The present invention relates to the field of treatment of proliferative disorders, in particular treatment of tumours such as glioblastoma, by administration of prolactin receptor antagonists.
Glioblastomas (ICS; C71.0-C71.9, D43.2) are the most common and the most aggressive primary brain tumors in humans. The incidence is 2-3 cases/100 000 individuals. Treatment involves surgery, chemotherapy and radiation. Without treatment the mean survival time is 4.5 months and with current treatments available this can be extended to 15 month. Because of the severity of the disease, one has tried to find new drugs to treat glioblastomas and this work has e.g. included the identification growth promoting receptors and key signalling systems as well as the search for agents that can block such receptors. As one example one has attempted to block the receptor for platelet derived growth factor (PDGF) and another example concern blocking agents of angiogenesis. Hyper proliferation of glia cells can also be seen in the condition of tuberous sclerosis (ICD Q 85.1) a genetic disease caused by a loss of function of TSC1/TSC2 that regulate the mTOR system.
Prolactin (Prl) is a hormone produced in the pituitary gland. Prl circulates in the blood stream and influences target tissue by binding to a prolactin receptor. A majority of studies on Prl concern actions of tissues outside of the central nervous system (CNS) e.g. breast, prostate and ovary. The existence of a blood brain barrier is considered to prevent entry of Prl into the CNS because of the size of Prl (around 200 amino acids) but it is possible that specific transport systems exist or that Prl can be synthetized within the CNS. There are however relatively few studies in the literature on the Prl system in the brain. There are reports suggesting that Prl receptors are present in glioblastomas (Soares Leaes et al., 2007) and studies also show that addition of Prl stimulates uptake of calcium and proliferation of cancer cells (Ducret et al., 2002, Oliveira-Ferrer et al., 2013). However, a vast amount of receptor types are expressed on glioblastoma cells and therefore the mere presence of Prl receptor per se does not provide any guidance as to its function on glioblastomas.
The present inventors have demonstrated that Prl receptors exist on cultured glioblastoma cells and that addition of exogenous Prl stimulates growth of these cells. Surprisingly, the present inventors also found that Prl receptor antagonists reduce cellular growth. Exposure of glioblastomas for prolactin receptor antagonist provides a novel treatment of glioblastomas.
In a first aspect, the invention concerns a prolactin receptor antagonist for use in the treatment of a neoplasm of the brain and/or spinal cord of a mammal.
In another aspect the invention concerns a method of treatment of glioblastomas of a mammal in need thereof, the method comprising the steps of:
a) obtaining tissue samples of a glioblastoma, and
b) analyzing said sample for presence of Prl receptors,
c) comparing said sample to a control sample from healthy tissue,
d) determining sensitivity of the mammal to treatment with a prolactin receptor antagonist according to any one of the preceding claims,
e) administering a therapeutically effective amount of said prolactin receptor antagonist defined in any one of the preceding claims.
In another aspect the invention concerns a method of inducing cell death in a tumor cell expressing a prolactin receptor, said method comprising administering a prolactin receptor antagonist to a patient diagnosed with a neoplasm of the brain or spinal cord.
In another aspect the invention concerns a method of inhibiting growth and/or invasion and/or proliferation of tumor cells, the method comprising administering a prolactin receptor antagonist to a patient in need thereof.
The glioblastoma cell line U343MG was tested for prolactin receptor expression using Western blot technique. Expression of Prl receptors were tested in two condition, 10% FCS (NTC) and serum free (S). Three cell lines; U343 MGa, U251 MG were tested for the presence of Prl receptors by Western blot using the antibody (clone 1A2B1, Life Technologies). Antibodies directed against the human Prl receptor detected at least two protein bands of which the larger form (90 kD) is assumed to be the full length receptor. It can be seen that Prl receptors are detectable in glioblastoma cells.
Because of the substantial effect of blocking Prl signals on glioblastoma cell growth we claim the use of Prl receptor antagonists for the treatment of glioblastomas. Gliomas are tumors in the brain and spinal cord and glioblastoma tumors can be sub-classified as Astrocytic tumors, Oligodendroglial tumors, Ependymal cell tumors, Mixed gliomas, Neuroepithelial tumors of uncertain origin, Tumors of the choroid plexus, Neuronal and mixed neuronal-glial tumors, Pineal Parenchyma Tumors and Tumors with neuroblastic or glioblastic elements (embryonal tumors). Glioblastomas can also be described based on genetic aberrations and they can also feature stem cell like properties. Tuberosclerosis is not a malignant tumor but this genetic disease has a market feature of glia proliferation.
The prolactin receptor antagonists can either be a monoclonal antibody or ligand based antagonists, optionally modified to change its half-life. In both cases the activation of the Prl receptors is interfered with and a well described activation mechanism is receptor dimerization meaning that two receptors form dimers that activate intracellular signalling systems including the JAK-STAT pathway. The present invention can be practised using different types of Prl receptor antagonists. In one embodiment the antagonists are so called ligand based antagonists using Prl as a back bone, Such antagonist have certain advantages in terms of manufacture, molecular size and may in fact pass the blood brain barrier because their similarity to native Prl. The features of ligand based antagonists include a high affinity for Prl receptor while receptor dimerization is blocked and this defines a class of substances that are useful in the practice of the present invention. This class of substances include the modified Prl designated as Prl Δ1-9 S33A, Q73L, G129R, K190R. This variant has the sequence of native human Prl, Seq ID No1, with the exception that the first 9 amino acids have been deleted and that amino acids in positions 33,73,129 and 190 have been exchanged for A,L,R,R respectively, Seq ID No2. Other Prl modifications of the amino acid sequence in Prl can be made to convert Prl into an antagonist that prevent Prl receptor dimerization and such changes are all within the scope of the present invention if they .lead to substances blocking the Prl receptor.
The Prl receptor antagonists in this invention are so called biological pharmaceuticals composed of specific amino acid sequences. Such agents can be produced using recombinant technologies where genes encoding the desired protein sequences are inserted into a host system that will produce the protein. Commonly used hosts are bacteria and eukaryotic cells. In one embodiment the host for production of the Prl receptor antagonist used in this invention is E. coli but also human eukaryotic cells can be used.
One practice of the present invention is therefore to isolate or synthetize the cDNA encoding human Prl with the modifications required to convert Prl into an antagonist as described above. This gene is inserted into E. coli using a vector that allows the gene to be transcribed and translated into protein. The protein, purified from bacterial extracts, should then be appropriately formulated to become a biopharmaceutical for treatment of glioblastomas.
In the case of monoclonal antibodies, cell clones are isolated that produce antibodies that block Prl receptors, such cells can be expanded and used as a source to purify monoclonal antibodies.
In one embodiment a blocking monoclonal antibody can be used. Such antibodies shall bind the Prl receptor and they may have some sequence similarity to the binding of Prl to its receptor. It is therefore possible to use the information stated above to create antibody-like molecules blocking the Prl receptor. Alternatively it is possible to screen for new antibodies. The reagents needed for screening is a recombinant E. coli produced Prl receptor consisting of cDNA encoding the extra cellular domain of the receptor. It is also required to have access to recombinant or purified Prl in order to set up an assay measuring binding of Prl to its receptor. Such assays can be designed in many different ways. There are also different methods to screen for monoclonal antibodies. One principle has been to create monoclonal antibodies in animals using the immune response to identify antibodies interfering with Prl binding and they “humanize” an isolated antibody using techniques of molecular biology. An alternative is to directly screen a library consisting of human antibody genes which can be expressed and tested for blocking the binding between Prl and the Prl receptor.
In one embodiment, Prl receptor gene expression is silenced using anti-sense DNA or siRNA. The design of such molecules originates from the Prl receptor gene sequence: Prolactin receptor (PrlR) NCBI gene ID 5618. Procedures to silence gene expression of the Prl receptor include the use of anti-sense DNA, siRNA or microRNA. Delivery of such gene silencing reagents can include viral or chemical transfection procedures.
In the field of protein therapy it is well known that the excipient is of large value to preserve stability, shelf life and bioactivity. The present invention therefore includes the use of different excipients ranging from amino acids e.g. glycine to carbohydrates e.g. mannitol that can be used to formulate the antagonist in an acceptable formulation to be injected into a living organism.
The present invention concerns treatment of subjects with glioblastomas with a Prl receptor antagonist and such treatments include different modes of administration. The antagonist can be administered via any suitable route such as by subcutaneous injections but it can also be by intravenous or intra-thecal delivery or directly onto the tumor site. The amount to be injected will vary but should be sufficient to block Prl receptors.
A factor of significance is further the pharmacokinetic profile of the biopharmaceutical to be injected. There are different means to change the half-life of proteins and a commonly used procedure is to PEGylate the protein of interest. An alternative it is create conjugates to albumin or to fuse the protein of interest to the FC portion of antibodies. In the case of Prl receptor antagonists for treatment of glioblastomas the need to change half-life will depend on the route of administration and the type of tumor to be treated.
In one embodiment the antagonist is subcutaneously injected into a patient with a glioblastoma but other modes of delivery can be considered including intravenous, intrathecal and directly on the tumor site. The dose of treatment can vary between e.g. 1-300 mg/day such as 10-30 mg/day. In one embodiment the drug composition is formulated as a lyophilized powder reconstituted before injection. The duration of treatment will also vary and is likely to be individually determined by the treating doctor. One key determinant is how the tumor size is affected by the treatment which can be determined by using different imaging techniques in standard clinical use.
It is also to be stated that treatment using the Prl receptor antagonist may be combined with other drugs for the treatment of glioblastomas and that combination treatment can improve the treatment outcome. Prl receptor antagonists affect a specific signalling pathway that does not overlap with other pathways. Therefore drugs affecting other pathways of relevance for glioblastoma treatments can be combined with treatments using a Prl receptor antagonist. Examples of such treatments include compounds affecting signals related to PDGF, EGF, angiogenic factors, kinase inhibitors such as staurosporine and mitogenic blockers such as Docitaxel.
The above mentioned antagonist, Prl Δ1-9 S33A, Q73L, G129R, K19OR (SEQ ID NO. 13): works by blocking Prl receptor dimerization but the ability to do this is not unique to this specific molecule. In fact other molecules e.g. monoclonal antibodies block Prl receptors in a similar manner and principally one can also use low molecular weight compounds to block the Prl receptor although such are not available yet. It is also possible to reduce the level of Prl receptor gene expression and for this the terms siRNA or antisense DNA are well known for persons skilled in the art. In terms of reducing growth of glioblastomas we predict that any substance with the ability to block Prl receptors will have similar effects. Therefore any substance blocking the Prl receptor can be used to affect glioblastoma growth. In one embodiment the use of a ligand based antagonist is Prl Δ1-9 S33A, Q73L, G129R, K19OR (SEQ ID NO. 13), optionally modified to increase its half-life when injected into an organism. The means to extend half-life of proteins can be PEGylation or linking the protein to albumin but other methods are known to persons skilled in the art. In the particular case of treating brain tumors it is essential to reach a sufficiently high concentration at the site of the tumor. Mechanisms to transport Prl into the CNS may be the function of Prl receptor levels in the choroid plexus and therefore ligand based Prl receptor antagonists may enter CNS via such receptors
In certain embodiments, the present invention is as described in the claims as originally filed.
Human Prl cDNA was obtained from commercial sources (Sino Biological Inc., Beijing China). The amino acid sequence in Prl cDNA was then be altered by site directed mutagenesis by using kits available from several vendors. The entire cDNA sequence can also be synthetized using services from e.g. Cambridge Bio Science. Ltd (Cambridge UK). The cDNA sequence encoding the polypeptide Prl Δ1-9 S33A, Q73L, G129R, K19OR (SEQ ID NO: 9) was put into a bacterial expression vector pNIOC28-Bsa4. Following introduction into E. coli (DH5 alpha). Other vectors can also be used. The His tagged protein was purified using Ni columns. Alternative modes of purification with or without purification tags can be utilized.
Human glioblastoma cells can be obtained from different sources including ATCC. The tested cell line were shown to express Prl receptors using both Western blots and immunohistochemistry and both methods are well established procedures to detect Prl receptors. A prerequisite for the tumors to respond to Prl receptor antagonist treatment is the presence of Prl receptors on tumor cells or on adjacent cells. As demonstrated in
The read-out to measure proliferation in this case was based on the ability of crystal violet to stain cells but other techniques to measure cell proliferation can be used. The experiment in
Surprisingly, the effect of blocking Prl was most dramatic in the presence of fetal calf serum (FCS) as demonstrated in
In terms of signals that are Prl dependent in glioblastoma cells, we found that addition of exogenous Prl activates (phosphorylates) the JAK-STAT5 pathway and that this effect is blocked by the Prl receptor antagonist (
Whole cell lysates were separated in SDS/PAGE gels and transferred to polyvinylidenediflouride (PVDF) membranes (Millipore). After blotting membranes were blocked in 5% non-fat skim milk or BSA (Sigma) in Tris-Buffered Saline (TBS) containing 0.1% Tween 20. Membranes were incubated with one or more of the following antibodies; PrlR antibody clone 1A2B1 (Invitrogen Thermo Ficher Scientific Waltham Mass.)). Antibodies to detect phosphorylated and un-phosphorylated STAT5 and STAT3 were obtained from Cell Signalling Technology (Danvers Mass.). For loading control, antibodies detecting GAPDH were used. Horse-radish peroxidase (HRP) conjugate secondary antibodies (Cell Signalling or Santa Cruz) were used for detection. Membranes were visualized with the ECL Western blotting detection system (Pierce) according to the manufacturer's instruction or Amersham ECL Prime Western Blotting Detection Reagent from GE healthcare. In essence we think that we have identified a model system where Prl receptor antagonists can be studied and that blocking of Prl receptors have a future medical utility for the treatment of glioblastomas.
A 45-year-old man suffers from fatigue, morning headache and slurred speech. In the medical center, MRI identifies a froto-parietal lesion with edema in the right hemisphere. The patient is transferred to the neurosurgery department where the lesion is steriotactically removed resulting in subtotal resection of the lesion. Subsequent pathological analysis reveal a glioblastoma multiformi (GMB).
Immunohistochemistry is also performed to analyse several markers for GMB. This analysis also include the analysis of the prolactin receptor which is found to be elevated.
In the post-operative phase the patient respond poorly to conventional medication for which reason a treatment with a prolactin receptor antagonist is initiated. The Prl receptor antagonist is injected subcutaneously at daily intervals using a single loading dose of 40 mg followed by daily injections of 10 mg. The patient is monitored regularly and clear signs of a reduced tumor expansion is subsequently demonstrated.
A tissue micro array (TMA) was purchased from Biomax Inc (Rockville, Md. 20850, USA). This TMA contains samples (histological sections) from 78 different cases of brain tumors (glioblastomas, astrocytomas, ependymomas, oligo-astrocytomas medulloblastoma and oligodentrogliomas). Immunohistochemistry was conducted to detect the human Prl receptor and demonstrated that the receptor was detectable in different types of brain tumors. The experiment thus shows that the Prl receptor is expressed in different forms of human brain tumors and is a suitable target for Prl antagonists of the present invention.
The glioblastoma cell line U251 MG was starved overnight. Prolactin (200 ng/ml) was added over night with or without simultaneous addition of the Prl receptor antagonist (SEQ ID NO: 13; 200 ng/ml) and control cells were exposed to vehicle. The invasive properties of tumor cells were analyzed using CytoSelect™ Cell Invasion Assay kit (Cell Biolabs, Inc., San Diego, Calif.), according to the manufacturer's instructions. The optical density of stained invading cells were measured at 560 nm. The invasive properties of human U251 MG cells cells were increased by the addition of hPrl and the increased invasion was blocked by a simultaneous addition of the Prl receptor antagonist. Under the conditions used, the high affinity PrlR antagonist added on its own did not affect cell invasion (see Table 1/
SEQ ID NO. 1: Human Prolactin Receptor (PrlR)
SEQ ID NO. 2: Human Prl including signal peptide (wild-type)
SEQ ID NO. 3: Human mature Prl (wild-type)
SEQ ID NO. 4: Human mature Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 5: Human N-terminally truncated (Δ1) Prl (mutated 533A , Q73L, G129R, K190R)
SEQ ID NO. 6: Human N-terminally truncated (Δ1-2) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 7: Human N-terminally truncated (Δ1-3) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 8: Human N-terminally truncated (Δ1-4) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 9: Human N-terminally truncated (Δ1-5) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 10: Human N-terminally truncated (Δ1-6) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 11: Human N-terminally truncated (Δ1-7) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 12: Human N-terminally truncated (Δ1-8) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 13: Human N-terminally truncated (Δ1-9) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 14: Human N-terminally truncated (Δ1-10) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 15: Human N-terminally truncated (Δ1-11) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 16: Human N-terminally truncated (Δ1-12) Prl (mutated 533A, Q73L, G129R, K190R)
SEQ ID NO. 17: Human mature Prl (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 18: Human N-terminally truncated Prl (Δ1) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 19: Human N-terminally truncated Prl (Δ1-2) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 20: Human N-terminally truncated Prl (Δ1-3) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 21: Human N-terminally truncated Prl (Δ1-4) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 22: Human N-terminally truncated Prl (Δ1-5) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 23: Human N-terminally truncated Prl (Δ1-6) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 24: Human N-terminally truncated Prl (Δ1-7) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 25: Human N-terminally truncated Prl (Δ1-8) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 26: Human N-terminally truncated Prl (Δ1-9) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 27: Human N-terminally truncated Prl (Δ1-10) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 28: Human N-terminally truncated Prl (Δ1-11) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 29: Human N-terminally truncated Prl (Δ1-12) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO. 30: Human N-terminally truncated S-Prl (Δ1-12) (mutated 561A, D68N, Q73L, G129R, K190R)
SEQ ID NO 31: CPGPPGS (N-terminal tag)
SEQ ID NO 32: 3) DDEWLCGWRPLCIDEILRPGPPGS (N terminal albumin binding peptide)
SEQ ID NO. 33: Prl—Human N-terminally truncated (Δ1-9) Prl (mutated 533A, Q73L, G129R, K190R) with N-terminal Serine i.e. Ser-SEQ ID NO.13).
SEQ ID NO. 34: Prl—Human N-terminally truncated Prl (Δ1-9) (mutated 561A, D68N, Q73L, G129R, K190R) with N-terminal Serine i.e. Ser-SEQ ID NO.26)
Number | Date | Country | Kind |
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1450757-8 | Jun 2014 | SE | national |
Filing Document | Filing Date | Country | Kind |
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PCT/EP2015/063680 | 6/18/2015 | WO | 00 |