HIST2H3C
LOC644464


UBA52
PLS1
TPRG1L
LOC644745


UBB
UBL3
TMPRSS11B
LOC645018


UBC
PPL
C20orf70
LOC645548


UBA1
PPP1R7
PPM1L
LOC646127


UBE2V2
PRCP
GBP6
LOC646316


UGDH
PRKCA
KRT78
LOC646359


UQCRC2
PRKCD
SLC37A2
LOC646785


VCP
PRKCH
NPNT
LOC646875


VIL1
PRKCI
KRT73
LOC646949


YWHAH
PRKCZ
HIST2H3A
LOC647000


CXCR4
PRNP
VWA2
LOC647285


SLC7A5
PRSS8
GSTK1
LOC650405


HIST1H4I
PRTN3
SBSN
LOC650901


HIST1H4A
PSMA1
C5orf46
LOC652493


HIST1H4D
PSMA3
LRRC26
LOC652797


HIST1H4F
PSMA4
C4orf40
LOC653162


HIST1H4K
PSMA5
LOC440786
PPIAL3


HIST1H4J
PSMB1
SCFV
LOC653232


HIST1H4C
PSMB2
LGALS7B
HSPBL2


HIST1H4H
PSMB5
HIST2H3D
LOC728002


HIST1H4B
PSMB6
ACAT2
LOC728088


HIST1H4E
PSMC5
ACTL6A
LOC728576


HIST1H4L
PSMD12
ADK
LOC728590


HIST2H4A
PSME2
ANXA8L2
LOC728791


TAGLN2
PTPN6
ATP1B3
LOC728979


RUVBL1
PTPN13
ATP2B1
ANG


VAMP8
PTPRO
ATP2B4
BDNF


SNAP23
QDPR
CAV1
CALU


IQGAP1
RAB27A
CD70
CCR4


KRT75
RAP1GDS1
CS
CCR5


TJP2
RBL2
DARS
CSF2


ROCK2
RBP4
DHX9
CSF3


ARPC3
RENBP
DPYSL2
DCN


ACTR3
RFC1
EEF1D
EPO


LRPPRC
RHEB
EPRS
F3


TRAP1
RNH1
FDPS
GPC5


TUBB4
RNPEP
FLNC
GDF1


GNB2L1
ROBO2
XRCC6
GDF9


BAIAP2
RP2
GFPT1
GFRA3


HYOU1
RPS11
HIST1H1B
GRN


AGR2
RREB1
HIST1H2BB
CXCL2


OLFM4
RYR1
H3F3A
GZMA


CCT2
S100A4
H3F3B
HIST1H2BD


ATP5L
S100A8
HNRNPF
HGF


CCT8
S100A9
HNRNPK
IFNG


SLC12A7
SERPINB4
IARS
IGFBP3


MASP2
SCN10A
LAMA3
IGFBP4


IQGAP2
SEC13
LAMB3
IGFBP6


RAB10
SECTM1
LAMC2
IGFBP7


PRDX3
SH3BGRL
LGALS1
IL1RAP


EHD1
SHMT1
NBR1
IL3


TMED2
SHMT2
MARS
IL5


LMAN2
SLC3A1
MX1
IL6ST


YWHAQ
SLC4A1
PFKP
IL7


GCN1L1
SLC5A1
PLAU
IL8


RAB35
SLC5A2
PSMB4
IL10


DSTN
SLC6A13
PSMC2
IL11


UPK1A
SLC9A3
PSMC4
IL13


PHB2
SLC15A2
PSMD2
IL15RA


RRAS2
SLC25A1
PSMD13
INHBA


SEC31A
SLC22A2
PYGL
INHBB


CLSTN1
SLC22A5
RPL10
IPO5


PTGR1
SMO
RPL15
LIF


RAB21
SORD
STX4
LRP6


CYFIP1
SORL1
TARS
LTBP1


SLC44A1
SPAST
CLDN5
MMP1


CORO1C
SPR
TPBG
MMP2


MTCH2
SPRR3
XPO1
MMP3


QPCT
SRC
XRCC5
MMP10


PRDX5
ST13
BAT1
NBL1


SND1
STK11
HIST1H2BG
TNFRSF11B


F11R
VAMP7
HIST1H2BF
OSM


LIMA1
SYPL1
HIST1H2BE
PDGFA


RAB6B
SERPINA7
HIST1H2BI
PRKCSH


KRT20
TECTA
HIST1H2BC
CCL2


VPS35
TGM4
HIST1H4G
CCL7


TOMM22
TGFBR3
EIF3A
CCL20


AKR1B10
TGM2
EIF3B
SFRP4


S100A14
TLN1
EIF3C
SOD3


DIP2B
DNAJC7
SLC5A6
SPARC


RAP2C
UBE2G1
HIST2H2AA4
TIMP1


FAM129B
UPK1B
LOC728358
TIMP2


MARCKSL1
UGP2
LOC730839
TIMP3


AHNAK
UPK3A
LOC100126583
ICAM5


VPS37B
UTRN
AARS
TNFRSF1A


TUBA4B
VASP
AK2
VEGFC


ARPC5L
VCL
APEH
GDF5


EPPK1
VDAC1
FAS
HIST3H3


ADSL
VDAC3
BAX
HIST1H2AI


AP2A1
XPNPEP2
FMNL1
HIST1H2AL


RHOC
BTG2
CASP9
HIST1H2AC


RHOG
GCS1
CD19
HIST1H2AM


ASNS
BAT2
MS4A1
HIST1H2BN


BSG
PTP4A2
CD22
HIST1H2BM


CAD
DYSF
TNFRSF8
HIST1H2BH


CBR1
EEA1
SCARB1
HIST1H2BO


CBR3
STK24
ENTPD1
HIST1H3A


CCT6A
CUL4B
CD48
HIST1H3D


CDH17
CUL3
CD58
HIST1H3C


CEACAM5
ATRN
CD74
HIST1H3E


COPB1
CDC42BPA
CD79B
HIST1H3I


CLDN4
PPFIA2
CD97
HIST1H3G


CLDN7
AKR7A2
41889
HIST1H3J


CRYZ
PPAP2A
CR2
HIST1H3H


CD55
ABCB11
CSNK2B
HIST1H3B


EEF1G
MAP2K1IP1
DBI
FADD


EPHA2
EIF3H
DHCR7
IL1RL2


EIF4A1
SLC4A4
DLG1
FGF18


EIF4A2
SNX3
DOCK2
FGF16


ENO2
MYH13
DUT
HIST1H3F


SLC29A1
NAPG
ECH1
HIST1H2AG


EPHB2
FBP2
VAPA
HIST1H2BJ


EPHB3
SCEL
H2AFY
NRG2


ESD
SUCLA2
PDIA4
GDF3


F7
GGH
EIF4A3
FGF19


FLOT2
PROZ
ACTR1B
GDF11


GARS
SQSTM1
OPTN
FST


GMDS
AP1M1
NAMPT
LASS1


GNB3
RAB7L1
MPZL2
HPSE


HIST1H2AE
WASL
STIP1
ESM1


HLA-C
PLOD3
PKP3
DKK1


HLA-H
PGLYRP1
POFUT2
IL17B


HPCAL1
KALRN
QPRT
IL19


IGSF3
CLIC3
WBP2
TNFRSF12A


IGH@
BAZ1B
ERO1L
IL23A


IGHG1
SPAG9
H2AFY2
FGFRL1


IGHG2
SLC13A2
RCC2
TREM1


IGHG3
ATP6V0D1
RTN4
IL1F9


IGHG4
HGS
GLT25D1
CXCL16


IGHM
AP4M1
RNASE7
IL22RA1


IGKC
ATP6V1F
FCRLA
HIST1H2BK


ITGA3
PTER
H2AFV
HIST3H2BB


KRT3
TRIP10
MRLC2
LOC440093


KRT4
SLC9A3R2
PAGE2
PGAM4


KRT6A
SLIT2
HIST1H2BA
PC-3


KRT6B
SLC22A6
SNX33
LOC729500


KRT7
KL
PTRF
KRT18P26


KRT17
KIF3B
HIST2H2BC
S100A11P


RPSA
SLC22A8
ANXA8
LOC729679


LFNG
GRHPR
NME1-NME2
KRT17P3


LGALS3
SLC22A13
EIF2S1
RCTPI1


LRP4
TMPRSS11D
EIF2S3
LOC729903


CD46
GSTO1
EIF4E
RP11-556K13.1


MICA
NPEPPS
EPB41L2
LOC100129982


MYH11
TMEM59
EVI2B
LOC100130100


NARS
ATP6V1G1
FCER2
LOC100130446


NEDD4
CDC42BPB
FGR
LOC100130562


RPL10A
CREB5
FH
LOC100130624


PCNA
CROCC
GART
LOC100130711


PLEC1
DHX34
GOT2
LOC100130819


PLXNA1
TMEM63A
NCKAP1L
LOC100131713


PPP2R1A
SLK
HLA-DPB1
LOC100131863


PSMC6
RUSC2
HLA-DQA1
LOC100132795


PSMD3
OXSR1
HNRNPA1
LOC100133211


PSMD11
SLC23A1
HNRNPC
LOC100133690


RAC3
DOPEY2
HPRT1
SET


RAP2A
ABI1
ICAM3
CCT6B


RAP2B
GNPDA1
INSR
ACTR3B


RPL12
TOM1
EIF3E
PSMA8


RPLP0
ABCB6
ITGAL
ARP11


RPS4X
ABCC9
ITGB3
BCHE


RPS4Y1
HUWE1
ITGB7
H2AFZ


RPS8
ARPC5
ITIH2
SNRPE


RPS16
ACTR2
STMN1
TFPI


SPTAN1
TSPAN3
LCK
ADAMTS1


VAMP1
ARPC2
LSP1
GDF15
















TABLE 5







Polypeptide Payloads and Receivers General Classes









Ankyrin repeat proteins
Fibronectins
Lyases













Antibodies
Complement receptors
GPI-linked
Nanobodies




polypeptides



Aptamers
Cyclic peptides
HEAT repeat proteins
Nucleic Acids


ARM repeat
DARPins
Hydrolases
Polypeptides


proteins





Carbohydrates
DNAses
Kinases
Single-chain





variable fragments





(scFv)


Cell surface
Enzymes
Lipoproteins
Tetratricopeptide


receptors


repeat proteins







Complement










Cl inhibitor
C4 binding protein
CR3
Factor I


C3 Beta chain
CD59
CR4
Homologous


Receptor


restriction factor


C3aR
CR1
Decay-accelerating
Membrane cofactor




factor (DAF)
protein (MCP)


C3eR
CR2
Factor H
PRELP







Enzymes










triacylglycerol
bile-acid-CoA hydrolase
feruloyl esterase
phosphatidate


lipase


phosphatase


(S)-
bis(2-
formyl-CoA
phosphatidylglycero


methylmalonyl-
ethylhexyl)phthalate
hydrolase
phosphatase


CoA hydrolase
esterase




[acyl-carrier-
bisphosphoglycerate
fructose-
phosphatidylinositol


protein]
phosphatase
bisphosphatase
deacylase


phosphodiesterase





[phosphorylase]
Carboxylic-Ester
fumarylacetoacetase
phosphodiesterase I


phosphatase
Hydrolases




1,4-lactonase
carboxymethylenebuten
fusarinine-C
phosphoglycerate



olidase
ornithinesterase
phosphatase


11-cis-retinyl-
cellulose-polysulfatase
galactolipase
phosphoglycolate


palmitate


phosphatase


hydrolase





1-alkyl-2-
cephalosporin-C
gluconolactonase
phosphoinositide


acetylglycerophosp
deacetylase

phospholipase C


hocholine esterase





2′-
cerebroside-sulfatase
glucose-1-
phospholipase A1


hydroxybiphenyl-

phosphatase



2-sulfinate





desulfinase





2-pyrone-4,6-
cetraxate benzylesterase
glucose-6-
phospholipase A2


dicarboxylate

phosphatase



lactonase





3′, 5′-bisphosphate
chlorogenate hydrolase
glutathione
phospholipase C


nucleotidase

thiolesterase



3-
chlorophyllase
glycerol-1-
phospholipase D


hydroxyisobutyryl-

phosphatase



CoA hydrolase





3′-nuclcotidasc
cholincsterasc
glycerol-2-
phosphonoacctaldch




phosphatase
yde hydrolase


3-oxoadipate enol-
choline-sulfatase
glycerophosphocholi
phosphonoacetate


lactonase

ne phosphodiesterase
hydrolase


3-phytase
choloyl-CoA hydrolase
Glycosidases, i.e.
phosphonopyruvate




enzymes that
hydrolase




hydrolyse O- and S-





glycosyl compounds



4-hydroxybenzoyl-
chondro-4-sulfatase
glycosulfatase
phosphoprotein


CoA thioesterase


phosphatase


4-
chondro-6-sulfatase
Glycosylases
Phosphoric-diester


methyloxaloacetate


hydrolases


esterase





4-phytase
citrate-lyase deacetylase
histidinol-
Phosphoric-monoester




phosphatase
hydrolases


4-
cocaine esterase
hormone-sensitive
Phosphoric-triester


pyridoxolactonase

lipase
hydrolases


5′-nucleotidase
cutinase
Hydrolysing N-
phosphoserine




glycosyl compounds
phosphatase


6-acetylglucose
cyclamate
Hydrolysing S-
poly(3-


deacetylase
sulfohydrolase
glycosyl compounds
hydroxybutyrate)





depolymerase


6-
Cysteine endopeptidases
hydroxyacylglutathio
poly(3-


phosphogluconolac

ne hydrolase
hydroxyoctanoate)


tonase


depolymerase


a-amino-acid
Cysteine-type
hydroxybutyrate-
polyneuridine-


esterase
carboxypeptidases
dimer hydrolase
aldehyde esterase


a-Amino-acyl-
D-arabinonolactonase
hydroxymethylglutar
protein-glutamate


peptide hydrolases

yl-CoA hydrolase
methylesterase


acetoacetyl-CoA
deoxylimonate A-ring-
iduronate-2-sulfatase
quorum-quenching


hydrolase
lactonase

N-acyl-homoserine





lactonase


acetoxybutynylbith
dGTPase
inositol-phosphate
retinyl-palmitate


iophene

phosphatase
esterase


deacetylase





acetylajmaline
dihydrocoumarin
juvenile-hormone
Serine dehyrdatase


esterase
hydrolase
esterase
or serine





hydroxymethyl





transferase


acetylalkylglycerol
Dipeptidases
kynureninase
Serine


acetylhydrolase


endopeptidases


acetylcholinesterase
Dipeptide hydrolases
L-arabinonolactonase
serine-





ethanolaminephosphate





phosphodiesterase


acetyl-CoA
Dipeptidyl-peptidases
limonin-D-ring-
Serine-type


hydrolase
and tripeptidyl-
lactonase
carboxypeptidases



peptidases




acetylesterase
Diphosphoric-monoester
lipoprotein lipase
S-formylglutathione



hydrolases

hydrolase


acetylpyruvate
disulfoglucosamine-6-
L-rhamnono-1,4-
sialate O-


hydrolase
sulfatase
lactonase
acetylesterase


acetylsalicylate
dodecanoyl-[acyl-
lysophospholipase
sinapine esterase


deacetylase
carrier-protein]





hydrolase




acetylxylan
Endodeoxyribonucleases
mannitol-1-
Site specific


esterase
producing 3’-
phosphatase
endodeoxyribonucle



phosphomonoesters

ases: cleavage is not





sequence specific


acid phosphatase
Endodeoxyribonucleases
Metallocarboxypeptid
Site-specific



producing 5’-
ases
endodeoxyribonucle



phosphomonoesters

ases that are specific





for altered bases.


Acting on acid
Endopeptidases of
Metalloendopeptidases.
Site-specific


anhydrides to
unknown catalytic

endodeoxyribonucle


catalyse
mechanism

ases: cleavage is


transmembrane


sequence specific


movement of





substances





Acting on acid
Endoribonucleases
methylphosphothiogl
sphingomyelin


anhydrides to
producing 3’-
ycerate phosphatase
phosphodiesterase


facilitate cellular
phosphomonoesters




and subcellular





movement





Acting on GTP to
Endoribonucleases
methylumbelliferyl-
S-


facilitate cellular
producing 5’-
acetate deacetylase
succinylglutathione


and subcellular
phosphomonoesters

hydrolase


movement





Acting on
Endoribonucleases that
monoterpene
steroid-lactonase


phosphorus-
are active with either
e-lactone hydrolase



nitrogen bonds
ribo- or





deoxyribonucleic acids





and produce 3’-





phosphomonoesters




Acting on sulfur-
Endoribonucleases that
N-
sterol esterase


nitrogen bonds
are active with either
acetylgalactosamine-




ribo- or
4-sulfatase




deoxyribonucleic acids





and produce 5’-





phosphomonoesters




actinomycin
Enzymes acting on acid
N-
steryl-sulfatase


lactonase
anhydrides
acetylgalactosamine-





6-sulfatase



acylcarnitine
Enzymes Acting on
N-
succinyl-CoA


hydrolase
carbon-carbon bonds
acetylgalactosaminog
hydrolase




lycan deacetylase



acyl-CoA
Enzymes acting on
N-acetylglucosamine-
sucrose-phosphate


hydrolase
carbon-nitrogen bonds,
6-sulfatase
phosphatase



other than peptide bonds




acylglycerol lipase
Enzymes acting on
N-sulfoglucosamine
sugar-phosphatase



carbon-phosphorus
sulfohydrolase




bonds




acyloxyacyl
Enzymes acting on
oleoyl-[acyl-carrier-
Sulfuric-ester


hydrolase
carbon-sulfur bonds
protein] hydrolase
hydrolases


acylpyruvate
Enzymes Acting on
Omega peptidases
tannase


hydrolase
ether bonds




ADAMTS13
Enzymes acting on
orsellinate-depside
Thioester hydrolases



halide bonds
hydrolase



Adenosine
Enzymes acting on
oxaloacetase
Thioether and


deaminase
peptide bonds

trialkylsulfonium



(peptidases)

hydrolases


adenylyl-
Enzymes acting on
palmitoyl[protein]
Threonine


[glutamate—
phosphorus-nitrogen
hydrolase
endopeptidases


ammonia ligase]
bonds




hydrolase





ADP-dependent
Enzymes acting on
palmitoyl-CoA
thymidine


medium-chain-
sulfur-nitrogen bonds
hydrolase
phosphorylase


acyl-CoA





hydrolase





ADP-dependent
Enzymes acting on
pectinesterase
trehalose-


short-chain-acyl-
sulfur-sulfur bonds

phosphatase


CoA hydrolase





ADP-
Ether hydrolases.
Peptidyl peptide
triacetate-lactonase


phosphoglycerate

hydrolases



phosphatase





alkaline
Exodeoxyribonucleases
Peptidyl-amino-acid
Triphosphoric-


phosphatase
producing 5’-
hydrolases
monoester



phosphomonoesters

hydrolases


all-trans-retinyl-
Exonucleases that are
Peptidylamino-acid
trithionate hydrolase


palmitate
active with either ribo-
hydrolases or



hydrolase
or deoxyribonucleic
acylamino-acid




acids and produce 3’-
hydrolases




phosphomonoesters




aminoacyl-tRNA
Exonucleases that are
Peptidyl-dipeptidases
tropinesterase


hydrolase
active with either ribo-





or deoxyribonucleic





acids and produce 5’-





phosphomonoesters




Aminopeptidases
Exoribonucleases
phenylacetyl-CoA
ubiquitin



producing 3’-
hydrolase
thiolesterase



phosphomonoesters




arylesterase
Exoribonucleases
Phenylalanine
UDP-sulfoquinovose



producing 5’-
ammonia lyase
synthase



phosphomonoesters.




arylsulfatase
Factor IX
Phenylalanine
uricase




hydroxylase



Asparaginase
Factor VIII
pheophorbidase
uronolactonase


Aspartic
fatty-acyl-ethyl-ester
phloretin hydrolase
wax-ester hydrolase


endopeptidases
synthase




b-diketone hydrolase

phorbol-diester
xylono-1,4-lactonase




hydrolase
















TABLE 6







Targets


General Classes of Targets










Microbes
Polypeptides
DNA
Amino Acids





Fungi
Toxins
RNA
Prions


Bacteria
Lipids
Parasites
Cytokines


Virus
Cells
Cellular Debris








Infectious Disease-Related Targets










Lipopolysaccharides
Cell invasion protein
Intermedilysin
Secreted effector





protein sptP


Zona occludcns
Cholera cnterotoxin
Invasion protein
Sccligcriolysin


toxin

sipA



Actin
Cysteine protease
Iota toxin
Serine protease


polymerization

component Ia



protein RickA





Actin
Cytolethal distending
Ivanolysin
Shiga toxin


polymerization
toxin




protein RickA





Adenosine
Cytolysin
LepB
Sphingomyelinase


monophosphate-





protein transferase





vopS





adenylate cyclase
Cytotoxic necrotizing
Lethal factor
Staphylokinase



factor




Adenylate cyclase
Cytotoxin
Leukotoxin
Streptokinase


ExoY





ADP-
Dermonecrotic toxin
Listeriolysin
Streptolysin


ribosyltransferase





enzymatic





component





Aerolysin
Deubiquitinase
Microbial
Streptopain




collagenase



Alpha-toxin
Diphtheria toxin
Outer membrane
Suilysin




protein IcsA





autotransporter



Alveolysin
Enterohemolysin
Panton-Valentine
Superantigen




Leucocidin F



Alveolysin
Enterotoxin
Perfringolysin
T3SS secreted





effector EspF


Anthrolysin O
Epidermal cell
Pertussis toxin
Tetanus toxin



differentiation inhibitor




Arp2/3 complex-
Exoenzyme
Phospholipase
Tir


activating protein





rickA





Binary ADP-
Exotoxin
Plasminogen
TolC


ribosyltransferase

activator



CDT toxin





Botulinum
G-nucleotide exchange
Pneumolysin
Toxic shock


neurotoxin
factor

syndrome toxin


C2 toxin,
Guanine nucleotide
Protective antigen
Zink-


component II
exchange factor sopE

carboxypeptidase


CagA
Heat stable enterotoxin
Protein kinase
Zink-





carboxypeptidase


Calmodulin-
IgA-specific serine
Pyolysin
Zn-dependent


sensitive adenylate
endopeptidase

peptidase


cyclase
autotransporter




Cell cycle
Inositol phosphate
RTX toxin



inhibiting factor
phosphatase sopB









Lipid & Cell Targets










Circulating tumor
very low density lipid
triglycerides
Fatty acids


cells
(VLDL)




Metastases
high density lipoprotein
chylomicrons
Cholesterol


Eukaryotic cells
low density lipoprotein
apolipoproteins
















TABLE 7





Exosome miRNAs


















let-7a
miR-301
miR-92b
miR-K12-7


let-7b
miR-302a
miR-93
miR-125b-1*


let-7c
miR-30a-3p
miR-95
miR-US25-2-5p


let-7d
miR-30a-5p
miR-96
miR-373*


let-7e
miR-30b
miR-98
miR-149*


let-7f
miR-30c
miR-99a
miR-200a*


let-7g
miR-30d
miR-99b
miR-513a-5p


let-7i
miR-30e-3p
U6-snRNA
miR-575


miR-100
miR-31
miR-760
miR-125a-3p


miR-101
miR-320
miR-630
miR-1224-5p


miR-103
miR-324-3p
miR-632
miR-490-5p


miR-105
miR-324-5p
miR-654-5p
miR-188-5p


miR-106a
miR-328
miR-671-5p
miR-1226*


miR-106b
miR-331
miR-US4
miR-610


miR-107
miR-335
miR-K12-3
miR-877


miR-10a
miR-339
miR-326
miR-424*


miR-10b
miR-342
miR-199b-5p
miR-887


miR-122a
miR-345
miR-502-5p
miR-601


miR-125a
miR-346
miR-551b
miR-125b-2*


miR-125b
miR-34a
miR-92a
miR-513b


miR-126
miR-361
miR-221*
miR-662


miR-128a
miR-362
miR-223*
miR-518e*


miR-128b
miR-365
miR-892b
miR-99b*


miR-129
miR-369-3p
miR-K12-12
miR-520e


miR-130a
miR-370
miR-542-5p
hiv1-miR-H1


miR-130b
miR-371
let-7i*
miR-617


miR-133a
miR-373
miR-188-3p
miR-513c


miR-135b
miR-375
miR-155
miR-10b*


miR-136
miR-421
miR-340*
miR-135a*


miR-137
miR-422a
miR-132*
miR-1225-5p


miR-138
miR-422b
miR-450a
miR-498


miR-140
miR-423
miR-361-3p
miR-BART14


miR-141
miR-424
miR-363
miR-200b*


miR-146a
miR-425-3p
miR-501-3p
miR-520b


miR-146b
miR-425-5p
miR-195
miR-134


miR-147
miR-429
miR-132
miR-518c*


miR-148a
miR-432
miR-500*
miR-BART7


miR-148b
miR-452
miR-22*
miR-491-5p


miR-149
miR-453
miR-342-3p
miR-382


miR-150
miR-454-3p
miR-128
miR-583


miR-151
miR-454-5p
miR-342-5p
miR-874


miR-152
miR-483
miR-362-3p
miR-516b


miR-15b
miR-484
miR-886-3p
miR-518f


miR-16
miR-485-5p
miR-361-5p
miR-622


miR-17-3p
miR-486
miR-30a
miR-K12-8


miR-17-5p
miR-487b
miR-223
miR-513a-3p


miR-181a
miR-494
miR-331-3p
miR-UL36


miR-181b
miR-500
miR-564
miR-141*


miR-181c
miR-502
miR-425
miR-492


miR-181d
miR-505
miR-502-3p
miR-129-5p


miR-182
miR-512-3p
miR-590-5p
miR-30c-2*


miR-183
miR-513
miR-330-3p
miR-486-5p


miR-185
miR-517c
miR-378
miR-631


miR-186
miR-519b
miR-139-3p
miR-184


miR-187
miR-521
miR-28-3p
miR-145


miR-188
miR-522
miR-32
miR-628-5p


miR-18a
miR-526a
miR-301a
miR-BHRF1-1


miR-18b
miR-527
miR-542-3p
miR-518d-3p


miR-190
miR-532
miR-34b*
let-7d*


miR-191
miR-550
miR-17
miR-93*


miR-192
miR-557
miR-532-3p
miR-548d-5p


miR-193a
miR-565
miR-140-3p
miR-548c-5p


miR-193b
miR-571
miR-28-5p
miR-770-5p


miR-194
miR-574
miR-30e*
miR-744*


miR-196b
miR-578
miR-532-5p
miR-449a


miR-197
miR-582
miR-146b-5p
miR-548a-5p


miR-198
miR-584
miR-503
miR-148a*


miR-19a
miR-585
miR-339-3p
miR-624*


miR-19b
miR-590
miR-338-3p
miR-219-5p


miR-200a
miR-593
miR-33a
miR-16-2*


miR-200b
miR-594
miR-374b
miR-29c*


miR-200c
miR-595
miR-30e
miR-550*


miR-202
miR-603
miR-362-5p
miR-15b*


miR-203
miR-608
miR-140-5p
miR-15a*


miR-205
miR-612
miR-151-3p
miR-106a*


miR-206
miR-625
miR-454
miR-196a


miR-20a
miR-628
miR-29c
miR-138-2*


miR-20b
miR-629
miR-15a
miR-33b


miR-21
miR-634
miR-142-5p
miR-301b


miR-210
miR-637
miR-374a
miR-7-1*


miR-214
miR-638
miR-193a-3p
miR-30d*


miR-22
miR-642
miR-151-5p
miR-574-3p


miR-220
miR-645
miR-744
miR-181a*


miR-221
miR-647
miR-BART19-3p
miR-19b-1*


miR-222
miR-649
miR-378*
miR-20a*


miR-224
miR-652
miR-340
miR-9*


miR-23a
miR-660
miR-21*
miR-7


miR-23b
miR-663
miR-17*
miR-431*


miR-24
miR-671
miR-142-3p
miR-BART12


miR-25
miR-765
miR-193a-5p
miR-153


miR-26a
miR-766
miR-936
miR-658


miR-26b
miR-768-3p
miR-193b*
miR-122


miR-27a
miR-768-5p
miR-451
miR-939


miR-27b
miR-769-3p
miR-921
miR-181c*


miR-28
miR-769-5p
miR-H1
miR-885-5p


miR-296
miR-801
miR-510
miR-BART11-5p


miR-29a
miR-9
miR-483-5p
miR-BART19-5p


miR-29b
miR-92
miR-150*
miR-BHRF1-2*
















TABLE 8





Diseases, Disorders and Conditions















Cancers










Acute
Colorectal cancer
Macroglobulinemia,
Pleuropulmonary


lymphoblastic

Waldenström
Blastoma,


leukaemia (ALL)


Childhood


Acute myeloid
Craniopharyngioma,
Male Breast Cancer
Pregnancy and


leukaemia (AML)
Childhood

Breast Cancer


Adrenocortical
Cutaneous T-Cell
Malignant Fibrous
Primary Central


Carcinoma
Lymphoma
Histiocytoma of Bone
Nervous System




and Osteosarcoma
(CNS) Lymphoma


AIDS-Related
Ductal Carcinoma In
Melanoma
Prostate Cancer


Kaposi Sarcoma
Situ (DCIS)




AIDS-Related
Embryonal Tumors,
Merkel Cell Carcinoma
Rare cancers


lymphoma
Childhood




Anal Cancer
Endometrial
Mesothelioma
Rectal Cancer



Cancer




Appendix Cancer
Ependymoma,
Metastatic Squamous
Renal cell



Childhood
Neck Cancer with
carcinoma




Occult Primary



Astrocytomas,
Epithelial cancer
Midline Tract
Renal Pelvis and


Childhood

Carcinoma
Ureter, Transitional




Involving NUT Gene
Cell Cancer


Atypical
Esophageal Cancer
Molar pregnancy
Retinoblastoma


Teratoid/Rhabdoid





Tumor, Childhood





Basal Cell
Esthesioneuroblastoma,
Mouth and
Rhabdomyosarcoma


Carcinoma
Childhood
oropharyngeal cancer



Bile duct cancer
Ewing sarcoma
Multiple Endocrine
Salivary Gland




Neoplasia Syndromes,
Cancer




Childhood



Bladder cancer
Extragonadal Germ
Multiple
Sarcoma



Cell Tumor
Myeloma/Plasma Cell





Neoplasm



Bone cancer
Extrahepatic Bile Duct
Mycosis Fungoides
Secondary cancers



Cancer




Bowel cancer
Eye Cancer
Myelodysplastic
Sézary Syndrome




Syndromes



Brain Stem
Gallbladder Cancer
Myelodysplastic/Myelo
Skin Cancer


Glioma, Childhood

proliferative





Neoplasms



Brain tumours
Gastric cancer
Myeloproliferative
Skin cancer (non




Disorders, Chronic
melanoma)


Breast cancer
Gastrointestinal
Nasal Cavity and
Small Cell Lung



Carcinoid Tumor
Paranasal Sinus Cancer
Cancer


Bronchial Tumors,
Germ Cell Tumor
Nasopharyngeal cancer
Small Intestine


Childhood


Cancer


Burkitt Lymphoma
Gestational
Neuroblastoma
Soft Tissue



trophoblastic tumours

Sarcoma



(GTT)




Cancer of
Glioma
Non-Hodgkin
Squamous Cell


unknown primary

Lymphoma
Carcinoma


Cancer spread to
Hairy cell leukaemia
Non-Small Cell Lung
Squamous Neck


bone

Cancer
Cancer with Occult





Primary, Metastatic


Cancer spread to
Head and neck cancer
Oesophageal cancer
Stomach (Gastric)


brain


Cancer


Cancer spread to
Heart Cancer,
Oral Cancer
Stomach cancer


liver
Childhood




Cancer spread to
Hepatocellular (Liver)
Oral Cavity Cancer
T-Cell Lymphoma,


lung
Cancer

Cutaneous - scc





Mycosis Fungoides





and Sézary





Syndrome


Carcinoid Tumor
Histiocytosis,
Oropharyngeal Cancer
Testicular cancer



Langerhans Cell




Carcinoma of
Hodgkin Lymphoma
Osteosarcoma (Bone
Throat Cancer


Unknown Primary

Cancer)



Cardiac (Heart)
Hypopharyngeal
Osteosarcoma and
Thymoma and


Tumors,
Cancer
Malignant Fibrous
Thymic Carcinoma


Childhood

Histiocytoma



Central Nervous
Intraocular Melanoma
Ovarian Cancer
Thyroid Cancer


System Atypical





Teratoid/Rhabdoid





Tumor,





Childhood





Central Nervous
Islet Cell Tumors,
Pancreatic Cancer
Transitional Cell


System Embryonal
Pancreatic

Cancer of the Renal


Tumors,
Neuroendocrine

Pelvis and Ureter


Childhood
Tumors




Central Nervous
Kidney cancer
Pancreatic
Unknown primary


System,

Neuroendocrine
cancer


Childhood

Tumors (Islet Cell





Tumors)



Cervical cancer
Langerhans Cell
Papillomatosis,
Ureter and Renal



Histiocytosis
Childhood
Pelvis, Transitional





Cell Cancer


Chordoma,
Laryngeal Cancer
Paraganglioma
Urethral Cancer


Childhood





Choriocarcinoma
Leukemia
Parathyroid Cancer
Uterine Cancer,





Endometrial


Chronic
Lip and Oral Cavity
Penile Cancer
Uterine Sarcoma


Lymphocytic
Cancer




Leukemia (CLL)





Chronic myeloid
Liver cancer
Pharyngeal Cancer
Vaginal cancer


leukaemia (CML)





Chronic
Lobular Carcinoma In
Pheochromocytoma
Vulvar Cancer


Myeloproliferative
Situ (LCIS)




Disorders





Colon cancer
Low Malignant
Pituitary Tumor
Waldenström



Potential Tumor

Macroglobulinemia


Lymphoma
Lung Cancer
Plasma Cell
Wilms Tumor




Neoplasm/Multiple





Myeloma








Complement and Immune Complex-Related Diseases










Age-related
ANCA-associated
Glomerulonephritis -
MYH9-related


macular
vasculitis (Includes
sparse hair -
disease


degeneration
Pauci-immune)
telangiectasis



Atypical hemolytic
Anti-glomerular
Goodpasture′s sndrome
Nail-patella


uremic syndrome
basement membrane

syndrome



disease





(Goodpasture′s)




Autoimmune
Arthus Reaction
Granulomatosis with
Nail-patella-like


hemolytic anemia

polyangiitis (ANCA
renal disease




and Wegeners)



C1 inhibitor
Asthma
Guillain-Barre
Nephritis


deficiency

syndrome



C1q deficiency
Atypical hemolytic
Hemolytic angioedema
Non-amyloid



uremic syndrome
(HAE)
monoclonal





immunoglobulin





deposition disease


C1r deficiency
Autoimmune inner ear
Henoch-Schonlein
Pauci-immune



disease (AIED)
purpura
glomerulonephritis



Sensorineural hearing





loss




C1s deficiency
Autoimmune uveitis
HIVICK
Pediatric systemic





lupus





erythematosus


C2 deficiency
Autosomal dominant
Hypersensitivty
Pierson syndrome



intermediate Charcot-
vasculitis




Marie-Tooth disease





type E




C3 deficiency
Behçet disease
Hypocomplementemic
Polyarteritis




urticarial vasculitis



C4 deficiency
Berger (IgA)
Idiopathic membranous
polyarteritis nodosa



Nephropathy
glomerulonephritis



C5 deficiency
Buergers disease
Idiopathic nephrotic
Polymyalgia




syndrome
rheumatica


C6 deficiency
Central nervous
IgA nephropathy
Polymyositis



system vasculitis
(Berger′s disease)



C7 deficiency
Choroiditis
IgA
Polymyositis/derma




nephropathy/vasculitis
tomyositis




(Henoch-Schonlein





purpura)



C8 deficiency
Chronic demyelinating
Immune
Poststaphilococcal



polyneuropathy
thrombocytopenia
glomerulonephritis



(CIDP)




C9 deficiency
Churg-strauss
Immunobullous
Poststeptococcal



syndrome
diseases
glomerulonephritis


CD55 deficiency
Cogan′s syndrome
Immunotactoid or
Primary




fibrillary
membranoproliferative




glomerulopathy
glomerulonephritis


CD59 deficiency
Collagen type III
Infection-related
Rapidly progressive



glomerulopathy
glomerulonephritis
glomerulonephritis





(Crescentic)


Complement
Congenital and
Inflammatory
Rapidly progressive


Factor I deficiency
infantile nephrotic
myopathies
glomerulonephritis



syndrome

(RPGN)


Complement
Congenital
Juvenile
Rasmussen


factor-H related
membranous
dermatomyositis
syndrome


1(CFHR1)
nephropathy due to




deficiency
maternal anti-neutral





endopeptidase





alloimmunization




Complement
Cryoglobulinaemia/
Juvenile polymyositis
Reactive arthritis


factor-H related
Cold agglutinin diease




3(CFHR3)





deficiency





CR3/CR4
Cryoglobulinemic
Kawasaki disease
Relapsing


defieciency
vasculitis

polychondritis


(leukocyte





adhesion





deficiency 1)





Factor B
Cutaneous vasculitis
Lipoprotein
Renal amyloidosis


deficiency

glomerulopathy



Factor D
Demyelinating
Lupus nephritis
Reynolds syndrome


deficiency
myopathies





(paraprotein





associated)




Factor H
Denys-Drash
Lupus nephropathy
Rheumatoid


deficiency
syndrome

arthritis


Factor I deficiency
Dermatomyositis
Can Hegglin anomaly
Sarcoidosis





(Nesnier Boeck





Schuamann





Disease)


Ficolin 3
Dernatomyositis
Membranoglomerular
Schimke immuno-


deficiency

nephritis
osseous dysplasia


MASP2 deficiency
Diabetic nephropathy
Membranoproliferative
Scleroderma




glomerulonephritis



MBL deficiency
Drug-induced immune
Membranoproliferative
Sebastian syndrome



complex vasculitis
glomerulonephritis





Type I (MPGN Type I)



Non-alcoholic
Eosinophilic
Membranoproliferative
Secondary


steatohepatitis
granulomatosis with
glomerulonephritis
amyloidosis



polyangiitis (Churgg-
Type II (Dense Deposit




Strauss)
Disease, MPGN Type





II)



Paroxysmal
Epstein Syndrome
Membranoproliferative
Severe or recurring


nocturnal

glomerulonephritis
C diff colitis


hemoglobinuria

Type III (MPGN Type





III)



Properdin
Essential mixed
Membranouse
Sjogren′s syndrome


deficency
cryoglobulinemia
glomerulonephritis



Action myoclonus -
Familial
Menieres disease
Staphylococcal or


renal failure
Mediterranean fever

streptococcal sepsis


syndrome





Acute respiratory
Familial renal
Microscopic
Stiff person


disease syndrome
amyloidosis
polyangiitis
syndrome


(ARDS)/Severe





acute respiratory





syndrome (SARS)





Acute serum
Familial steroid-
Minimal change
Systemic lupus


sickness
resistant nephrotic
disease
erythematosus



syndrome with





sensorineural deafness




Adult-onset Still
Farmer′s lung
Mixed connective
Systemic sclerosis


disease

tissue disease



Age-related
Fechtner Syndrome
Mostly large vessel
Takayasu arteritis


macular

vasculitis



degeneration





AL amyloidosis
Fibronectin
mostly medium vessel
Toxic epidermal



glomerulopathy
vasculitis
necrolysis (Stevens





Johnson syndrome)


Alport′s syndrome
Fibrosing alveolitis
Mostly small vessel
Transplantation/




vsculitis
reperfusion (solid organ)


Alzheimer′s
Focal segmental
Muckle-Wells
Vasculitis


disease
glomerular
syndrome



Amyloidosis (AL,
Focal segmental
Myasthenia gravis
Wegener′s


AA, MIDD, Other)
glomerulosclerosis

granulomatosis


Giant cell arteritis
Frasier syndrome
Galloway-Mowat syndrome



Type 1 diabetes
Myasthenia gravis
Graves′ disease
Pernicious anemia


Crohn′s disease
alopecia areata
thrombocytopenic
Primary biliary




purpura
cirrhosis


Ulcerative colitis
autoimmune hepatitis
Guillain-Barre
Psoriasis




syndrome



Inflammatory
autoimmune
Autoimmune
Rheumatoid


bowel syndrome
deramtomyositis
myocarditis
arthritis


Multiple sclerosis
Juvenile idiopathic
Autoimmune
Vitiligo



arthritis
pemphigus








Enzyme Deficiencies & Vascular Diseases










2,4-dienoyl-CoA
Fabry disease
Isobutyryl-CoA
Peripheral


reductase
(1:80, 000 to
dehydrogenase
neuropathy


deficiency
1:117, 000)




2-Methyl-3-
Familial
Isovaleric acidemia
Peroxisomal


hydroxy butyric
hypercholesterolemia

disorders (1:50, 000;


aciduria
(1:500)

e.g., Zellweger





syndrome, neonatal





adrenoleukodystrophy,





Refsum′s





disease)


2-methylbutyryl-
Familial myocardial
Lactase deficiency
Phenylketonuria


CoA
infarct/stroke
(common)



dehydrogenase





3-hydroxy-3-
Fatty acid oxidation
Lesch-Nyhan syndrome
Primary


methylglutaryl
disorders (1:10, 000)

hyperoxaluria


(HMG) aciduria





3-
Galactokinase
Lipoprotein lipase
Propionic acidemia


methylglutaconic
deficiency
deficiency (rare)



aciduria





3-oxothiolase
Galactose epimerase
long-chain 1-3-
Recurrent emesis


deficiency

hdroxyacyl-CoA



(1:100, 000)

dehydrogenase



4-hydroxybutyric
Galactosemia
Lysinuric protein
Short-chain acyl-


aciduria

intolerance (rare)
CoA





dehydrogenase


5,10-
Galactosemia
Lysinuric protein
Sucrase-isomaltase


methylenetetrahyd
(1:40, 000)
intolerance (rare)
deficiency (rare)


rofolate reductase





deficiency





(common)





5-Oxoprolinuria
Gaucher′s disease
Malonic acidemia
Symptoms of


(pyroglutamic


pancreatitis


aciduria)





Abetalipoproteine
Glutaric acidemia type
Maple syrup urine
Transferase


mia (rare)
I
disease
deficient





galactosemia





(Galactosemia type 1)


Acute Intermittent
Glutaric acidemia
Medium chain acyl-
Trifunctional


Porphyria
Type II
CoA dehydrogenase
protein deficiency


Alkaptonuria
Glutathione
Medium/short chain L-
Tyrosinemia type 1



Synthetase Deficiency
3-hydroxy acyl-CoA




w/ 5-oxoprolinuria
dehydrogenase



Argininemia
Glutathione
Medum-chain ketoacyl-
Tyrosinemia type 2



Synthetase Deficiency
coA thiolase




w/o 5-oxoprolinuria




argininosuccinate
Glycogenolysis
Metachromatic
Tyrosinemia type 3


aciduria
disorders (1:20, 000)
leukodystrophy





(1:100, 000)



Benign
Glycogenosis, type I
Metachromatic
Upward gaze


hyperphenylalaninemia
(1:70, 000)
leukodystrophy
paralysis




(1:100, 000)



beta ketothiolase
Hemolytic anemia due
Methylmalonic
Very long chain


deficiency
to adenylate kinase
acidemia (Cbl C)
acyl-CoA



deficiency

dehydrogenase


Biopterin cofactor
Hemolytic anemia due
Methylmalonic
Wilson Disease


biosynthesis
to deficiency in
acidemia (Cbl D)



defects
Glucose 6 phosphate





dehydrogenase




Bioptcrin cofactor
Hemolytic anemia due
Methylmalonic
Aicardi-Goutieres


regeneration
to diphosphoglycerate
acidemia (vitamin b12
Syndrome (can be


defects
mutase deficiency
non-responsive)
an allelic form of





CLE)


biotin-
Hemolytic anemia due
Methylmalonic
Cutaneous lupus


unresponsive 3-
to erythrocyte
acidemia w/0
erythematosus


methylcrotonyl-
adenosine deaminase
homocystinuria



CoA carboxylase
overproduction




deficiency





Carbamoyl
Hemolytic anemia due
Methylmalonic aciduria
Dermatitis


phosphate
to glucophosphate
and homocystinuria
herpetiformis


synthetase
isomerase deficiency




Carnitine
Hemolytic anemia due
Mitochondrial
hemophilia A


acylcarnitine
to glutathione
disorders (1:30, 000)



translocase
reductase deficiency




Carnitine
Hemolytic anemia due
Mitochondrial
hemophilia B


palmitoyltransferase
to glyceraldehyde-3-
disorders (1:30, 000;



I
phosphate
e.g., cytochrome-c




dehydrogenase
oxidase deficiency;




deficiency
MELAS syndrome;





Pearson′s syndrome [all





rare])



Carnitine
Hemolytic anemia due
Mitochondrial
Idiopathic steroid


palmitoyltransferase
to pyrimidine 5′
disorders (1:30, 000;
sensitive nephrotic


II
nucleotidase
e.g., Leigh disease,
syndrome (same as



deficiency
Kearns-Sayre
focal segmental




syndrome [rare])
glomerulaosclerosis)


Carnitine uptake
Hemolytic anemia due
Mitochondrial
Immune


defect
to red cell pyruvate
disorders (1:30, 000;
thrombocytopenic



kinase deficiency
e.g., lipoamide
purpura




dehydrogenase





deficiency [rare])



citrullinemia type I
HHH syndrome (rare)
Mitochondrial
Myasthenia gravis




disorders (1:30, 000;





e.g., Pearson′s





syndrome [rare])



Citrullinemia type
homocysteinuria
Multiple carboxylase
Oligoarticular


II

(holocarboxylase
juvenile arthritis




synthetase)



Congenital
Homocystinuria
Multiple carboxylase
Scleroderma


disorders of
(1:200, 000)
deficiency (e.g.,



glycosylation

holocarboxylase



(rare)

synthetase [rare]) and





biotinidase deficiencies





(1:60, 000)



D-2-
hyperammonemia/
Muscle
Solar urticaria


hydroxyglutaric
ornithinemia/citrullinemia
cramps/spasticity
(maybe protophyria


aciduria
(omithine transporter

erythema)



defect)




D-2-
Hyperlipoproteinemia,
Myoadenylate
Thrombotic


hydroxyglutaricaci
types I and IV (rare)
deaminase deficiency
thrombocytopenic


duria (rare)

(1:100, 000)
purpura


Enteropeptidase
Hypermethioninemia
Niemann-Pick disease,
Tubulointerstitial


deficiency (rare)
due to glycine N-
type C (rare)
nephritis with



methyltransferase

Uveitis/ATIN



deficiency




Ethylmalonic
Hypermethioninemia
Nonketotic
Von willebrand


encephalopathy
encephalopathy due to
hyperglycinemia
disease



adenosine kinase





deficiency





Hyperprolinemia









Infectious Diseases & Infectious Agents










Acinetobacter
Dengue haemorrhagic
Infection-induced
Sepsis



fever
immune complex





vasculitis



Arcobacter butzleri
Disseminated infection
Klebsiella
Serratia


infection - blood
with mycobacterium




infection
avium complex -





blood infection




Arcobacter

E. coli

Leprosy/Hansen′s
Staphylococcus


cryaerophilus

disease
Aureus


infection - blood





infection





Arcobacter
Enterobacter
Malaria
Stenotrophomonas


infection - blood


maltophilia - blood


infection


infection


Bacteremia
Enterococcus
Meningococcus
Streptococcal





Group A invasive





disease - blood





infection


Bacterial
Glanders - blood
Methicillin Resistant
Streptococcus


endocarditis
infection
Staphylococcus Aureus
pneumoniae


Campylobacter
Gonorrhea
Pseudomonas
Streptococcus


fetus infection -


pyogenes


blood infection





Campylobacter
Hepatitis
Rhodococcus equi -
Trypanosomiasis


jejuni infection -

blood infection



blood infection





Candida
Human
Salmonella
Yellow fever



Immunodeficiency





Virus









Coagulase-negative Staphylococcus
















TABLE 9







Selected Diseases, Receivers and Targets










Category
Disease
Receiver
Target





Amyloidoses
AA Amyloidosis
an an antibody-like
Serum amyloid A




binder to serum
protein and amyloid




amyloid A protein or
placques




serum amyloid P





component



Amyloidoses
beta2 microglobulin
an an antibody-like
Beta2



amyloidosis
binder to beta-2
microglobulin or




microglobulin or serum
amyloid placques




amyloid P component



Amyloidoses
Light chain
an an antibody-like
Antibody light



amyloidosis
binder to light chain,
chain or amyloid




serum amyloid P
placques




component



Cell clearance
Cancer
an an antibody-like
a circulating tumor




binder to CD44
cell


Cell clearance
Cancer
an an antibody-like
a circulating tumor




binder to EpCam
cell


Cell clearance
Cancer
an an antibody-like
a circulating tumor




binder to Her2
cell


Cell clearance
Cancer
an an antibody-like
a circulating tumor




binder to EGFR
cell


Cell clearance
Cancer (B cell)
an an antibody-like
a cancerous B cell




binder to CD20



Cell clearance
Cancer (B cell)
an an antibody-like
a cancerous B cell




binder to CD19



Clearance Ab
Antiphospholipid
beta2-glycoprotein-1
pathogenic self-



syndrome

antibody against





beta2-glycoprotein-





1


Clearance Ab
Catastrophic
beta2-glycoprotein-1
pathogenic self-



antiphospholipid

antibody against



syndrome

beta2-glycoprotein-





1


Clearance Ab
Cold agglutinin
I/i antigen
Pathogenic self-



disease

antibody against I/i





antigen


Clearance Ab
Goodpasture
a3 NC1 domain of
pathogenic self-



syndrome
collagen (IV)
antibody against a3





NC1 domain of





Collagen (IV)


Clearance Ab
Immune
platelet Glycoproteins
pathogenic self-antibody



thrombocytopenia
(Ib-IX, IIb-IIIa, IV, Ia-
against platelet



purpura
IIa)
glycoprotein


Clearance Ab
Membranous
Phospholipase A2
pathogenic self-



Nephropathy
receptor
antibody against





phospholipase A2





receptor


Clearance Ab
Warm antibody
Glycophorin A,
pathogenic self-



hemolytic anemia
glycophorin B, and/or
antibody against




glycophorin C, Rh
glycophorins and/or




antigen
Rh antigen


Complement
Age-related macular
a suitable complement
active complement



degeneration
regulatory protein



Complement
Atypical hemolytic
complement factor H,
active complement



uremic syndrome
or a suitable





complement regulatory





protein



Complement
Autoimmune
a suitable complement
active complement



hemolytic anemia
regulatory molecule



Complement
Complement Factor I
Complement factor I, a
active complement



deficiency
suitable complement





regulatory protein



Complement
Non-alcoholic
a suitable complement
active complement



steatohepatitis
regulatory molecule



Complement
Paroxysmal nocturnal
a suitable complement
active complement



hemoglobinuria
regulatory protein



Enzyme
3-methylcrotonyl-CoA
3-methylcrotonyl-CoA
3-



carboxylase deficiency
carboxylase
hydroxyvalerylcarn





itine, 3-





methylcrotonylglycine





(3-MCG) and 3-





hydroxyisovaleric





acid (3-HIVA)


Enzyme
Acute Intermittent
Porphobilinogcn
Porphobilinogen



Porphyria
deaminase



Enzyme
Acute lymphoblastic
Asparaginase
Asparagine



leukemia




Enzyme
Acute lymphocytic
Asparaginase
Asparagine



leukemia, acute





myeloid leukemia




Enzyme
Acute myeloblastic
Asparaginase
Asparagine



leukemia




Enzyme
Adenine
adenine
Insoluble purine



phosphoribosyltransfe
phosphoribosyltransfer
2,8-



rase deficiency
ase
dihydroxyadenine


Enzyme
Adenosine deaminase
Adenosine deaminase
Adenosine



deficiency




Enzyme
Afibrinogenomia
FI
enzyme





replacement


Enzyme
Alcohol poisoning
Alcohol
Ethanol




dehydrogenase/oxidase



Enzyme
Alexander′s disease
FVII
enzyme





replacement


Enzyme
Alkaptonuria
homogentisate oxidase
homogentisate


Enzyme
Argininemia
Ammonia
ammonia




monooxygenase



Enzyme
argininosuccinate
Ammonia
ammonia



aciduria
monooxygenase



Enzyme
citrullinemia type I
Ammonia
ammonia




monooxygenase



Enzyme
Citrullinemia type II
Ammonia
ammonia




monooxygenase



Enzyme
Complete LCAT
Lecithin-cholesterol
Cholesterol



deficiency, Fish-eye
acyltransferase (LCAT)




disease,





atherosclerosis,





hypercholesterolemia




Enzyme
Cyanide poisoning
Thiosulfate-cyanide
Cyanide




sulfurtransferase



Enzyme
Diabetes
Hexokinase,
Glucose




glucokinase



Enzyme
Factor II Deficiency
FII
enzyme





replacement


Enzyme
Familial
Arginase
Arginine



hyperarginemia




Enzyme
Fibrin Stabilizing
FXIII
enzyme



factor Def

replacement


Enzyme
Glutaric acidemia type
lysine oxidase
3-hydroxyglutaric



I

and glutaric acid





(C5-DC), lysine


Enzyme
Gout
Uricase
Uric Acid


Enzyme
Gout - hyperuricemia
Uricase
Uric acid (Urate





crystals)


Enzyme
Hageman Def.
FXII
enzyme





replacement


Enzyme
Hemolytic anemia due
pyrimidine 5′
pyrimidines



to pyrimidine 5′
nucleotidase




nucleotidase





deficiency




Enzyme
Hemophilia A
Factor VIII
Thrombin (factor II





a) or Factor X


Enzyme
Hemophilia B
Factor IX
Factor XIa or





Factor X


Enzyme
Hemophilia C
FXI
enzyme





replacement


Enzyme
Hepatocellular
Arginine deiminase
Arginine



carcinoma, melanoma




Enzyme
Homocystinuria
Cystathionine B
homocysteine




synthase



Enzyme
hyperammonemia/orni
Ammonia
Ammonia



thinemia/citrullinemia
monooxygenase




(ornithine transporter





defect)




Enzyme
Isovaleric acidemia
Leucine metabolizing
leucine




enzyme



Enzyme
Lead poisoning
d-aminolevulinate
lead




dehydrogenase



Enzyme
Lesch-Nyhan
Uricase
Uric acid



syndrome




Enzyme
Maple syrup urine
Leucine metabolizing
Leucine



disease
enzyme



Enzyme
Methylmalonic
methylmalonyl-CoA
methylmalonate



acidemia (vitamin b12
mutase




non-responsive)




Enzyme
Mitochondrial
thymidine
thymidine



neurogastrointestinal
phosphorylase




encephalomyopathy




Enzyme
Mitochondrial
Thymidine
Thymidine



neurogastrointestinal
phosphorylase




encephalomyopathy





(MNGIE)




Enzyme
Owren′s disease
FV
enzyme





replacement


Enzyme
p53-null solid tumor
Serine dehyrdatase or
serine




serine hydroxymethyl





transferase



Enzyme
Pancreatic
Asparaginase
asparagine



adenocarcinoma




Enzyme
Phenylketonuria
Phenylalanine
Phenylalanine




hydroxylase,





phenylalanine ammonia





lyase



Enzyme
Primary hyperoxaluria
Oxalate oxidase
Oxalate


Enzyme
Propionic acidemia
Propionate conversion
Proprionyl coA




enzyme?



Enzyme
Purine nucleoside
Purine nucleoside
Inosine, dGTP



phosphorylase
phosphorylase




deficiency




Enzyme
Stuart-Power Def.
FX
enzyme





replacement


Enzyme
Thrombotic
ADAMTS13
ultra-large von



Thrombocytopenic

willebrand factor



Purpura

(ULVWF)


Enzyme
Transferase deficient
galactose
Galactose-1-



galactosemia
dehydrogenase
phosphate



(Galactosemia type 1)




Enzyme
Tyrosinemia type 1
tyrosine phenol-lyase
tyrosine


Enzyme
von Willebrand
vWF
enzyme



disease

replacement


IC clearance
IgA Nephropathy
Complement receptor 1
Immune complexes


IC clearance
Lupus nephritis
Complement receptor 1
immune complex


IC clearance
Systemic lupus
Complement receptor 1
immune complex



erythematosus




Infectious
Anthrax (B. anthracis)
an an antibody-like
B. anthracis



infection
binder to B. anthracis





surface protein



Infectious
C. botulinum infection
an an antibody-like
C. botulinum




binder to C. botulinum





surface protein



Infectious
C. difficile infection
an antibody-like binder
C. difficile




to C. difficile surface





protein



Infectious
Candida infection
an antibody-like binder
candida




to candida surface





protein



Infectious

E. coli infection

an antibody-like binder

E. coli





to E.coli surface





protein



Infectious
Ebola infection
an antibody-like binder
Ebola




to Ebola surface protein



Infectious
Hepatitis B (HBV)
an antibody-like binder
HBV



infection
to HBV surface protein



Infectious
Hepatitis C (HCV)
an antibody-like binder
HCV



infection
to HCV surface protein



Infectious
Human
an antibody-like binder
HIV



immunodeficiency
to HIV envelope




virus (HIV) infection
proteins or CD4 or





CCR5 or



Infectious
M. tuberculosis
an antibody-like binder
M. tuberculosis



infection
to M. tuberculosis





surface protein



Infectious
Malaria (P.
an antibody-like binder
P. falciparum



falciparum) infection
to P. falciparum surface





protein



Lipid
Hepatic lipase
Hepatic lipase (LIPC)
Lipoprotein,



deficiency,

intermediate



hypercholesterolemia

density (IDL)


Lipid
Hyperalphalipoproteinemia 1
Cholesteryl ester
Lipoprotein, high




transfer protein(CETP)
density (HDL)


Lipid
hypercholesterolemia
an antibody-like binder
LDL




to low-density





lipoprotein (LDL),





LDL receptor



Lipid
hypercholesterolemia
an antibody-like binder
HDL




to high-density





lipoprotein (HDL) or





HDL receptor



Lipid
lipoprotein lipase
lipoprotein lipase
chilomicrons and



deficiency

very low density





lipoproteins





(VLDL)


Lipid
Lipoprotein lipase
lipoprotein lipase
Lipoprotein, very



deficiency, disorders
(LPL)
low density



of lipoprotein

(VLDL)



metabolism




Lysosomal storage
Aspartylglucosaminuria
N-
glycoproteins



(208400)
Aspartylglucosaminidase



Lysosomal storage
Cerebrotendinous
Sterol 27-hydroxylase
lipids, cholesterol,



xanthomatosis

and bile acid



(cholestanol lipidosis;





213700)




Lysosomal storage
Ceroid lipofuscinosis
Palmitoyl-protein
lipopigments



Adult form (CLN4,
thioesterase-1




Kufs′ disease; 204300)




Lysosomal storage
Ceroid lipofuscinosis
Palmitoyl-protein
lipopigments



Infantile form (CLN1,
thioesterase-1




Santavuori-Haltia





disease; 256730)




Lysosomal storage
Ceroid lipofuscinosis
Lysosomal
lipopigments



Juvenile form (CLN3,
transmembrane CLN3




Batten disease, Vogt-
protein




Spielmeyer disease;





204200)




Lysosomal storage
Ceroid lipofuscinosis
Lysosomal pepstatin-
lipopigments



Late infantile form
insensitive peptidase




(CLN2, Jansky-





Bielschowsky disease;





204500)




Lysosomal storage
Ceroid lipofuscinosis
Transmembrane CLN8
lipopigments



Progressive epilepsy
protein




with intellectual





disability (600143)




Lysosomal storage
Ceroid lipofuscinosis
Transmembrane CLN6
lipopigments



Variant late infantile
protein




form (CLN6; 601780)




Lysosomal storage
Ceroid lipofuscinosis
Lysosomal
lipopigments



Variant late infantile
transmembrane CLN5




form, Finnish type
protein




(CLN5; 256731)




Lysosomal storage
Cholesteryl ester
lisosomal acid lipase
lipids and



storage disease

cholesterol



(CESD)




Lysosomal storage
Congenital disorders
Phosphomannomutase-
N-glycosylated



of N-glycosylation
2
protein



CDG Ta (solely





neurologic and





neurologic-





multivisceral forms;





212065)




Lysosomal storage
Congenital disorders
Mannose (Man)
N-glycosylated



of N-glycosylation
phosphate (P)
protein



CDG Ib (602579)
isomerase



Lysosomal storage
Congenital disorders
Dolicho-P-
N-glycosylated



of N-glycosylation
Glc:Man9G1cNAc2-
protein



CDG Ic (603147)
PP-dolichol





glucosyltransferase



Lysosomal storage
Congenital disorders
Dolicho-P-
N-glycosylated



of N-glycosylation
Man:Man5G1cNAc2-
protein



CDG Id (601110)
PP-dolichol





mannosyltransferase



Lysosomal storage
Congenital disorders
Dolichol-P-mannose
N-glycosylated



of N-glycosylation
synthase
protein



CDG Ie (608799)




Lysosomal storage
Congenital disorders
Protein involved in
N-glycosylated



of N-glycosylation
mannose-P-dolichol
protein



CDG If (609180)
utilization



Lysosomal storage
Congenital disorders
Dolichyl-P-
N-glycosylated



of N-glycosylation
mannose:Man-7-
protein



CDG Ig (607143)
GlcNAc-2-PP-dolichyl-





α-6-





mannosyltransferase



Lysosomal storage
Congenital disorders
Dolichyl-P-
N-glycosylated



of N-glycosylation
glucose:Glc-1-Man-9-
protein



CDG Ih (608104)
GlcNAc-2-PP-dolichyl-





α-3-glucosyltransferase



Lysosomal storage
Congenital disorders
α-1,3-
N-glycosylated



of N-glycosylation
Mannosyltransferase
protein



CDG Ii (607906)




Lysosomal storage
Congenital disorders
Mannosyl-α-1,6-
N-glycosylated



of N-glycosylation
glycoprotein-β-1,2-N-
protein



CDG IIa (212066)
acetylglucosminyltrans





ferase



Lysosomal storage
Congenital disorders
Glucosidase I
N-glycosylated



of N-glycosylation

protein



CDG IIb (606056)




Lysosomal storage
Congenital disorders
GDP-fucose
N-glycosylated



of N-glycosylation
transporter-1
protein



CDG IIc (Rambam-





Hasharon syndrome;





266265




Lysosomal storage
Congenital disorders
β-1,4-
N-glycosylated



of N-glycosylation
Galactosyltransferase
protein



CDG IId (607091)




Lysosomal storage
Congenital disorders
Oligomeric Golgi
N-glycosylated



of N-glycosylation
complex-7
protein



CDG IIe (608779)




Lysosomal storage
Congenital disorders
UDP-G1cNAc:dolichyl-
N-glycosylated



of N-glycosylation
P NAcGlc
protein



CDG Ij (608093)
phosphotransferase



Lysosomal storage
Congenital disorders
β-1,4-
N-glycosylated



of N-glycosylation
Mannosyltransferase
protein



CDG Ik (608540)




Lysosomal storage
Congenital disorders
α-1,2-
N-glycosylated



of N-glycosylation
Mannosyltransferase
protein



CDG I1 (608776)




Lysosomal storage
Congenital disorders
α-1,2-
N-glycosylated



of N-glycosylation,
Mannosyltransferase
protein



type I (pre-Golgi





glycosylation defects)




Lysosomal storage
Cystinosis
Cystinosin (lysosomal
Cysteine




cystine transporter)



Lysosomal storage
Fabry′s disease
Trihexosylceramide α-
globotriaosylceramide



(301500)
galactosidase



Lysosomal storage
Farber′s disease
Ceramidase
lipids



(lipogranulomatosis;





228000)




Lysosomal storage
Fucosidosis (230000)
α-L-Fucosidase
fucose and complex





sugars


Lysosomal storage
Galactosialidosis
Protective
lysosomal content



(Goldberg′s syndrome,
protein/cathepsin A




combined
(PPCA)




neuraminidase and β-





galactosidase





deficiency; 256540)




Lysosomal storage
Gaucher′s disease
Glucosylceramide β-
sphingolipids




glucosidase



Lysosomal storage
Glutamyl ribose-5-
ADP-ribose protein
glutamyl ribose 5-



phosphate storage
hydrolase
phosphate



disease (305920)




Lysosomal storage
Glycogen storage
alpha glucosidase
glycogen



disease type 2





(Pompe′s disease)




Lysosomal storage
GM1 gangliosidosis,
Ganglioside β-
acidic lipid



generalized
galactosidase
material,





gangliosides


Lysosomal storage
GM2 activator protein
GM2 activator protein
gangliosides



deficiency (Tay-Sachs





disease AB variant,





GM2A; 272750)




Lysosomal storage
GM2 gangliosidosis
Ganglioside β-
gangliosides




galactosidase



Lysosomal storage
Infantile sialic acid
Na phosphate
sialic acid



storage disorder
cotransporter, sialin




(269920)




Lysosomal storage
Krabbe's disease
Galactosylceramide β-
sphingolipids



(245200)
galactosidase



Lysosomal storage
Lysosomal acid lipase
Lysosomal acid lipase
cholesteryl



deficiency (278000)

esters and triglycerides


Lysosomal storage
Metachromatic
Arylsulfatase A
sulfatides



leukodystrophy





(250100)




Lysosomal storage
Mucolipidosis ML II
N-Acetylglucosaminyl-
N-linked



(I-cell disease;
1-phosphotransfeerase
glycoproteins



252500)
catalytic subunit



Lysosomal storage
Mucolipidosis ML III
N-acetylglucosaminyl-
N-linked



(pseudo-Hurler′s
1-phosphotransfeerase
glycoproteins



polydystrophy)




Lysosomal storage
Mucolipidosis ML III
Catalytic subunit
N-linked



(pseudo-Hurler′s

glycoproteins



polydystrophy) Type





III-A (252600)




Lysosomal storage
Mucolipidosis ML III
Substrate-recognition
N-linked



(pseudo-Hurler′s
subunit
glycoproteins



polydystrophy) Type





III-C (252605)




Lysosomal storage
Mucopolysaccharidosis
α-1-Iduronidase
glycosaminoglycans



MPS I H/S (Hurler-





Scheie syndrome;





607015)




Lysosomal storage
Mucopolysaccharidosis
α-1-Iduronidase
glycosaminoglycans



MPS I-H (Hurler′s





syndrome; 607014)




Lysosomal storage
Mucopolysaccharidosis
Iduronate sulfate
glycosaminoglycans



MPS II (Hunter′s
sulfatase




syndrome; 309900)




Lysosomal storage
Mucopolysaccharidosis
Heparan-S-sulfate
glycosaminoglycans



MPS III (Sanfilippo′s
sulfamidase




syndrome) Type III-A





(252900)




Lysosomal storage
Mucopolysaccharidosis
N-acetyl-D-
glycosaminoglycans



MPS III (Sanfilippo′s
glucosaminidase




syndrome) Type III-B





(252920)




Lysosomal storage
Mucopolysaccharidosis
Acetyl-CoA-
glycosaminoglycans



MPS III (Sanfilippo′s
glucosaminides N-




syndrome) Type III-C
acetyltransferase




(252930)




Lysosomal storage
Mucopolysaccharidosis
N-acetyl-
glycosaminoglycans



MPS III (Sanfilippo′s
glucosaminine-6-




syndrome) Type III-D
sulfate sulfatase




(252940)




Lysosomal storage
Mucopolysaccharidosis
α-1-Iduronidase
glycosaminoglycans



MPS I-S (Scheie′s





syndrome; 607016)




Lysosomal storage
Mucopolysaccharidosis
Galactosamine-6-
glycosaminoglycans



MPS IV (Morquio′s
sulfate sulfatase




syndrome) Type IV-A





(253000)




Lysosomal storage
Mucopolysaccharidosis
β-Galactosidase
glycosaminoglycans



MPS IV (Morquio′s





syndrome) Type IV-B





(253010)




Lysosomal storage
Mucopolysaccharidosis
Hyaluronidase
glycosaminoglycans



MPS IX
deficiency




(hyaluronidase





deficiency; 601492)




Lysosomal storage
Mucopolysaccharidosis
N-Acetyl
glycosaminoglycans



MPS VI (Maroteaux-
galactosamine α-4-




Lamy syndrome;
sulfate sulfatase




253200)
(arylsulfatase B)



Lysosomal storage
Mucopolysaccharidosis
β-Glucuronidases
glycosaminoglycans



MPS VII (Sly′s





syndrome; 253220)




Lysosomal storage
Mucosulfatidosis
Sulfatase-modifying
sulfatides



(multiple sulfatase
factor-1




deficiency; 272200)




Lysosomal storage
Niemann-Pick disease
Sphingomyelinase
sphingomyelin



type A




Lysosomal storage
Niemann-Pick disease
Sphingomyelinase
sphingomyelin



type B




Lysosomal storage
Niemann-Pick disease
NPC1 protein
sphingomyelin



Type C1/Type D





((257220)




Lysosomal storage
Niemann-Pick disease
Epididymal secretory
sphingomyelin



Type C2 (607625)
protein 1 (HE1; NPC2





protein)



Lysosomal storage
Prosaposin deficiency
Prosaposin
sphingolipids



(176801)




Lysosomal storage
Pycnodysostosis
Cathepsin K
kinins



(265800)




Lysosomal storage
Sandhoff′s disease;
β-Hexosaminidase B
gangliosides



268800




Lysosomal storage
Saposin B deficiency
Saposin B
sphingolipids



(sulfatide activator





deficiency)




Lysosomal storage
Saposin C deficiency
Saposin C
sphingolipids



(Gaucher's activator





deficiency)




Lysosomal storage
Schindler′s disease
N-Acetyl-
glycoproteins



Type I (infantile
galactosaminidase




severe form; 609241)




Lysosomal storage
Schindler′s disease
N-Acetyl-
glycoproteins



Type II (Kanzaki
galactosaminidase




disease, adult-onset





form; 609242)




Lysosomal storage
Schindler′s disease
N-Acetyl-
glycoproteins



Type III (intermediate
galactosaminidase




form; 609241)




Lysosomal storage
Sialidosis (256550)
Neuraminidase 1
mucopolysaccharides




(sialidase)
and mucolipids


Lysosomal storage
Sialuria Finnish type
Na phosphate
sialic acid



(Salla disease;
cotransporter, sialin




604369)




Lysosomal storage
Sialuria French type
UDP-N-
sialic acid



(269921)
acetylglucosamine-2-





epimerase/N-





acetylmannosamine





kinase, sialin



Lysosomal storage
Sphingolipidosis Type
Ganglioside β-
sphingolipids



I (230500)
galactosidase



Lysosomal storage
Sphingolipidosis Type
Ganglioside β-
sphingolipids



II (juvenile type;
galactosidase




230600)




Lysosomal storage
Sphingolipidosis Type
Ganglioside β-
sphingolipids



III (adult type;
galactosidase




230650)




Lysosomal storage
Tay-Sachs disease;
β-Hexosaminidase A
gangliosides



272800




Lysosomal storage
Winchester syndrome
Metalloproteinase-2
mucopolysaccharides



(277950)




Lysosomal storage
Wolman′s disease
lysosomal acid lipase
lipids and





cholesterol


Lysosomal storage
α-Mannosidosis
α-D-Mannosidase
carbohydrates and



(248500), type I

glycoproteins



(severe) or II (mild)




Lysosomal storage
β-Mannosidosis
β-D-Mannosidase
carbohydrates and



(248510)

glycoproteins


Toxic Molecule
alpha hemolysin
an antibody-like binder
alpha hemolysin



poisoning
to alpha hemolysin



Toxic Molecule
antrax toxin poisoning
an antibody-like binder
anthrax toxin




to anthrax toxin



Toxic Molecule
bacterial toxin-
an antibody-like binder
bacterial toxin



induced shock
to bacterial toxin



Toxic Molecule
botulinum toxin
an antibody-like binder
botulinum toxin



poisoning
to botulinum toxin



Toxic Molecule
Hemochromatosis
iron chelator
molecular iron



(iron poisoning)




Toxic Molecule
Methanol poisoning
Methanol dehdrogenase
Methanol


Toxic Molecule
Nerve gas poisoning
Butyryl cholinesterase
Sarin


Toxic Molecule
Prion disease caused
an antibody-like binder
Prion protein PRP



by PRP
to prion protein PRP



Toxic Molecule
Prion disease causcd
an antibody-like binder
Prion protein PRPc



by PRPc
to prion protein PRPc



Toxic Molecule
Prion disease caused
an antibody-like binder
Prion protein



by PRPsc
to prion protein PRPsc
PRPsc


Toxic Molecule
Prion disease cuased
an antibody-like binder
Prion protein



by PRPres
to prion protein PRPres
PRPres


Toxic Molecule
Sepsis or cytokine
an antibody-like binder
cytokines



storm
to cytokines or Duffy





antigen receptor of





chemokines (DARC)



Toxic Molecule
spider venom
an antibody-like binder
spider venom



poisoning
to spider venom



Toxic Molecule
Wilson disease
copper chelator
molecular copper








Claims
  • 1. A method of introducing exosomes to a subject, the method comprising: administering to the subject a first dose comprising non-therapeutic exosomes; andadministering to the subject a second dose comprising therapeutic exosomes.
  • 2. The method according to claim 1, wherein the therapeutic exosomes comprise a receiver.
  • 3. The method according to claim 1 or claim 2, wherein the non-therapeutic and therapeutic exosomes are administered separately.
  • 4. The method according to any one of the preceding claims, wherein the second dose is administered at a period of time which is 15 minutes or greater after administration of the first dose.
  • 5. The method according to any one of the preceding claims, wherein the second dose is administered at a period of time which is 3 hours or less after administration of the first dose.
  • 6. The method according to any one of the preceding claims, wherein the first dose comprises an exosome quantity that is different from an exosome quantity of the second dose.
  • 7. The method according to any one of the preceding claims, wherein the first dose comprises an exosome quantity that is greater than an exosome quantity of the second dose.
  • 8. The method according to any one of the preceding claims, wherein the first and second doses are administered parenterally.
  • 9. The method according to claim 8, wherein the administration is intravenous administration.
  • 10. The method according to claim 9, wherein the first dose is a bolus dose comprising an exosome quantity that is greater than an exosome quantity of the second dose, and wherein the second dose is administered as a continuous infusion.
  • 11. The method according to claim 9, wherein the first dose is a bolus dose comprising an exosome quantity that is greater than an exosome quantity of the second dose, and the second dose is administered in a plurality of repeated administration steps.
  • 12. The method according to claim 9, wherein the first dose is administered in a plurality of repeated administration steps.
  • 13. The method according to claim 12, wherein the second dose is administered in a time period ranging from 15 minutes to 3 hours after completion of the plurality of repeated administration steps.
  • 14. The method according to any one of the preceding claims, wherein the non-therapeutic exosomes, the therapeutic exosomes or both the non-therapeutic and therapeutic exosomes comprise an imaging agent.
  • 15. The method according to claim 14, wherein the imaging agent is a fluorescent compound.
  • 16. The method according to any one of the preceding claims, further comprising imaging the subject after administration of the non-therapeutic exosomes, the therapeutic exosomes or both the non-therapeutic and therapeutic exosomes and thereby detecting the location of the exosomes in the subject.
  • 17. The method according to claim 16, wherein the imaging comprises magnetic resonance imaging.
  • 18. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise RNA.
  • 19. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise microRNA (miRNA).
  • 20. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise siRNA.
  • 21. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise DNA.
  • 22. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise a polypeptide.
  • 23. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise a small molecule.
  • 24. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise a large molecule biologic.
  • 25. The method according to any one of the preceding claims, wherein therapeutic exosomes comprise more than one distinct payload.
  • 26. The method according to claim 25, wherein the payload comprises more than one type of payload selected from the group consisting of: peptide, protein, DNA, RNA, siRNA, miRNA, shRNA, small molecule, large molecule biologic, polysaccharide, lipid, toxin and combinations thereof.
  • 27. The method according to any one of the preceding claims, wherein the therapeutic exosomes comprise a payload labeled with a detectable moiety.
  • 28. The method according to any one of the preceding claims, wherein the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are synthetic.
  • 29. The method according to any one of the preceding claims, wherein the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are derived from a producer cell.
  • 30. The method according to any one of the preceding claims, wherein the exosomes are contacted with sialyltransferase prior to administration.
  • 31. The method according to any one of the preceding claims, wherein the therapeutic exosomes, non-therapeutic exosomes or both the therapeutic and non-therapeutic exosomes are co-administered either concurrently or sequentially, with an agent that inhibits phagocytosis of the exosomes.
  • 32. The method according to any one of the preceding claims, wherein the first dose, the second dose, or both the first and second doses harbor a plurality of distinct exosomes, wherein the distinct exosomes harbor distinct payloads.
  • 33. The method according to any one of the preceding claims, wherein the exosomes comprise a largest diameter ranging from 30 nm to 500 nm.
  • 34. The method according to any one of the preceding claims, wherein the exosomes comprise a largest diameter ranging from 30 nm to 200 nm.
  • 35. The method according to any one of the preceding claims, wherein the exosomes comprise a largest diameter ranging from 30 nm to 100 nm.
  • 36. The method according to any one of the preceding claims, wherein administration of the first dose comprising non-therapeutic exosomes causes reduced delivery of the therapeutic exosomes to an organ selected from the group consisting of: the liver, spleen, or combinations thereof, compared to delivery of the therapeutic exosomes administered at the same dose, but without prior administration of the first dose comprising non-therapeutic exosomes.
  • 37. The method according to any one of the preceding claims, wherein administration of the non-therapeutic exosomes causes increased delivery of the therapeutic exosomes to a target cell or tissue, compared to delivery of therapeutic exosomes administered at the same dose, but without prior administration of the first dose comprising non-therapeutic exosomes.
  • 38. A method of introducing exosomes to a subject, the method comprising administering to the subject a dose of therapeutic exosomes, wherein said therapeutic exosomes are modified, said modification causing increased delivery of said therapeutic exosomes to a target cell or tissue as compared to delivery of unmodified therapeutic exosomes that have been obtained by identical methods.
  • 39. The method according to claim 38, wherein the exosomes are modified by contacting with sialyltransferase prior to administration.
  • 40. The method according to claim 38 or claim 39, wherein the exosomes are administered either concurrently or sequentially with an agent that inhibits phagocytosis of the exosomes.
  • 41. The method according to any of claims 38 to 40, wherein the exosomes comprise an imaging agent.
  • 42. The method according to claim 41, wherein the imaging agent is a fluorescent compound.
  • 43. The method according to any of claims 38 to 42, further comprising imaging the subject after administration of the exosomes and thereby detecting the location of the exosomes in the subject.
  • 44. The method according to claim 43, wherein the imaging comprises magnetic resonance imaging.
  • 45. The method according to any of claims 38 to 44, wherein the exosomes comprise RNA.
  • 46. The method according to any of claims 38 to 45, wherein the exosomes comprise microRNA (miRNA).
  • 47. The method according to any of claims 38 to 46, wherein the exosomes comprise siRNA.
  • 48. The method according to any of claims 38 to 47, wherein the exosomes comprise DNA.
  • 49. The method according to any of claims 38 to 48, wherein the exosomes comprise a polypeptide.
  • 50. The method according to any of claims 38 to 49, wherein the exosomes comprise a small molecule.
  • 51. The method according to any of claims 38 to 50, wherein the exosomes comprise a large molecule biologic.
  • 52. The method according to any of claims 38 to 51, wherein the exosomes comprise more than one distinct payload.
  • 53. The method according to claim 52, wherein the payload comprises more than one type of payload selected from the group consisting of: peptide, protein, DNA, RNA, siRNA, miRNA, shRNA, small molecule, large molecule biologic, polysaccharide, lipid, toxin and combinations thereof.
  • 54. The method according to any of claims 38 to 53, wherein the exosomes comprise a payload labeled with a detectable moiety.
  • 55. The method according to any of claims 38 to 54, wherein the exosomes are synthetic.
  • 56. The method according to any of claims 38 to 55, wherein exosomes are derived from a producer cell.
  • 57. The method according to any of claims 38 to 56, wherein the exosomes comprise a largest diameter ranging from 30 nm to 500 nm.
  • 58. The method according to any of claims 38 to 57, wherein the exosomes comprise a largest diameter ranging from 30 nm to 200 nm.
  • 59. The method according to any of claims 38 to 58, wherein the exosomes comprise a largest diameter ranging from 30 nm to 100 nm.
  • 60. The method according to any of claims 38-59, wherein the therapeutic exosomes comprise a receiver.
  • 61. The method according to any of claims 38 to 60, wherein administration of the modified exosomes causes reduced delivery of the exosomes to an organ selected from the group consisting of: the liver, spleen, or combinations thereof, compared to delivery of unmodified exosomes that have been obtained by identical methods and administered at the same dose.
  • 62. A method of introducing exosomes to a subject, the method comprising: administering to the subject a first dose comprising non-therapeutic exosomes; andadministering to the subject a second dose comprising therapeutic exosomes, wherein administering to the subject the first dose comprises accumulating the non-therapeutic exosomes in the liver, spleen, or any combination thereof, of the subject.
  • 63. A kit, comprising: a pharmaceutical composition comprising the therapeutic exosomes of any of claims 40 to 62 and instructions for use.
  • 64. A kit, comprising: a first pharmaceutical composition comprising non-therapeutic exosomes;a second pharmaceutical composition comprising therapeutic exosomes and instructions for use.
CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Patent Application No. 62/378,122 filed Aug. 22, 2016, which is hereby incorporated by reference in its entirety.

PCT Information
Filing Document Filing Date Country Kind
PCT/US2017/047794 8/21/2017 WO 00
Provisional Applications (1)
Number Date Country
62378122 Aug 2016 US