The instant application contains a Sequence Listing with 5 sequences.
Regulatory T cells belong to a small but important subset of T cells which maintain immunological tolerance to self and non-pathogenic antigens and maintain immune homeostasis. There are two major populations of regulatory T cells—CD4+, Foxp3+ CD25+ T cells (Foxp3+ cells) and type 1 regulatory T (Tr1) cells. Both Foxp3+ and Tr1 cells downregulate pathogenic T-cell responses in various preclinical models for organ and pancreatic islet transplantation, GvHD and various autoimmune and inflammatory diseases.
Tr1 cells have shown to be effective in clinical studies. Administration of cloned, antigen-specific, autologous Tr1 cells to patients with ongoing moderate to severe Crohn's disease resulted in objective, transient remissions (Desreumaux et al., Gastroenterology. 2012; 143(5):1207-1217.e2.). In addition, adoptive transfer of donor-derived allo-specific CD4+ T cell populations enriched for Tr1 cells to leukemia patients following allogeneic HSCT resulted in a rapid reconstitution of the immune system and protection against microbial and viral infections, without severe GvHD. In the responder patients, long term remissions and tolerance (>7 years) resulting in cures were achieved (Bacchetta et al., Front Immunol. 2014; 5:16).
Despite these encouraging results, the production of donor-derived or autologous Tr1 cells for large scale therapy for patients with high unmet medical needs is not always feasible, is very cumbersome, and also does not allow for the generation of large quantities of pure Tr1 cells.
Recently, Locafaro and colleagues circumvented some of these problems by transducing purified CD4+ T cells from a single donor with a bidirectional lentiviral vector containing a human IL-10 gene. The resulting single-donor CD4IL-10 populations shared the major functions of naturally occurring Tr1 cells. Like Tr1 cells, single-donor CD4IL-10 cells produce high levels of IL-10 and downregulate the proliferation of both allogeneic CD4+ and CD8+ T cells. In addition, they are cytotoxic for both normal myeloid cells (including antigen presenting cells, APC) and myeloid leukemia cells. These single-donor CD4IL-10 cells were shown to be effective in reducing GvHD in a humanized xeno-GvHD model while retaining graft-versus-leukemia (GvL) activity. See Locafaro et al. Mol Ther. 2017; 25(10):2254-2269 and WO 2016/146,542.
Although it is possible to produce highly purified single-donor CD4IL-10 cells for therapeutic use, there are still significant limitations, because of qualitative and quantitative differences between the various individual batches, which most likely are related to intrinsic differences between the various donors in addition to variations in the quality of buffy coats.
The present disclosure provides a new Tr1-based therapy using a population of poly-donor CD4IL-10 cells. Poly-donor CD4IL-10 cells refer to CD4+ T cells obtained from at least three different T cell donors and then genetically modified to comprise an exogenous polynucleotide encoding IL-10. The T cell donors are third party donors who are neither a host to be treated with the poly-donor CD4IL-10 cells nor an HSC or organ transplant donor. The poly-donor CD4′ 1° cells are not alloantigen-specific, i.e., they have not been primed or stimulated with cells from the host before administration.
Applicant demonstrated that the poly-donor CD4IL-10 cells have cytokine production profiles, immune suppressive- and cytotoxic capabilities comparable to those of single-donor CD4IL-10 cells. In addition, in vivo, they are more effective in preventing xeno GvHD mediated by CD4+ T cells than single-donor CD4IL-10 cells, while they do not induce GvHD by themselves. Overall, the functional properties of these poly-donor CD4IL-10 cells both in vitro and in vivo were comparable to or better than those of single donor CD4IL-10 cells.
Based on these results, Applicant claims that poly-donor allogeneic CD4IL-10 cells can be used for therapeutic purposes in GvHD, cell and organ transplantation, autoimmune- and inflammatory diseases.
Further, by using third party T cells and eliminating the requirement of allo-specificity, poly-donor CD4IL-10 cells makes the Tr1-based cell therapy available to a larger population of patients with various genetic backgrounds.
Accordingly, the present disclosure provides a population of CD4+ T cells that have been genetically modified to comprise an exogenous polynucleotide encoding IL-10, wherein the CD4+ T cells were obtained from at least three different T cell donors (poly-donor CD4IL-10 cells).
In some embodiments, the CD4+ T cells were obtained from three, four, five, six, seven, eight, nine, or ten different T cell donors. In some embodiments, the CD4+ T cells in the population collectively have six, seven, eight, nine, ten, eleven, twelve, or more different HLA haplotypes.
In some embodiments, all the CD4+ T cells in the population have at least 5/10, 6/10, 7/10, 8/10, or 9/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to each other. In some embodiments, all the CD4+ T cells in the population have at least 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-A locus to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-B locus to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-C locus to each other. In some embodiments, all the CD4+ T cells in the population have at least 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci with each other. In some embodiments, all the CD4+ T cells in the population have an A*02 allele.
In some embodiments, none of the CD4+ T cells is immortalized. In some embodiments, the exogenous polynucleotide comprises an IL-10-encoding polynucleotide segment operably linked to expression control elements. In some embodiments, the IL-10 is a human IL-10. In some embodiments, the IL-10 is a viral IL-10. In some embodiments, the IL-10-encoding polynucleotide segment encodes a protein having the sequence of SEQ ID NO:1. In some embodiments, the IL-10-encoding polynucleotide segment has the sequence of SEQ ID NO:2. In some embodiments, the expression control elements drive constitutive expression of the encoded IL-10. In some embodiments, the expression control elements drive expression of IL-10 in activated CD4+ T cells. In some embodiments, the expression control elements drive tissue-specific or CD4+ T cell-specific expression.
In some embodiments, the exogenous polynucleotide further comprises a sequence encoding a selection marker. In some embodiments, the selection marker is ΔNGFR. In some embodiments, the ANGFR has the sequence of SEQ ID NO: 3. In some embodiments, the exogenous polynucleotide comprises a sequence of SEQ ID NO:4. In some embodiments, the exogenous polynucleotide having a sequence of SEQ ID NO: 5.
In some embodiments, the selection marker is a truncated EGFR polypeptide. In some embodiments, the selection marker is a truncated human EGFR polypeptide.
In some embodiments, the exogenous polynucleotide is integrated into the T cell nuclear genome. In some embodiments, the exogenous polynucleotide is not integrated into the T cell nuclear genome. In some embodiments, the exogenous polynucleotide further comprises lentiviral vector sequences. In some embodiments, the exogenous polynucleotide is not integrated into the T cell nuclear genome.
In some embodiments, at least 90% of the CD4+ T cells within the population express IL-10. In some embodiments, at least 95% of the CD4+ T cells within the population express IL-10. In some embodiments, at least 98% of the CD4+ T cells within the population express IL-10.
In some embodiments, the genetically modified CD4+ T cells constitutively express at least 100 pg IL-10 per 106 of the CD4+ T cells/ml of culture medium. In some embodiments, the genetically modified CD4+ T cells constitutively express at least 200 pg, 500 pg, 1 ng, 5 ng, 10 ng, or 50 ng IL-10 per 106 of the CD4+ T cells/ml. In some embodiments, the genetically modified CD4+ T cells express at least for 2 ng IL-10 per 106 of the CD4+ T cells/ml after activation with anti-CD3 and anti-CD28 antibodies. In some embodiments, the genetically modified CD4+ T cells express at least 2 ng, 5 ng, 10 ng, 100 ng, 200 ng, or 500 ng IL-10 per 106 of the CD4+ T cells/ml after activation with anti-CD3 and anti-CD28 antibodies. In some embodiments, the genetically modified CD4+ T cells express IL-10 at a level at least 5-fold higher than unmodified CD4+ T cells. In some embodiments, the genetically modified CD4+ T cells express IL-10 at a level at least 10-fold higher than unmodified CD4+ T cells.
In some embodiments, at least 90% of the CD4+ T cells within the population express the selection marker from the exogenous polynucleotide. In some embodiments, at least 95% of the CD4+ T cells within the population express the selection marker from the exogenous polynucleotide. In some embodiments, at least 98% of the CD4+ T cells within the population express the selection marker from the exogenous polynucleotide.
In some embodiments, the genetically modified CD4+ T cells express CD49b. In some embodiments, the genetically modified CD4+ T cells express LAG-3. In some embodiments, the genetically modified CD4+ T cells express TGF-β. In some embodiments, the genetically modified CD4+ T cells express IFNγ. In some embodiments, the genetically modified CD4+ T cells express GzB. In some embodiments, the genetically modified CD4+ T cells express perforin. In some embodiments, the genetically modified CD4+ T cells express CD18. In some embodiments, the genetically modified CD4+ T cells express CD2. In some embodiments, the genetically modified CD4+ T cells express CD226. In some embodiments, the genetically modified CD4+ T cells express IL-22.
In some embodiments, the CD4+ T cells have not been anergized in the presence of peripheral blood mononuclear cells (PBMCs) from a host. In some embodiments, the CD4+ T cells have not been anergized in the presence of recombinant IL-10 protein, wherein the recombinant IL-10 protein is not expressed from the CD4+ T cells. In some embodiments, the CD4+ T cells have not been anergized in the presence of DC10 cells from a host.
In some embodiments, the CD4+ T cells are in a frozen suspension. In some embodiments, the CD4+ T cells are in a liquid suspension. In some embodiments, the liquid suspension has previously been frozen.
In another aspect of the present disclosure provides a pharmaceutical composition comprising:
In yet another aspect, the present disclosure provides a method of making poly-donor CD4IL-10 cells, comprising the steps of:
In one aspect, the present disclosure provides a method of making poly-donor CD4IL-10 cells, comprising the steps of:
In some embodiments, the method further comprises the step, after step (i) and before step (ii), after step (ii), after step (ii) and before step (iii), or after step (iii), of:
incubating the primary CD4+ T cells in the presence of an anti-CD3 antibody, and anti-CD28 antibody or anti-CD3 antibody and CD28 antibody coated beads.
In some embodiments, the method comprises incubating the primary CD4+ T cells further in the presence of IL-2. In some embodiments, the exogenous polynucleotide is introduced into the primary CD4+ T cells using a viral vector. In some embodiments, the viral vector is a lentiviral vector. In some embodiments, the exogenous polynucleotide comprises a segment encoding IL-10 having the sequence of SEQ ID NO:1. In some embodiments, the IL-10-encoding polynucleotide segment has the sequence of SEQ ID NO:2.
In some embodiments, the exogenous polynucleotide further comprises a segment encoding a selection marker. In some embodiments, the encoded selection marker is ΔNGFR. In some embodiments, the encoded selection marker has the sequence of SEQ ID NO:3. In some embodiments, the encoded selection marker is a truncated EGFR polypeptide. In some embodiments, the encoded selection marker is a truncated human EGFR polypeptide.
In some embodiments, the method further comprises the step, after step (ii), of:
isolating the genetically-modified CD4+ T cells expressing the selection marker, thereby generating an enriched population of genetically-modified CD4+ T cells.
In some embodiments, at least 90% or at least 95% of the genetically-modified CD4+ T cells in the enriched population express IL-10. In some embodiments, at least 98% of the genetically-modified CD4+ T cells in the enriched population express IL-10. In some embodiments, at least 90% or at least 95% of the genetically-modified CD4+ T cells in the enriched population express the selection marker. In some embodiments, at least 98% of the genetically-modified CD4+ T cells in the enriched population express the selection marker.
In some embodiments, the method further comprises the step of incubating the enriched population of genetically-modified CD4+ T cells. In some embodiments, the step of incubating the enriched population of genetically-modified CD4+ T cells is performed in the presence of anti-CD3 antibody and anti-CD28 antibody or CD3 antibody and CD28 antibody coated beads in the presence of IL-2.
In some embodiments, the method further comprises the later step of freezing the genetically-modified CD4+ T cells. In some embodiments, in step (i), the primary CD4+ T cells are obtained from three, four, five, six, seven, eight, nine, or ten different T cell donors. In some embodiments, the at least three T cell donors have at least 5/10, 6/10, 7/10, 8/10, or 9/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to each other. In some embodiments, the at least three T cell donors have at least 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-A locus to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-B locus to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-C locus to each other. In some embodiments, the at least three T cell donors have at least 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to each other. In some embodiments, each of the at least three T cell donors has an A*02 allele.
In some embodiments, in step (i), the primary CD4+ T cells are obtained from one or more frozen stocks. In some embodiments, in step (i), the primary CD4+ T cells are obtained from unfrozen peripheral blood mononuclear cells of the at least three different T cell donors.
In some embodiments, the method further comprises the step of isolating CD4+ T cells from the peripheral blood mononuclear cells. In some embodiments, the peripheral blood mononuclear cells are obtained from buffy coat or apheresis.
In another aspect, the present disclosure provides method of treating a patient, comprising the step of:
administering the poly-donor CD4IL-10 cells or the pharmaceutical composition of the present disclosure to a patient in need of immune tolerization.
In some embodiments, the method further comprises the preceding step of thawing a frozen suspension of poly-donor CD4IL-10 cells.
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of pathogenic T cell response in the patient.
In some embodiments, the method further comprises the step of administering mononuclear cells from a hematopoietic stem cells (HSC) donor to the patient. In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition and the mononuclear cells from a HSC donor are administered concurrently. In some embodiments, the mononuclear cells from a HSC is administered either prior to or subsequent to administration of the poly-donor CD4IL-10 cells or the pharmaceutical composition. In some embodiments, the mononuclear cells are in the PBMC. In some embodiments, the mononuclear cells are in the bone marrow. In some embodiments, the mononuclear cells are in the cord blood. In some embodiments, the mononuclear cells have been isolated from the PBMC, bone marrow or cord blood.
In some embodiments, the method further comprises the step of:
administering hematopoietic stem cells (HSC) of an HSC donor to the patient either prior to or subsequent to administration of the poly-donor CD4IL-10 cells or pharmaceutical composition.
In some embodiments, the HSC donor is partially HLA-mismatched to the patient. In some embodiments, the HSC donor has less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the patient. In some embodiments, the HSC donor has less than 4/8, 5/8,6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the patient. In some embodiments, the HSC donor has less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the patient. In some embodiments, the HSC donor has less than 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the patient.
In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched to the patient. In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the patient. In some embodiments, one or more of the T cell donors have less than 2/4, 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the patient. In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched with the HSC donor. In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the HSC donor. In some embodiments, one or more of the T cell donors have less than 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the HSC donor.
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of GvHD by the transplanted hematopoietic stem cells.
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of pathogenic response of lymphoid cells from the transplanted hematopoietic stem cells.
In some embodiments, the patient has a cancer. In some embodiments, the patient has neoplastic cells. In some embodiments, the neoplastic cells express CD13, HLA-class I and CD54. In some embodiments, the neoplastic cells express CD112, CD58, or CD155.
In some embodiments, the patient has a cancer. In some embodiments, the cancer is a solid or hematological neoplasm. In some embodiments, the patient has a cancer selected from the group consisting of: Adrenal Cancer, Anal Cancer, Bile Duct Cancer, Bladder Cancer, Bone Cancer, Brain/CNS Tumors In Adults, Brain/CNS Tumors In Children, Breast Cancer, Breast Cancer In Men, Cancer of Unknown Primary, Castleman Disease, Cervical Cancer, Colon/Rectum Cancer, Endometrial Cancer, Esophagus Cancer, Ewing Family Of Tumors, Eye Cancer, Gallbladder Cancer, Gastrointestinal Carcinoid Tumors, Gastrointestinal Stromal Tumor (GIST), Gestational Trophoblastic Disease, Hodgkin Disease, Kaposi Sarcoma, Kidney Cancer, Laryngeal and Hypopharyngeal Cancer, Leukemia, Acute Lymphocytic (ALL), Acute Myeloid (AML, including myeloid sarcoma and leukemia cutis), Chronic Lymphocytic (CLL), Chronic Myeloid (CML) Leukemia, Chronic Myelomonocytic (CMML), Leukemia in Children, Liver Cancer, Lung Cancer, Lung Cancer with Non-Small Cell, Lung Cancer with Small Cell, Lung Carcinoid Tumor, Lymphoma, Lymphoma of the Skin, Malignant Mesothelioma, Multiple Myeloma, Myelodysplastic Syndrome, Nasal Cavity and Paranasal Sinus Cancer, Nasopharyngeal Cancer, Neuroblastoma, Non-Hodgkin Lymphoma, Non-Hodgkin Lymphoma In Children, Oral Cavity and Oropharyngeal Cancer, Osteosarcoma, Ovarian Cancer, Pancreatic Cancer, Penile Cancer, Pituitary Tumors, Prostate Cancer, Retinoblastoma, Rhabdomyosarcoma, Salivary Gland Cancer, Sarcoma—Adult Soft Tissue Cancer, Skin Cancer, Skin Cancer—Basal and Squamous Cell, Skin Cancer—Melanoma, Skin Cancer—Merkel Cell, Small Intestine Cancer, Stomach Cancer, Testicular Cancer, Thymus Cancer, Thyroid Cancer, Uterine Sarcoma, Vaginal Cancer, Vulvar Cancer, Waldenstrom Macroglobulinemia, and Wilms Tumor.
In some embodiments, the cancer is a myeloid cancer. In some embodiments, the cancer is AML or CML.
In some embodiments, the patient has an inflammatory or autoimmune disease. In some embodiments, the inflammatory or autoimmune disease is selected from the group consisting of: type-1 diabetes, autoimmune uveitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, multiple sclerosis, systemic lupus, inflammatory bowel disease, Addison's disease, Graves' disease, Sjögren's syndrome, Hashimoto's thyroiditis, myasthenia gravis, autoimmune vasculitis, pernicious anemia, ulcerative colitis, bullous diseases, scleroderma, and celiac disease.
In some embodiments, the inflammatory or autoimmune disease is Crohn's disease, ulcerative colitis, celiac disease, type-1 diabetes, lupus, psoriasis, psoriatic arthritis, or rheumatoid arthritis.
In some embodiments, the patient has a disease or disorder involving hyperactivity of NLPR3 inflammasome. In some embodiments, the patient has type 2 diabetes, neurodegenerative diseases, or inflammatory bowel disease.
In some embodiments, the patient has a disease or disorder involving increased IL-1β production by activated monocytes, macrophages or dendritic cells.
In some embodiments, the patient has a disease or disorder involving increased IL-18 production by activated monocytes, macrophages or dendritic cells.
In some embodiments, the patient has a disease or disorder involving increased mature caspase 1 production by activated monocytes, macrophages or dendritic cells.
In some embodiments, the patient has an allergic or atopic disease. In some embodiments, the allergic or atopic disease is selected from the group consisting of: asthma, atopic dermatitis, and rhinitis. In some embodiments, the patient has a food allergy.
In some embodiments, the method further comprises the step of cell and organ transplantation to the patient, either prior to or subsequent to administration of the population of CD4+ T cells or the pharmaceutical composition. In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of host rejection of the cell and organ transplantation.
In some embodiments, the method further comprises the step of transplanting iPS cell-derived cells or tissues to the patient, either prior to or subsequent to administration of the population of CD4+ T cells or the pharmaceutical composition.
In some embodiments, poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of host rejection of the transplantation.
In some embodiments, the method further comprises the step of administering a recombinant AAV to the patient, either prior to or subsequent to administration of the poly-donor CD4IL-10 cells or the pharmaceutical composition. In some embodiments, the poly-donor CD4′ 1° cells or the pharmaceutical composition reduces immune responses against the recombinant AAV.
In some embodiments, the patient has an excessive immune response against viral or bacterial infection. In some embodiments, the patient has a coronavirus infection.
In some embodiments, the method further comprises the step of detecting the selection marker in a biological sample obtained from the patient, thereby detecting presence or absence of poly-donor CD4IL-10 T cells. In some embodiments, the biological sample is a biopsy or blood from the patient.
In one aspect, the present disclosure provides a method of treating a patient with a malignancy, comprising: administering an allo-HSCT graft to the patient, and administering a therapeutically effective amount of poly-donor CD4IL-10 cells.
In some embodiments, none of the donors of the CD4IL-10 cells in the poly-donor CD4IL-10 cells is the donor of the HSCT graft.
In another aspect, the present disclosure provides a method of treating a hematological cancer, comprising: administering to a hematological cancer patient an amount of poly-donor CD4IL-10 cells sufficient to induce anti-cancer effects, wherein the poly-donor CD4IL-10 cells comprise CD4+ T cells that have been obtained from at least three different T cell donors and then genetically modified by vector-mediated gene transfer of the coding sequence of human IL-10 under control of a constitutive promoter.
In some embodiments, the method further comprises the step of administering allo HSCT graft to the patient prior to or subsequence to administration of the poly-donor CD4IL-10 cells. In some embodiments, the amount of poly-donor CD4IL-10 cells is further sufficient to suppress graft-versus-host disease (GvHD) without suppressing graft-versus-leukemia (GvL) or graft-versus-tumor (GvT) efficacy of the allo HSCT.
In some embodiments, the hematological cancer is a myeloid leukemia.
In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells that express CD13. In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells that express HLA-class I. In some embodiments, the myeloid leukemia is acute myeloid leukemia (AML).
In some embodiments, the allo-HSCT graft is obtained from a related or unrelated donor with respect to the recipient. In some embodiments, the poly-donor CD4IL-10 cells are non-autologous to the recipient. In some embodiments, the poly-donor CD4IL-10 cells are allogeneic to the recipient. In some embodiments, the poly-donor CD4IL-10 cells are not anergized to host allo-antigens prior to administration to the host.
In some embodiments, the poly-donor CD4IL-10 cells are Tr1-like cells.
In some embodiments, the poly-donor CD4IL-10 cells are polyclonal. In some embodiments, the poly-donor CD4IL-10 cells are polyclonal and non-autologous to the recipient.
In some embodiments, the poly-donor CD4IL-10 cells are isolated from at least three donors prior to being genetically modified. In some embodiments, none of the at least three donors is the same donor as the allo-HSCT donor. In some embodiments, the allo-HSCT graft is obtained from a matched or mismatched donor with respect to the recipient.
In some embodiments, the poly-donor CD4IL-10 cells target and kill cells that express CD54. In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells that express HLA-class I and CD54. In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells that express CD112. In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells that express CD58. In some embodiments, the poly-donor CD4IL-10 cells target and kill cancer cells in the host.
One aspect of the present disclosure provides a method of treating a hematological cancer by allogeneic hematopoietic stem cell transplant (allo-HSCT), comprising:
Another aspect of the present disclosure provides a method of treating a hematological cancer by allogeneic hematopoietic stem cell transplant (allo-HSCT), comprising:
The figures depict various embodiments of the present invention for purposes of illustration only. One skilled in the art will readily recognize from the following discussion that alternative embodiments of the structures and methods illustrated herein may be employed without departing from the principles of the invention described herein.
Unless defined otherwise, all technical and scientific terms used herein have the meaning commonly understood by a person skilled in the art to which this invention belongs. As used herein, the following terms have the meanings ascribed to them below.
“Graft-versus-leukemia effect” or “GvL” refers to an effect that appears after allogeneic hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). T lymphocytes in the allogeneic graft eliminate malignant residual host leukemia cells.
“Graft versus tumor effect” or “GvT refers to an effect that appears after allogeneic hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). T lymphocytes in the allogeneic graft eliminate malignant residual host cancer cells, e.g., cells of myeloma and lymphoid and myeloid leukemias, lymphoma, multiple myeloma and possibly breast cancer. The term GvT is generic to GvL.
The terms “treatment”, “treating”, and the like are used herein in the broadest sense understood in the medical arts. In particular, the terms generally mean obtaining a desired pharmacologic and/or physiologic effect. The effect may be prophylactic, in terms of completely or partially preventing a disease, condition, or symptoms thereof, and/or may be therapeutic in terms of a partial or complete cure for a disease or condition and/or adverse effect, such as a symptom, attributable to the disease or condition. “Treatment” as used herein covers any treatment of a disease or condition of a mammal, particularly a human, and includes: (a) preventing the disease or condition from occurring in a subject which may be predisposed to the disease or condition but has not yet been diagnosed as having it; (b) inhibiting the disease or condition (e.g., arresting its development); or (c) relieving the disease or condition (e.g., causing regression of the disease or condition, providing improvement in one or more symptoms). Improvements in any conditions can be readily assessed according to standard methods and techniques known in the art. The population of subjects treated by the method of the disease includes subjects suffering from the undesirable condition or disease, as well as subjects at risk for development of the condition or disease.
“HLA-matched” as used herein refers to a pair of individuals having a matching HLA allele in the HLA class I (HLA-A, HLA-B, and HLA-C) and class II (HLA-DRB1 and HLA-DQB1) loci that allow the individuals to be immunologically compatible with each other. HLA compatibility can be determined using any of the methods available in the art, for example, as described in Tiervy, Haematologica 2016 Volume 101(6):680-687, which is incorporated by reference herein.
For a given locus, a pair of individuals have 2/2 match when each of two alleles of one individual match with the two alleles of the other individual. A pair of individuals have 1/2 match when only one of two alleles of one individual match with one of two alleles of the other individual. A pair of individuals have 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci when all of the ten alleles (two for each of the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci) of one individual match with all ten alleles of the other individual.
In preferred embodiments, allele level typing is used for determination of HLA compatibility. Allele level typing corresponds to a unique nucleotide sequence for an HLA gene, as defined by using all digits in the first, second, third and fourth fields, e.g. A*02:01:01:01. Functionally, the third and fourth fields which characterize alleles that differ, respectively, by silent substitutions in the coding sequence and by substitutions in the non-coding sequence, are irrelevant, except when substitutions prevent the expression of HLA alleles (e.g. the null allele B*15:01:01:02N). Missing a null allele will lead to a mismatch that is very likely to be recognized by alloreactive T cells and have a deleterious clinical impact. Substitutions in non-coding sequences may influence the level of expression (e.g. the A24low allele A*24:02:01:02L). Such variability may also have an impact on anti-HLA allorecognition.
The term “HLA-mismatched” as used herein refers to a pair of individuals having a mis-matching HLA allele in the HLA class I (HLA-A, HLA-B, and HLA-C) and class II (HLA-DRB1 and HLA-DQB1) loci that make the individuals to be immunologically incompatible with each other.
The term “partially HLA-mismatched” as used herein refers to a pair of individuals having a mis-matching HLA allele in the HLA class I (HLA-A, HLA-B, and HLA-C) and class II (HLA-DRB1 and HLA-DQB1) loci that make the individuals to be immunologically incompatible with each other in a permissible degree. Some studies have identified permissive mismatches. Some HLA class I incompatibilities are considered to be more permissive.
“HLA haplotype” refers to a series of HLA loci-alleles by chromosome, one passed from the mother and one from the father. Genotypes for HLA class I (HLA-A, HLA-B, and HLA-C) and class II (HLA-DRB1 and HLA-DQB1) loci can be used to determine the HLA haplotype.
The term “therapeutically effective amount” is an amount that is effective to treat, and thus ameliorate a symptom of a disease. A therapeutically effective amount can be a “prophylactically effective amount” as prophylaxis can be considered therapy.
The term “ameliorating” refers to any therapeutically beneficial result in the treatment of a disease state, e.g., a neurodegenerative disease state, including prophylaxis, lessening in the severity or progression, remission, or cure thereof.
Ranges recited herein are understood to be shorthand for all of the values within the range, inclusive of the recited endpoints. For example, a range of 1 to 50 is understood to include any number, combination of numbers, or sub-range from the group consisting of 1, 2, 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, and 50.
The present disclosure provides the methods for production and use of highly purified, allogeneic CD4+ T cells that have been transduced with a bidirectional lentiviral vector containing the human IL-10 gene and a truncated, non-signaling form of the human NGFR. The successfully transduced CD4+ T cells were purified utilizing a NGFR specific monoclonal antibody resulting in >95% pure IL-10 producing and NGFR expressing CD4+ T cells (designated CD4IL-10 cells). CD4IL-10 cells from 3 different allogeneic HLA mismatched donors were pooled at 1:1:1 ratios.
These pooled populations, also referred to herein as poly-donor CD4IL-10 cells, had cytokine production profiles comparable to those of single-donor CD4IL-10 cells and naturally derived type 1 regulatory T (Tr1) cells. They produce high levels of IL-10, IL-22, IFN-γ, IL-5 and low levels of IL-4. The poly-donor CD4IL-10 cells were polyclonal (has multiple antigen specificities) and suppressed proliferation of both allogeneic CD4+ and CD8+ T cells in vitro. In addition, they specifically killed myeloid leukemia cells in vitro. Adoptive transfer of poly-donor CD4IL-10 cells in a humanized mouse model for Graft versus Host Disease (GvHD) indicated that these cells efficiently home to the spleen. Adoptive transfer of poly-donor CD4IL-10 cells in a humanized mouse model of GvHD inhibited severe xeno-GvHD induced by human CD4+ T cells. Importantly, even at high concentrations, poly-donor CD4IL-10 cells did not induce GvHD by themselves. These results demonstrate that poly-donor CD4IL-10 cells can be used for the treatment and/or prevention of GvHD; can be used as an adjunct to allogeneic hematopoietic stem cell transplant (HSCT) for treatment of leukemias and other malignancies to reduce GvHD while preserving GvL or GvT therapeutic effects of the HSCT; and for treating cell and organ rejection and autoimmune and inflammatory diseases.
In a first aspect, a population of CD4+ T cells that have been genetically modified to comprise an exogenous polynucleotide encoding IL-10 is provided (CD4IL-10 cells). The population comprises CD4+ T cells obtained from at least three different T cell donors (poly-donor CD4IL-10 cells).
6.4.1. CD4+ T Cells and T Cell Donors
CD4+ T cells used in poly-donor CD4IL-10 populations can be isolated from peripheral blood, cord blood, or other blood samples from a donor, using methods available in the art. In typical embodiments, CD4+ T cells are isolated from peripheral blood. In certain embodiments, CD4+ T cells are isolated from peripheral blood obtained from third party-blood banks.
In some embodiments, CD4+ T cells are isolated from a prior-frozen stock of blood or a prior-frozen stock of peripheral blood mononuclear cells (PBMCs). In some embodiments, CD4+ T cells are isolated from peripheral blood or from PBMCs that have not previously been frozen. In some embodiments, the CD4+ T cells are separately isolated from blood or PBMCs obtained from a plurality of donors, and then pooled. In some embodiments, the CD4+ T cells are isolated from blood or PBMCs that have first been pooled from a plurality of donors.
In some embodiments, the CD4+ T cells are obtained from three, four, five, six, seven, eight, nine, or ten different T cell donors.
In some embodiments, the at least three different T cell donors are selected without regard to genotype. In some embodiments, the at least three different T cell donors are selected based on genotype.
In certain embodiments, the at least three different T cell donors are selected based on their HLA haplotypes.
In some embodiments, some or all of the at least three different T cell donors have matching HLA haplotypes. In some embodiments, some or all of the at least three different T cell donors have a mis-matched HLA haplotype.
In some embodiments, all of the CD4+ T cells in the population have at least 5/10, 6/10, 7/10, 8/10, or 9/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to each other. In some embodiments, all of the CD4+ T cells in the population have at least 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-A locus to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-B locus to each other. In some embodiments, all the CD4+ T cells in the population have 2/2 match at the HLA-C locus to each other. In some embodiments, all the CD4+ T cells in the population have at least 3/4 or 4/4 match at the HLA-DRB1 and HLA DQB1 loci with each other. In some embodiments, all the CD4+ T cells in the population have an A*02 allele.
In preferred embodiments, none of the at least three different T cell donors is a host to be treated with the CD4IL-10 cells. In preferred embodiments, none of the at least three different T cell donors is a donor of stem cells (e.g., HSC), tissue or organ that will be used together with the CD4IL-10 cells in the methods of treatment described herein.
In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched to the patient to be treated (host). In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the patient. In some embodiments, one or more of the T cell donors have less than 2/4, 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the patient.
In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched with the HSC donor. In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the HSC donor. In some embodiments, one or more of the T cell donors have less than 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the HSC donor.
In the preferred embodiments, none of the CD4+ T cells is immortalized.
6.4.2. Exogenous Polynucleotide Encoding IL-10
Poly-donor CD4IL-10 cells of the present disclosure are CD4+ T cells that have been genetically modified to comprise an exogenous polynucleotide encoding IL-10. The exogenous polynucleotide comprises an IL-10-encoding polynucleotide segment operably linked to expression control elements.
The IL-10-encoding polynucleotide segment can encode IL-10 of a human, bonobo or rhesus. In some embodiments, the IL-10-encoding polynucleotide segment encodes human IL-10 having the sequence of SEQ ID NO: 1. In some embodiments, the IL-10-encoding polynucleotide segment encodes a variant of human IL-10 having at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 1. In some embodiments, the IL-10-encoding polynucleotide segment has the nucleotide sequence of SEQ ID NO:2. In some embodiments, the IL-10-encoding polynucleotide segment has at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 2.
In some embodiments, the exogenous polynucleotide encodes viral-IL-10. In various embodiments, the exogenous polypeptide encodes IL-10 from HCMV, GMCMV, RhCMV, BaCMV, MOCMV, SMCMV, EBV, Bonobo-HV, BaLCV, OvHV-2, EHV-2, CyHV-3, AngHV-1, ORFV, BPSV, PCPV, LSDV, SPV, GPV, or CNPV. In some embodiments, the exogenous polypeptide encodes viral IL-10 from EBV or ORFV.
The exogenous polynucleotide further comprises expression control elements that direct expression of the encoded IL-10 in transduced CD4+ T cells.
In some embodiments, the expression control elements comprise a promoter capable of directing expression of IL-10 in CD4+ T cells. In some embodiments, the promoter drives constitutive expression of IL-10 in CD4+ T cells. In some embodiments, the promoter drives expression of IL-10 in activated CD4+ T cells.
In some embodiments, an inducible promoter is used to induce expression of IL-10 when therapeutically appropriate. In some embodiments, the IL-10 promoter is used. In some embodiments a tissue-specific promoter is used. In some embodiments, a lineage-specific promoter is used. In some embodiments, a ubiquitously expressed promoter is used.
In some embodiments, a native human promoter is used. In some embodiments, a human elongation factor (EF)1α promoter is used. In some embodiments, a human phosphoglycerate kinase promoter (PGK) is used. In some embodiments, a human ubiquitin C promoter (UBI-C) is used.
In some embodiments, a synthetic promoter is used. In certain embodiments, a minimal CMV core promoter is used. In particular embodiments, an inducible or constitutive bidirectional promoter is used. In specific embodiments, the synthetic bidirectional promoter disclosed in Amendola et al., Nature Biotechnology, 23(1):108-116 (2005) is used. This promoter can mediate coordinated transcription of two mRNAs in a ubiquitous or a tissue-specific manner. In certain embodiments, the bidirectional promoter induces expression of IL-10 and a selection marker.
In some embodiments, the exogenous polynucleotide further comprises a segment encoding a selection marker that permits selection of successfully transduced CD4+ T cells. In some embodiments, the selection marker is ΔNGFR. In certain embodiments, the selection marker is a polypeptide having the sequence of SEQ ID NO:3. In certain embodiments, the selection marker is a polypeptide having at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 3. In particular embodiments, the nucleotide sequence encoding the ΔNGFR selection marker has the sequence of SEQ ID NO: 4. In some embodiments, the nucleotide sequence encoding the ΔNGFR selection marker has at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 4.
In some embodiments, the selection marker is a truncated form of EGFR polypeptide. In some embodiments, the selection marker is a truncated form of the human EGFR polypeptide, optionally huEGFRt disclosed in Wang et al. “A transgene-encoded cell surface polypeptide for selection, in vivo tracking, and ablation of engineered cells”, Blood, v. 118, n. 5 (2011), incorporated by reference in its entirety herein.
In some embodiments, the exogenous polynucleotide further comprises a sequence encoding an antibiotic resistance gene. In some embodiments, the exogenous polynucleotide comprises a sequence encoding an ampicillin resistance gene. In some embodiments, the exogenous polynucleotide comprises a sequence encoding a kanamycin resistance gene.
In typical embodiments, the exogenous polynucleotide is delivered into CD4+ T cells using a vector. In some embodiments, the vector is a plasmid vector. In some embodiments, the vector is a viral vector.
In certain embodiments, the exogenous polynucleotide is delivered into CD4+ T cells using a lentiviral vector and the exogenous polynucleotide comprises lentiviral vector sequences. In certain embodiments, a lentiviral vector disclosed in Mátrai et al., Molecular Therapy 18(3):477-490 (2010) (“Mátrai”), incorporated by reference herein, is used.
In some embodiments, the lentiviral vector is capable of integrating into the T cell nuclear genome. In some embodiments, the lentiviral vector is not capable of integrating into T cell nuclear genome. In some embodiments, an integration-deficient lentiviral vector is used. For example, in some embodiments, an integration-deficient or other lentiviral vector disclosed in Mátrai is used. In some embodiments, an integrase-defective lentivirus is used. For example, an integrase-defective lentivirus containing an inactivating mutation in the integrase (D64V) can be used as described in Mátrai et al., Hepatology 53:1696-1707 (2011), which is incorporated by reference herein, is used.
In some embodiments, the exogenous polynucleotide is integrated in the T cell nuclear genome. In some embodiments, the exogenous polynucleotide is not integrated in the nuclear genome. In some embodiments, the exogenous polynucleotide exists in the T cell cytoplasm.
In particular embodiments, the exogenous polynucleotide has the sequence of SEQ ID NO:5. In some embodiments, the exogenous polynucleotide has at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 5.
6.4.3. Gene Expression of Poly-Donor CD4IL-10 T Cells
Poly-donor CD4IL-10 T cells express IL-10. In some embodiments, poly-donor CD4IL-10 T cells constitutively express IL-10. In some embodiments, poly-donor CD4IL-10 T cells express IL-10 when activated.
In some embodiments, poly-donor CD4IL-10 T cells constitutively express at least 100 pg of IL-10 per 106 of the CD4+ T cells/ml of culture. In some embodiments, poly-donor CD4IL-10 T cells constitutively express at least 200 pg, 500 pg, 1 ng, 5 ng, 10 ng, or 50 ng of IL-10 per 106 of the CD4+ T cells/ml of culture.
In some embodiments, poly-donor CD4IL-10 T cells express at least 1 ng or 2 ng IL-10 per 106 of the CD4+ T cells/ml of culture after activation with a combination of anti-CD3 and anti-CD28 antibodies, or anti-CD3 antibody and anti-CD28 antibody coated beads. In some embodiments, poly-donor CD4IL-10 T cells express at least 5 ng, 10 ng, 100 ng, 200 ng, or 500 ng IL-10 per 106 of the CD4+ T cells/ml of culture after activation with anti-CD3 and anti-CD28 antibodies or CD3 antibody and CD28 antibody coated beads.
In various embodiments, the amount of IL-10 production is determined 12 hours, 24 hours, or 48 hours after activation using various methods for protein detection and measurement, such as ELISA, spectroscopic procedures, colorimetry, amino acid analysis, radiolabeling, Edman degradation, HPLC, western blotting, etc. In preferred embodiments, the amount of IL-10 production is determined by ELISA 48 hours after activation with anti-CD3 and anti-CD28 antibodies.
In some embodiments, poly-donor CD4IL-10 T cells express IL-10 at a level at least 5-fold higher than unmodified CD4+ T cells. In some embodiments, poly-donor CD4IL-10 T cells express IL-10 at a level at least 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 30, 40, or 50-fold higher than unmodified CD4+ T cells.
In some embodiments, poly-donor CD4IL-10 T cells further express a selection marker. In some embodiments, poly-donor CD4IL-10 T cells express a protein typically expressed in Tr1 cells. In some embodiments, poly-donor CD4IL-10 T cells express a marker protein characteristic of Tr1 cells.
In some embodiments, poly-donor CD4IL-10 T cells express CD49b. In some embodiments, poly-donor CD4IL-10 T cells express LAG-3. In some embodiments, poly-donor CD4IL-10 T cells express TGF-β. In some embodiments, poly-donor CD4IL-10 T cells express IFNγ. In some embodiments, poly-donor CD4IL-10 T cells express GzB. In some embodiments, poly-donor CD4IL-10 T cells release GzB when activated with myeloid antigen-presenting cells. In some embodiments, poly-donor CD4IL-10 T cells express perforin. In some embodiments, poly-donor CD4IL-10 T cells release perforin when activated with myeloid antigen-presenting cells. In some embodiments, poly-donor CD4IL-10 T cells express CD18. In some embodiments, poly-donor CD4IL-10 T cells express CD2. In some embodiments, poly-donor CD4IL-10 T cells express CD226. In some embodiments, poly-donor CD4IL-10 T cells express IL-22. In some embodiments, poly-donor CD4IL-10 T cells express IL-10.
In some embodiments, poly-donor CD4IL-10 T cells exhibit at least one phenotypic function of Tr1 cells. In various embodiments, the function is secretion of IL-10, secretion of TGF-β, and by the specific killing of myeloid antigen-presenting cells through the release of Granzyme B (GzB) and perforin.
6.4.4. Product by Process
In typical embodiments, poly-donor CD4IL-10 T cells are obtained by modifying CD4+ T cells with an exogenous polynucleotide encoding IL-10.
In some embodiments, the exogenous polynucleotide is introduced to CD4+ T cells by a viral vector or a plasmid vector. In particular embodiments, CD4+ T cells are transduced with a lentivirus containing a coding sequence of IL-10.
In some embodiments, poly-donor CD4IL-10 T cells are generated by (i) pooling primary CD4+ T cells obtained from at least three different T cell donors; and (ii) modifying the pooled CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10. In some embodiments, poly-donor CD4IL-10 T cells are generated by (i) obtaining primary CD4+ T cells from at least three different T cell donors; (ii) separately modifying each donor's CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10, and then (iii) pooling the genetically modified CD4+ T cells.
In some embodiments, poly-donor CD4IL-10 T cells have been cultured in the presence of proteins capable of activating CD4+ T cells. In some embodiments, poly-donor CD4IL-10 T cells have been cultured in the presence of anti-CD3 antibody and anti-CD28 antibody, or anti-CD3 antibody and anti-CD28 antibody coated beads. In some embodiments, poly-donor CD4IL-10 T cells have been cultured in the presence of anti-CD3 antibodies, anti-CD28 antibodies, and IL-2, or anti-CD3 antibody and anti-CD28 antibody coated beads and IL-2. In some embodiments, poly-donor CD4IL-10 T cells have been cultured in the presence of T Cell TransAct™ from Miltenyi Biotec. In some embodiments, poly-donor CD4IL-10 T cells have been cultured in the presence of ImmunoCult Human T Cell Activator™ from STEMCELL Technologies.
In some embodiments, poly-donor CD4IL-10 T cells are in a frozen stock.
In another aspect, pharmaceutical compositions are provided. The pharmaceutical comprises the poly-donor CD4IL-10 T cells disclosed herein and a pharmaceutically acceptable carrier or diluent.
The pharmaceutical composition can be formulated for administration by any route of administration appropriate for human or veterinary medicine. In typical embodiments, the composition is formulated for intravenous (IV) administration. In some embodiments, the composition is formulated for intravenous (IV) infusion. In embodiments formulated for IV administration, the pharmaceutical composition will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability.
In some embodiments, the pharmaceutically acceptable carrier or diluent is saline, lactated Ringer's solution, or other physiologically compatible solution. In various embodiments, the pharmaceutical composition solution comprises 2-20%, preferably 5%, human serum albumin.
In some embodiments, unit dosage forms of the pharmaceutical composition are provided that are adapted for administration of the pharmaceutical composition by systemic administration, in particular, for intravenous administration.
In some embodiments, the unit dosage form contains 104 to 1011 poly-donor CD4IL-10 T cells, 104 to 1010 poly-donor CD4IL-10 T cells, 104 to 109 poly-donor CD4IL-10 T cells, 105 to 1010 poly-donor CD4IL-10 T cells, 105 to 109 poly-donor CD4IL-10 T cells, 105 to 108 poly-donor CD4IL-10 T cells, or 105 to 107 poly-donor CD4IL-10 T cells.
In typical embodiments, the pharmaceutical composition in the unit dosage form is in liquid form.
In another aspect, the present disclosure provides a method of making poly-donor CD4IL-10 cells.
In some embodiments, the method comprises the steps of: (i) pooling primary CD4+ T cells obtained from at least three different T cell donors; and (ii) modifying the pooled CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10. In other embodiments, the method comprises the steps of: (i) obtaining primary CD4+ T cells from at least three different T cell donors; (ii) separately modifying each donor's CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10; and then (iii) pooling the genetically modified CD4+ T cells, thereby obtaining the poly-donor CD4IL-10 cells. Various methods known in the art can be used to introduce an exogenous polynucleotide encoding IL-10 to primary CD4+ T cells.
In some embodiments, the method further comprises the step of incubating the primary CD4+ T cells or genetically-modified CD4+ T cells in the presence of an anti-CD3 antibody and anti-CD28 antibody, or anti-CD3 antibody and anti-CD28 antibody coated beads. In some embodiments, the method further comprises the step of incubating the primary CD4+ T cells or genetically-modified CD4+ T cells in the presence of anti-CD3 antibody, anti-CD28 antibody and IL-2 or anti-CD3 antibody and anti-CD28 antibody coated beads and IL-2. In some embodiments, the method further comprises the step of incubating the primary CD4+ T cells or genetically-modified CD4+ T cells in the presence of a mixture of feeder cells. In some embodiments, the method further comprises the step of incubating the primary CD4+ T cells or genetically-modified CD4+ T cells in the presence of nanopreparations of anti-CD3 antibody and anti-CD28 antibody. In some embodiments, the incubation is done in the presence of T Cell TransAct™ from Miltenyi Biotec. In some embodiments, the incubation is done in the presence of ImmunoCult Human T Cell Activator™ from STEMCELL Technologies.
In some embodiments, the incubation step is performed before introducing an exogenous polynucleotide encoding IL-10. In some embodiments, the incubation step is performed after (i) pooling primary CD4+ T cells obtained from at least three different T cell donors; but before (ii) modifying the pooled CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10. In some embodiments, the incubation step is performed after (i) obtaining primary CD4+ T cells from at least three different T cell donors; but before (ii) separately modifying each donor's CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10.
In some embodiments, the incubation step is performed after step (ii). In other words, in some embodiments, the incubation step is performed after (ii) modifying the pooled CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10. In some embodiments, the incubation step is performed after (ii) separately modifying each donor's CD4+ T cells by introducing an exogenous polynucleotide encoding IL-10, but before (iii) pooling the genetically modified CD4+ T cells, thereby obtaining the genetically-modified CD4+ T cells. In some embodiments, the incubation step is performed after (iii) pooling the genetically modified CD4+ T cells, thereby obtaining the poly-donor CD4IL-10 cells.
In some embodiments, the incubation step is performed more than once. In some embodiments, the incubation step is performed both before and after genetic modification of CD4+ T cells.
In some embodiments, the exogenous polynucleotide is introduced into the primary CD4+ T cells using a viral vector. In some embodiments, the viral vector is a lentiviral vector. In some embodiments, the exogenous polynucleotide comprises a segment encoding IL-10 having the sequence of SEQ ID NO: 1. In some embodiments, the exogenous polynucleotide comprises a segment encoding IL-10 having at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 1. In some embodiments, the IL-10-encoding polynucleotide segment has the sequence of SEQ ID NO: 2. In some embodiments, the IL-10-encoding polynucleotide segment has at least 90%, 95%, 98%, or 99% sequence identity to SEQ ID NO: 2. In some embodiments, the exogenous polynucleotide further comprises a segment encoding a marker permitting selection of successfully transduced CD4+ T cells. In some embodiments, the encoded selection marker is ΔNGFR. In certain embodiments, the encoded selection marker has the sequence of SEQ ID NO:3. In particular embodiments, the exogenous polynucleotide comprises a sequence of SEQ ID NO:4. In some embodiments, the encoded selection marker is a truncated form of human EGFR polypeptide.
In some embodiments, the method further comprises the step of isolating the genetically-modified CD4+ T cells expressing the selection marker, thereby generating an enriched population of genetically-modified CD4IL-10 cells.
In some embodiments, at least 90% of the genetically-modified CD4+ T cells in the enriched population express a selection marker. In some embodiments, at least 95% of the genetically-modified CD4+ T cells in the enriched population express a selection marker. In some embodiments, at least 96, 97, 98, or 99% of the genetically-modified CD4+ T cells in the enriched population express a selection marker.
In some embodiments, at least 90% of the genetically-modified CD4+ T cells in the enriched population express IL-10. In some embodiments, at least 95% of the genetically-modified CD4+ T cells in the enriched population express IL-10. In some embodiments, at least 96, 97, 98, or 99% of the genetically-modified CD4+ T cells in the enriched population express IL-10.
In some embodiments, the method further comprises the step of incubating the enriched population of the genetically-modified CD4+ T cells. In some embodiments, the incubation is performed in the presence of anti-CD3 antibody and anti-CD28 antibody, or anti-CD3 antibody and anti-CD28 antibody coated beads. In some embodiments, the incubation is performed further in presence of IL-2. In some embodiments, the incubation is performed in the presence of feeder cells. In some embodiments, the incubation is performed in the presence of nanopreparations of anti-CD3 antibody and anti-CD28 antibody. In some embodiments, the incubation is performed in the presence of T Cell TransAct™ from Miltenyi Biotec. In some embodiments, the incubation is performed in the presence of ImmunoCult Human T Cell Activator™ from STEMCELL Technologies.
In some embodiments, the method further comprises the step of freezing the genetically-modified CD4+ T cells.
In some embodiments, the primary CD4+ T cells are from donors selected based on their HLA haplotypes. In some embodiments, the method further comprises the step of selecting T cell donors by analyzing their genetic information. In some embodiments, the method comprises the step of analyzing genetic information or HLA haplotype of potential T cell donors.
In some embodiments, the primary CD4+ T cells are from donors having at least a partial HLA match with a host to be treated with the primary CD4+ T cells or a modification thereof. In some embodiments, the primary CD4+ T cells are from donors having at least a partial HLA match with a stem cell (HSC), tissue or organ donor. In some embodiments, the primary CD4+ T cells are obtained from third party donors who are not biologically related with a host. In some embodiments, the primary CD4+ T cells are obtained from third party donors who are not biologically related with a stem cell, tissue or organ donor.
In some embodiments, in step (i), the primary CD4+ T cells are obtained from three, four, five, six, seven, eight, nine, or ten different T cell donors. In some embodiments, the at least three T cell donors have at least 5/10, 6/10, 7/10, 8/10, or 9/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to each other. In some embodiments, the at least three T cell donors have at least 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-A locus to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-B locus to each other. In some embodiments, the at least three T cell donors have 2/2 match at the HLA-C locus to each other. In some embodiments, the at least three T cell donors have at least 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to each other. In some embodiments, each of the at least three T cell donors has an A*02 allele.
In some embodiments, in step (i), the primary CD4+ T cells are obtained from one or more frozen stocks. In some embodiments, in step (i), the primary CD4+T cells are obtained from unfrozen peripheral blood mononuclear cells of the at least three different T cell donors. In some embodiments, the method further comprises the step of isolating CD4+ T cells from the peripheral blood mononuclear cells. In some embodiments, in step (i), the primary CD4+ T cells are obtained from a liquid suspension. In some embodiments, the liquid suspension is obtained from a previously frozen stock.
In some embodiments, CD4+ T cells from donors are contacted with patient antigen-presenting cells (monocytes, dendritic cells, or DC-10 cells), generating allo-specific CD4+ T cells that are then modified to produce high levels of IL-10 (allo-CD4IL-10 cell).
In some embodiments, the method does not comprise the step of anergizing the CD4+ T cells in the presence of peripheral blood mononuclear cells (PBMCs) from a host. In some embodiments, the method does not comprise the step of anergizing the CD4+ T cells in the presence of recombinant IL-10 protein, wherein the recombinant IL-10 protein is not expressed from the CD4+ T cells. In some embodiments, the method does not comprise the step of anergizing the CD4+ T cells in the presence of DC10 cells from a host.
In yet another aspect, the present disclosure provides a method of treating a patient, comprising the step of administering the poly-donor CD4IL-10 cells or the pharmaceutical composition provided herein to a patient in need of immune tolerization.
In some embodiments, the method further comprises the preceding step of thawing a frozen suspension of poly-donor CD4IL-10 cells.
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of pathogenic T cell response in the patient.
In some embodiments, the treatment method further comprises monitoring poly-donor CD4IL-10 cells in a patient after administration. In some embodiments, the method comprises the step of detecting a selection marker in a biological sample obtained from the patient, thereby detecting presence or absence of poly-donor CD4IL-10 T cells. In some embodiments, the selection marker is detected at multiple time points to trace changes in presence of poly-donor CD4IL-10 cells in a patient. In some embodiments, the biological sample is a biopsy or blood sample from the patient.
The poly-donor CD4IL-10 T cells are administered in a therapeutically effective amount. The amount can be determined based on the body weight and other clinical factors. In some embodiments, 103 to 109 cells/kg are administered. In some embodiments, 103 to 108 cells/kg are administered. In some embodiments, 103 to 107 cells/kg are administered. In some embodiments, 103 to 106 cells/kg are administered. In some embodiments, 103 to 105 cells/kg are administered. In some embodiments, 103 to 104 cells/kg are administered.
In various embodiments, poly-donor CD4IL-10 T cells are administered on a therapeutically effective schedule. In some embodiments, poly-donor CD4IL-10 T cells are administered once. In some embodiments, poly-donor CD4IL-10 cells are administered every day, every 3 days, every 7 days, every 14 days, every 21 days, or every month.
The poly-donor CD4IL-10 T cells can be administered according to different administration routes, such as systemically, subcutaneously, or intraperitoneally. In some embodiments, the cells are administered within a saline or physiological solution which may contain 2-20%, preferably 5% human serum albumin.
6.7.1. Methods of Reducing or Preventing GvHD
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition comprising poly-donor CD4IL-10 cells is used to treat a patient before a hematopoietic stem cell (HSC) transplant (HSCT), concurrently with an HSCT, or following an HSCT.
In various embodiments, the HSCT is a matched related HSCT. In various embodiments, the HSCT is a haploidentical HSCT, a mismatched related HSCT, or a mismatched unrelated HSCT.
In some embodiments, the patient has a hematological malignancy which requires treatment with allo-HSCT. In some embodiments, the hematological malignancy is mediated by aberrant myeloid cells.
In some embodiments, T cell donors are selected based on genetic information of a patient to be treated with poly-donor CD4IL-10 cells and HSC, and/or genetic information of the HSC donor. In some embodiments, T cell donors are selected based on HLA haplotype of a patient to be treated with poly-donor CD4IL-10 cells and HSC, and/or HLA haplotype of the HSC donor. In some embodiments, the method further comprises the step, prior to administering CD4IL-10 cells, of analyzing genetic information or HLA haplotype of T cell donors. In some embodiments, the method further comprises the step of analyzing genetic information or HLA haplotype of a host. In some embodiments, the method further comprises the step of analyzing genetic information or HLA haplotype of an HSC donor.
In some embodiments, T cell donors, a host and an HSC donor are not biologically related. In some embodiments, T cell donors, a host and an HSC donor have different HLA haplotypes. In some embodiments, T cell donors, a host and an HSC donor have at least partial mismatch in HLA haplotype. In some embodiments, T cell donors are selected when they have HLA haplotype with an HLA match over a threshold value.
In some embodiments, the HSC donor is partially HLA mismatched to the patient. In some embodiments, the HSC donor has less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the patient. In some embodiments, the HSC donor has less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the patient. In some embodiments, the HSC donor has less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the patient. In some embodiments, the HSC donor has less than 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the patient.
In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched to the patient. In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the patient. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the patient. In some embodiments, one or more of the T cell donors have less than 2/4, 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the patient.
In some embodiments, one or more of the T cell donors are HLA-mismatched or partially HLA-mismatched with the HSC donor. In some embodiments, one or more of the T cell donors have less than 5/10, 6/10, 7/10, 8/10, 9/10 or 10/10 match at the HLA-A, HLA-B, HLA-C, HLA-DRB1, and HLA-DQB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 4/8, 5/8, 6/8, 7/8, or 8/8 match at the HLA-A, HLA-B, HLA-C, and HLA-DRB1 loci to the HSC donor. In some embodiments, one or more of the T cell donors have less than 2/2 match at the HLA-A, HLA-B, or HLA-C locus to the HSC donor. In some embodiments, one or more of the T cell donors have less than 3/4 or 4/4 match at the HLA-DRB1 and HLA-DQB1 loci to the HSC donor. In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of GvHD by the transplanted hematopoietic stem cells.
In some embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of pathological T cell response by the transplanted hematopoietic cells. In specific embodiments, the poly-donor CD4IL-10 cells prevents or reduces GvHD.
6.7.2. Methods of Treating Cancer
In some embodiments, poly-donor CD4IL-10 cells are used for treatment of cancer. In preferred embodiments, the poly-donor CD4IL-10 cells directly mediate anti-tumor effects (Graft versus Tumor, GvT), and in particular embodiments, an anti-leukemic effect (Graft versus Leukemia, GvL).
In some embodiments, poly-donor CD4IL-10 cells are administered in combination with allogeneic mononuclear cells or PBMC for treatment of cancer. In some embodiments, poly-donor CD4IL-10 cells are administered prior to or subsequence to administration of PBMC. In some embodiments, poly-donor CD4IL-10 cells and allogeneic mononuclear cells or PBMC are administered concurrently.
In some embodiments, poly-donor CD4IL-10 cells and allogeneic mononuclear cells or PBMC are administered at 1:3, 1:2, 1:1, 2:1 or 3:1 ratio.
In some embodiments, the neoplastic cells express CD13. In some embodiments, the neoplastic cells express HLA-class I. In some embodiments, the neoplastic cells express CD54. In some embodiments, the neoplastic cells express CD13, HLA-class I and CD54. In some embodiments, the neoplastic cells express CD112. In some embodiments, the neoplastic cells express CD58. In some embodiments, the neoplastic cells express CD155. In some embodiments, the tumor expresses CD112, CD58, or CD155. In various embodiments, the tumor is a solid or hematological tumor.
In some embodiments, the patient has a cancer selected from the group consisting of: Adrenal Cancer, Anal Cancer, Bile Duct Cancer, Bladder Cancer, Bone Cancer, Brain/CNS Tumors In Adults, Brain/CNS Tumors In Children, Breast Cancer, Breast Cancer In Men, Cancer of Unknown Primary, Castleman Disease, Cervical Cancer, Colon/Rectum Cancer, Endometrial Cancer, Esophagus Cancer, Ewing Family Of Tumors, Eye Cancer, Gallbladder Cancer, Gastrointestinal Carcinoid Tumors, Gastrointestinal Stromal Tumor (GIST), Gestational Trophoblastic Disease, Hodgkin Disease, Kaposi Sarcoma, Kidney Cancer, Laryngeal and Hypopharyngeal Cancer, Leukemia, Acute Lymphocytic (ALL), Acute Myeloid (AML, including myeloid sarcoma and leukemia cutis), Chronic Lymphocytic (CLL), Chronic Myeloid (CML) Leukemia, Chronic Myelomonocytic (CMML), Leukemia in Children, Liver Cancer, Lung Cancer, Lung Cancer with Non-Small Cell, Lung Cancer with Small Cell, Lung Carcinoid Tumor, Lymphoma, Lymphoma of the Skin, Malignant Mesothelioma, Multiple Myeloma, Myelodysplastic Syndrome, Nasal Cavity and Paranasal Sinus Cancer, Nasopharyngeal Cancer, Neuroblastoma, Non-Hodgkin Lymphoma, Non-Hodgkin Lymphoma In Children, Oral Cavity and Oropharyngeal Cancer, Osteosarcoma, Ovarian Cancer, Pancreatic Cancer, Penile Cancer, Pituitary Tumors, Prostate Cancer, Retinoblastoma, Rhabdomyosarcoma, Salivary Gland Cancer, Sarcoma—Adult Soft Tissue Cancer, Skin Cancer, Skin Cancer—Basal and Squamous Cell, Skin Cancer—Melanoma, Skin Cancer—Merkel Cell, Small Intestine Cancer, Stomach Cancer, Testicular Cancer, Thymus Cancer, Thyroid Cancer, Uterine Sarcoma, Vaginal Cancer, Vulvar Cancer, Waldenstrom Macroglobulinemia, and Wilms Tumor.
In some embodiments, the cancer is a myeloid tumor. In particular embodiments, the cancer is AML or CML. In some embodiments, the cancer is a myeloid tumor.
In some embodiments, the method is used to treat a hematological cancer affecting blood, bone marrow, and lymph nodes. In various embodiments, the hematological cancer is a lymphoma (e.g. Hodgkin's Lymphoma), lymphocytic leukemias, myeloma. In various embodiments, the hematological cancer is acute or chronic myelogenous (myeloid) leukemia (AML, CML), or a myelodysplastic syndrome.
In some embodiments, the cancer is refractory or resistant to a therapeutic intervention.
In some embodiments, the poly-donor CD4IL-10 cells are used in combination with a therapeutic intervention. The combination may be simultaneous or performed at different times. Preferably the therapeutic intervention is selected from the group consisting of: chemotherapy, radiotherapy, allo-HSCT, immune suppression, blood transfusion, bone marrow transplant, growth factors, biologicals.
In some embodiments, the poly-donor CD4IL-10 cells induce cell death of tumor infiltrating myeloid lineage cells (e.g., monocytes, macrophages, neutrophils).
6.7.3. Methods of Treating Other Disorders
In some embodiments, poly-donor CD4IL-10 cells are administered to treat autoimmune disease.
In some embodiments, the autoimmune disease is selected from the group consisting of: type-1 diabetes, autoimmune uveitis, rheumatoid arthritis, psoriasis, psoriatic arthritis, multiple sclerosis, systemic lupus, inflammatory bowel disease, Addison's disease, Graves' disease, Sjögren's syndrome, Hashimoto's thyroiditis, myasthenia gravis, autoimmune vasculitis, pernicious anemia, ulcerative colitis, bullous diseases, scleroderma, and celiac disease. In some embodiments, the autoimmune disease is Crohn's disease, ulcerative colitis, celiac disease, type-1 diabetes, lupus, psoriasis, psoriatic arthritis, or rheumatoid arthritis. In some embodiments, the patient has an allergic or atopic disease. The allergic or atopic disease can be selected from the group consisting of: asthma, atopic dermatitis, and rhinitis. In some embodiments, the patient has a food allergy.
In some embodiments, poly-donor CD4IL-10 cells are administered to prevent or reduce severity of pathogenic T cell response to cell and organ transplantation other than HSCT. In some embodiments, the method comprises the step of organ transplantation to the patient, either prior to or subsequent to administration of poly-donor CD4IL-10 T cells or the pharmaceutical composition. In certain embodiments, the organ is a kidney, a heart, or pancreatic islet cells. In preferred embodiments, the poly-donor CD4IL-10 cells or the pharmaceutical composition prevents or reduces severity of host rejection of the organ transplantation.
In some embodiments, poly-donor CD4IL-10 cells are administered to prevent or reduce immune response associated with gene therapy, e.g., administration of recombinant AAV (rAAV). In these embodiments, the method further comprises the step of administering a recombinant AAV to the patient, either prior to or subsequent to administration of the poly-donor CD4IL-10 cells or the pharmaceutical composition.
In some embodiments, poly-donor CD4IL-10 cells are administered to prevent or reduce immune response associated with transplantation of iPS-derived tissues or cells. The iPS-derived tissues and cells include, but are not limited to cardiomyocytes, hepatocytes, epithelial cells, cartilage, bone and muscle cells, neurons.
In some embodiments, poly-donor CD4IL-10 cells are administered to treat inflammation. The inflammation can be related to coronary artery disease (CAD), Type 2 diabetes, neurodegenerative diseases, or inflammatory bowel disease, but is not limited thereto.
In some embodiments, poly-donor CD4IL-10 cells are administered to treat a disease or disorder involving hyperactivity of NLPR3 inflammasome. In some embodiments, poly-donor CD4IL-10 cells are administered to treat a disease or disorder involving increased IL-1β production by activated monocytes, macrophages or dendritic cells. In some embodiments, poly-donor CD4IL-10 cells are administered to treat a disease or disorder involving increased IL-18 production by activated monocytes, macrophages or dendritic cells. In some embodiments, poly-donor CD4IL-10 cells are administered to treat a disease or disorder involving increased mature caspase 1 production by activated monocytes, macrophages or dendritic cells.
In some embodiments, poly-donor CD4IL-10 cells are administered to reduce IL-1β production by activated monocytes, macrophages or dendritic cells. In some embodiments, poly-donor CD4IL-10 cells are administered to reduce IL-18 production by activated monocytes, macrophages or dendritic cells. In some embodiments, poly-donor CD4IL-10 cells are administered to reduce mature caspase 1 production by activated monocytes, macrophages or dendritic cells.
In some embodiments, poly-donor CD4IL-10 cells are administered to reduce patient hyperactive immune response to viral infection. In some embodiments, the virus is SARS-coV-2. In some embodiments, poly-donor CD4IL-10 cells are administered to reduce hyperactive immune responses to bacterial infections, such as toxic shock and cytokine storm.
The following examples are provided by way of illustration not limitation.
6.8.1. Example 1: Generation of Poly-Donor CD4IL-10 Cells
Poly-donor CD4IL-10 cells were produced by transduction with a lentiviral vector containing coding sequences of both the human IL-10 and a truncated form of the NGFR (ΔNGFR) (
The lentiviral vectors were produced by Ca3PO4 transient four-plasmid co-transfection into 293T cells and concentrated by ultracentrifugation: 1 μM sodium butyrate was added to the cultures for vector collection. Titer was estimated on 293T cells by limiting dilution, and vector particles were measured by HIV-1 Gag p24 antigen immune capture (NEN Life Science Products; Waltham, MA). Vector infectivity was calculated as the ratio between titer and particle. For concentrated vectors, titers ranged from 5×108 to 6×109 transducing units/ml, and infectivity from 5×104 to 5×105 transducing units/ng.
After 11 days, transduced cells were analyzed by FACS for the expression of ΔNGFR, and the vector copy number (VCN) was quantified by digital droplet PCR (ddPCR).
The mean transduction efficiency of CD4+ T cells from 10 different donors was 45±17% with VCN of 2.7±0.6%.
ΔNGFR+ T cells were purified using anti-CD271 mAb-coated microbeads and resulted in >95% pure CD4IL-10 cells populations. After purification, cells were stained with markers for CD4 and ΔNGFR and analyzed by FACS. The data showed purity resulting from the purification step was over 98%.
Resting CD4IL-10 cells produced IL-10 constitutively. Upon activation, the level of IL-10 produced was strongly enhanced.
CD4IL-10 Cells have a Cytokine Production Profile which is Comparable to that of Naturally Derived Tr1 Cells.
Cytokine production profiles of single donor CD4IL-10 cells were analyzed after the second (TF2) and third (TF3) restimulation and the results are provided in
Although considerable variations between the different donors were observed, the overall cytokine production profiles after the second (TF2) or the third (TF3) restimulation were comparable and reflected those of Tr1 cells (Roncarolo et al., Immunity, 2018). Like Tr1 cells, the CD4IL-10 cells produced high levels of IL-10, IL-5, IFN-γ and IL-22, but low levels of IL-4 and undetectable levels of IL-2.
The CD4IL-10 cells were further analyzed after the 2nd round (TF2) of restimulation for expression of granzyme B (GzB). The data in
The CD4IL-10 cells from the 2nd round (TF2) of restimulation were further analyzed for their cytotoxic effects against myeloid leukemia cells (ALL-CM) and an erythroid leukemia cell line (K562). CD4IL-10 cells (105/well) were co-cultured with K562 and ALL-CM cells (105/well) at 1:1 ratio for 3 days. Residual leukemic cell lines (CD451′CD33+) were counted by FACS for each target cell.
The CD4IL-10 cells selectively killed the myeloid leukemia cells (ALL-CM) as shown in
CD4IL-10 Cells Suppress the Proliferative Responses of Both Allogeneic CD4+ and CD8+ T Cells
The CD4IL-10 cells were also analyzed for their effects on allogeneic CD4+ T cells or CD8+ T cells. Specifically, allogeneic PBMC cells were labeled with eFluor® 670 (105 cells/well) and stimulated with allogeneic mature dendritic (DC) cells (5×104 cells/well) and soluble anti-CD3 mAbs in the absence or presence of CD4IL-10 cells (105 cells/well) at a 1:1 Responder:Suppressor ratio. After 4 days of culture, the percentages of proliferating responder cells were determined by eFluor® 670 dilution with flow cytometry after gating on CD4+ΔNGFR− T cells or CD8+ΔNGFR− T cells.
The results demonstrated that CD4IL-10 cells from 6 different donors, unpooled and tested separately, downregulated the proliferative responses of both allogeneic CD4+ and CD8+ T cells. The suppressive effects on the CD4+ T-cells varied between 51% and 96%, while the suppressive effects on the CD8+ T-cells varied between 62% and 73%.
CD4IL-10 cells were generated as described above and
Poly-Donor CD4IL-10 Cells have a Cytokine Production Profile which is Comparable to that of CD4Il-10 Cells of Individual Donors and Tr1 Cells.
Culture supernatants were collected and levels of IL-10, IL-4, IL-5, IFN-γ and IL-22 were determined by ELISA. The results provided in
The poly-donor CD4IL-10 cells were further analyzed after 3rd round (TF3) of restimulation for expression of granzyme B (GzB). The data in
The CD4IL-10 cells from 3rd round (TF3) of restimulation were further analyzed for their cytotoxic effects on myeloid leukemia cells (ALL-CM cell line) or K562. The poly-donor CD4IL-10 cells (105/well) were co-cultured with K562 and ALL-CM cells (105/well) at 1:1 ratio for 3 days. Residual leukemic cell lines (CD45lowCD33+) were counted by FACS for each target cell. The results provided in
Poly-Donor CD4IL-10 Cells Suppress the Proliferative Responses of Both Allogeneic CD4+ and CD8+ T cells.
The poly-donor CD4IL-10 cells were also analyzed for their effects on allogeneic CD4+ T cells or CD8+ T cells. Specifically, allogeneic PBMC cells were labeled with eFluor® 670 (105 cells/well) and stimulated with allogenic mature dendritic (DC) cells (5×104 cells/well) and soluble anti-CD3 mAbs in the absence or presence of poly-donor CD4IL-10 cells (105 cells/well) at a 1:1 Responder:Suppressor ratio. After 4 days of culture, the percentages of proliferating responder cells were determined by eFluor® 670 dilution with flow cytometry after gating on CD4+ΔNGFR− T cells and CD8+ΔNGFR− T cells.
Collectively the data obtained with poly-donor CD4IL10 cells indicate that these cell preparations can be pooled without any problems. They contain >95% viable cells and maintain all the relevant functions (cytokine production, cytotoxic capacity, and suppression of allogeneic T cell responses) of single donor CD4IL-10 cells. The use of larger pools of poly-donor CD4IL-10 cells should reduce the natural variations observed between CD4IL-10 cell lots originating from different individual donors, and should provide a large quantity of off-the-shelf CD4IL-10 cells for human therapy.
A poly-donor CD4IL-10 cell product will have significant advantages in terms of a more homogeneous product which will allow the determination of well defined, less lot-to-lot variation, potency, and release criteria. In addition, it will enable the development of a continuous large-scale cell production process.
Before the lentiviral transduction, buffy coats from minimally 3-5 different donors are pooled. CD4+ cells are isolated from buffy coats by positive selection using anti-CD4 antibody. Purity of the pooled CD4+ cells is checked by FACS. Alternatively, frozen human CD4+ cells are obtained from minimally 3-5 normal healthy donors. The frozen human CD4+ cells are thawed before use. CD4+ cells from buffy coats or frozen stocks are activated for 24-48 hrs by a combination of CD3 and CD28 antibodies or CD3− and CD28 antibody coated beads in the presence of IL-2. In some cases, CD4+ cells from buffy coats or frozen stocks are activated with soluble anti-CD3, soluble anti-CD28 mAbs, and rhlL-2 (50 U/mL) for 48 hours and transduced with a bidirectional lentiviral vector encoding for human IL-10 as described above for production of CD4IL-10 cells.
In some cases, the HLA haplotype of the T cell donors (or CD4+ cells isolated from the donors) are first determined and CD4+ cells having desired HLA haplotypes are selectively pooled and used.
Poly-donor CD4IL-10 cells are generated by transducing the activated CD4+ cells described above with the lentiviral vector containing human IL-10 and ΔNGFR coding sequences described above.
On Day 7-11, which is 5-9 days after the transduction, the cells are harvested and successfully transduced T cells purified utilizing an anti-NGFR antibody. This process generally results in 95% pure populations of poly-donor CD4IL-10 cells.
The purified poly-donor CD4IL-10 cells are counted and re-stimulated by a mixture of CD3− and CD28 antibodies, CD3− and CD28 antibody coated beads, optionally in the presence of feeder cells for another 8-10 days in the presence of IL-2. In some cases, the purified poly-donor CD4IL-10 cells are re-stimulated in the presence of feeder cells.
After a total culture period of 14-18 days, CD4IL-10 cells are harvested, counted and tested for their capacity to produce IL-10 spontaneously or following activation with CD3 and CD28 antibodies or CD3 and CD28 antibody coated beads. Additionally, the levels of GrzB and perforin are measured. Their capacity to suppress human T cell (PBMC) and purified CD4+ and CD8+ T cell proliferation are also tested.
In addition, the production of IL-22 is measured both constitutively and following activation of 200,000 CD4IL-10 cells in a volume of 200 microliter using a combination of CD3 and CD28 antibodies as described previously for the production of other cytokines such as IFNγ, IL-10, IL-4 and IL-5. IL-22 production levels are measured in IL-22 specific ELISA as described for the other cytokines in WO2016/146542. The pooled CD4IL-10 cells are frozen before storage.
6.8.2. Example 2: Treatment or Prevention of GvHD Using Poly-Donor CD4IL-10 Cells
A population of poly-donor CD4IL-10 cells were tested in a humanized xeno GvHD disease model, an NSG mouse model, for their effect on GvHD induced by human PBMC as illustrated in
The presence of human CD4IL-10 cells were also tested in the spleen (
Poly-Donor CD4IL-10 Cells Inhibit Severe Xeno GvHD by Purified CD4+ Cells.
Poly-donor CD4IL-10 cells were tested in a humanized xeno GvHD model in which GvHD disease was induced by administration of 2.5×106 purified human CD4+ T cells as illustrated in
Therapeutic effects of the poly-donor CD4IL-10 cells are tested in four different groups of mice: (i) mice receiving human PBMC from a donor unrelated to the CD4IL-10 cells (GvHD positive control); (ii) mice receiving the poly-donor CD4IL-10 cells (negative control); (iii) mice receiving a combination of PBMC and the poly-donor CD4IL-10 cells at 1:1 ratio; and (iv) mice receiving a combination of PBMC and the poly-donor CD4IL-10 cells at 2:1 ratio or at different ratios. Among animals receiving combination of PBMC and the poly-donor CD4IL-10 cells, some animals receive PBMC and the poly-donor CD4IL-10 cells concurrently, some animals receive poly-donor CD4IL-10 cells several days (e.g., 5 days) after receiving PBMC, and some animals receive poly-donor CD4IL-10 cells several days (e.g., 5 days) before receiving PBMC.
The mice are monitored for development of GvHD by measuring weight at weeks 1, 2, 3, 4, and if necessary week 5, after administration of PBMC and/or the poly-donor CD4IL-10 cells. In addition to weight loss, the mice will be inspected for skin lesions, fur condition and activity. The mice in the treatment groups are monitored for additional periods to determine effects of the poly-donor CD4IL-10 cells on long term survival.
The amount and localization of the poly-donor CD4IL-10 cells are also monitored in peripheral blood and tissues after administration. Specifically, presence of poly-donor CD4′ to cells are monitored in peripheral blood and at sites of inflammation: lymph nodes, spleen, gut, and bone marrow. The mice in the treatment group(s) are monitored for an additional 3 weeks to determine long-term survival.
The results demonstrate that poly-donor CD4IL-10 cells are effective in reducing and preventing xeno-GvHD.
6.8.3. Example 3: Inhibition of GvHD and Treatment of Cancer
A population of poly-donor CD4IL-10 cells are tested in an NSG mouse model transplanted with human PBMC and AML tumor cells for their effect on xeno-GvHD induced by human PBMC and anti-tumor effects. AML cells (ALL-CM) are administered i.v. as described previously in WO 2016/146542. PBMC or poly-donor CD4IL-10 cells or combinations thereof are administered 3 days later.
Poly-donor CD4IL-10 cells are obtained as described in Example 1. Therapeutic effects of the poly-donor CD4IL-10 cells are tested in four different groups of mice, each having received irradiation and 5×106 ALL-CM cells (AML mice) at day 0: (i) AML mice without additional treatment; (ii) AML mice receiving 5×106 human PBMC from a donor unrelated to the poly-donor CD4IL-10 cells—the PBMCs cause severe xeno-GvHD; (iii) AML mice receiving 2.5×106 poly-donor CD4IL-10 cells; and (iv) AML mice receiving combinations of PBMC and the poly-donor CD4IL-10 cells at 1:1 or 2:1 ratio or at different ratios. One additional group of mice do not receive ALL-CML cells but receive 5×106 human PBMC at day 3 after irradiation.
Effects of the poly-donor CD4IL-10 cells on xeno-GvHD induced by human PBMC are tested based on weight loss, skin lesions, fur condition, activity, death rate and long-term survival. Anti-tumor or graft versus leukemia (GvL) effects of the poly-donor CD4IL-10 cells are tested based on reduction of tumor cells in the circulation and long-term tumor free survival.
Some mice are monitored for up to 7 weeks in order to monitor long-term survival and complete tumor remissions.
Results demonstrate that poly-donor CD4IL-10 cells are effective in both inhibition of xeno-GvHD and treatment of cancer.
6.8.4. Example 4: Treatment of Cancer Using Poly-Donor CD4IL-10 Cells
A population of poly-donor CD4IL-10 cells are tested in an ALL-CM leukemia model of T cell therapy in NSG mice.
NSG mice were sub-lethally irradiated and intravenously injected with myeloid leukemia cells (ALL-CM) (5×106) at day 0. In the first group of animals, PBMC (5×106) or single donor (from donor BC-I and donor BC-H) CD4IL-10 cells (2.5×106) were injected at day 3. In the second group of animals, PBMC (5×106) or poly-donor CD4IL-10 cells (2.5×106) were injected at day 3. Graft-versus-leukemia (GvL) effect was tested in the animals based on reduction of circulating leukemia cells and long-term leukemia free survival. Leukemia was measured as previously described (Locafaro G. et al Molecular Therapy 2017).
As provided in
Graft-versus-leukemia (GvL) effects of single-donor CD4IL-10 and poly-donor CD4IL10 were further tested in combination with PBMC in mice injected with ALL-CM myeloid leukemia cells. Administration of 5×106 PBMC resulted in a strong inhibition of leukemia progression and administration of 5×106 PBMC combined with single donors CD4IL10 (2.5×106) had synergistic effect (
6.8.5. Example 5: Treatment of Chronic Inflammatory and Autoimmune Diseases Using Poly-Donor CD4IL-10 Cells
Activation of the NLPR3 inflammasome has been implicated in many chronic inflammatory and autoimmune diseases. The NLPR3 inflammasome can be activated by “danger signals” which lead to caspase1-mediated production of the pro-inflammatory cytokines IL-1β and IL-18 by monocytes/macrophages. A series of in vitro experiments are performed to investigate the effects of poly-donor CD4IL-10 cells on the NLPR3 inflammasome and IL-1 PAL-18 production by human monocytes.
First, human PBMC are isolated from peripheral blood by standard density centrifugation on Ficoll/Paque (Sigma-Aldrich). Monocytes are isolated from the human PBMC by negative selection using monocyte isolation kit II (Miltenyi) according to the manufacturer's instructions. Negative selection is preferred because positive selection or adherence can lead to undesired activation of the cells. Isolated monocytes are plated at 5×104 cells/200 μl in the presence of 2×105 or 1×105 poly-donor CD4IL-10 cells/200 μl per well in 96-well microtiter plates in culture medium containing 3% toxin free human AB serum.
Table 1 summarizes treatment conditions applied to 17 sets of monocytes, each set including 6 wells of cells. It is known that LPS alone can activate human monocytes without a second signal provided by ATP.
After treatments outlined in Table 1, supernatants are collected from 6 wells for each group and IL-1β/IL-18 production is measured by ELISA specific for mature IL-1β or IL-18 (Biolegend). Cells collected from 6 wells for Group #3, 10, 13, 14, and 17 are analyzed by Western Blot to determine levels of activated caspase 1.
Data from the experiments show that poly-donor CD4IL-10 cells down-regulate IL-1β and IL-18 production by activated monocytes. They further show that poly-donor CD4IL-10 cells down-regulate mature caspase-1 production in activated monocytes. Additionally, poly-donor CD4IL-10 and IL-10 produced by the poly-donor CD4IL-10 down-regulate inflammasome.
Similar experiments are performed with human macrophages or dendritic cells instead of monocytes. Results from the experiments demonstrate that poly-donor CD4IL-10 cells further down-regulate IL-1β, IL-18, and mature caspase-1 production from activated macrophages and dendritic cells.
These suggest that poly-donor CD4IL-10 cells can be used to treat diseases or disorders involving hyperactivation of NLPR3 inflammasome. In particular, poly-donor CD4IL-10 cells can be used to treat chronic inflammatory and autoimmune diseases. The NLPR3 inflammasome can be activated by exogenous or endogenous “danger signals”, such as Pathogen Associated Molecular Patterns (PAMPs), silica, asbestos, Danger Associated Molecular Patterns (DAMPs) like products from damaged mitochondria, necrotic and stressed cells, and uremic acid crystals.
6.8.6. Experimental Methods and Materials
Cell preparation and cell lines. Peripheral blood mononuclear cells (PBMC) were prepared by centrifugation over Ficoll-Hypaque gradients. CD4+ T cells were purified with a CD4 T cell isolation kit (Miltenyi Biotec, Bergisch Gladbach, Germany) with a resulting purity of >95%. Mature dendritic cells (DC) were generated from peripheral blood CD14+ monocytes positively selected using CD14+ MicroBeads (Miltenyi Biotech, Germany) according to the manufacturer's instructions and cultured in RPMI 1640 (Lonza, Italy) supplemented with 10% fetal bovine serum (FBS; Lonza, Italy), 100 U/mL penicillin/streptomycin (Lonza, Italy), 2 mM L-glutamine (Lonza, Italy), at 37° C. in the presence of 10 ng/mL recombinant human (rh) IL-4 (R&D Systems, Minneapolis MN, USA) and 100 ng/mL rhGM-CSF (Genzyme, Seattle, WA, USA) for 5 days and matured with 1 mg/mL of lipopolysaccharide (LPS, Sigma, CA, USA) for an additional two days.
Plasmid construction. The coding sequence of human IL-10 was excised from pH15C (ATCC n° 68192), and the 549 bp fragment was cloned into the multiple cloning site of pBluKSM (Invitrogen) to obtain pBluKSM-hIL-10. A fragment of 555 bp was obtained by excision of hIL-10 from pBluKSM-hIL-10 and ligation to 1074.1071.hPGK.GFP.WPRE.mhCMV.dNGFR.SV40PA (here named LV-ΔNGFR), to obtain LV-IL-10/ΔNGFR. The presence of the bidirectional promoter (human PGK promoter plus minimal core element of the CMV promoter in opposite direction) allows co-expression of the two transgenes (Locafaro et al. Mol Ther. 2017; 25(10):2254-2269). The sequence of LV-IL-10/ΔNGFR was verified by pyrosequencing (Primm).
Vector production and titration. VSV-G-pseudotyped third generation bidirectional lentiviral vectors were produced by Ca3PO4 transient four-plasmid co-transfection into 293T cells and concentrated by ultracentrifugation as described (Locafaro et al. Mol Ther. 2017; 25(10):2254-2269). Titer was estimated by limiting dilution, vector particles were measured by HIV-1 Gag p24 antigen immune capture (NEN Life Science Products; Waltham, MA), and vector infectivity was calculated as the ratio between titer and particle. Titers ranged from 5×108 to 6×109 transducing units/mL, and infectivity from 5×104 to 105 transducing units/ng of p24.
Generation of CD4IL-10 cell lines. Polyclonal CD4-transduced cells were obtained as previously described (Andolfi et al. Mol Ther. 2012; 20(9):1778-1790). Briefly, CD4 purified T cells were activated for 48 hours with soluble anti-CD3 monoclonal antibody (mAb, 30 ng/mL, OKT3, Janssen-Cilag, Raritan, NJ, USA), anti-CD28 mAb (1 μg/mL, BD) and rhlL-2 (50 U/mL, PROLEUKIN, Novartis, Italy). T cells were transduced with LV-IL-10/ΔNGFR (CD4IL-10) with multiplicity of infection (MOI) of 20. At day 11, CD4+ΔNGFR+ cells were beads-sorted using CD271+ Microbeads (Miltenyi Biotec, Bergisch Gladbach, Germany) and expanded in X-VIVO15 medium with 5% human serum (BioWhittaker-Lonza, Washington), 100 U/mL penicillin-streptomycin (BioWhittaker), and 50 U/mL rhlL-2 (PROLEUKIN, Novartis, Italy). At day 7 and 10, medium was replaced by fresh medium supplemented with 50 U/mL of rhlL-2. At day 14, cells were collected, washed, and restimulated with allogeneic feeder mixture as previously described (Andolfi et al. Mol Ther. 2012; 20(9):1778-1790). After 14 days, cells were collected and frozen. Thawed CD4IL-10 cells were restimulated and after the 2nd and 3rd re-stimulation and expansion were functionally characterized in vitro and used for in vivo experiments.
Vector Copy Number Analysis. Cells were cultured for at 11 days after transduction in order to get rid of non-integrated vector forms. Genomic DNA was isolated with QIAamp DNA Blood Mini Kit (QIAGEN, 51106), according to the manufacturer's instructions. Vector integrations were quantified by QX200 Droplet Digital PCR System (Bio-Rad), according to the manufacturer's instructions.
Cytokine determination. To measure cytokine production, after 2nd and 3rd re-stimulation single donor and poly-donor CD4IL-10 cells were left unstimulated or stimulated with immobilized anti-CD3 (10 μg/mL) and soluble anti-CD28 (1 μg/mL) mAbs in a final volume of 200 μl of medium (96 well round-bottom plates, 2×105/well). Supernatants were harvested after 48 hours of culture and levels of IL-10, IL-4, IL-5, IFN-γ and IL-22 were determined by ELISA according to the manufacturer's instructions (BD Biosciences).
Flow cytometry analysis. For the expression of Granzyme B (clone MHGB04, Invitrogen, USA) after surface staining with CD4, CD4IL-10 cells were fixed, permeabilized, and stained using the BD Cytofix/Cytoperm™ Kit according to the manufacturer's instructions (Cat. No. 554714, Biolegend, USA). Stained cells were washed two times with PBS supplemented with 1% FBS and analysed with a BD LSRFortessa analysed utilizing FlowJo 10 software.
Killing assays. After 2nd and 3rd re-stimulation, cytotoxicity of single-donor and poly-donor CD4IL-10 cells was analysed in co-culture experiments. Briefly, non-myeloid leukemia and a myeloid leukemia cell lines, K562 and ALL-CM respectively, were used as target cells and plated with CD4IL-10 cells at 1:1 ratio (105 target cells and 105 CD4IL-10 cells) for 3 days. At the end of co-culture, cells were harvested and K562 and ALL-CM cells were analysed and counted by FACS.
Suppression assays. To measure the suppressive capacity of single donor and poly-donor CD4IL-10 cells, allogeneic PBMC were labeled with Cell Proliferation Dye eFluor® 670 (Invitrogen, CA, USA), according to manufacturer's instructions prior to stimulation with allogeneic mature DC (5×104 cells/well) and soluble anti-CD3 (50 ng/mL) mAb. PBMC and suppressor cells were added at a 1:1 ratio (105 PBMC and 105 CD4IL-10 cells). After 3 days of culture, proliferation of responder cells was determined by analyzing the eFluor670 dilution of CD4+ΔNGFR− or CD8+ΔNGFR− T cells by FACS.
Graft-versus Host Disease models: In all experiments 6/8 week-old female NSG mice were used. On day 0 mice received total body irradiation with a single dose of 175-200 cGy from a linear accelerator according to the weight of the mice, and were intravenously with PBMC cells (5×106), or CD4IL-10 cells (single-donors or poly-donor—pool of three donors—5×106 or 2.5×106), or with PBMC (5×106) in combination with CD4IL-10 cells (5×106 or 2.5×106). Survival, weight loss, activity, fur, skin, and hunch were monitored at least 3 times per week as previously described (Bondanza et al. Blood. 2006; 107(5):1828-1836). Mice were euthanized for ethical reasons when their loss of bodyweight was 20%.
Alternatively, on day 0 mice received total body irradiation as above. On day 3 mice were injected with CD4+ T cells (2.5×106), single and poly-donor (pool of three donors) CD4IL-10 cells (2.5×106), or CD4+ T cells (2.5×106) in combination with single and poly-donor (pool of three donors) CD4IL-10 cells (2.5×106). GvHD induction was monitored as indicated above.
All publications, patents, patent applications and other documents cited in this application are hereby incorporated by reference in their entireties for all purposes to the same extent as if each individual publication, patent, patent application or other document were individually indicated to be incorporated by reference for all purposes.
While various specific embodiments have been illustrated and described, the above specification is not restrictive. It will be appreciated that various changes can be made without departing from the spirit and scope of the invention(s). Many variations will become apparent to those skilled in the art upon review of this specification.
Number | Date | Country | Kind |
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US20/40372 | Jun 2020 | US | national |
The instant application claims priority to PCT application, PCT/US2020/040372 filed on Jun. 30, 2020, which has been incorporated by reference in its entirety herein.
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/039464 | 6/28/2021 | WO |