Patent Application
20200181582
N/A.
The field of the invention is related to treatment of diseases and disorders associated with a single altered protein or enzyme, in particular diseases that can be treated with engrafted hematopoietic cells, for example, lysosomal storage disorders such as Fabry disease and Gaucher disease which are associated with dysregulation or deficiency of a single protein or in some instances a single protein combined with a co-activator protein.
Lysosomes are membrane-bound organelles in animal cells that contain more than 60 different enzymes capable of digesting nearly any biomolecule. They carry many critical biological functions, including acting as the cell's waste disposal system by digesting unwanted materials in the cytoplasm, both from outside of the cell and obsolete components inside the cell. Lysosomal Storage Disorders (LSDs, lysosomal storage diseases) are a group of more than 60 rare inherited metabolic disorders that result from lysosome dysfunction, usually as a consequence of a deficiency in a single enzyme required for the intracellular digestion of lipids, glycoproteins, or mucopolysaccharides. As a result of such deficiencies, the molecules that would normally be degraded accumulate inside the cell, leading to dysfunction or death of the cell.
Fabry disease is a LSD resulting from a deficiency in the enzyme α-galactosidase A (α-gal A encoded by the AGA transgene), an enzyme that hydrolyses α-galactose from glycosphingolipids, in particular globotriaosylceramide (Gb3). Sphingolipids play an important role in signal transmission and cell recognition, and sphingolipidoses can impact all tissues. Currently, enzyme replacement therapy (ERT) is used to treat Fabry disease, and with ERT, patients with Fabry disease may live well into adulthood. However, ERT requires lengthy intravenous infusions of α-gal A administered every few weeks, usually at an outpatient center. In addition, Fabry patients often require treatments for pain, gastrointestinal dysfunction, arrhythmias and other heart problems, as well as blood thinners and blood pressure medications to protect kidney function. Although Fabry disease is relatively rare—there are about 4000 patients in the US—treatment costs are on the order of $300,000/year/patient, or $1.2B/y for all US patients.
Genetic Modification of Hematopoietic Stem Cells from Fabry Patients
Prior work by the inventor related to the use of a cellular therapy for Fabry disease. The method is based on the use of hematopoietic stem cells (HSCs), which are “multipotent” cells present in bone marrow that can differentiate into all blood cell types. A method of genetically modifying HSCs taken from Fabry patients was developed by “transducing” the cells with a recombinant lentivirus vector carrying the transgene for the α-gal A enzyme. Upon re-introduction of the patient's modified cells back into the patient (an “autologous” graft), the genetically modified stem cells will populate all downstream lineages of the hematopoietic system and then circulate throughout the body. The modified cells secrete a form of α-gal A with a molecular “tag” (mannose 6-phosphate) which allows uncorrected “bystander” cells in the patient to take up and transport α-gal A intracellularly into their lysosomes, where it can compensate for the patient's α-gal A deficiency, and effectively degrade the accumulated sphingolipids. This method is undergoing clinical trials in Canada (ClinicalTrials.gov # NCT02800070).
However, systemic expression of α-gal A using this method is relatively low, in part because of a key step in the process. It is only possible to obtain a relatively small number of HSCs from patients as HSCs are relatively rare cells, and it is also difficult to get a high level of transduction in HSCs. These limitations may constrain ability of these cells to adequately increase the systemic levels of α-gal A within a subject. Increasing the number of cells producing α-gal A will in turn increase the systemic α-gal A levels. Thus, there is a need to develop methods of increasing the number of α-gal A-expressing cells after HSC engraftment to subsequently increase systemic levels of α-gal A for treatment of Fabry disease.
Gaucher disease is an autosomal recessive inherited disorder caused by mutations in the GBA transgene that leads to a reduction or elimination of activity of beta-glucocerebrosidase (GBA protein). This enzyme breaks down glucocerebroside into a sugar (glucose) and a simpler fat-like molecule (ceramide). Without enough of this enzyme, glucocerebroside and related substances can build up to toxic levels within cells, including the spleen, liver and bone tissue. Tissues and organs are damaged by the abnormal accumulation and storage of these substances, causing the characteristic features of Gaucher disease.
Traditional treatment for Gaucher disease is enzyme replacement therapy. However, better methods of treating such a disease are needed.
The present invention overcomes the aforementioned drawbacks by providing a method of enriching for hematopoietic cells in vitro, ex vivo and in vivo that express the desired transgene, for example, but not limited to, AGA transgene for Fabry Disease or GBA transgene for Gaucher disease.
The inventors in the present invention have engineered a “dual promoter” lentivirus vector for expression of a protein from a transgene of interest, for example, but not limited to, α-gal A or GBA protein, and an enzyme, IMPDH2(IY), that confers mycophenolic acid (MPA) resistance to transduced B- and T-cells in the white cell population. MPA, which is delivered in vivo as the FDA approved drug mycophenolate mofetil (MMF), inhibits an enzyme needed for the growth of T cells and B cells. MMF is used routinely in the clinic as an immunosuppressive agent for a variety of indications (e.g., to prevent organ transplant rejection) with a low incidence of adverse side-effects. The primary consequence of in vivo administration of MPA/MMF is on T and B cell depletion, but T and B cells that arise from the engrafted hematopoietic stem cells (HSCs) that are transduced with the dual promoter lentiviral vector are resistant to MPA and have a selective growth advantage. Treatment with low doses of MMF increases the number of therapeutic lymphocytes in vivo, without affecting the original engraftment, with minimal toxicity. This, in turn, increases the total number of circulating cells that are expressing the transgene of interest, and thus the cells are able to express and/or secrete the protein encoded by the transgene, for example, secreting α-gal A, GBA protein, or other protein expressed by other transgenes of interest, which can lead to treatment or correction of the disease associated with the transgene, e.g., the lysosomal storage disorder.
This platform technology is broadly applicable to hematopoietic cell-based treatment of many inherited disorders, including other lysosomal storage disorders or hematopoietic system diseases in which a selective growth advantage of altered hematopoietic cells allows for treatment of the disease.
In one aspect, a dual promoter lentivirus vector that expresses α-galactosidase A and IMPDH2(IY) when transduced into a host cell and confers resistance to mycophenolic acid (MPA) and/or mycophenolate mofetil (MMF) in vitro and/or in vivo is provided herein.
In another aspect, the invention provides a dual promoter lentivirus vector that expresses a protein of interest encoded by a transgene along with IMPDH2(IY) when transduced into a host cell and confers resistance to mycophenolic acid (MPA) and/or mycophenolate mofetil (MMF) in vitro and/or in vivo. Suitable, the transgene can encode for a protein or enzyme deficient or dysregulated in a disease or disorder.
In another aspect, the invention provides a method of treating a subject in need of treatment for Fabry disease. The method comprises the steps of i) obtaining hematopoietic stem cells (HSCs) from the patient and/or HSCs from a suitable donor, ii) transducing the HSCs ex vivo or in vitro with a dual promoter lentivirus vector that expresses α-gal A and IMPDH2(IY) in the transduced cells, iii) introducing the transduced HSCs into the subject, and iv) administering to the subject an amount of mycophenolate mofetil (MMF) sufficient to enrich the population of lentivirus vector transduced hematopoietic cells, e.g. T and B cells in the subject.
In another aspect, a method of treating a subject having a disease associated with a defect in a single protein are provided. The method comprising the steps of i) obtaining hematopoietic stem cells (HSCs) from the patient and/or HSCs from a suitable donor, ii) transducing the HSCs ex vivo or in vitro with a dual promoter lentivirus vector that expresses a functional form of the protein of interest encoded by a transgene, and IMPDH2(IY) in the transduced cells, iii) introducing the transduced HSCs into the subject, and iv) administering to the subject an amount of mycophenolate mofetil (MMF) sufficient to enrich for the population of hematopoietic cells (e.g. T cells and B cells) that are formed from the lentivirus vector transduced HSCs engrafted in the subject.
In a particular aspect, the disease is Gaucher disease and the single protein is beta-glucocerebrosidase (GBA protein) encoded by the GBA transgene.
In another particular aspect, the disease is Fabry disease and the single protein is alpha galactosidase. In one aspect, the dual promoter is SEQ ID NO:3 or a sequence that has at least 80% identity to SEQ ID NO:3.
In another aspect, the dual promoter lentivirus vector expresses GBA protein and IMPDH2(IY). A suitable vector is found in SEQ ID NO:4 or a sequence that has at least 80% identity to SEQ ID NO:4, alternatively a sequence that has at least 90% identity, alternatively a sequence that has about 95% identity, alternatively a sequence that has at least 98% identity, alternatively a sequence that has about 99% sequence identity.
In another aspect, the invention provides a method of treating a subject in need of treatment for Gaucher disease. The method comprises the steps of i) obtaining hematopoietic stem cells (HSCs) from the patient and/or HSCs from a suitable donor, ii) transducing the HSCs ex vivo or in vitro with a dual promoter lentivirus vector that expresses GBA protein and IMPDH2(IY) in the transduced cells, iii) introducing the transduced HSCs into the subject, and iv) administering to the subject an amount of mycophenolate mofetil (MMF) sufficient to enrich the population of lentivirus vector transduced hematopoietic cells, e.g. T and B cells in the subject. The method is able to treat or reduce one or more symptoms of Gaucher disease.
The foregoing and other aspects and advantages of the invention will appear from the following description. In the description, reference is made to the accompanying drawings which form a part hereof, and in which there is shown by way of illustration a preferred embodiment of the invention. Such embodiment does not necessarily represent the full scope of the invention, however, and reference is made therefore to the claims and herein for interpreting the scope of the invention.
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
The present invention has been described in terms of one or more preferred embodiments, and it should be appreciated that many equivalents, alternatives, variations, and modifications, aside from those expressly stated, are possible and within the scope of the invention.
The present invention provides dual promoter lentiviral vectors that can be used for the treatment of diseases and disorders that are the result of the dysregulation or dysfunction of a single protein or enzyme. Specifically, the present invention provides a dual promoter lentiviral vector that expresses a transgene of interest and a mutant form of inosine-5′-monophosphate dehydrogenase 2 (IMPDH2) that contains T333I and S351Y (IY) mutations within the gene (IMPDH2(IY)) which confers resistance to MPA in a trans-dominant manner. The vector confers resistance to mycophenolic acid (MPA) and/or mycophenolate mofetil (MMF) in vitro and in vivo when expressed within the host cell. As such the dual promoter lentiviral vectors may be used to transform hematopoietic stem cells that confers mycophenolic acid (MPA) resistance to transduced hematopoietic cells, including the derived B- and T-cells in the white cell population. MPA, which is delivered in vivo as the FDA approved drug mycophenolate mofetil (MMF), inhibits an enzyme needed for the growth of T cells and B cells. As discussed above, the primary consequence of in vivo administration of MPA/MMF is on T and B cell depletion, but in addition, the present invention shows that T and B cells that arise from the engrafted hematopoietic stem cells (HSCs) that are transduced with the dual promoter lentiviral vector are resistant to MPA and have a selective growth advantage. Treatment with low doses of MMF increases the number of therapeutic transduced lymphocytes in vivo with minimal toxicity. This, in turn, increases the total number of circulating cells that are expressing the transgene of interest, and thus the cells are able to express and/or secrete the protein encoded by the transgene of interest, which can lead to treatment or correction of the disease associated with the transgene, e.g., the lysosomal storage disorder.
This platform technology is broadly applicable to hematopoietic cell-based treatment of many inherited disorders, including other lysosomal storage disorders or hematopoietic system diseases in which a selective growth advantage of altered T cells or B cells allows for treatment of the disease. In some embodiments, this technology is applicable to hematopoeiteic cell-based treatment of inherited disorders, for example, clotting disorders, in which a
The transgene may be any protein or enzyme that is associated with a disease or disorder. In some instances, the transgene is an enzyme or protein associated with a lysosomal storage disorder. In one embodiment, the lysosomal storage disorder is Fabry disease and the transgene is AGA which encodes the enzyme α-galactosidase A (α-gal A). As used herein, the term α-galactosidase A and α-gal A are used interchangeably to refer to α-galactosidase enzyme (protein). In suitable embodiments, the transgene is a human protein, for example, α-galactosidase A, for treatment of Fabry disease. Suitable transgenes include transgenes that are not immunogenic (e.g. are preferably from human), and/or (b) have no gross effect on the hematopoietic system. Another suitable embodiment, the transgene encodes for a human protein for beta-glucocerebrosidase or glucosylceramidase (GBA protein or GCase). In suitable embodiments, the vector encodes for and expresses a transgene lacking in the disease, particularly lysosomal storage diseases, for example, but not limited to, α-gal A for Fabry disease, beta-glucocerebrosidase (GBA) for Gaucher disease, acid ceramidase (ASAH1) for Farber disease, acid α-glucosidase (GAA, also known as acid maltase) for Pompe disease.
Suitable diseases and transgenes may relate to lysosomal storage disorders, including inherited metabolic disorders that result from defects in lysosomal function. Lysosomal storage disorders are caused by lysosomal dysfunction usually as a consequence of deficiency of a single enzyme required for the metabolism of lipids, glycoproteins (sugar containing proteins) or so-called mucopolysaccharides. Suitable lysosomal storage disorders and transgenes that are contemplated to be treated by this method include, but are not limited to, for example, mucolipidosis type II and IIIa (N-acetylglucosamine-1-phosphate transferase), galactosialidosis (cathepsinA), GM2-AP deficiency (GM2-AP), Niemann-Pick disease type C2 (NPC2), Niemann-Pick disease type C1 (NPC1), Salla disease (sialin), Krabbe disease (galactosylceramidase), GM1 gangliosidosis (beta-galactosidase), GM gangliosidoses (beta-hexosaminidases), Fabry disease (α-galactosidase A), Schindler disease (α-galactosidase B), Sandhoff disease (beta-hexosaminidase B), Tay-Sachs disease (beta-hexosaminidase A), Gaucher's disease (glucocerebrosidase), lysosomal acid lipase deficiency (lysosomal acid lipase (LAL) enzyme), sulfatidosis (sulfatase enzymes), Metachromatic leukodystrophy (MLD, also called arylsulfatase A deficiency, enzyme arylsulfatase A (ARSA)), multiple sulfatase deficiency or Austin disease (formylglycine-generating enzyme), mucopolysaccharidoses, Hurler syndrome (α-L iduronidase), Scheie and Hurler-Scheie syndrome (α-L iduronidase), Hunter syndrome (iduronate-2-sulfatase (I2S)), Sanfilippo syndrome (heparan N-sulfatase (MPS-IIIA)), N-acetyl-α-D-glucosaminidase (MPS-IIIB), acetyl-CoA:α-glucosaminidine acetyltransferase (MPS-III C), N-acetylglucosamine-G-sulfate sulfatase (MPS-IIID), Maroteaux-Lamy syndrome (arylsulfatase B), Sly syndrome (beta-glucuronidase), hyaluronidase deficiency (hyaluronidase), Sialidosis (α-N-acetyl neuraminidase (sialidase)), Inclusion-cell (I-cell) disease (phosphotransferase), Mucolipidin 1 deficiency (mucolipidin 1), neuronal ceroid lipofuscinosis (CLN) family (palmitoyl-protein thioesterase 1 (PPT-1), tripeptidyl peptidase I (TPP1), battenin (CLN3), Ceroid-lipofuscinosis neuronal protein 6 (CLN6 gene), Ceroid-lipofuscinosis neuronal protein 5, Ceroid-lipofuscinosis neuronal protein 8, Major facilitator superfamily domain containing 8, cathepsin D, among others), α-mannosidosis (α-mannosidase enzyme), beta-mannosidosis (beta-mannosidase), Aspartylglucosaminuria (AGU) (aspartylglucosaminidase), fucosidosis (α-L-fucosidase enzyme), cystinosis (cystinosin), pycnodysostosis (enzyme cathepsin K), infantile free sialic acid storage disease (solute carrier family 17), among other lysosomal storage disorders known in the art (protein/enzymes are within the brackets after the disease).
In one embodiment, the present invention employs a dual promoter vector that expresses α-galactosidase A (α-gal A) (for example, SEQ ID NO:5) and (IMPDH2(IY)) (SEQ ID NO:7). A suitable nucleic acid sequence encoding α-gal A includes, for example, but not limited to, SEQ ID NO:7 or a sequence that is about 80% sequence identity to SEQ ID NO:7, alternatively at least 85% identity to SEQ ID NO:7, alternatively at least 90% identity to SEQ ID NO:7, alternatively at least 95% sequence identity to SEQ ID NO:7, alternatively at least 98% identity to SEQ ID NO:7, alternatively at least 99% identity to SEQ ID NO:7. A suitable vector includes, for example, but not limited to, SEQ ID NO: 3 or a vector that is about 80% sequence identity to SEQ ID NO:3, alternatively at least 85% identity to SEQ ID NO:3, alternatively at least 90% identity to SEQ ID NO:3, alternatively at least 95% sequence identity to SEQ ID NO:3, alternatively at least 98% identity to SEQ ID NO:3.
In another embodiment, the present invention employs a dual promoter vector that expresses glucocerebrosidase (or beta-glucocerebrosidase, for example encoded by the transgene of SEQ ID NO:6) and IMPDH2(IY) (SEQ ID NO:7). A suitable nucleic acid sequence encoding beta-glucocerebrosidase includes, for example, but not limited to, SEQ ID NO:6 or a sequence that is about 80% sequence identity to SEQ ID NO:6, alternatively at least 85% identity to SEQ ID NO:6, alternatively at least 90% identity to SEQ ID NO:6, alternatively at least 95% sequence identity to SEQ ID NO:6, alternatively at least 98% identity to SEQ ID NO:6, alternatively at least 99% identity to SEQ ID NO:6. A suitable vector includes, for example, but not limited to, SEQ ID NO:4 or a vector that is about 80% sequence identity to SEQ ID NO:4, alternatively at least 85% identity to SEQ ID NO:4, alternatively at least 90% identity to SEQ ID NO:4, alternatively at least 95% sequence identity to SEQ ID NO:4, alternatively at least 98% identity to SEQ ID NO:4.
In another embodiment, the present invention employs a dual promoter vector that expresses acid ceramidase (ASAH1, for example encoded by the transgene of SEQ ID NO:8) and IMPDH2(IY) (SEQ ID NO:7). This vector may be used to transduce HSCs for treatment of Faber disease. A suitable nucleic acid sequence encoding ASAH1 includes, for example, but not limited to, SEQ ID NO:8 or a sequence that is about 80% sequence identity to SEQ ID NO:8, alternatively at least 85% identity to SEQ ID NO:8, alternatively at least 90% identity to SEQ ID NO:8, alternatively at least 95% sequence identity to SEQ ID NO:8, alternatively at least 98% identity to SEQ ID NO:8, alternatively at least 99% identity to SEQ ID NO:8.
In another embodiment, the present invention employs a dual promoter vector that expresses GAA, for example encoded by the transgene of SEQ ID NO:9 and IMPDH2(IY) (SEQ ID NO:7). This vector may be used for transducing HSCs for treatment of Pompe disease. A suitable nucleic acid sequence encoding GAA includes, for example, but not limited to, SEQ ID NO:9 or a sequence that is about 80% sequence identity to SEQ ID NO:9, alternatively at least 85% identity to SEQ ID NO:9, alternatively at least 90% identity to SEQ ID NO:9, alternatively at least 95% sequence identity to SEQ ID NO:9, alternatively at least 98% identity to SEQ ID NO:9, alternatively at least 99% identity to SEQ ID NO:9.
IMPDH2(IY) is resistant to mycophenolic acid (MPA). Mycophenolate Mofetil (MMF) is the pro-drug for MPA and is used routinely in the clinic for a variety of indications, with low incidence of adverse side-effects.
The primary consequence of MPA administration is T and B cell depletion. By expressing IMPDH2(IY), T and B cells that arise from transduced and engrafted hematopoietic stem cells (HSCs) are resistant to MPA. Treatment with low doses of MMF can increase the number of therapeutic lymphocytes, without affecting the original engraftment, while causing minimal toxicity. This, in turn, increases the total number of circulating cells that are expressing and secreting the transgene, for example, α-galactosidase A, which can lead to better correction of the disease. Previous attempts at amplification of therapeutic cells have targeted the original HSC engraftment. These strategies either provide HSCs with resistance to cytotoxic agents, or with drug inducible growth modules. Administration of cytotoxic drugs is often associated with severe adverse events, and repeat-administration is also not ideal. Drugs used for inducible growth are not approved for use in patients, limiting their potential. High induction of growth in HSCs can also be associated with stem cell exhaustion, limiting the utility of the graft. Targeting the HSC compartment with a chemical compound is also difficult, due to their unique niche. The aforementioned concerns are ameliorated with the use of our enrichment strategy described herein, since it excludes the HSC compartment.
A suitable nucleic acid sequence encoding for IMPDH2(IY) is found in SEQ ID NO:7. Suitably, the dual lentiviral vectors comprise SEQ ID NO:7 or a sequence that is about 80% sequence identity to SEQ ID NO:7, alternatively at least 85% identity to SEQ ID NO:7, alternatively at least 90% identity to SEQ ID NO:7, alternatively at least 95% sequence identity to SEQ ID NO:7, alternatively at least 98% identity to SEQ ID NO:7, alternatively at least 99% identity to SEQ ID NO:7. Suitable nucleic acid sequence allow for the expression of IMPDH2(IY) which confers resistance to MPA.
The Examples demonstrate the enrichment of lentiviral-transduced cells in vitro and that this enrichment leads to increased enzyme activity and secretion of enzyme from the cells. Further, we show that this enrichment can be carried out in vivo by administering MMF to the subject.
Current gene therapy involving hematopoietic cells targets correction of cells and engraftment into hosts. The cells are then left on their own to engraft and cure the host. Yet oftentimes the transduction or engraftment efficiency is low. The current method gives a way to enrich for transduced cells in vivo and allows some gating as to how selective and strong that enrichment is depending on the administration of the MMF. The present methods also allow for cells harboring this lentiviral vector to be enriched for even years down the road to renew the correcting cell population expressing the transgene of interest.
In some instances, the dual promoters are promoters known in the art. In one embodiment, the first promoter is hPGK promoter and the second promoter is EF1α promoter. Other promoters are able to be used in the practice of the present invention, as long as the promoters allow for expression of the downstream gene.
In another embodiment, a dual promoter lentiviral vector that expresses α-galactosidase A (encodes the AGA transgene) and IMPDH2(IY) when transduced into a host cell and as such confers resistance to mycophenolic acid (MPA) and/or mycophenolate mofetil (MMF) in vitro and/or in vivo is provided. A suitable dual promoter lentivirus vector that expresses α-galactosidase A and IMPDH2(IY) is depicted in
In another embodiment, a dual promoter lentiviral vector that expresses a transgene and IMPDH2(IY) when transduced into a host cell is provided. The vector confers resistance to mycophenolic acid (MPA) and/or mycophenolate mofetil (MMF) in vitro and/or in vivo in the host cell. A suitable dual promoter lentivirus vector contains a multiple cloning site to clone the transgene of interest and IMPDH2(IY) is provided in SEQ ID NO: 2.
In some embodiments, the vector comprises the SEQ ID NO:2 wherein the target gene of interest is cloned into the multiple cloning site. Suitable target gene of interests able to be cloned into the multiple cloning site of SEQ ID NO:2 include, but are not limited to, for example, AGA (SEQ ID NO:5), GBA (SEQ ID NO:6), ASAH1 (SEQ ID NO:7) and GAA (SEQ ID NO:9). One skilled in the art would be able to encode the target gene of interest into the vector of SEQ ID NO:2 without undue experimentation.
Methods of treating a patient using the dual promoter lentiviral vector described herein are provided. The method comprises, i) obtaining hematopoietic stem cells (HSCs) from the patient and/or HSCs from a suitable donor, ii) transducing the HSCs ex vivo with a dual promoter lentivirus vector containing IMPDH2(IY) and a transgene (e.g. AGA transgene), iii) introducing the transduced HSCs into the subject, and iv) administering to the subject an amount of mycophenolate mofetil (MMF) sufficient to enrich the population of lentivirus vector transduced hematopoietic cells, for example, T and B cells in the subject.
One embodiment provides a method of treating a subject having a disease associated with a defect in a single protein or enzyme, the method comprising the steps of i) obtaining hematopoietic stem cells (HSCs) from the patient and/or HSCs from a suitable donor, ii) transducing the HSCs ex vivo with a dual promoter lentivirus vector that expresses a suitable form of the protein or enzyme and IMPDH2(IY) in the transduced cells, iii) introducing the transduced HSCs into the subject, and iv) administering to the subject an amount of mycophenolate mofetil (MMF) sufficient to enrich the population hematopoietic cells arising from lentivirus vector transduced HSCs engrafted in the subject.
In some embodiments, the subject has a lysosomal storage disorder (LSD), and the transgene encodes an enzyme or protein associated with the LSD that is deficient in the subject. In some embodiments, the LSD is Fabry disease and the transgene is AGA, the LSD is Gaucher disease and the transgene of interest is GBA, the LSD is Faber disease and the transgene is ASAH1, or the LSD is Pompe and the transgene is GAA.
Another embodiment provides a method of treating Fabry disease patients by:
1) obtaining HSCs from the patient or a suitable donor;
2) transducing the HSCs ex vivo with a dual promoter lentivirus vector that expresses α-gal A and IMPDH2(IY) in the transduced cells;
3) introducing the transduced HSCs and/or hematopoietic cells back into the patient; and,
4) administering mycophenolate mofetil (MMF) to the patient in order to enrich the population of lentivirus vector transduced T and B cells engrafted in the patient, thereby increasing the amount of α-gal A produced in the body. The method treats one or more symptoms of Fabry disease.
In some embodiments, the lysosomal storage disorder is Farber disease (also known as Farber's lipogranulomatosis, ceramidase deficiency, “Fibrocytic dysmucopolysaccharidosis,” and “Lipogranulomatosis”) and the transgene expresses ASAH1. Farber disease is an extremely rare autosomal recessive lysosomal storage disorder marked by a deficiency in the enzyme acid ceramidase that causes an accumulation of a waxy class of lipids known as sphingolipids, in particular ceramide, leading to abnormalities in the joints, liver, throat, visceral tissues and central nervous system. Suitable embodiments provide T-Rapa cells expressing N-Acylsphingosine Amidohydrolase 1 (ASAH1) for the treatment of Farber disease. As used in the present invention, a suitable dual promoter lentiviral vector expresses ASAH1 and IMPDH2(IY) in the HSC cells. For example, a suitable vector can express ASAH1 using the ASAH1 transgene of SEQ ID NO:8 or a sequence having 80% similarity to SEQ ID NO:8. Suitably, the ASAH1 transgene will have at least 80% similarity to the SEQ ID NO:8, alternatively at least 85% sequence similarity to SEQ ID NO:8, alternatively at least 90% sequence similarity to SEQ ID NO:8, alternatively at least 95% sequence similarity to SEQ ID NO:8, alternatively at least 98% sequence similarity to SEQ ID NO:8, alternatively at least 99% sequence similarity to SEQ ID NO:8, alternatively at least 100% sequence similarity to SEQ ID NO:8.
Pompe disease is an inherited disorder resulting from the buildup of a complex sugar called glycogen in the body's cells resulting in accumulation of glycogen in certain organs and tissues, especially muscles, which impairs their ability to function normally. Mutations within the GAA gene cause Pompe disease as the GAA gene provides instructions for producing an enzyme called acid α-glucosidase (also known as acid maltase). This enzyme is active in lysosomes which serve as recycling centers within cells. The enzyme normally breaks down glycogen in lysosomes into a simpler sugar called glucose, which is the main energy source for most cells. In some embodiments, T-Rapa cells expressing GAA are used to treat a subject having Pompe disease. As described above, dual lentiviral vectors expressing GAA and IMPDH2(IY) transgene within transduced HSCs. In one embodiment, the dual promoter vectors, can express the GAA transgene of SEQ ID NO:9 or a sequence at least 80% similar to SEQ ID NO:9. Suitably, the GAA transgene will have at least 80% similarity to the SEQ ID NO:9, alternatively at least 85% sequence similarity to SEQ ID NO:9, alternatively at least 90% sequence similarity to SEQ ID NO:9, alternatively at least 95% sequence similarity to SEQ ID NO:9, alternatively at least 98% sequence similarity to SEQ ID NO:9, alternatively at least 99% sequence similarity to SEQ ID NO:9, alternatively at least 100% sequence similarity to SEQ ID NO:9.
“Treat” or “treating” includes reducing, inhibiting, or eliminating one or more symptom of the disease or management and care of a subject for the purpose of combating the disease. Treating includes the administration of the HSCs of present invention to prevent or reduce the onset of the symptoms or complications, alleviating the symptoms or complications, or eliminating the disease, condition, or disorder. The aim of treatment includes the alleviation or prevention of symptoms, slowing or stopping the progression or worsening of a disease, disorder, or condition and/or the remission of the disease, disorder or condition. In certain embodiments, the treatment comprises HSCs transduced with the dual promoter and treatment with MMF. The term “treatment” can be characterized by at least one of the following: reducing, ameliorating, slowing or inhibiting one or more symptom of the disease or disorder. In some embodiments, the optimum effective amount can be readily determined by one skilled in the art using routine experimentation.
Symptoms of Fabry disease are known in the art and include, but are not limited to, pain or burning in the hands and/or feet, rash, narrowing of blood vessels, cloudy vision, hearing loss, ringing in the ears, sweating less than normal, stomach pain, kidney problems, high blood pressure, heart failure, enlarged heart, osteoporosis, among others.
In another embodiment, the invention provides a method of treating Gaucher disease by: 1) obtaining HSCs from the patient or a suitable donor; 2) transducing the HSCs ex vivo with a dual promoter lentivirus vector that expresses GBA protein and IMPDH2(IY) in the transduced cells (for example the vector of SEQ ID NO:4); 3) introducing the transduced HSCs and/or hematopoietic cells back into the patient; and, 4) administering mycophenolate mofetil (MMF) to the patient in order to enrich the population of lentivirus vector transduced T and B cells engrafted in the patient, thereby increasing the amount of GBA protein/enzyme produced in the body. The method treats one or more symptoms of Gaucher disease.
Symptoms of Gaucher Disease include, for example, an abnormally enlarged liver and/or spleen (hepatosplenomegaly), low levels of circulating red blood cells (anemia), low levels of platelets (thrombocytopenia), and skeletal abnormalities, among others.
The term “subject” or “patient” are used interchangeably and refer to a mammalian subject, for example, a mouse, a rat, a monkey, a human, etc. In a preferred embodiment, the subject is a human. It is contemplated that the subject or patient may have already been treated with one or more therapies for the lysosomal storage disorder before undergoing the treatment contemplated herein.
The host cell is suitably a hematopoietic cell, for example hematopoietic stem cells (HSCs).
In suitable embodiments, the MMF is administered at an effective dosage. An “effective dosage” refers to a dosage that allows for selective enrichment for T and B cells that express the transgene via the lentiviral vector with minimal side effects. In one embodiment, the effective dosage is a low dosage. Suitable low dosages include, but are not limited to, for example, 0.1-5 mg/kg body weight given TIB (three times a day), alternatively include from about 0.1-3 mg/kg body weight given TIB. Alternatively, the effective dose may include higher doses of MMF. Suitable higher dosage of MMF for practice of this invention include MMF in an amount of about 5-10 mg/kg body weight TID (three times a day), alternatively 1000 mg given BID (two times a day). Suitably, an “effective amount” of MMF will result in a blood concentration within the subject of about 0.4 to about 2 μM free mycophenolic acid (MPA). Suitable dosages to obtain this blood concentration are readily determined by a physician treating the subject. MMF may also be substituted for MPA formulations (Myfortic, Novartis, or approved generic).
Methods of obtaining HSCs from a subject are known in the art. For example an agent may be used to stimulate mobilization of HSCs to the peripheral blood. Suitable agents are known in the art and include, but are not limited to, for example, G-CSF or plerixafor (Mozobil, Sanofi).
HSCs can be transduced ex vivo using a suitable amount of lentivirus, for example, using a MOI (multiplicity of infection) of 1-100, preferably a MOI of 1-30, alternatively a MOI of 1-20, alternatively a MOI of 1-10. The cells may be exposed to the lentivirus for from 10-24 hours, suitably for example for 12 hours. Cytokines may be added to the culture medium during transduction. After transduction, the cells can be either transferred back into the patient or cryopreserved for later transplantation, or a combination of both. In some instances, the transduced cells may be cultured for a number of days before being transferred or cryopreserved. Suitable methods of cryopreservation are known in the art.
Suitable methods of cryopreservation include, but are not limited to, suspending the cells in a cryopreservation medium and storing the cells at −80° C. to −196° C., preferably below −80° C. Suitable cryopreservation media are known in the art and may comprise some combination of base medium, cryopreservative (e.g., DMSO) and a protein source. For example, a suitable cryopreservation medium may comprise complete medium and 10% glycerol, complete medium containing 10% DMSO (dimethlysulfoxide), or 45% cell-conditioned medium with 45% fresh medium and 10% glycerol or DMSO. In alternative embodiments, the cryopreservation medium may be serum free, for example, comprises 46.25% cell-conditioned serum-free medium with 46.25% fresh serum-free medium and 7.5% DMSO.
Subjects may be conditioned before transfer of the hematopoietic cells. Suitable methods of conditioning the patient are known in the art, and include, for example, low-dose regimen (e.g. 30-50% of normal dose) of melphalan or another chemotherapeutic drug. For example, a patient may be treated for 1-3 days by administration once a day with melphalan, as determined by a physician. One skilled in the art of treating the subject will be able to provide an appropriate conditioning regimen. The purpose of conditioning is to reduce the number of endogenous bone marrow cells to provide an advantage to the newly transferred transduced HSCs to engraft and grow.
After conditioning, the patients may receive at least one administration of transduced cells, for example, from about 2-10×106 transduced cells/kg body weight intravenously. Suitably amounts of cells include, but are not limited to, e.g. 2×106 transduced cells/kg, 2.5×106 transduced cells/kg, 3×106 transduced cells/kg, 4×106 transduced cells/kg, 4.5×106 transduced cells/kg, 5×106 transduced cells/kg, and include amounts and ranges in between. In some embodiments, subjects may receive additional administration of cells after the first administration at later time points (e.g. hours, days, weeks or months after the first administration). In one embodiment, additional cells may be administered in the same week as the first treatment (e.g. day 2-7) or in the additional weeks post first administration (e.g. week 2-6). In some embodiments, the levels of transgene being expressed can be determined and if the levels become sufficiently low an additional conditioning and/or administration of transduced cells that were cryopreserved can be administered (e.g. weeks or months later).
Timing of MMF doses can be determined by one skilled in the art. In some embodiments, the MMF may be administered during conditioning regimen, depending on the source of the transferring cells. Suitable examples of MMF are described below and MMF can be administered continuously throughout the subject's lifetime or stopped for periods of time or when no longer necessary. In other embodiments, MMF is administered after transfer/engraftment of the transduced HSCs to the subject. Suitably, MMF may be administered for at least 0.5-2 years after engraftment. In some instances, MMF may be administered periodically over the subject's lifetime after transplantation to re-enrich for the transduced cells, e.g. may be administered 5 or 10 years after initial engraftments. MMF may be administered in low dosages continuously, or MMF may be administered non-continuously, for example, MMF may be administered after engraftment for a period of at least six months, followed by a period of time without MMF treatment (e.g. months or years), followed by a restarting of MMF treatment as a “booster” to re-enrich for transduced cells at later time points in the subject's life. Monitoring of transgene protein (e.g. α-gal A) levels within the subject may determine the length of time of administration and dose of MMF, or if additional booster treatment with MMF are needed at later time points after MMF treatment was stopped to re-enrich for more transduced cells to increase the systemic levels of the transgene (e.g. AGA transgene) expressed within the subject. In some embodiments, the transgene may reach suitable levels systemically within the subject where the subject may not need MMF treatment. However, if at later times the transgene systemic levels fall, then MMF treatment can be reinitiated to re-enrich for α-gal A expressing cells.
The methods contemplated herein can be adapted to other LSDs, because the dual promoter lentivirus vector can be modified to express the enzyme (transgene) that is deficient in other LSDs. In addition, there are other disorders, particularly hematopoietic disorders, that the method of the invention can be used to treat, specifically diseases that are related to a single gene defect. For example, hemaptopoeitic disorders that specifically relate to T or B cells may be treated by the methods described herein, including, but not limited to, for example, Wiskott-Aldrich Syndrome with the WAS protein, Leukodystrophies (X-linked and Metachromatic) (ABCD1 gene (adrenoleukodystrophy protein) andARSA gene (arylsufatase A) protein, and the like. Other inherited diseases that are associated with a single gene defect include, but are not limited to, for example, X-linked agammaglbulinemia (BTK gene which encodes the BTK protein),
Specifically, in some embodiments, the methods can be used to treat hematopoietic disorders that are able to be treated with transduced hematopoietic stem cells that express a soluble protein encoded by a transgene of interest. For example, one type of suitable diseases are clotting factor deficiencies, for example, hemophilia A, a Factor VIII deficiency, hemophila B, a Factor IX deficiency, Von Willebrand's disease, a von Willebrand factor associated disease. A suitable transgene includes Factor VIII of SEQ ID NO:11, or a sequence that is at least 80% identity to SEQ ID NO:11, alternatively a sequence that has at least 85% identity, alternatively a sequence that has at least 90% identity, alternatively a sequence that has about 95% identity, alternatively a sequence that has at least 98% identity, alternatively a sequence that has about 99% sequence identity. A suitable vector encoding for Factor VIII is found in SEQ ID NO: 12, or a sequence that is at least 80% identity to SEQ ID NO:12, alternatively a sequence that has at least 85% identity, alternatively a sequence that has at least 90% identity, alternatively a sequence that has about 95% identity, alternatively a sequence that has at least 98% identity, alternatively a sequence that has about 99% sequence identity.
In addition, considering that HSCs have been used experimentally to treat a variety of non-hematopoietic diseases including spinal cord injuries, liver cirrhosis, and peripheral vascular disease, the inventors' dual promoter lentivirus vector and in vivo enrichment strategy can be used in the treatment of other diseases by enriching for transduced T and B cell populations that secrete therapeutic proteins targeting other diseases, for example, expression of therapeutic antibodies against tumor cells, or in the treatment of autoimmune diseases.
Current gene therapy involving hematopoietic cells targets correction of cells and engraftment into hosts. The cells are then left on their own to engraft and cure the host. However, the transduction or engraftment efficiency is often low. The current method provides a way to enrich for transduced cells in vivo and allows some degree of “gating” as to how selective and strong that enrichment is. In this regard, cells harboring the lentiviral vector could be enriched for even years down the road to renew the transduced cell population that express the desired transgene.
The invention overcomes the following problems associated with current HSC-based therapies:
Previous attempts at amplification of therapeutic cells have targeted the original HSC engraftment. Such inventions provide HSCs and their progeny with resistance to cytotoxic agents, or with drug inducible growth modules.
Administration of cytotoxic drugs is often associated with severe adverse events, and repeat-administration is also not ideal. MMF is used routinely in the clinic with a low incidence of adverse side-effects.
Drugs used for inducible growth are not approved for use in patients, limiting their potential. High induction of growth in HSCs can also be associated with stem cell exhaustion, limiting the utility of the graft. MMF is a commonly used, FDA approved drug that has no known effect on HSCs.
Targeting the HSC compartment with a chemical compound is also difficult, due to their unique niche. The enrichment strategy disclosed by the inventors would overcome this problem because it excludes the HSC compartment.
Many LSD patients may have been treated with standard of care, which is often enzyme replacement therapy. These therapies may lead to formation of an adaptive immune response against the therapeutic protein of interest, that is, the therapy is recognized as foreign material, for example against the enzyme replacement therapy. One such response is an adaptive immune response, for example formation of therapeutic-specific antibodies which occurs in most patients receiving enzyme replacement therapies, including, but not limited to, Fabry and Pompe disease, reduces the efficacy of the therapy dramatically and leads to clearance of the corrective protein. As such, patients that have pre-existing immune response against the corrective protein treated with gene therapy may have clearance of the therapeutic protein and therefore reduced efficacy. The inventors have observed this occurring in some patients that have been previously treated with enzyme therapy. The current methods described herein overcome the previous problems with standard enzyme replacement therapy in that the MMF used in the present methods not only provides a selective advantage to the transduced cells expressing the enzyme of interest, but also is able to prevent the proliferation of endogenous antibody producing B cells that may react with the therapeutic enzyme. The inventors therefore envision an additional benefit of their platform in that endogenous adaptive immune responses, for example B cells that produce antibodies against the therapeutic protein, can be suppressed in addition to enriching for vector positive B and T cells that should be tolerant and not react to the therapeutic protein. In this way, greater efficacy may be achieved especially in patients whose immune systems are not fully ablated.
Thus the methods of the present invention described herein may be used in patients that are fully ablated, partially ablated or have not undergone ablation prior to treatment with HSCs transduced with the dual promoter lentiviral vector.
“Percentage of sequence identity” or “sequence similarity” is determined by comparing two optimally aligned sequences over a comparison window, wherein the portion of the polynucleotide sequence in the comparison window may comprise substitutions, or additions or deletions (i.e., gaps) as compared to the reference sequence (which does not comprise substitutions, additions or deletions) for optimal alignment of the two sequences. The percentage is calculated by determining the number of positions at which the identical nucleic acid base or amino acid residue occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the window of comparison and multiplying the result by 100 to yield the percentage of sequence identity.
The term “substantial identity” or “similarity” of polynucleotide sequences means that a polynucleotide comprises a sequence that has at least 80% sequence identity. Suitable sequence similarity allows for small changes in the transgene that do not affect the function of the protein expressed by the transgene. Alternatively, percent identity can be any integer from 75% to 100%. More preferred embodiments include at least: 75%, 80%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98% or 99% compared to a reference sequence using programs such as BLAST using standard parameters. These values can be appropriately adjusted to determine corresponding identity of proteins encoded by two nucleotide sequences by taking into account codon degeneracy, amino acid similarity, reading frame positioning and the like.
The present invention has been described in terms of one or more preferred embodiments, and it should be appreciated that many equivalents, alternatives, variations, and modifications, aside from those expressly stated, are possible and within the scope of the invention.
It should be apparent to those skilled in the art that many additional modifications beside those already described are possible without departing from the inventive concepts. In interpreting this disclosure, all terms should be interpreted in the broadest possible manner consistent with the context. Variations of the term “comprising” should be interpreted as referring to elements, components, or steps in a non-exclusive manner, so the referenced elements, components, or steps may be combined with other elements, components, or steps that are not expressly referenced. Embodiments referenced as “comprising” certain elements are also contemplated as “consisting essentially of” and “consisting of” those elements. In places where ranges of values are given, this disclosure explicitly contemplates other combinations of the lower and upper limits of those ranges that are not explicitly recited. For example, recitation of a value between 1 and 10 or between 2 and 9 also contemplates a value between 1 and 9 or between 2 and 10. Ranges identified as being “between” two values are inclusive of the end-point values. For example, recitation of a value between 1 and 10 includes the values 1 and 10.
Aspects of the present disclosure that are described with respect to methods can be utilized in the context of the compositions of matter or kits discussed in this disclosure. Similarly, aspects of the present disclosure that are described with respect to compositions of matter can be utilized in the context of the methods and kits, and aspects of the present disclosure that are described with respect to kits can be utilized in the context of the methods and compositions of matter.
The invention will be more fully understood upon consideration of the following non-limiting examples.
The present invention uses dual promoter lentivirus vectors to transfer a transgene and the resistance gene to mycophenolate mofetil (MMF) into the target cell.
Suitable methods of producing lentiviral vectors are known in the art. A suitable protocol is shown in
This Example demonstrates that cells expressing the dual promoter lentiviral vector of the present invention can be enriched by treatment of the cells with low doses of MPA in vitro. In this Example, Jurkat cells (immortalized T cells) are used.
Thus, IMPDH2(IY) vector can be used to enrich for cells that express the transgene both in vitro and in vivo.
Patient hematopoietic stem cells (HSCs) are mobilized to the peripheral blood by appropriate agents, for example G-CSF or plerixafor by known methods in the art. The patient is then subjected to apheresis to collect cells. Cells are then enriched for CD34, a cell surface marker of hematopoietic progenitor cells, using clinical magnet-assisted cell sorting (CliniMACS). The CD34+ cells are then cultured in the presence of cytokines and transduced using lentivirus ex vivo at an MOI of 1-10 for 12 hours, after which they are processed for cryopreservation. The patient may be conditioned using a low-dose regimen (30-50% of normal dose) of melphalan or other chemotherapeutic drug, after which they receive 2-10×106 cells/kg intravenously. Patients are then monitored for hematopoietic reconstitution from transduced cells using plasma enzyme activity and vector copy number (VCN) per genome. Cell administration may be repeated after recovery from conditioning, as recommended by an appropriate physician.
Enrichment can be initiated if required by treatment with mycophenolate mofetil (MMF; CellCept, Roche, or approved generic); transduced T and B cells are resistant to the effects of this drug, providing them with a growth advantage. A low dose of oral MMF may be effective (0.1-5 mg/kg TID) but higher doses (5-10 mg/kg TID or 1000 mg BID) may also be tolerated, depending on the patient. As a general guideline, a blood concentration of 0.4-2 μM free mycophenolic acid (MPA) is desirable. MMF may be administered for the duration for which increased enzyme activity is desired, and doses adjusted to titrate the activity. MMF may also be substituted for MPA formulations (Myfortic, Novartis, or approved generic).
As demonstrated in
This Example demonstrates in vitro viral transduction followed by enrichment of Jurkat cells using the viral vectors for expression of GBA protein/enzyme, and increase in GBA enzyme activity in transduced cells.
A codon-optimized copy of the cDNA for GBA transgene was synthesized by GenScript. LV/GBA+(IY) was constructed by inserting the synthesized GBA transgene (SEQ ID NO:6) into the dual promoter backbone (SEQ ID NO:2) at the EF1a locus using standard recombinant technology methods. A control vector with eGFP in place of IMPDH2(IY) was constructed using similar methods. Lentivirus was packaged as previously described in Example 1; briefly HEK293T were transiently transfected with packaging plasmids and the appropriate transfer vectors, and media replaced 16 hrs later. Supernatant containing viral particles were collected 40 and 64 hrs after transfection, filtered through a 0.22 um membrane and concentrated by centrifugation. Pellets were resuspended in complete culture medium for Jurkat cells (RPMI-1640+10% FBS+Pen/strep/L-glutamine).
Jurkat cells were transduced with lentivirus at an MOI of ˜0.1-0.2. Cells were cultured for at least 2 weeks prior to measuring baseline vector copy number. Cell lines for each of LV/GBA+eGFP and LV/GBA+(IY), or non-transduced cells were produced in this way. To measure enrichment, testing was carried out as described in Example 2. Briefly, cells at known densities were seeded in quadruplicate for each cell line, and maintained in culture for 16 days with either vehicle (DMSO) or 0.5 μM MPA, with media being replaced every two days. After treatment, cells were diluted and recovered for 4-8 days. gDNA was extracted from cells sampled from each well, and vector copy number analyses were carried out using qPCR. Results are shown in
Each publication, patent, and patent publication cited in this disclosure is incorporated in reference herein in its entirety. The present invention is not intended to be limited to the foregoing examples but encompasses all such modifications and variations as come within the scope of the appended claims.
AGTGCAGTGAGTGGACGCCGCCTTCGACCTGGGCTGAAGAAGTTCTTTTC
TCGAACTTCAGTTCGCCGGAATACATCATTGCCCGCACCTGTGTCAGGCT
CTTAGCGCCGATATCCTGGCATGAATGCTGAATTCCGGCGATCAGGTAAG
GCACGAATTTGTGAATACTGCCCTTATCCTGGACAGCTCCAGACACGCCC
TGTGCGACTTTGATCTTGTCTGCCTCGGAAAAATACCTGTTCTGAGAGGA
CAGATGCTTATCCATGGCGTCCAGTGACCCCATGCCCCTATATTTCTTCA
GTCTGAACCCATCACTAAAGAAGTACTCGCCGGGGGCTTCTGTGGTTGCA
GCCAGCAGGCTGCCCATCATCACTGTGCTTGCCCCCAGAGCCAGGGCTTT
CGAATCTCCGGGCATACTCGTACACCTTGTAGACAGCAGTTGCCTGAGGT
CGTCCACAGGCCAGCACTTCCTGAATGATGCAGATTGATCCACTCCCCAT
TCCGACCCTCAGAGCATCCACTCCTGCGTCAATCAGGTTTTTGGCCTGGG
CTGCGGTCACGACATTGCCTCCGATGACCTGCAGATTTGGGTACTTGTCC
TTAATGTACTTGATCATATTAATCTGGAAGATGCTGTTTCCCTGGCTTGA
ATCCAGCACGACCACGTCCACCCCTGCCTGAGCCAGCAGATCCAGGCGAT
ATTTATCGTCCTCGTGTGTGCCAATAGCGGCTCCACACAGCAGCTGTTTC
TTTGCGTCCTTACTAGCCAGAGGGTAATCTCGATTTTTCTTCAGGTCGGT
GCGGGCAATGATTGCCACCAGCTCATCGTCTTCATTCACGATAGGCAGTT
TTCCTTTCTTAGACCGCTGCAGAATCTCGTTGGCTTCCTTCAGTGTGATG
CCGGCAGGTGCGACCACCAGATCTTCGCGTTTGGTCATAATCTCTTCCAG
AAAACAGTCATGCTCTTCCTCCTTCAGGAAATCGATGTCTCGACTAGAAA
TGATTCCCACCAGTCGGCTGCCCATTCGTCCAGTATCTGTAATGGGGATG
CCGCAAAATCCGTGCCTAGCTTTGGCCTCGAACACATCGCGGACCCTGTC
CTTGGGGCTCAGGACCACTGGGTCGGTGATAAAGCCCTGTTCGTATTTCT
TCACCTTTCTGACCTCATTGGCCTGAAATTCTGGAGTGCAGTTATGGTGA
ATGAACCCGATCCCGCCTGTCAGTGCCATAGCAATGGCCATGCCAGCCTC
GGTGACAGTGTCCATAGGGGAGCTCACCAGGGGTGTCTTCAGGGTGATTT
TCTTGGTCAGGGCAGAAGTCAGATCCACCTGGTCTGCGGTAAAATCAATA
TAGCCGGGCAGGATCAGGAAGTCGTTGTAAGTCAGCCCGTCTCCACAATT
AAACAGCTGCTGGGCGGTCAGTCCATCATCAGGGACATAGGAAGTGCCTC
CAGAAATCAGGTAGTCGGCCATGGTGGCGCTAGCCCTGGGGAGAGAGGTC
AGTGCAGTGAGTGGACGCCGCCTTCGACCTGGGCTGAAGAAGTTCTTTTC
TCGAACTTCAGTTCGCCGGAATACATCATTGCCCGCACCTGTGTCAGGCT
CTTAGCGCCGATATCCTGGCATGAATGCTGAATTCCGGCGATCAGGTAAG
GCACGAATTTGTGAATACTGCCCTTATCCTGGACAGCTCCAGACACGCCC
TGTGCGACTTTGATCTTGTCTGCCTCGGAAAAATACCTGTTCTGAGAGGA
CAGATGCTTATCCATGGCGTCCAGTGACCCCATGCCCCTATATTTCTTCA
GTCTGAACCCATCACTAAAGAAGTACTCGCCGGGGGCTTCTGTGGTTGCA
GCCAGCAGGCTGCCCATCATCACTGTGCTTGCCCCCAGAGCCAGGGCTTT
TGCGATGTGGCCCACATTCTGAATTCCCCCGTCAGCGATCACTGGGACTC
CGAATCTCCGGGCATACTCGTACACCTTGTAGACAGCAGTTGCCTGAGGT
CGTCCACAGGCCAGCACTTCCTGAATGATGCAGATTGATCCACTCCCCAT
TCCGACCCTCAGAGCATCCACTCCTGCGTCAATCAGGTTTTTGGCCTGGG
CTGCGGTCACGACATTGCCTCCGATGACCTGCAGATTTGGGTACTTGTCC
TTAATGTACTTGATCATATTAATCTGGAAGATGCTGTTTCCCTGGCTTGA
ATCCAGCACGACCACGTCCACCCCTGCCTGAGCCAGCAGATCCAGGCGAT
ATTTATCGTCCTCGTGTGTGCCAATAGCGGCTCCACACAGCAGCTGTTTC
TTTGCGTCCTTACTAGCCAGAGGGTAATCTCGATTTTTCTTCAGGTCGGT
GCGGGCAATGATTGCCACCAGCTCATCGTCTTCATTCACGATAGGCAGTT
TTCCTTTCTTAGACCGCTGCAGAATCTCGTTGGCTTCCTTCAGTGTGATG
CCGGCAGGTGCGACCACCAGATCTTCGCGTTTGGTCATAATCTCTTCCAG
AAAACAGTCATGCTCTTCCTCCTTCAGGAAATCGATGTCTCGACTAGAAA
TGATTCCCACCAGTCGGCTGCCCATTCGTCCAGTATCTGTAATGGGGATG
CCGCAAAATCCGTGCCTAGCTTTGGCCTCGAACACATCGCGGACCCTGTC
CTTGGGGCTCAGGACCACTGGGTCGGTGATAAAGCCCTGTTCGTATTTCT
TCACCTTTCTGACCTCATTGGCCTGAAATTCTGGAGTGCAGTTATGGTGA
ATGAACCCGATCCCGCCTGTCAGTGCCATAGCAATGGCCATGCCAGCCTC
GGTGACAGTGTCCATAGGGGAGCTCACCAGGGGTGTCTTCAGGGTGATTT
TCTTGGTCAGGGCAGAAGTCAGATCCACCTGGTCTGCGGTAAAATCAATA
TAGCCGGGCAGGATCAGGAAGTCGTTGTAAGTCAGCCCGTCTCCACAATT
AAACAGCTGCTGGGCGGTCAGTCCATCATCAGGGACATAGGAAGTGCCTC
CAGAAATCAGGTAGTCGGCCATGGTGGCGCTAGCCCTGGGGAGAGAGGTC
GATGTGCCCTTGCTCTGAGGTTCCTGGCGCTGGTGTCTTGGGATATACCC
GCTCCATTGGGAAAGGTTTATGTGCAACTTGGACTGCCAGGAAGAACCCG
ACTCCTGTATTTCCGAGAAACTCTTCATGGAGATGGCCGAGCTGATGGTT
AGCGAAGGCTGGAAGGATGCCGGTTATGAATACTTGTGTATCGACGATTG
TTGGATGGCTCCCCAGCGGGACAGTGAAGGACGACTCCAGGCAGATCCGC
AACGGTTCCCTCATGGCATACGGCAGCTCGCCAATTACGTGCACAGCAAG
GGTTTGAAGCTGGGGATATATGCTGACGTGGGCAACAAAACCTGTGCTGG
TTTCCCCGGCAGCTTCGGCTACTATGATATAGATGCACAAACCTTCGCTG
ATTGGGGCGTGGACCTGCTTAAATTTGACGGCTGTTACTGCGACAGCTTG
GAAAACCTCGCCGATGGATATAAACACATGAGCCTTGCACTCAATCGGAC
TGGCCGGAGCATTGTCTACTCTTGCGAGTGGCCATTGTACATGTGGCCTT
TCCAGAAGCCTAACTATACGGAGATTAGACAGTATTGTAATCACTGGAGA
AACTTTGCAGATATCGACGACTCATGGAAGTCCATCAAATCTATTCTGGA
CTGGACTTCATTCAATCAGGAGCGCATCGTCGATGTTGCCGGTCCAGGTG
GATGGAACGACCCTGACATGCTCGTAATTGGGAATTTCGGACTGTCCTGG
AATCAGCAGGTCACACAGATGGCTTTGTGGGCTATCATGGCAGCCCCACT
CTTTATGTCTAACGATTTGCGGCATATTTCACCACAGGCCAAAGCCCTGC
TGCAAGATAAGGACGTCATAGCGATTAACCAGGACCCACTGGGAAAGCAG
GGCTACCAGCTGAGACAGGGCGACAATTTTGAGGTCTGGGAAAGACCTCT
TAGCGGGCTGGCGTGGGCCGTAGCCATGATTAATCGCCAGGAAATTGGCG
GCCCTCGCTCTTACACTATCGCGGTCGCCAGTCTGGGCAAGGGAGTCGCT
TGTAACCCCGCCTGCTTCATAACTCAGTTGCTGCCCGTGAAACGGAAGCT
GGGCTTCTATGAATGGACTAGCAGACTCCGCAGTCATATTAATCCGACTG
GTACGGTGCTGCTGCAACTGGAGAATACCATGCAGATGTCACTTAAGGAT
CTTCTGTGAGAACCCGGGATCCAAGCTTCAATTGTGGTCACTCGACAATC
GCCCAAAACCTCTGTCACGGGTGTCTATCATGGCTGGATCACTGACTGGC
CTGCTGCTGCTGCAGGCCGTGAGCTGGGCCTCCGGAGCCCGGCCTTGCAT
CCCAAAGTCTTTCGGCTACAGCTCCGTGGTGTGCGTGTGCAACGCCACCT
ATTGTGACTCCTTCGATCCCCCTACCTTTCCCGCCCTGGGCACATTTTCT
CGGTACGAGTCTACACGCAGCGGCAGGAGAATGGAGCTGAGCATGGGCCC
TATCCAGGCCAATCACACCGGAACAGGCCTGCTGCTGACCCTGCAGCCAG
AGCAGAAGTTCCAGAAGGTGAAGGGCTTTGGAGGAGCAATGACAGACGCA
GCCGCCCTGAACATCCTGGCCCTGTCCCCACCCGCCCAGAATCTGCTGCT
GAAGTCCTACTTCTCTGAGGAGGGCATCGGCTATAACATCATCAGGGTGC
CCATGGCCAGCTGCGACTTTTCCATCAGAACCTACACATATGCCGATACC
CCTGACGATTTCCAGCTGCACAATTTTTCCCTGCCAGAGGAGGATACAAA
GCTGAAGATCCCACTGATCCACAGGGCCCTGCAGCTGGCCCAGAGGCCCG
TGAGCCTGCTGGCCAGCCCCTGGACCTCCCCTACATGGCTGAAGACCAAC
GGCGCCGTGAATGGCAAGGGCTCTCTGAAGGGACAGCCAGGCGACATCTA
AGCACAAGCTGCAGTTCTGGGCCGTGACCGCAGAGAACGAGCCTTCTGCC
GGCCTGCTGAGCGGCTATCCCTTCCAGTGCCTGGGCTTTACACCTGAGCA
CCAGAGGGACTTTATCGCCAGAGATCTGGGCCCAACCCTGGCCAACTCCA
CACACCACAATGTGCGGCTGCTGATGCTGGACGATCAGCGCCTGCTGCTG
CCTCACTGGGCCAAGGTGGTGCTGACCGACCCAGAGGCCGCCAAGTACGT
GCACGGCATCGCCGTGCACTGGTATCTGGATTTCCTGGCACCAGCAAAGG
CCACCCTGGGAGAGACACACAGGCTGTTCCCTAACACCATGCTGTTTGCC
AGCGAGGCCTGCGTGGGCTCCAAGTTTTGGGAGCAGTCCGTGCGGCTGGG
CTCTTGGGACAGGGGCATGCAGTACTCCCACTCTATCATCACCAATCTGC
TGTATCACGTGGTGGGCTGGACAGACTGGAACCTGGCCCTGAATCCAGAG
GGCGGCCCCAACTGGGTGAGAAATTTCGTGGATAGCCCCATCATCGTGGA
CATCACCAAGGATACATTCTACAAGCAGCCAATGTTTTATCACCTGGGCC
ACTTCTCTAAGTTTATCCCAGAGGGCAGCCAGAGGGTGGGCCTGGTGGCC
AGCCAGAAGAACGACCTGGATGCAGTGGCCCTGATGCACCCTGACGGCTC
CGCCGTGGTGGTGGTGCTGAATCGCTCTAGCAAGGACGTGCCTCTGACCA
TCAAGGACCCCGCCGTGGGCTTTCTGGAGACCATTTCACCCGGCTATTCT
ATTCATACCTATCTGTGGAGGAGGCAGTAACCTGCAGGGGATCCAAGCTT
GAACAGTCTCTTTTCGTATGAGTGCAGTGAGTGGACGCCGCCTTCGACCT
GGGCTGAAGAAGTTCTTTTCTCGAACTTCAGTTCGCCGGAATACATCATT
GCCCGCACCTGTGTCAGGCTCTTAGCGCCGATATCCTGGCATGAATGCTG
AATTCCGGCGATCAGGTAAGGCACGAATTTGTGAATACTGCCCTTATCCT
GGACAGCTCCAGACACGCCCTGTGCGACTTTGATCTTGTCTGCCTCGGAA
AAATACCTGTTCTGAGAGGACAGATGCTTATCCATGGCGTCCAGTGACCC
CATGCCCCTATATTTCTTCAGTCTGAACCCATCACTAAAGAAGTACTCGC
CGGGGGCTTCTGTGGTTGCAGCCAGCAGGCTGCCCATCATCACTGTGCTT
GCCCCCAGAGCCAGGGCTTTTGCGATGTGGCCCACATTCTGAATTCCCCC
GTCAGCGATCACTGGGACTCCGAATCTCCGGGCATACTCGTACACCTTGT
AGACAGCAGTTGCCTGAGGTCGTCCACAGGCCAGCACTTCCTGAATGATG
CAGATTGATCCACTCCCCATTCCGACCCTCAGAGCATCCACTCCTGCGTC
AATCAGGTTTTTGGCCTGGGCTGCGGTCACGACATTGCCTCCGATGACCT
GCAGATTTGGGTACTTGTCCTTAATGTACTTGATCATATTAATCTGGAAG
ATGCTGTTTCCCTGGCTTGAATCCAGCACGACCACGTCCACCCCTGCCTG
AGCCAGCAGATCCAGGCGATATTTATCGTCCTCGTGTGTGCCAATAGCGG
CTCCACACAGCAGCTGTTTCTTTGCGTCCTTACTAGCCAGAGGGTAATCT
CGATTTTTCTTCAGGTCGGTGCGGGCAATGATTGCCACCAGCTCATCGTC
TTCATTCACGATAGGCAGTTTTCCTTTCTTAGACCGCTGCAGAATCTCGT
TGGCTTCCTTCAGTGTGATGCCGGCAGGTGCGACCACCAGATCTTCGCGT
TTGGTCATAATCTCTTCCAGAAAACAGTCATGCTCTTCCTCCTTCAGGAA
ATCGATGTCTCGACTAGAAATGATTCCCACCAGTCGGCTGCCCATTCGTC
AACACATCGCGGACCCTGTCCTTGGGGCTCAGGACCACTGGGTCGGTGAT
AAAGCCCTGTTCGTATTTCTTCACCTTTCTGACCTCATTGGCCTGAAATT
CTGGAGTGCAGTTATGGTGAATGAACCCGATCCCGCCTGTCAGTGCCATA
GCAATGGCCATGCCAGCCTCGGTGACAGTGTCCATAGGGGAGCTCACCAG
GGGTGTCTTCAGGGTGATTTTCTTGGTCAGGGCAGAAGTCAGATCCACCT
GGTCTGCGGTAAAATCAATATAGCCGGGCAGGATCAGGAAGTCGTTGTAA
GTCAGCCCGTCTCCACAATTAAACAGCTGCTGGGCGGTCAGTCCATCATC
AGGGACATAGGAAGTGCCTCCAGAAATCAGGTAGTCGGCCATGGTGGCGC
This application claims priority to U.S. Provisional Application No. 62/515,022 filed on Jun. 6, 2017 and U.S. Provisional Application No. 62/664,671 filed on Apr. 30, 2018, the contents of which are incorporated by reference in their entireties.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US18/36292 | 6/6/2018 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62516022 | Jun 2017 | US | |
| 62664671 | Apr 2018 | US |
