Patent Application
20230310537
The present invention relates to vascular Ehlers-Danlos syndrome (vEDS) and related syndromes.
Vascular Ehlers Danlos Syndrome (vEDS) is an inherited connective tissue disorder caused by heterozygous mutations in the COL3A1 gene, resulting in spontaneous vascular and/or organ rupture. New compositions and methods for treating vEDS, and related syndromes are needed.
Provided herein are, inter alia, methods, compositions and kits for treating and preventing vascular Ehlers-Danlos syndrome, and related syndromes. Also included herein are kits for treating vascular Ehlers-Danlos syndrome, and related syndromes.
In aspects, provided herein are methods of treating or preventing a vasculopathy in a subject. For example, the method includes administering an effective amount of an agent (e. g,. wherein the agent increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof), and thereby treating the vasculopathy.
In embodiments, the vasculopathy comprises vascular Ehlers-Danlos Syndrome (vEDS). In other embodiments, the vasculopathy may include related syndromes, including for example other presentations of aortic or peripheral aneurysms.
In embodiments, the agent of the present invention includes an antibody or fragment thereof, a polypeptide, a small molecule, a nucleic acid molecule, or any combination thereof.
As used herein, “small molecule” may be referred to broadly as an organic, inorganic or organometallic compound with a low molecular weight compound (e.g., a molecular weight of less than about 2,000 Da or less than about 1,000 Da). The small molecule may have a molecular weight of less than about 2,000 Da, a molecular weight of less than about 1,500 Da, a molecular weight of less than about 1,000 Da, a molecular weight of less than about 900 Da, a molecular weight of less than about 800 Da, a molecular weight of less than about 700 Da, a molecular weight of less than about 600 Da, a molecular weight of less than about 500 Da, a molecular weight of less than about 400 Da, a molecular weight of less than about 300 Da, a molecular weight of less than about 200 Da, a molecular weight of less than about 100 Da, or a molecular weight of less than about 50 Da. Small molecules are organic or inorganic. Exemplary organic small molecules include, but are not limited to, aliphatic hydrocarbons, alcohols, aldehydes, ketones, organic acids, esters, mono- and disaccharides, aromatic hydrocarbons, amino acids, and lipids. Exemplary inorganic small molecules comprise trace minerals, ions, free radicals, and metabolites. Alternatively, small molecules can be synthetically engineered to consist of a fragment, or small portion, or a longer amino acid chain to fill a binding pocket of an enzyme. Typically small molecules are less than one kilodalton.
In embodiments, an antibody described herein may be a polyclonal antisera or monoclonal antibody. The term antibody may include any of the various classes or sub-classes of immunoglobulin (e.g., IgG, IgA, IgM, IgD, or IgE derived from any animal, e.g., any of the animals conventionally used, e.g., sheep, rabbits, goats, or mice, or human), e.g., the antibody comprises a monoclonal antibody, e.g., a p38 monoclonal antibody.
In other embodiments, the MAPK comprises p38. For example, p38 includes an isoform selected from p38-α, p38-β, p38-γ, or p38-δ.
In cerain aspects, one or more p38 MAPK agonists may be administered to a patient in needed thereof in accordance with the present methods. Preferred p38 MAPK agonists include for example anismyin and sorbitol.
In other embodiments, the methods include administering an agent that decreases the activity or expression of extracellular signal-regulated kinase (ERK) or protein kinase C (PKC). In examples, the agent that decreases the activity or expression of ERK or PKC includes cobimetinib, trametinib, ruboxistaurin, enzastaurin, sotrastaurin, or any combination thereof.
In embodiments, the protein phosphatase (PP) includes protein phosphatase 1 (PP1), protein phosphatase 2A (PP2A), or a combination thereof.
In embodiments, the agent to increase the activity or expression of a mitogen-activated protein kinase (MAPK) (p38), a protein phosphatase (PP) (PP1), or a combination thereof) is a small molecule.
In embodiments, the effective amount of the agent to increase the activity or expression of p38 and/or PP1 is from about 0.001 mg/kg to 250 mg/kg body weight.
In other embodiments, the subject has a level of MAPK or PP protein or mRNA that is different than a normal control. For example, the subject has a level of MAPK (p38) or PP protein (PP1) or mRNA that is at least about 5%, 10%, 15%, 20%, 25%, 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95%, 99%, 100%, 5-50%, 50-75%, 75-100%, 1-fold, 2-fold, 3-fold, 4-fold, or 5-fold higher compared to a normal control. In other examples, the subject has a level of MAPK (p38) or PP (PP1) activity that is at least about 5%, 10%, 15%, 20%, 25%, 30%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 90%, 95%, 99%, 100%, 5-50%, 50-75%, 75-100%, 1-fold, 2-fold, 3-fold, 4-fold, or 5-fold higher compared to a normal control.
In examples, the level (e.g., of MAPK or PP) is in a test sample obtained from the subject. For example, the test sample includes blood, serum, plasma, saliva, tears, vitreous, cerebrospinal fluid, sweat, cerebrospinal fluid, or urine.
In certain aspects, methods are provided for treating vascular Ehlers-Danlos Syndrome in a subject in need thereof comprising: (a) assessing the subject for a level of MAPK or PP protein or mRNA that is different than a normal control (e.g. assessing a subject sample) and/or (b) identifying the subject as having a level of MAPK or PP protein or mRNA that is different than a normal control (e.g. healthy subject); and (c) administering to the subject (e.g. the identified subject) a therapeutically effective amount of an agent as disclosed herein including an agent that can increase the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof. Suitably, the subject is a human subject.
Exemplary preferred agents for use in the present treatment methods and pharmaceutical compositions include for example one or more of anismyin, a substituted anismyin, sorbitol, a microcystin compound, cobimetinib, trametinib, ruboxistaurin, enzastaurin, sotrastaurin, or any combination thereof.
In aspects, provided herein is a method of treating or preventing a vasculopathy in a subject, the method including administering an effective amount of an agent (e.g., an agent that increases the activity of MAP2K6 and hence p38 mitogen-activated protein kinase (MAPK) pathway signaling, thereby treating the vasculopathy.
In embodiments, the vasculopathy is vascular Ehlers-Danlos Syndrome (vEDS).
In other embodiments, the agent that increase MAP pathway signaling (p38) or PP1 includes an antibody or fragment thereof, a polypeptide, a small molecule, a nucleic acid molecule, or any combination thereof.
In aspects, provided herein is a pharmaceutical composition for the treatment of a vasculopathy, the composition including an effective amount an agent, wherein the agent increases the activity or expression of mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof, and thereby treating the vasculopathy.
In embodiments, the agent of the pharmaceutical composition is an antibody or fragment thereof, a polypeptide, a small molecule, a nucleic acid molecule, or any combination thereof.
In aspects, provided herein is a kit including a pharmaceutical composition of any of the agents described herein, and written instructions for treating the vasculopathy.
Other aspects of the invention are disclosed infra.
The patent or application file contains at least one drawing executed in color.
Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
Provided herein are, inter alia, methods, compositions and kits for treating and preventing vascular Ehlers-Danlos syndrome, and related syndromes.
Vascular Ehlers Danlos syndrome (vEDS) is an inherited connective tissue disorder caused by heterozygous mutations in the COL3A1 gene(1-6). The major cause of mortality is spontaneous vascular rupture or organ rupture(1,2). The PLC/IP3/PKC/ERK axis (phospholipase C/inositol 1,4,5-triphosphate/protein kinase C/extracellular signal-regulated kinase) has emerged as a candidate mediator of disease pathology and a key therapeutic target in vEDS. The link between COL3A1 mutations and initiation of the intracellular signaling cascade remains incompletely understood. However, there is a clear signature for increased PKC and ERK signaling in severe (Col3a1/G938134) and mild (Col3a1G209S/+)mouse models of vEDS. The difference in severity observed in these models is attributed to the different substitutions for glycine residues that disrupt collagen triple helix folding at separate locations. However pharmacological interventions that inhibit PKC/ERK activation in either vEDS model rescue aortic disease rupture risk, including MEK inhibitors trametinib and cobimetinib, a PKC inhibitor ruboxistaurin, or an IP3 inhibitor hydralazine.
Genotype-phenotype correlations in vEDS have been extensively studied in humans. These data suggest that both the nature and location of COL3A1 mutations can influence disease severity. Overall, substitutions of glycine residues and splice-site mutations that lead to in-frame exon skipping are associated with a more severe phenotype when compared to any mutational mechanism that leads to functional haploinsufficiency(3). Intuitively, since type III collagen monomers interact to form a triple helical structure; 7/8 of the total type III collagen triple helices will be abnormal if the allele produces a mutant protein that is competent for interaction. In contrast, while haploinsufficiency is expected to lead to half normal levels of type III collagen, all of the resultant protein aggregates will be qualitatively normal. While these types of functional arguments allow broad generalizations regarding classes of mutations and their resultant phenotypes, there is a broad range of severity within a given mutational class. Furthermore, the often marked intrafamilial clinical variability observed in vEDS remains impossible to reconcile based on isolated consideration of the primary disease allele, suggesting sources of genetic and/or environmental modification that remain to be defined (6-9).
Genetic modification of disease severity has recently been recognized in other connective tissue disorders. Previously, it was recognized that genetic background had a major modifying effect on disease severity in mouse models of Marfan Syndrome (MFS) (10-12). When the Fbn1 mutation in MFS was placed on an ultrapure 12956/SvEvTac (129) background, aortic root aneurysms and biochemical abnormalities (e.g. high SMAD2/3 and ERK1/2 activation) were greatly accentuated and accelerated compared to those observed previously in mixed background or C57BL6/J (BL6) MFS mice (10).
Provided herein, vEDS mutations (Col3a1G209S/+ and Col3a1G938D/+) were introduced onto pure 129 and BL6 backgrounds to assess for modulation of phenotypic severity. Equally dramatic effects of background on phenotype was observed, but the directionality was the opposite to that observed in Marfan Syndrome (MFS).
Moreover, a single significant protective locus was identified, at which a single gene and variant was identified that modified the severity of disease in vEDS mice in a PKC and ERK-dependent manner. These results defined a pathway of natural potent protective disease modification and pharmacologic interventions that mimic nature's successful modification strategy will afford substantial protection to patients with vEDS.
Significant advantages of the compositions and methods described herein include, for example, the demonstration that enhanced MAP2K6 and hence p38 activity is a natural, potent and tolerated mechanism to prevent the sequelae of a deficiency of type III collagen deficiency including vascular rupture, as observed in vEDS. This method is preferable to global ERK inhibition, as the latter is known to cause retinal detachment, a catastrophic event to which patients with vEDS are naturally predisposed.
General Definitions
The following definitions are included for the purpose of understanding the present subject matter and for constructing the appended patent claims. The abbreviations used herein have their conventional meanings within the chemical and biological arts.
While various embodiments and aspects of the present invention are shown and described herein, it will be obvious to those skilled in the art that such embodiments and aspects are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention.
The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described. All documents, or portions of documents, cited in the application including, without limitation, patents, patent applications, articles, books, manuals, and treatises are hereby expressly incorporated by reference in their entirety for any purpose.
Unless defined otherwise, technical and scientific terms used herein have the same meaning as commonly understood by a person of ordinary skill in the art. See, e.g., Singleton et al., DICTIONARY OF MICROBIOLOGY AND MOLECULAR BIOLOGY 2nd ed., J. Wiley & Sons (New York, NY 1994); Sambrook et al., MOLECULAR CLONING, A LABORATORY MANUAL, Cold Springs Harbor Press (Cold Springs Harbor, N Y 1989). Any methods, devices and materials similar or equivalent to those described herein can be used in the practice of this invention. The following definitions are provided to facilitate understanding of certain terms used frequently herein and are not meant to limit the scope of the present disclosure.
The term “disease” refers to any deviation from the normal health of a mammal and includes a state when disease symptoms are present, as well as conditions in which a deviation (e.g., vascular Ehlers-Danlos syndrome, and related syndromes) has occurred, but symptoms are not yet manifested.
“Patient” or “subject in need thereof” refers to a living member of the animal kingdom suffering from or who may suffer from the indicated disorder. In embodiments, the subject is a member of a species comprising individuals who may naturally suffer from the disease. In embodiments, the subject is a mammal. Non-limiting examples of mammals include rodents (e.g., mice and rats), primates (e.g., lemurs, bushbabies, monkeys, apes, and humans), rabbits, dogs (e.g., companion dogs, service dogs, or work dogs such as police dogs, military dogs, race dogs, or show dogs), horses (such as race horses and work horses), cats (e.g., domesticated cats), livestock (such as pigs, bovines, donkeys, mules, bison, goats, camels, and sheep), and deer. In embodiments, the subject is a human.
The terms “subject,” “patient,” “individual,” etc. are not intended to be limiting and can be generally interchanged. That is, an individual described as a “patient” does not necessarily have a given disease, but may be merely seeking medical advice.
The transitional term “comprising,” which is synonymous with “including,” “containing,” or “characterized by,” is inclusive or open-ended and does not exclude additional, unrecited elements or method steps. By contrast, the transitional phrase “consisting” of excludes any element, step, or ingredient not specified in the claim. The transitional phrase “consisting essentially of” limits the scope of a claim to the specified materials or steps “and those that do not materially affect the basic and novel characteristic(s)” of the claimed invention.
In the descriptions herein and in the claims, phrases such as “at least one of” or “one or more of” may occur followed by a conjunctive list of elements or features. The term “and/or” may also occur in a list of two or more elements or features. Unless otherwise implicitly or explicitly contradicted by the context in which it is used, such a phrase is intended to mean any of the listed elements or features individually or any of the recited elements or features in combination with any of the other recited elements or features. For example, the phrases “at least one of A and B;” “one or more of A and B;” and “A and/or B” are each intended to mean “A alone, B alone, or A and B together.” A similar interpretation is also intended for lists including three or more items. For example, the phrases “at least one of A, B, and C;” “one or more of A, B, and C;” and “A, B, and/or C” are each intended to mean “A alone, B alone, C alone, A and B together, A and C together, B and C together, or A and B and C together.” In addition, use of the term “based on,” above and in the claims is intended to mean, “based at least in part on,” such that an unrecited feature or element is also permissible.
It is understood that where a parameter range is provided, all integers within that range, and tenths thereof, are also provided by the invention. For example, “0.2-5 mg” is a disclosure of 0.2 mg, 0.3 mg, 0.4 mg, 0.5 mg, 0.6 mg etc. up to and including 5.0 mg.
As used in the description herein and throughout the claims that follow, the meaning of “a,” “an,” and “the” includes plural reference unless the context clearly dictates otherwise.
As used herein, “treating” or “treatment” of a condition, disease or disorder or symptoms associated with a condition, disease or disorder refers to an approach for obtaining beneficial or desired results, including clinical results. Beneficial or desired clinical results can include, but are not limited to, alleviation or amelioration of one or more symptoms or conditions, diminishment of extent of condition, disorder or disease, stabilization of the state of condition, disorder or disease, prevention of development of condition, disorder or disease, prevention of spread of condition, disorder or disease, delay or slowing of condition, disorder or disease progression, delay or slowing of condition, disorder or disease onset, amelioration or palliation of the condition, disorder or disease state, and remission, whether partial or total. “Treating” can also mean inhibiting the progression of the condition, disorder or disease, slowing the progression of the condition, disorder or disease temporarily, although in some instances, it involves halting the progression of the condition, disorder or disease permanently.
As used herein, the terms “treat” and “prevent” are not intended to be absolute terms. In various embodiments, treatment can refer to a 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, or 100% reduction in the severity of an established disease, condition, or symptom of the disease or condition. In embodiments, a method for treating a disease is considered to be a treatment if there is a 10% reduction in one or more symptoms of the disease in a subject as compared to a control. Thus the reduction can be a 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, or any percent reduction in between 10% and 100% as compared to native or control levels. It is understood that treatment does not necessarily refer to a cure or complete ablation of the disease, condition, or symptoms of the disease or condition. In embodiments, references to decreasing, reducing, or inhibiting include a change of 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90% or greater as compared to a control level and such terms can include but do not necessarily include complete elimination. In embodiments, the severity of disease is reduced by at least 10%, as compared, e.g., to the individual before administration or to a control individual not undergoing treatment. In some aspects the severity of disease is reduced by at least 25%, 50%, 75%, 80%, or 90%, or in some cases, no longer detectable using standard diagnostic techniques.
The terms “effective amount,” “effective dose,” etc. refer to the amount of an agent that is sufficient to achieve a desired effect, as described herein. In embodiments, the term “effective” when referring to an amount of cells or a therapeutic compound may refer to a quantity of the cells or the compound that is sufficient to yield an improvement or a desired therapeutic response without undue adverse side effects (such as toxicity, irritation, or allergic response) commensurate with a reasonable benefit/risk ratio when used in the manner of this disclosure. In embodiments, the term “effective” when referring to the generation of a desired cell population may refer to an amount of one or more compounds that is sufficient to result in or promote the production of members of the desired cell population, especially compared to culture conditions that lack the one or more compounds.
As used herein, an “isolated” or “purified” nucleic acid molecule, polynucleotide, polypeptide, or protein, is substantially free of other cellular material, or culture medium when produced by recombinant techniques, or chemical precursors or other chemicals when chemically synthesized. Purified compounds are at least 60% by weight (dry weight) the compound of interest. Preferably, the preparation is at least 75%, more preferably at least 90%, and most preferably at least 99%, by weight the compound of interest. For example, a purified compound is one that is at least 90%, 91%, 92%, 93%, 94%, 95%, 98%, 99%, or 100% (w/w) of the desired compound by weight. Purity is measured by any appropriate standard method, for example, by column chromatography, thin layer chromatography, or high-performance liquid chromatography (HPLC) analysis. A purified or isolated polynucleotide (RNA or DNA) is free of the genes or sequences that flank it in its naturally-occurring state. Purified also defines a degree of sterility that is safe for administration to a human subject, e.g., lacking infectious or toxic agents.
Similarly, by “substantially pure” is meant a nucleotide or polypeptide that has been separated from the components that naturally accompany it. Typically, the nucleotides and polypeptides are substantially pure when they are at least 60%, 70%, 80%, 90%, 95%, or even 99%, by weight, free from the proteins and naturally-occurring organic molecules with they are naturally associated.
By “agonist” is meant a chemical that binds to a receptor and activates the receptor to produce a biological response. Whereas an agonist causes an action, an “antagonist” blocks the action of the agonist and an inverse agonist causes an action opposite to that of the agonist. As used herein, the terms “antagonist” and “inhibitor” are used interchangeably to refer to any molecule that counteracts or inhibits, decreases, or suppresses the biological activity of its target molecule. In some embodiments, an agonist is a “superagonist” when it induces or increases the biological activity of its target molecule. In some embodiments, an antagonist is a “superantagonist” when it counteracts or inhibits, decreases, or suppresses the biological activity of its target molecule. Suitable inhibitors, antagonists, agonists include soluble receptors, peptide inhibitors, small molecule inhibitors, ligand fusions, and antibodies.
As used herein, an “antagonist” may refer to an antibody or fragment thereof, peptides, polypeptide or fragments thereof, small molecules, and inhibitory nucleic acids or fragments thereof that interferes with the activity or binding of another, for example, by competing for the one or more binding sites of an agonist, but does not induce an active response.
The term “administering,” as used herein, refers to any mode of transferring, delivering, introducing, or transporting an agent, for example, to a subject in need of treatment for a disease or condition. Such modes include, but are not limited to, oral, topical, intravenous, intraperitoneal, intramuscular, intradermal, intranasal, and subcutaneous administration.
By “co-administer” it is meant that a composition described herein is administered at the same time, just prior to, or just after the administration of additional therapies. The agent or the composition of the disclosure can be administered alone or can be co-administered to the patient. Co-administration is meant to include simultaneous or sequential administration of the compound individually or in combination (more than one compound or agent). The preparations can also be combined, when desired, with other active substances.
As used herein, “sequential administration” includes that the administration of two agents (e.g., the agents or compositions described herein) occurs separately on the same day or do not occur on a same day (e.g., occurs on consecutive days).
As used herein, “concurrent administration” includes overlapping in duration at least in part. For example, when two agents (e.g., any of the agents described herein that has bioactivity) are administered concurrently, their administration occurs within a certain desired time. The agents' administration may begin and end on the same day. The administration of one agent can also precede the administration of a second agent by day(s) as long as both agents are taken on the same day at least once. Similarly, the administration of one agent can extend beyond the administration of a second agent as long as both agents are taken on the same day at least once. The bioactive agents/agents do not have to be taken at the same time each day to include concurrent administration.
As used herein, “intermittent administration” includes the administration of an agent for a period of time (which can be considered a “first period of administration”), followed by a time during which the agent is not taken or is taken at a lower maintenance dose (which can be considered “off-period”) followed by a period during which the agent is administered again (which can be considered a “second period of administration”). Generally, during the second phase of administration, the dosage level of the agent will match that administered during the first period of administration but can be increased or decreased as medically necessary.
As used herein an “alteration” also includes a 2-fold or more change in expression levels or activity of a gene or polypeptide, for example, 5-fold, 10-fold, 20-fold, 30-fold, 40-fold, 50-fold, 100-fold, 500-fold, 1000-fold or more.
As defined herein, the term “inhibition,” “inhibit,” “inhibiting” and the like in reference to a protein-inhibitor the activity or function of the protein (e.g., decreasing the activity or amount of ERK or PKC, or PLC or IP3, decreasing the ability of ERK or PKC, or PLC or IP3 to bind to a receptor, decreasing the ability of a receptor to bind ERK or PKC, or decreasing ERK or PKC signaling upon the binding of ERK or PKC, or PLC or IP3 to a receptor) relative to the activity or function of the protein in the absence of the inhibitor. In embodiments, inhibition refers to reduction of a disease or symptoms of disease (e.g., connective tissue disorder). Similarly an “inhibitor” is a compound or protein that inhibits a target by binding, partially or totally blocking, decreasing, preventing, delaying, inactivating, desensitizing, or down-regulating activity.
As defined herein, the term “activation,” “activate,” “activating” and the like in reference to a protein-activator (e.g., a p38 activator,) interaction means positively affecting (e.g., increasing) the activity or function of the protein (e.g., increasing the activity or amount of p38 or PP1,) relative to the activity or function of the protein in the absence of the activator.
The dosage and frequency (single or multiple doses) administered to a mammal can vary depending upon a variety of factors, for example, whether the mammal suffers from another disease, and its route of administration; size, age, sex, health, body weight, body mass index, and diet of the recipient; nature and extent of symptoms of the disease being treated, kind of concurrent treatment, complications from the disease being treated or other health-related problems. Other therapeutic regimens or agents can be used in conjunction with the methods and agents of this disclosure. Adjustment and manipulation of established dosages (e.g., frequency and duration) are well within the ability of those skilled in the art.
For any agent described herein, the therapeutically effective amount (e.g., effective dose or effective amount) can be initially determined from cell culture assays. Target concentrations will be those concentrations of therapeutic drug(s) that are capable of achieving the methods described herein, as measured using the methods described herein or known in the art.
As is well known in the art, therapeutically effective amounts for use in humans can also be determined from animal models. For example, a dose for humans can be formulated to achieve a concentration that has been found to be effective in animals. The dosage in humans can be adjusted by monitoring agent's effectiveness and adjusting the dosage upwards or downwards, as described above. Adjusting the dose to achieve maximal efficacy in humans based on the methods described above and other methods is well within the capabilities of the ordinarily skilled artisan.
Dosages may be varied depending upon the requirements of the patient and the therapeutic drug being employed. The dose administered to a patient should be sufficient to effect a beneficial therapeutic response in the patient over time. The size of the dose also will be determined by the existence, nature, and extent of any adverse side-effects. Determination of the proper dosage for a particular situation is within the skill of the practitioner. Generally, treatment is initiated with smaller dosages which are less than the optimum dose of the agent. Thereafter, the dosage is increased by small increments until the optimum effect under circumstances is reached. Dosage amounts and intervals can be adjusted individually to provide levels of the administered agent effective for the particular clinical indication being treated. This will provide a therapeutic regimen that is commensurate with the severity of the individual's disease state.
The effective dose of the agent (e.g., pharmacological inhibitor or activator) of the present disclosure for treating vEDS, and/or a related syndrome may be from about 0.001 mg/kg to about 0.01 mg/kg of the agent, from about 0.01 mg/kg to about 0.1 mg/kg of the agent, from about 0.1 mg/kg to about 1.0 mg/kg of the agent, from about 1.0 mg/kg to about 5.0 mg/kg of the agent, from about 5.0 mg/kg to about 10 mg/kg of the agent, from about 10 mg/kg to about 15 mg/kg of the agent, from about 15 mg/kg to about 20 mg/kg of the agent, from about 20 mg/kg to about 25 mg/kg of the agent, from about 25 mg/kg to about 30 mg/kg of the agent, from about 30 mg/kg to about 35 mg/kg of the agent, from about 35 mg/kg to about 40 mg/kg of the agent, from about 40 mg/kg to about 45 mg/kg of the agent, from about 45 mg/kg to about 50 mg/kg of the agent, from about 50 mg/kg to about 55 mg/kg of the agent, from about 55 mg/kg to about 60 mg/kg of the agent, from about 60 mg/kg to about 65 mg/kg of the agent, from about 65 mg/kg to about 70 mg/kg of the agent, from about 70 mg/kg to about 75 mg/kg of the agent, from about 75 mg/kg to about 80 mg/kg of the agent, from about 80 mg/kg to about 85 mg/kg of the agent, from about 85 mg/kg to about 90 mg/kg of the agent, from about 90 mg/kg to about 95 mg/kg of the agent, or from about 95 mg/kg to about 100 mg/kg of the agent.
In some aspects, the present disclosure includes compositions with an effective dose of an agent(s) of the present disclosure in which the agent may be from about 0.1% to about 20% w/v of the composition. A weight percent of a component, unless specifically stated to the contrary, is based on the total weight of the formulation or composition in which the component is included.
For example, the effective dose of an agent disclosed herein may be from about 0.001% -about 0.01%, from about 0.01% -about 0.1%, from about 0.1% -about 1.0%, from about 1.0% -about 2.0%, from about 2.0% -about 3.0%, from about 3.0% -about 4.0%, from about 4.0% -about 5.0%, from about 5.0% -about 6.0%, from about 6.0% -about 7.0%, from about 7.0% -about 8.0%, from about 8.0% -about 9.0%, from about 9.0% -about 10%, from about 10% -about 11%, from about 11% -about 12%, from about 12% -about 13%, from about 13% -about 14%, from about 14% -about 15%, from about 15% -about 16%, from about 16% -about 17%, from about 17% -about 18%, from about 18% -about 19%, or from about 19% -about 20% w/v of the composition.
A “control” sample or value refers to a sample that serves as a reference, usually a known reference, for comparison to a test sample. For example, a test sample can be taken from a test subject, e.g., a subject with vascular Ehlers-Danlos syndrome (or a related syndrome), and compared to samples from known conditions, e.g., a subject (or subjects) that does not have vascular Ehlers-Danlos syndrome (or a related syndrome) (a negative or normal control), or a subject (or subjects) who does have vascular Ehlers-Danlos syndrome (or a related syndrome) (positive control). A control can also represent an average value gathered from a number of tests or results. One of skill in the art will recognize that controls can be designed for assessment of any number of parameters. One of skill in the art will understand which controls are valuable in a given situation and be able to analyze data based on comparisons to control values. Controls are also valuable for determining the significance of data. For example, if values for a given parameter are variable in controls, variation in test samples will not be considered as significant.
The term, “normal amount” with respect to a compound (e.g., a protein or mRNA) refers to a normal amount of the compound in an individual who does not have vascular Ehlers-Danlos syndrome (or a related syndrome) in a healthy or general population. The amount of a compound can be measured in a test sample and compared to the “normal control” level, utilizing techniques such as reference limits, discrimination limits, or risk defining thresholds to define cutoff points and abnormal values (e.g., for vascular Ehlers-Danlos syndrome (or a related syndrome) or a symptom thereof). The normal control level means the level of one or more compounds or combined compounds typically found in a subject known not suffering from vascular Ehlers-Danlos syndrome (or a related syndrome). Such normal control levels and cutoff points may vary based on whether a compound is used alone or in a formula combining with other compounds into an index. Alternatively, the normal control level can be a database of compounds patterns from previously tested subjects who did not develop vascular Ehlers-Danlos syndrome (or a related syndrome)or a particular symptom thereof (e.g., in the event the vascular Ehlers-Danlos syndrome (or a related syndrome) develops or a subject already having vascular Ehlers-Danlos syndrome (or a related syndrome) is tested) over a clinically relevant time horizon.
The level that is determined may be the same as a control level or a cut off level or a threshold level, or may be increased or decreased relative to a control level or a cut off level or a threshold level. In some aspects, the control subject is a matched control of the same species, gender, ethnicity, age group, smoking status, body mass index (BMI), current therapeutic regimen status, medical history, or a combination thereof, but differs from the subject being diagnosed in that the control does not suffer from the disease (or a symptom thereof) in question or is not at risk for the disease.
Relative to a control level, the level that is determined may an increased level. As used herein, the term “increased” with respect to level (e.g., protein or mRNA level) refers to any % increase above a control level. In various embodiments, the increased level may be at least or about a 5% increase, at least or about a 10% increase, at least or about a 15% increase, at least or about a 20% increase, at least or about a 25% increase, at least or about a 30% increase, at least or about a 35% increase, at least or about a 40% increase, at least or about a 45% increase, at least or about a 50% increase, at least or about a 55% increase, at least or about a 60% increase, at least or about a 65% increase, at least or about a 70% increase, at least or about a 75% increase, at least or about a 80% increase, at least or about a 85% increase, at least or about a 90% increase, at least or about a 95% increase, relative to a control level.
Relative to a control level, the level that is determined may a decreased level. As used herein, the term “decreased” with respect to level (e.g., protein or mRNA level) refers to any % decrease below a control level. In various embodiments, the decreased level may be at least or about a 5% decrease, at least or about a 10% decrease, at least or about a 15% decrease, at least or about a 20% decrease, at least or about a 25% decrease, at least or about a 30% decrease, at least or about a 35% decrease, at least or about a 40% decrease, at least or about a 45% decrease, at least or about a 50% decrease, at least or about a 55% decrease, at least or about a 60% decrease, at least or about a 65% decrease, at least or about a 70% decrease, at least or about a 75% decrease, at least or about a 80% decrease, at least or about a 85% decrease, at least or about a 90% decrease, at least or about a 95% decrease, relative to a control level.
The term “sample” as used herein refers to a biological sample obtained for the purpose of evaluation in vitro. In embodiments, the sample may comprise a body fluid. In some embodiments, the body fluid includes, but is not limited to, whole blood, plasma, serum, lymph, breast milk, saliva, mucous, semen, cellular extracts, inflammatory fluids, cerebrospinal fluid, vitreous humor, tears, vitreous, aqueous humor, or urine obtained from the subject. In some aspects, the sample is a composite panel of two or more body fluids. In exemplary aspects, the sample comprises blood or a fraction thereof (e.g., plasma, serum, or a fraction obtained via leukapheresis).
The terms “polypeptide,” “peptide” and “protein” are used interchangeably herein to refer to a polymer of amino acid residues, wherein the polymer may in embodiments be conjugated to a moiety that does not consist of amino acids. The terms also apply to amino acid polymers in which one or more amino acid residue is an artificial chemical mimetic of a corresponding naturally occurring amino acid, as well as to naturally occurring amino acid polymers and non-naturally occurring amino acid polymers. A “fusion protein” refers to a chimeric protein encoding two or more separate protein sequences that are recombinantly expressed or chemically synthesized as a single moiety.
“Polypeptide fragment” refers to a polypeptide that has an amino-terminal and/or carboxy-terminal deletion, in which the remaining amino acid sequence is usually identical to the corresponding positions in the naturally-occurring sequence. Fragments typically are at least 5, 6, 8 or 10 amino acids long, at least 14 amino acids long, at least 20 amino acids long, at least 50 amino acids long, or at least 70 amino acids long.
“Percentage of sequence identity” is determined by comparing two optimally aligned sequences over a comparison window, wherein the portion of the polynucleotide or polypeptide sequence in the comparison window may comprise additions or deletions (i.e., gaps) as compared to the reference sequence (which does not comprise additions or deletions) for optimal alignment of the two sequences. In embodiments, the percentage is calculated by determining the number of positions at which the identical nucleic acid base or amino acid residue occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the window of comparison and multiplying the result by 100 to yield the percentage of sequence identity.
The term “identical” or percent “identity,” in the context of two or more nucleic acids or polypeptide sequences, refer to two or more sequences or subsequences that are the same or have a specified percentage of amino acid residues or nucleotides that are the same (e.g., 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or more identity over a specified region, e.g., of an entire polypeptide sequence or an individual domain thereof), when compared and aligned for maximum correspondence over a comparison window, or designated region as measured using a sequence comparison algorithm or by manual alignment and visual inspection. In embodiments, two sequences are 100% identical. In embodiments, two sequences are 100% identical over the entire length of one of the sequences (e.g., the shorter of the two sequences where the sequences have different lengths). In embodiments, identity may refer to the complement of a test sequence. In embodiments, the identity exists over a region that is at least about 10 to about 100, about to about 75, about 30 to about 50 amino acids or nucleotides in length. In embodiments, the identity exists over a region that is at least about 50 amino acids or nucleotides in length, or more preferably over a region that is 100 to 500, 100 to 200, 150 to 200, 175 to 200, 175 to 225, 175 to 250, 200 to 225, 200 to 250 or more amino acids or nucleotides in length.
For sequence comparison, typically one sequence acts as a reference sequence, to which test sequences are compared. In embodiments, when using a sequence comparison algorithm, test and reference sequences are entered into a computer, subsequence coordinates are designated, if necessary, and sequence algorithm program parameters are designated. Preferably, default program parameters can be used, or alternative parameters can be designated. The sequence comparison algorithm then calculates the percent sequence identities for the test sequences relative to the reference sequence, based on the program parameters.
A “comparison window” refers to a segment of any one of the number of contiguous positions (e.g., least about 10 to about 100, about 20 to about 75, about 30 to about 50, 100 to 500, 100 to 200, 150 to 200, 175 to 200, 175 to 225, 175 to 250, 200 to 225, 200 to 250) in which a sequence may be compared to a reference sequence of the same number of contiguous positions after the two sequences are optimally aligned. In embodiments, a comparison window is the entire length of one or both of two aligned sequences. In embodiments, two sequences being compared comprise different lengths, and the comparison window is the entire length of the longer or the shorter of the two sequences. In embodiments relating to two sequences of different lengths, the comparison window includes the entire length of the shorter of the two sequences. In embodiments relating to two sequences of different lengths, the comparison window includes the entire length of the longer of the two sequences.
Methods of alignment of sequences for comparison are well-known in the art. Optimal alignment of sequences for comparison can be conducted, e.g., by the local homology algorithm of Smith & Waterman, Adv. Appl. Math. 2:482 (1981), by the homology alignment algorithm of Needleman & Wunsch, J. Mol. Biol. 48:443 (1970), by the search for similarity method of Pearson & Lipman, Proc. Nat'l. Acad. Sci. USA 85:2444 (1988), by computerized implementations of these algorithms (GAP, BESTFIT, FASTA, and TFASTA in the Wisconsin Genetics Software Package, Genetics Computer Group, 575 Science Dr., Madison, Wis.), or by manual alignment and visual inspection (see, e.g., Current Protocols in Molecular Biology (Ausubel et al., eds. 1995 supplement)).
Non-limiting examples of algorithms that are suitable for determining percent sequence identity and sequence similarity are the BLAST and BLAST 2.0 algorithms, which are described in Altschul et al., Nuc. Acids Res. 25:3389-3402 (1977) and Altschul et al., J. Mol. Biol. 215:403-410 (1990), respectively. BLAST and BLAST 2.0 may be used, with the parameters described herein, to determine percent sequence identity for nucleic acids and proteins. Software for performing BLAST analyses is publicly available through the National Center for Biotechnology Information (NCBI), as is known in the art. An exemplary BLAST algorithm involves first identifying high scoring sequence pairs (HSPs) by identifying short words of length W in the query sequence, which either match or satisfy some positive-valued threshold score T when aligned with a word of the same length in a database sequence. T is referred to as the neighborhood word score threshold (Altschul et al., supra). These initial neighborhood word hits act as seeds for initiating searches to find longer HSPs containing them. The word hits are extended in both directions along each sequence for as far as the cumulative alignment score can be increased. Cumulative scores are calculated using, for nucleotide sequences, the parameters M (reward score for a pair of matching residues; always >0) and N (penalty score for mismatching residues; always <0). For amino acid sequences, a scoring matrix is used to calculate the cumulative score. Extension of the word hits in each direction are halted when: the cumulative alignment score falls off by the quantity X from its maximum achieved value; the cumulative score goes to zero or below, due to the accumulation of one or more negative-scoring residue alignments; or the end of either sequence is reached. The BLAST algorithm parameters W, T, and X determine the sensitivity and speed of the alignment. In embodiments, the NCBI BLASTN or BLASTP program is used to align sequences. In embodiments, the BLASTN or BLASTP program uses the defaults used by the NCBI. In embodiments, the BLASTN program (for nucleotide sequences) uses as defaults: a word size (W) of 28; an expectation threshold (E) of 10; max matches in a query range set to 0; match/mismatch scores of 1,-2; linear gap costs; the filter for low complexity regions used; and mask for lookup table only used. In embodiments, the BLASTP program (for amino acid sequences) uses as defaults: a word size (W) of 3; an expectation threshold (E) of 10; max matches in a query range set to 0; the BLOSUM62 matrix (see Henikoff & Henikoff, Proc. Natl. Acad. Sci. USA 89:10915 (1992)); gap costs of existence: 11 and extension: 1; and conditional compositional score matrix adjustment.
An amino acid or nucleotide base “position” is denoted by a number that sequentially identifies each amino acid (or nucleotide base) in the reference sequence based on its position relative to the N-terminus (or 5′-end). Due to deletions, insertions, truncations, fusions, and the like that must be taken into account when determining an optimal alignment, in general the amino acid residue number in a test sequence determined by simply counting from the N-terminus will not necessarily be the same as the number of its corresponding position in the reference sequence. For example, in a case where a variant has a deletion relative to an aligned reference sequence, there will be no amino acid in the variant that corresponds to a position in the reference sequence at the site of deletion. Where there is an insertion in an aligned reference sequence, that insertion will not correspond to a numbered amino acid position in the reference sequence. In the case of truncations or fusions there can be stretches of amino acids in either the reference or aligned sequence that do not correspond to any amino acid in the corresponding sequence.
The terms “numbered with reference to” or “corresponding to,” when used in the context of the numbering of a given amino acid or polynucleotide sequence, refers to the numbering of the residues of a specified reference sequence when the given amino acid or polynucleotide sequence is compared to the reference sequence.
“Nucleic acid” refers to nucleotides (e.g., deoxyribonucleotides, ribonucleotides, and 2′-modified nucleotides) and polymers thereof in either single-, double- or multiple-stranded form, or complements thereof. The terms “polynucleotide,” “oligonucleotide,” “oligo” or the like refer, in the usual and customary sense, to a linear sequence of nucleotides. The term “nucleotide” refers, in the usual and customary sense, to a single unit of a polynucleotide, i.e., a monomer. Nucleotides can be ribonucleotides, deoxyribonucleotides, or modified versions thereof. Examples of polynucleotides contemplated herein include single and double stranded DNA, single and double stranded RNA, and hybrid molecules having mixtures of single and double stranded DNA and RNA. Examples of nucleic acid, e.g. polynucleotides contemplated herein include any types of RNA, e.g. mRNA, siRNA, miRNA, and guide RNA and any types of DNA, genomic DNA, plasmid DNA, and minicircle DNA, and any fragments thereof. The term “duplex” in the context of polynucleotides refers, in the usual and customary sense, to double strandedness.
Nucleic acids, including e.g., nucleic acids with a phosphorothioate backbone, can include one or more reactive moieties. As used herein, the term reactive moiety includes any group capable of reacting with another molecule, e.g., a nucleic acid or polypeptide through covalent, non-covalent or other interactions. By way of example, the nucleic acid can include an amino acid reactive moiety that reacts with an amino acid on a protein or polypeptide through a covalent, non-covalent, or other interaction.
The terms also encompass nucleic acids containing known nucleotide analogs or modified backbone residues or linkages, which are synthetic, naturally occurring, and non-naturally occurring, which have similar binding properties as the reference nucleic acid, and which are metabolized in a manner similar to the reference nucleotides. Examples of such analogs include, include, without limitation, phosphodiester derivatives including, e.g., phosphoramidate, phosphorodiamidate, phosphorothioate (also known as phosphothioate having double bonded sulfur replacing oxygen in the phosphate), phosphorodithioate, phosphonocarboxylic acids, phosphonocarboxylates, phosphonoacetic acid, phosphonoformic acid, methyl phosphonate, boron phosphonate, or O-methylphosphoroamidite linkages (see Eckstein, OLIGONUCLEOTIDES AND ANALOGUES: A PRACTICAL APPROACH, Oxford University Press) as well as modifications to the nucleotide bases such as in 5-methyl cytidine or pseudouridine.; and peptide nucleic acid backbones and linkages. Other analog nucleic acids include those with positive backbones; non-ionic backbones, modified sugars, and non-ribose backbones (e.g. phosphorodiamidate morpholino oligos or locked nucleic acids (LNA) as known in the art), including those described in U.S. Pat. Nos. 5,235,033 and 5,034,506, and Chapters 6 and 7, ASC Symposium Series 580, CARBOHYDRATE MODIFICATIONS IN ANTISENSE RESEARCH, Sanghui & Cook, eds. Nucleic acids containing one or more carbocyclic sugars are also included within one definition of nucleic acids. Modifications of the ribose-phosphate backbone may be done for a variety of reasons, e.g., to increase the stability and half-life of such molecules in physiological environments or as probes on a biochip. Mixtures of naturally occurring nucleic acids and analogs can be made; alternatively, mixtures of different nucleic acid analogs, and mixtures of naturally occurring nucleic acids and analogs may be made. In embodiments, the internucleotide linkages in DNA are phosphodiester, phosphodiester derivatives, or a combination of both.
“Operably linked” refers to a juxtaposition wherein the components so described are in a relationship permitting them to function in their intended manner. A control sequence “operably linked” to a coding sequence is ligated in such a way that expression of the coding sequence is achieved under conditions compatible with the control sequences
As may be used herein, the terms “nucleic acid,” “nucleic acid molecule,” “nucleic acid oligomer,” “oligonucleotide,” “nucleic acid sequence,” “nucleic acid fragment” and “polynucleotide” are used interchangeably and are intended to include, but are not limited to, a polymeric form of nucleotides covalently linked together that may have various lengths, either deoxyribonucleotides and/or ribonucleotides, and/or analogs, derivatives or modifications thereof. Different polynucleotides may have different three-dimensional structures, and may perform various functions, known or unknown. Non-limiting examples of polynucleotides include genomic DNA, a genome, mitochondrial DNA, a gene, a gene fragment, an exon, an intron, intergenic DNA (including, without limitation, heterochromatic DNA), messenger RNA (mRNA), transfer RNA, ribosomal RNA, a ribozyme, cDNA, a recombinant polynucleotide, a branched polynucleotide, a plasmid, a vector, isolated DNA of a sequence, isolated RNA of a sequence, a nucleic acid probe, and a primer. Polynucleotides useful in the methods of the disclosure may comprise natural nucleic acid sequences and variants thereof, artificial nucleic acid sequences, or a combination of such sequences.
The term “amino acid residue,” as used herein, encompasses both naturally-occurring amino acids and non-naturally-occurring amino acids. Examples of non-naturally occurring amino acids include, but are not limited to, D-amino acids (i.e. an amino acid of an opposite chirality to the naturally-occurring form), N-a-methyl amino acids, C-a-methyl amino acids, β-methyl amino acids and D- or L-β-amino acids. Other non-naturally occurring amino acids include, for example, (β-alanine (β-Ala), norleucine (Nle), norvaline (Nva), homoarginine (Har), 4-aminobutyric acid (γ-Abu), 2-aminoisobutyric acid (Aib), 6-aminohexanoic acid (ε-Ahx), ornithine (orn), sarcosine, α-amino isobutyric acid, 3-aminopropionic acid, 2,3-diaminopropionic acid (2,3-diaP), D- or L-phenylglycine, D-(trifluoromethyl)-phenylalanine, and D-p-fluorophenylalanine.
As used herein, “peptide bond” can be a naturally-occurring peptide bond or a non-naturally occurring (i.e. modified) peptide bond. Examples of suitable modified peptide bonds are well known in the art and include, but are not limited to, —CH2NH—, —CH2S—, —CH2CH2—, —CH═CH— (cis or trans), —COCH2—, —CH(OH)CH2—, —CH2SO—, —CS—NH— and —NH—CO— (i.e. a reversed peptide bond) (see, for example, Spatola, Vega Data Vol. 1, Issue 3, (1983); Spatola, in Chemistry and Biochemistry of Amino Acids Peptides and Proteins, Weinstein, ed., Marcel Dekker, New York, p. 267 (1983); Morley, J. S., Trends Pharm. Sci. pp. 463-468 (1980); Hudson et al., Int. J. Pept. Prot. Res. 14:177-185 (1979); Spatola et al., Life Sci. 38:1243-1249 (1986); Hann, J. Chem. Soc. Perkin Trans. 1307-314 (1982); Almquist et al., J. Med. Chem. 23:1392-1398 (1980); Jennings-White et al., Tetrahedron Lett. 23:2533 (1982); Szelke et al., EP 45665 (1982); Holladay et al., Tetrahedron Lett. 24:4401-4404 (1983); and Hruby, Life Sci. 31:189-199 (1982)).
A polynucleotide is typically composed of a specific sequence of four nucleotide bases: adenine (A); cytosine (C); guanine (G); and thymine (T) (uracil (U) for thymine (T) when the polynucleotide is RNA). Thus, the term “polynucleotide sequence” is the alphabetical representation of a polynucleotide molecule; alternatively, the term may be applied to the polynucleotide molecule itself. This alphabetical representation can be input into databases in a computer having a central processing unit and used for bioinformatics applications such as functional genomics and homology searching. Polynucleotides may optionally include one or more non-standard nucleotide(s), nucleotide analog(s) and/or modified nucleotides.
Vasculopathy is a term used to describe a disease affecting blood vessels. It often includes vascular abnormalities caused by degenerative, metabolic and inflammatory conditions, embolic diseases, coagulative disorders, and functional disorders such as posteri or reversible encephalopathy syndrome. The etiology of vasculopathy is generally unknown and the condition is frequently not pathologically proven. Vasculitis, on the other hand, is a more specific term and is defined as inflammation of the wall of a blood vessel.
As used herein, “vasculitis (angiitis or angitis)” refers to inflammation of a blood vessel, e.g., arteritis, phlebitis, or lymphatic vessel, e.g., lymphangitis. Vasculitis can take various forms such as cutaneous vasculitis, urticarial vasculitis, leukocytoclastic vasculitis, livedo vasculitis and nodular vasculitis. Small vessel vasculitis may refer to inflammation of small or medium sized blood or lymphatic vessel, e.g., capillaries, venules, arterioles and arteries.
Vascular Ehlers-Danlos Syndrome (vEDS)
Vascular Ehlers-Danlos Syndrome (vEDS) is an inherited connective tissue disorder caused by heterozygous mutations in the collagen type III alpha 1 chain (COL3A1) gene. The major cause of mortality in vEDS is arterial dissection and/or rupture, but little is known about the pathogenesis of this disease. Effective treatment strategies for this devastating condition do not exist. The current belief is that reduced amounts of collagen III lead directly to the signs and symptoms of vEDS due to an inherent loss of structural integrity of the tissues. However, early pathogenic models of Marfan Syndrome (MFS) also singularly invoked tissue weakness imposed by failed elastogenesis, but subsequent work clearly demonstrated enhanced transforming growth factor beta (TGF-β) signaling in a mouse model deficient in fibrillin-1, the deficient gene product in MFS. Follow-up work went on to show that TGF-β and downstream cellular signaling molecules were major mediators of disease pathology. Further, therapies that attenuate TGF-β signaling and related pathways, such as TGF-β neutralizing antibody (Nab), the angiotensin-II (Ang-II) type 1 receptor blocker (ARB) losartan, or the inhibitor of ERK1/2 activation RDEA119/trametinib, can suppress aortic disease in MFS mice.
However, similar to other heritable vasculopathies such as Marfan syndrome and Loeys-Dietz syndrome, provided herein are signaling abnormalities that are major mediators of disease pathology in vEDS. RNA-seq profiling on the aortas of mice with patient-derived Col3a1 mutations demonstrated elevated PLC/IP3/PKC/ERK signaling compared to wild-type aortas. Immunoblotting of the proximal descending thoracic aorta confirmed elevated PKC and ERK1/2 activation.
p38 mitogen-activated protein kinases are a class of mitogen-activated protein kinases (MAPKs) that are responsive to stress stimuli, such as cytokines, ultraviolet irradiation, heat shock, and osmotic shock, and are involved in cell differentiation, apoptosis and autophagy. Persistent activation of the p38 MAPK pathway in muscle satellite cells (muscle stem cells) due to ageing, impairs muscle regeneration.
p38 MAP Kinase (MAPK), also called RK or CSBP (Cytokinin Specific Binding Protein), is the mammalian orthologue of the yeast Hog1p MAP kinase, which participates in a signaling cascade controlling cellular responses to cytokines and stress.
Four p38 MAP kinases, p38-α (MAPK14), (MAPK11), -γ (MAPK12/ERK6), and -δ (MAPK13/SAPK4), have been identified. Similar to the SAPK/JNK pathway, p38 MAP kinase is activated by a variety of cellular stresses including osmotic shock, inflammatory cytokines, lipopolysaccharides (LPS), Ultraviolet light, and growth factors.
In certain embodiments, p38 comprises the following amino acid sequence (NCBI Accession No: 095433.1 (SEQ ID NO: 1), incorporated herein by reference in its entirety):
In certain embodiments, the p38 comprises the following nucleotide sequence. Four isoforms of p38 are known:
A phosphatase is an enzyme that uses water to cleave a phosphoric acid monoester into a phosphate ion and an alcohol. Because a phosphatase enzyme catalyzes the hydrolysis of its substrate, it is a subcategory of hydrolases. Phosphatase enzymes are essential to many biological functions, because phosphorylation (e.g. by protein kinases) and dephosphorylation (by phosphatases) serve diverse roles in cellular regulation and signaling. Whereas phosphatases remove phosphate groups from molecules, kinases catalyze the transfer of phosphate groups to molecules from ATP. Together, kinases and phosphatases direct a form of post-translational modification that is essential to the cell's regulatory network. Phosphatase enzymes are not to be confused with phosphorylase enzymes, which catalyze the transfer of a phosphate group from hydrogen phosphate to an acceptor. Due to their prevalence in cellular regulation, phosphatases are an area of interest for pharmaceutical research.
Within the larger class of phosphatase, there are approximately 104 distinct enzyme families. Phosphatases are classified by substrate specificity and sequence homology in catalytic domains. Despite their classification into over one hundred families, all phosphatases still catalyze the same general hydrolysis reaction.
Protein phosphatase 1 (PP1) belongs to a certain class of phosphatases known as protein serine/threonine phosphatases. This type of phosphatase includes metal-dependent protein phosphatases (PPMs) and aspartate-based phosphatases. PP1 has been found to be important in the control of glycogen metabolism, muscle contraction, cell progression, neuronal activities, splicing of RNA, mitosis, cell division, apoptosis, protein synthesis, and regulation of membrane receptors and channels.
In certain embodiments, PP1 comprises the following amino acid sequence (NCBI Accession No: AAA36508.1 (SEQ ID NO: 6), incorporated herein by reference in its entirety):
PP1 is know to comprise multiple subunits. In particular, the nucleotide sequences of human subunits A, B and C and mouse subunits A, B and C are as follows: Human PP1 subunit A (SEO ID NO:7):
In certain embodiments, the PP1 comprises one or more of the above subunits, or a sequence that has at least 85, 90, 95, 96, 97 or 98 sequence identity to one of the above listed subunit sequences. For example, the PP1 may comprises one, two, three or more of the the above sequences of human subunits A, B and/or C, or mouse subnits A, B and/or C, or a sequence that has at least 85, 90, 95, 96, 97 or 98 sequence identity to one of the above listed subunit sequences.
The MAPK/ERK pathway (also known as the Ras-Raf-MEK-ERK pathway) is a chain of proteins in the cell that communicates a signal from a receptor on the surface of the cell to the DNA in the nucleus of the cell.
The signal starts when a signaling molecule binds to the receptor on the cell surface and ends when the DNA in the nucleus expresses a protein and produces some change in the cell, such as cell division. The pathway includes many proteins, including MAPK (mitogen-activated protein kinases, originally called ERK, extracellular signal-regulated kinases), which communicate by adding phosphate groups to a neighboring protein, which acts as an “on” or “off” switch.
The term “ERK” refers to any human ERK1 or ERK2 gene or protein. ERK1 is known by several names including, for example, mitogen-activated protein kinase 3, extracellular signal-regulated kinase 1, insulin-stimulated MAP2 kinase, MAP kinase 1, MAPK 1, p44-ERK1, ERT2, p44-MAPK or microtubule-associated protein 2 kinase.
ERK2 is known by several names including, for example, mitogen-activated protein kinase 1, extracellular signal-regulated kinase 2, mitogen-activated protein kinase 2, MAP kinase 2, MAPK 2, p42-MAPK, or ERT1.
In certain embodiments, ERK1 comprises the following amino acid sequence (NCBI Accession No: P27361.4 (SEQ ID NO: 13), incorporated herein by reference in its entirety):
In certain embodiments, the ERK1 comprises the following nucleotide sequence (NCBI Accession No: X60188.1 (SEQ ID NO: 14), incorporated herein by reference in its entirety):
In certain embodiments, ERK2 comprises the following amino acid sequence (NCBI Accession No: P28482.3 (SEQ ID NO: 15), incorporated herein by reference in its entirety):
In certain embodiments, the ERK2 comprises the following nucleotide sequence (NCBI Accession No: NM 138957.3 (SEQ ID NO: 16), incorporated herein by reference in its entirety):
Ehlers—Danlos syndromes (EDSs) are a group of genetic connective tissue disorders. Symptoms may include loose joints, stretchy skin, and abnormal scar formation. These can be noticed at birth or in early childhood. Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis.
EDSs are due to a mutation in one of more than a dozen different genes. The specific gene affected determines the specific EDS. Some cases result from a new mutation occurring during early development, while others are inherited in an autosomal dominant or recessive manner. This results in defects in the structure or processing of collagen. The diagnosis may be confirmed with genetic testing or a skin biopsy. People may be misdiagnosed with hypochondriasis, depression, or chronic fatigue syndrome.
To date, no cure is known, however, physical therapy and bracing may help strengthen muscles and support joints. While some disorders result in a normal life expectancy, those that affect blood vessels generally result in a shorter life expectancy. EDSs affect about one in 5,000 people globally, and the prognosis depends on the specific disorder.
Hypermobile EDS (type 3 hEDS) is characterized primarily by joint hypermobility affecting both large and small joints, which may lead to recurrent joint dislocations and subluxations (partial dislocation). In general, people with this type have soft, smooth, and velvety skin with easy bruising and chronic pain of the muscles and/or bones. The mutation that causes this type of EDS is unknown. Less skin involvement is seen than other types. No genetic test for this type is available.
Classical EDS (type 1 cEDS) is associated with extremely elastic (stretchy), smooth skin that is fragile and bruises easily; wide, atrophic scars (flat or depressed scars); and joint hypermobility. Molluscoid pseudotumors (calcified hematomas over pressure points such as the elbow) and spheroids (fat-containing cysts on forearms and shins) are also frequently seen. Hypotonia and delayed motor development may occur. The mutation that causes this type of EDS is in the genes COL5A1, COL5A2, and COL1A1. It involves the skin more than hEDS.
Vascular EDS (type 4 vEDS) is characterized by thin, translucent skin that is extremely fragile and bruises easily. Arteries and certain organs such as the intestines and uterus are also fragile and prone to rupture. People with this type typically have short stature, and thin scalp hair. It also has characteristic facial features including large eyes, an undersized chin, sunken cheeks, a thin nose and lips, and ears without lobes. Joint hypermobility is present, but generally confined to the small joints (fingers, toes). Other common features include club foot, tendon and/or muscle rupture, acrogeria (premature aging of the skin of the hands and feet), early onset varicose veins, pneumothorax (collapse of a lung), recession of the gums, and a decreased amount of fat under the skin. Is can be caused by the mutations in the COL3A1 gene.
Kyphoscoliosis EDS (type 6 kEDS) is associated with severe hypotonia at birth, delayed motor development, progressive scoliosis (present from birth), and scleral fragility. Affected people may also have easy bruising, fragile arteries that are prone to rupture, unusually small corneas, and osteopenia (low bone density). Other common features include a “marfanoid habitus” which is characterized by long, slender fingers (arachnodactyly), unusually long limbs, and a sunken chest (pectus excavatum) or protruding chest (pectus carinatum). It can be caused by mutations in the gene PLOD1.
Arthrochalasia EDS (types 7A & B aEDS) is characterized by severe joint hypermobility and congenital hip dislocation. Other common features include fragile, elastic skin with easy bruising, hypotonia, kyphoscoliosis (kyphosis and scoliosis), and mild osteopenia. Type-I collagen is usually affected. It is very rare, with about 30 cases reported. It is more severe than the hypermobility type. Mutations in the genes COL1A1 and COL1A2 cause it.
Dermatosparaxis EDS (type 7C dEDS) is associated with extremely fragile skin leading to severe bruising and scarring; saggy, redundant skin, especially on the face; and hernias. It is extremely rare, with around 10 cases reported.
Brittle cornea syndrome is characterized by thin corneaa, early-onset progressive keratoglobus or keratoconus, and blue sclerae. Classic symptoms, such as hypermobile joints and hyperelastic skin, are also seen often.
Classical-like EDS (type 1 cEDS) is characterized by skin hyperextensibility with velvety skin texture and absence of atrophic scarring, generalized joint hypermobility with or without recurrent dislocations (most often shoulder and ankle), and easily bruised skin or spontaneous ecchymoses (discolorations of the skin resulting from bleeding underneath).
Spondylodysplastic EDS (spEDS) is characterized by short stature (progressive in childhood), muscle hypotonia (ranging from severe congenital, to mild later-onset), and bowing of limbs.
Musculocontractural EDS (mcEDS) is characterized by congenital multiple contractures, characteristically adduction-flexion contractures and/or talipes equinovarus (clubfoot), characteristic craniofacial features, which are evident at birth or in early infancy, and skin features such as skin hyperextensibility, bruising, skin fragility with atrophic scars, and increased palmar wrinkling.
Myopathic EDS (mEDS) is characterized by congenital muscle hypotonia and/or muscle atrophy that improves with age, proximal joint contractures (joints of the knee, hip and elbow), and hypermobility of distal joints (joints of the ankles, wrists, feet and hands).
Periodontal EDS (pEDS) is characterized by severe and intractable periodontitis of early onset (childhood or adolescence), lack of attached gingiva, pretibial plaques, and family history of a first-degree relative who meets clinical criteria.
Cardiac-valvular EDS (cvEDS) is characterized by severe progressive cardiac-valvular problems (aortic valve, mitral valve), skin problems (hyperextensibility, atrophic scars, thin skin, easy bruising), and joint hypermobility (generalized or restricted to small joints).
Methods for Treating vEDS and Related Syndromes
Included herein is a method of preventing or treating a vEDS and related syndromes in a subject in need thereof. In further embodiments, the method comprises administering to the subject an effective amount of the composition comprising the agent (e.g., For example, methods for preventing or treating vEDS and related syndromes include administering a composition comprising an agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof.
In certain aspects, a small molecule compound therapeutic agent (e.g. MAPK agonist) is administered to a subject in accordance with the present methods.
In certain aspects, anisomycin or a substituted anisomycin compound or other p38 MAPK activator (MAPK agonist) is administered to a subject in accordance with the present methods, for example to prevent or treat vEDS. Exemplary substituted anisomycin compounds for administration to a subject in accordance with the present methods include for example 4-O-dodecanoyl-3-O-carba moyldeacetylanisomycin; 3-O-methylcarbamoyl-deacetylanisomycin; 4-O-acetyl-3-O-carbamoyldeacetylanisomycin; 4-O-hexanoyl-3-O-carbamoyldeacetylanisomycin; 4-O-heptanoyl-3-O-carbamoyldeacetylanisomycin; 3-O-methoxymethyldeacetylanisomycin and/or 3-O-carbamoyldeacytylanisomycin.
In certain aspects, a microcystin compound is administered to a subject in accordance with the present methods, for example to prevent or treat vEDS. In certain embodiments, the microcystin compound is selected one or more of MC-LR, MC-LA, MC-LF, MC-LW, MC-YR, and MC-RR.
In additional aspects, C2 Ceramide (also known as D-erythro-Sphingosine, N-Acetyl and may function as a PP1 activator) may be used in the present pharmaceutical compositions and administered to a subject in accordance with the present methods, for example to prevent or treat vEDS.
In additional aspects, 4-benzenesulfonyl fluoride (including a 4-benzenesulfonyl fluoride salt such as 4-benzenesulfonyl fluoride hydrochloride) may be used in the present pharmaceutical compositions and administered to a subject in accordance with the present methods, for example to prevent or treat vEDS.
MAPK agonists that may be utilized in the present methods (e.g. administered to a subject in need thereof to treat vEDS) and pharmaceutical compositions also have been disclosed e.g. in WO2010/033906 including Formulae XI, XI(a) and XI(b) thereof. In certain other aspects, however, the present therapeutic methods and compostions may not include one or more compounds disclosed WO2010/033906 including Formulae XI, XI(a) and XI(b) thereof.
Additional MPK agonists or other agents that may be used in the present therapeutic methods and pharmaceutical compositions include for example anandamide, angiotensin II, amsomycin, aurintricarboxyhc acid, 1,1-dimethylbiguamde, interlukin-11, isoproterenol, lactosyl ceramide, leukotriene D4, lipoxin A4, platelet activating factor-16, N-acetyl-D-erythro-sphingosine, N- hexanoyl-D-erythro-sphingosine, N-octanoyl-D-erythro-sphingosine, sphingosylphosphorylcholine and TNF-alpha.
Suitable agents for use in the present methods and pharmaceutical compositions (including to administer in a therapeutically effective amount to treat a vasculopathy such as vascular Ehlers-Danlos Syndrome (vEDS)) also can be determined empirically, for example in an assay (including an in vitro assay) that shows an increase of activity or expression of a mitogen-activated protein kinase (MAPK) or a protein phosphatase (PP) in the presence of a candidate compound relative to a control, for instance at least about a 5, 10, 20, 30, 40, or 50 percent or more increase in activity or expression of a mitogen-activated protein kinase (MAPK) or a protein phosphatase (PP) relative to a control. A control may be the same assay conducted without the candidate compound. See also U.S. Pat. No. 9,624,196 for assays that can be used for assessing p38 MAP kinase activity of candidate compounds.
In other embodiments, the methods for treating vEDS and related syndroms comprise administering to a subject a composition comprising an agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof, produced according to the methods described herein, in combination with methods for controlling the outset of symptoms. In particular, the combination treatment can include administering readily known treatments. Additionally, combination therapy may include hormonal and/or chemotherapy (e.g. taxane-based) treatment (therapy).
The described composition can be administered as a pharmaceutically or physiologically acceptable preparation or composition containing a physiologically acceptable carrier, excipient, or diluent, and administered to the tissues of the recipient organism of interest, including humans and non-human animals.
The agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof (e.g., a composition comprising the agent can be prepared by re-suspending in a suitable liquid or solution such as sterile physiological saline or other physiologically acceptable injectable aqueous liquids. The amounts of the components to be used in such compositions can be routinely determined by those having skill in the art.
In examples, for injectable administration, the composition (e.g., a composition comprising the agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof is in sterile solution or suspension or can be resuspended in pharmaceutically- and physiologically-acceptable aqueous or oleaginous vehicles, which may contain preservatives, stabilizers, and material for rendering the solution or suspension isotonic with body fluids (i.e. blood) of the recipient. Non-limiting examples of excipients suitable for use include water, phosphate buffered saline, pH 7.4, 0.15 M aqueous sodium chloride solution, dextrose, glycerol, dilute ethanol, and the like, and mixtures thereof. Illustrative stabilizers are polyethylene glycol, proteins, saccharides, amino acids, inorganic acids, and organic acids, which may be used either on their own or as admixtures. The amounts or quantities, as well as the routes of administration used, are determined on an individual basis, and correspond to the amounts used in similar types of applications or indications known to those of skill in the art.
In embodiments, a therapeutically effective amount of the composition (e.g., a composition comprising an agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof in humans can be any therapeutically effective amount. In one embodiment, the composition (e.g., a composition comprising the agent is administered thrice daily, twice daily, once daily, fourteen days on (four times daily, thrice daily or twice daily, or once daily) and 7 days off in a 3-week cycle, up to five or seven days on (four times daily, thrice daily or twice daily, or once daily) and 14-16 days off in 3 week cycle, or once every two days, or once a week, or once every 2 weeks, or once every 3 weeks.
In an embodiment, the composition (e.g., a composition comprising the agent is administered once a week, or once every two weeks, or once every 3 weeks or once every 4 weeks for at least 1 week, in some embodiments for 1 to 4 weeks, from 2 to 6 weeks, from 2 to 8 weeks, from 2 to 10 weeks, or from 2 to 12 weeks, 2 to 16 weeks, or longer (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 36, 48, or more weeks).
Additional advantages of the methods described herein include that the agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof (e.g., a composition comprising agent) can be injected systemically, as opposed to local delivery. Additional advantages include that patients requiring treatment typically require at least 1 local injections, and the injections are about 7 days apart. The compositions and methods described herein provide that patients require about 1 injection(s), systemically. In some examples, the injections can be every week.
The present invention provides pharmaceutical compositions comprising an effective amount of a composition (e.g., a composition comprising an agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof) and at least one pharmaceutically acceptable excipient or carrier, wherein the effective amount is as described above in connection with the methods of the invention.
In one embodiment, the composition (e.g., a composition comprising an agent that increases the activity or expression of a mitogen-activated protein kinase (MAPK), a protein phosphatase (PP), or a combination thereof) is further combined with at least one additional therapeutic agent in a single dosage form.
The term “pharmaceutically acceptable” refers to those compounds, materials, compositions, carriers, and/or dosage forms which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem or complication, commensurate with a reasonable benefit/risk ratio.
“Pharmaceutically acceptable excipient” means an excipient that is useful in preparing a pharmaceutical composition that is generally safe, non-toxic and neither biologically nor otherwise undesirable, and includes excipient that is acceptable for veterinary use as well as human pharmaceutical use. Examples of pharmaceutically acceptable excipients include, without limitation, sterile liquids, water, buffered saline, ethanol, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol and the like), oils, detergents, suspending agents, carbohydrates (e.g., glucose, lactose, sucrose or dextran), antioxidants (e.g., ascorbic acid or glutathione), chelating agents, low molecular weight proteins, or suitable mixtures thereof
A pharmaceutical composition can be provided in bulk or in dosage unit form. It is especially advantageous to formulate pharmaceutical compositions in dosage unit form for ease of administration and uniformity of dosage. The term “dosage unit form” as used herein refers to physically discrete units suited as unitary dosages for the subject to be treated; each unit containing a predetermined quantity of active compound calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier. The specification for the dosage unit forms of the invention are dictated by and directly dependent on the unique characteristics of the active compound and the particular therapeutic effect to be achieved. A dosage unit form can be an ampoule, a vial, a suppository, a dragee, a tablet, a capsule, an IV bag, or a single pump on an aerosol inhaler.
In therapeutic applications, the dosages vary depending on the agent, the age, weight, and clinical condition of the recipient patient, and the experience and judgment of the clinician or practitioner administering the therapy, among other factors affecting the selected dosage. Generally, the dose should be a therapeutically effective amount. Dosages can be provided in mg/kg/day units of measurement (which dose may be adjusted for the patient's weight in kg, body surface area in m2, and age in years). Exemplary doses and dosages regimens for the compositions in methods of treating muscle diseases or disorders are described herein.
The pharmaceutical compositions can take any suitable form (e.g, liquids, aerosols, solutions, inhalants, mists, sprays; or solids, powders, ointments, pastes, creams, lotions, gels, patches and the like) for administration by any desired route (e.g, pulmonary, inhalation, intranasal, oral, buccal, sublingual, parenteral, subcutaneous, intravenous, intramuscular, intraperitoneal, intrapleural, intrathecal, transdermal, transmucosal, rectal, and the like). For example, a pharmaceutical composition of the invention may be in the form of an aqueous solution or powder for aerosol administration by inhalation or insufflation (either through the mouth or the nose), in the form of a tablet or capsule for oral administration; in the form of a sterile aqueous solution or dispersion suitable for administration by either direct injection or by addition to sterile infusion fluids for intravenous infusion; or in the form of a lotion, cream, foam, patch, suspension, solution, or suppository for transdermal or transmucosal administration.
In embodiments, the pharmaceutical composition comprises an injectable form.
A pharmaceutical composition can be in the form of an orally acceptable dosage form including, but not limited to, capsules, tablets, buccal forms, troches, lozenges, and oral liquids in the form of emulsions, aqueous suspensions, dispersions or solutions. Capsules may contain mixtures of a compound of the present invention with inert fillers and/or diluents such as the pharmaceutically acceptable starches (e.g., corn, potato or tapioca starch), sugars, artificial sweetening agents, powdered celluloses, such as crystalline and microcrystalline celluloses, flours, gelatins, gums, etc.
A pharmaceutical composition can be in the form of a sterile aqueous solution or dispersion suitable for parenteral administration. The term parenteral as used herein includes subcutaneous, intracutaneous, intravenous, intramuscular, intra-articular, intraarterial, intrasynovial, intrasternal, intrathecal, intralesional and intracranial injection or infusion techniques.
A pharmaceutical composition can be in the form of a sterile aqueous solution or dispersion suitable for administration by either direct injection or by addition to sterile infusion fluids for intravenous infusion, and comprises a solvent or dispersion medium containing, water, ethanol, a polyol (e.g., glycerol, propylene glycol and liquid polyethylene glycol), suitable mixtures thereof, or one or more vegetable oils. Solutions or suspensions of the compound of the present invention as a free base or pharmacologically acceptable salt can be prepared in water suitably mixed with a surfactant. Examples of suitable surfactants are given below. Dispersions can also be prepared, for example, in glycerol, liquid polyethylene glycols and mixtures of the same in oils.
The pharmaceutical compositions for use in the methods of the present invention can further comprise one or more additives in addition to any carrier or diluent (such as lactose or mannitol) that is present in the formulation. The one or more additives can comprise or consist of one or more surfactants. Surfactants typically have one or more long aliphatic chains such as fatty acids which enables them to insert directly into the lipid structures of cells to enhance drug penetration and absorption. An empirical parameter commonly used to characterize the relative hydrophilicity and hydrophobicity of surfactants is the hydrophilic-lipophilic balance (“HLB” value). Surfactants with lower HLB values are more hydrophobic, and have greater solubility in oils, while surfactants with higher HLB values are more hydrophilic, and have greater solubility in aqueous solutions. Thus, hydrophilic surfactants are generally considered to be those compounds having an HLB value greater than about 10, and hydrophobic surfactants are generally those having an HLB value less than about 10. However, these HLB values are merely a guide since for many surfactants, the HLB values can differ by as much as about 8 HLB units, depending upon the empirical method chosen to determine the HLB value. All percentages and ratios used herein, unless otherwise indicated, are by weight.
Other features and advantages of the present invention are apparent from the different examples. The provided examples illustrate different components and methodology useful in practicing the present invention. The examples do not limit the claimed invention. Based on the present disclosure the skilled artisan can identify and employ other components and methodology useful for practicing the present invention.
In aspects, a kit for increasing the activity or expression of MAP, PP (e.g., PP1), or p38 is provided. In embodiments, the kit comprises the agent and reagents.
In embodiments, components of the kit are suitable for delivery (e.g., local injection) to a subject.
The present invention also provides packaging and kits comprising pharmaceutical compositions for use in the methods of the present invention. The kit can comprise one or more containers selected from the group consisting of a bottle, a vial, an ampoule, a blister pack, and a syringe. The kit can further include one or more of instructions for use in treating and/or preventing a disease, condition or disorder of the present invention (e.g., a vEDS and related syndromes), one or more syringes, one or more applicators, or a sterile solution suitable for reconstituting a pharmaceutical composition of the present invention.
The following examples illustrate certain specific embodiments of the invention and are not meant to limit the scope of the invention.
Embodiments herein are further illustrated by the following examples and detailed protocols. However, the examples are merely intended to illustrate embodiments and are not to be construed to limit the scope herein. The contents of all references and published patents and patent applications cited throughout this application are hereby incorporated by reference.
As described in the following Examples, vEDS is an inherited connective tissue disorder caused by heterozygous mutations in the COL3A1 gene, resulting in spontaneous vascular and/or organ rupture. The PLC/IP3/PKC/ERK pathway is activated in vulnerable vascular segments in a mouse model (Col3a1G939D/+) of vEDS. Attenuation of this signaling axis using either IP3/PKC or MEK/ERK inhibitors affords overt protection from vascular rupture in vEDS mice. Genetic modifiers of vascular rupture were identified in vEDS after observing that, compared to a C57BL/6J (BL6) background, vEDS mice on a 129S6/SvEvTac (129) background show near-complete life-long protection from vascular rupture and premature lethality. This protection was not associated with improved aortic wall biomechanical strength, histologic architecture, or changes in blood pressure but rather was associated with decreased activation of PKC/ERK signaling and essentially complete normalization of genome-wide mRNA expression changes as assessed by RNAseq of the descending thoracic aorta, the most vulnerable aortic segment. This unanticipated dissociation between structural tissue integrity and phenotypic outcome provided the first evidence that a nonproductive cellular response to an altered extracellular matrix, rather than the matrix deficiency per se, is the dominant determinant of vascular disease in vEDS, boding well for the identification of pharmacologic interventions.
Genome-wide genotyping of intercrossed BL6/129 vEDS mice stratified by survival identified a single significant protective locus on mouse chromosome 11 (OR=0.2412, p=3.73E-5)M. ap2k6, encoding a p38-activating kinase, emerged as the only likely candidate gene based on both expression in the aorta and predicted functional strain-specific sequence variation (p. G76E). Protected 129 vEDS mice showed higher expression of Map2k6 in the aorta and increased phosphorylation of p38. Increased activation of p38 associated with increased activity of its substrate PP1 in the aortic wall, a phosphatase that dephosphorylates and deactivates pPKC and pERK. Inhibition of this protective axis using a selective p38 inhibitor significantly accelerated vascular rupture in vEDS mice in a PKC and ERK-dependent manner. These results both validate and extend the understanding of cellular signaling events that culminate in vascular rupture in vEDS and define a pathway of natural potent protective disease modification. Pharmacologic interventions that mimic nature's successful modification strategy will afford substantial protection to patients with vEDS.
Heterozygous mice were characterized for a disease-causing Col3a1 allele (Col3a1/G938D/+) on a pure BL6 mouse background. These mice recapitulate severe vEDS phenotypes, with spontaneous death due to aortic rupture, leading to a median survival of only 45 days(13). The BL6 vEDS mice were backcrossed onto a 129 background to assess the impact of mouse strain on disease severity.
Remarkably, the 129 background led to essentially complete protection from aortic rupture and premature death, with the long-term performance of these mice indistinguishable from that observed for wild-type littermates (93% vs 98% survival after 6 months) (
Given that the PLC/IP3/PKC/ERK axis was implicated in vEDS aortic pathology, the status of PKC and ERK activation was investigated in the 129 vEDS aortas by western blot analysis. Activation of ERK1/2 and PKC was accentuated in BL6 vEDS aortas, while the level of activation in 129 vEDS aortas was not different from wildtype littermate aortas (
To identify variants in genes that modify vascular rupture risk in vEDS, animals were stratified based on survival. Extremes of this distribution were investigated to maximize both signal intensity and power, using the Col3a1G938D/+ model which shows early death due to vascular rupture. Greater than 63% of all vEDS mice on the BL6 background die by 50 days of age, while >90% of vEDS mice on the 129 background live longer than 6 months. Due to ambiguity regarding the cause of perinatal lethality and the associated difficulty in reliable sample collection, a “severe phenotype” was defined as mice that died from aortic rupture between 1 and 7 weeks and defined a “mild phenotype” as mice that showed survival past 24 weeks of age. vEDS mice that have been backcrossed one time (F1 generation) showed improved long-term survival similar to completely backcrossed 129 vEDS mice, suggesting the presence of a genetic modifier that acts in an autosomal dominant manner (
Wild-type BL6 and 129 animals were intercrossed, and subsequently their progeny for 4 generations, to introduce extensive recombination between the strain-specific chromosomes, with expansion of numbers of mice in each generation. These mixed genetic mice were bred to BL6 vEDS mice to produce a large population with a mixed but mostly BL6 genetic background, from which an autosomal dominant protective allele was identified (
91 mixed background vEDS mice were genotyped with a mild phenotype, and 96 mixed background vEDS mice with a severe phenotype. Sufficient animals of both sexes were included for use in combined and parallel sex-specific analyses, due to evidence in humans that males with vEDS have a more severe vascular phenotype, as well the possibility of sex-specific modification mechanisms (8,13). A linkage disequilibrium (LD) block-pruned set of 603 SNPs was used to perform logistic regression GWAS, assuming full dominance for the minor allele and using sex as a covariate.
1 locus was identified that was linked with protection from aortic rupture on chromosome 11, with a peak p-value of 7.081E-03 (
Surprisingly, despite the sex specific effects in the incidence of aortic rupture, no association signal on the chromosome X was observed. This suggested that the increased severity in males is not attributable to an X-linked trait but rather an autosomal trait that is sex-limited (i.e. androgen production). Male and female mice were separated and GWAS logistic analysis was performed in each cohort, hypothesizing that there were sex-specific autosomal modifiers of disease. Unfortunately, when split by sex, the cohorts individually are under-powered, and no suggestive signals are revealed.
A candidate functional variant within the locus was investigated that differed between the backgrounds. The area of formal analysis was a 10.1 Mb region, including the region between the closest neighboring upstream and downstream SNP markers below the peak on chromosome 11 (103,513,550-113,599,747 bp) (
To assess the role of Map2k6 on vascular rupture risk in vEDS, BL6 and 129 background vEDS mice were crossed to Map2k6−/− mice to generate vEDS mice haploinsufficient or fully deficient for Map2k6. On a BL6 background, zero vEDS mice survived past P1 with one copy of Map2k6 deleted (Col3a1G938D/+Map2k6+/−), suggesting that the loss of one Map2k6 allele in BL6 vEDS mice was significantly lethal in the prenatal or early postnatal period (Table 2, below). 129 background vEDS mice with a complete loss of Map2k6 have an elevated risk of vascular rupture (
Previous work described that the Map2k6 BL6 allele leads to decreased function compared to the 129 allele (10). MKK6, together with MAP3K4, is known to increase p38 activation, which in turn negatively regulates PKC and ERK activation via protein phosphatase 1 and 2A (PP1/2A) (14-16). Within the 129 background, the increased MKK6 activity lead to increased p38 activation and hence increased PP1/2A activity, with consequent reduction in PKC and ERK activation (
The hypothesis that the elevated p38 and PP1 activity led to protection from vascular rupture in vEDS was investigated. To examine the role of elevated p38 activity on vascular rupture directly, BL6 vEDS mice were treated with SB203580, a selective p38 inhibitor. Treatment with the p38 inhibitor significantly increased the rate of death in BL6 vEDS mice (
Provided herein, it was demonstrated that the 129 background attenuates the PLC/PKC/ERK signaling cascade in association with prevention of vascular events and premature death in vEDS mice. Remarkably, this rescue on the 129 background is not dependent upon an improvement in collagen deposition or inherent structural integrity of the aortic wall. Instead, phenotypic rescue appears to be dependent on the biochemical response of vascular cells. This bodes well for the development of pharmacologic strategies that can mimic this mechanism of protection. As such, p38 or PP1 activation may represent novel therapeutic strategies for reducing rupture risk in vEDS. This confluence of discovery-based and hypothesis-driven interrogations informs disease pathogenesis of vEDS and provides added confidence regarding the potential of therapeutic strategies targeting the PKC/ERK1/2 axis of activation.
GWAS was used in inbred mouse strains with differing disease severity and rigorous follow up biochemical and functional analyses to identify and validate a genetic modifier that protects vEDS mice from vascular rupture. This association directly implicated a region on chromosome 11 which contained only one functional variant between the two strains of interest. Map2k6 expression was higher in 129 background mice and it contained a variant which led to elevated MKK6 activity. Correlating with improved survival, increased p38 phosphorylation and elevated PP1/2A activity was observed on the 129 background, suggesting that activation of this pathway was protective in vEDS.
A critical test of hypothesis was to show that directed provocations altered the survival of the vEDS mice in a predictable and robust manner. vEDS mice were deficient in either Map2k6 or p38 activity significantly worsened survival. Together these data indicated that Map2k6 was responsible, at least in part, for the protective effect that the 129 background has on vEDS vascular phenotypes. This work defines MKK6/p38 as a negative regulator of the altered molecular signaling axis that is responsible for the increase in vascular rupture risk in vEDS mice.
The chromosome 11 locus, as defined by the 10.1 Mb interval between the neighboring SNPs to the two genome-wide significant SNPs, contained 117 genes. The Map2k6 variant was based on the hypothesis that the modifier would lead to a functional protein difference in a gene expressed in the aorta, however this is not enough to definitively exclude other genes at this locus. Importantly, all of the experimental results confirmed that Map2k6 played a protective role in vascular rupture risk, as deletion of Map2k6 or inhibition of its direct downstream target, p38, significantly increased the risk of early death and vascular rupture. While these data support a role for MKK6 and p38 in vascular rupture risk, they do not exclude any of the other genes at this locus. Furthermore, this variant alone does not explain the full protective effect of the 129 background on vEDS rupture risk, suggesting that there are other relevant variants that remain to be identified.
The work herein provides that p38 is working to negatively regulate the PKC/ERK axis via induction of PP1 activity. p38 has also previously been implicated in the negative regulation of androgen receptor activity (17,18). Exploration of the effects of the Map2k6 variant on androgen receptor signaling will be important for understanding the sexual dimorphism identified in this study.
While the genetic background affects vEDS phenotypes in an opposite manner as MFS phenotypes, robust unbiased whole genome association analysis showed genome-wide significance for the same locus and putative single gene variation. MFS aortic disease exclusively affects the aortic root, while vEDS vascular disease can occur in any medium or large arterial segment, generally excluding the aortic root. Furthermore, p38 has been demonstrated to potentiate SMAD signaling, which plays a critical role in MFS but not in vEDS (19-21).
Methods
Mice
Mice were maintained either on a C57BL/6J background (#000664, The Jackson Laboratory) or on a 129S6/SvEvTac background (#129SVE, Taconic Biosciences). Mice were considered to be 129S6/SvEvTac after backcrossing for a minimum of 4 generations. F1 and mixed mice were generated by interbreeding pure C57BL/6J and 129S6/SvEvTac mice. To identify the dominant genetic locus, mixed background wild-type females were bred to Col3a1G938D/+ male mice on a pure BL6 background. Mice haploinsufficient or knockout for Map2k6 were originally obtained from the Jackson Laboratory (#008382) and backcrossed in the lab for a minimum of 10 generations. Restriction enzymes were used to detect the presence or absence of the Col3a1 mutation. The G209S mutation leads to the loss of an AvaII cut site and the G938D mutation leads to the gain of a BamHI cut site (AvaII R0153L; BamHI-HF R3136S, New England Biolabs). All mice found dead were assessed for cause of death by necropsy, noting in particular hemothorax and hemoperitoneum.
Histology and Immunofluorescence
Mice were euthanized by isoflurane inhalation and the left common iliac artery was transected to allow for drainage. PBS and PBS containing 4% paraformaldehyde (PFA) was flushed through the left ventricle. The heart and thoracic aorta were removed en block and fixed in 4% PFA overnight at 4° C. Aortas were submitted for paraffin fixation and longitudinal sections 5 micrometers thick were mounted on glass slides and stained with hematoxylin & eosin (HE), Verhoeff-van Giesen (VVG), Masson's Trichrome, or Picrosirius red (PSR). Slides were imaged at 20× and 40× magnification using a Nikon Eclipse E400 microscope. Collagen content was determined by polarized PSR intensity (22) and elastin breaks were counted by a researcher blinded to genotype and treatment arm using only VVG-stained sections where elastin breaks were clearly visualized.
Human samples were obtained from surgical pathology records. Tissue samples were submitted for paraffin fixation after fixation in formaldehyde. Longitudinal sections 5 micrometers thick were mounted on glass slides. Slides were deparaffinized and incubated in antigen retrieval solution in a pressure cooker for 1 minute (Vector labs, H3300). After this antigen retrieval step, sections were incubated with 1% BSA for 1 hour at room temperature. Primary antibodies were diluted at 1:200 in blocking buffer (1% BSA) and incubated overnight at 4° C. Three consecutive washes were performed prior to incubation with anti-rabbit secondary antibody conjugated to Alexa Fluor 594 (Invitrogen, R37119) or Alexa Fluor 488 (Invitrogen, A21206) at 1:100 for 1 hour. Slides were again washed 3 times, incubated with DAPI nuclear stain at 1:40,000 for 10 minutes, and washed again prior to mounting with VECTASHIELD Hard Set Mounting Media (H-1400). The following primary antibodies were used: anti-phospho ERK1/2 (Cell Signaling Technology, 4370), anti-PKCβ (phospho 5660) (Abcam, 75837). Images were acquired on a Zeiss LSM780-FCS confocal microscope at ×20 magnification and are presented as maximal intensity projection. Image adjustments to enhance visualization of information present in the original were applied equally across samples.
Descending thoracic aortas (distal to the left subclavian branch and proximal to the diaphragm) from mice that did not die from aortic rupture and did not have any overt pathology at the time of planned sacrifice were harvested, snap frozen in liquid nitrogen, and stored at −80° C. until processed. Protein was extracted using an automatic bead homogenizer in conjunction with a Protein Extraction Kit (Full Moon Biosystems). All protein lysis buffers contained both PhosSTOP and Complete™, Mini, EDTA-free Protease Inhibitor Cocktail (Roche). Western blotting was performed using LI-COR buffer and species appropriate secondary antibodies conjugated to IR-dye700 or IRdye-800 (LI-COR Biosciences), according to the manufacturer's guidelines and analyzed using LI-COR Odyssey. The following primary antibodies were used: anti-β-Actin (8H10D10) (Cell Signaling Technology, 3700), anti-phospho ERK1/2 (Cell Signaling Technology, 4370), anti-PKCβ (phospho 5660) (Abcam, 75837), anti-phospho p38 (Cell Signaling Technology, 4511).
RNA was isolated from the proximal descending thoracic aorta of three mice for each condition, flushed in PBS, and directly stored into TRIzol (Invitrogen). RNA was extracted according to manufacturer's instructions and purified using the PureLink RNA Mini Kit (Invitrogen). Library prep was performed using TruSeq Stranded Total RNA with Ribo-Zero (Illumina). Sequencing was run on an Illumina HiSeq2500 using standard protocols.
Illumina's CASAVA 1.8.4 was used to convert BCL files to FASTQ files. Default parameters were used. rsem-1.3.0 was used for running the alignments as well as generating gene and transcript expression levels. The data was aligned to “mm10” reference genome. EBseq was used for Differential Expression analysis and default parameters were used(25).
Aortas were dissected as described above, flushed in PBS, and directly stored in TRIzol (Invitrogen). RNA was extracted according to the manufacturer's instructions and purified with RNAeasy mini columns (Qiagen). Complementary DNA (cDNA) was generated using TaqMan High Capacity cDNA Reverse Transcription reagents (Applied Biosystems) and qPCR was performed in triplicate with TaqMan Universal PCR Master Mix (Applied Biosystems). The following TaqMan probes were used: Mm00803694 ml (Map2k6), Mm00446968 ml (Hprt). Relative quantification for each transcript was obtained by normalizing against Hprt transcript abundance according to the formula 2(−Ct)/2(−Ct Hprf). All expression levels were normalized to untreated wild-type control expression levels.
For drug trials in the Col3a1/G938D/+ mice, mice were initiated on medication at weaning and continued until the end of the trial. Cobimetinib (GDC-0973/R0551404, Active Biochem) was dissolved in drinking water and filtered to reach a final concentration of 0.02 g/L giving an estimated dose of 2 mg/kg/day. Ruboxistaurin (LY333531 HCl, Selleck Chemicals) was mixed with powdered food (LabDiet) to give a concentration of 0.1 mg/g giving an estimated dose of 8 mg/kg/day. SB203580 (Selleck Chemicals) was administered at a dose of 5 mg/kg/d every 3 days by intraperitoneal injection. Animals receiving placebo (5% Tween in PBS) were also injected every 3 days by intraperitoneal injection.
Blood pressures were measured by tail cuff plethysmography one week prior to completion of a study. To measure and record blood pressures, the BP-2000 Blood Pressure Analysis system was utilized. This method utilizes variations in the amount of light transmitted through the tail as the basic signal that is analyzed to determine the blood pressure and pulse rate. After the software determines the pulse rate, it inflates the occlusion cuff and records diastolic pressure when the wave form starts to decrease and systolic pressure when the waveform remains at a steady value. If either measurement is unclear to the software, it is not recorded. Mice were habituated to the system for three days prior to collection in which 10-15 measurements were obtained and averaged.
Genotyping was performed using the GigaMUGA array, which has been optimized to interrogate SNPs that allow discrimination of very closely related mouse strains, such as C57BL6/J and 129SveTac. Standard GoldenGate chemistry was applied on an iScan mircroarray scanner. SNPs were called using GenomeStudio version 2011.1, Genotyping Module version 1.9.4, and GenTrain Version 1.0 with Genome Build 37. A total of 143,446 SNPs were attempted per individual (137,746 autosomal, 5,601 X chromosome, and 99 Y chromosome SNPs).
SNPs with less than 90% call rate were filtered as assay failures, which eliminated 3,942. SNPs were filtered as uninformative using the following criteria: if the Minor Allele Frequency (MAF) equaled 0 (removing 97,595 SNPs), if the heterozygote rate (AB Freq) was greater than 80% or equal to 0 (removing an additional 707 SNPs), or if the homozygote rate (AA Freq or BB Freq) was equal to 0 (removing an additional 6,461 SNPs). Genotype frequencies were investigated for parental strains (B6, 129) and F1 samples (50/50 mix of B6 and 129) and any SNP that did not have the 2 parental strains as opposite homozygotes was filtered as uninformative (AA or BB Freq=0) and any SNP that did not have F1 samples as heterozygotes was filtered as uninformative (AB Freq=0). In total, 32,218 SNPs were released per individual. Of the 5,573,714 released SNPs, only 7,917 no calls were made, indicating a missing data rate of 0.14%. PLINK software was utilized to prune SNPs to include only one per LD block using default values. PLINK software was used to calculate genome wide association using logistic analysis, covariate for sex, and an autosomal dominant allele assumption.
Descending thoracic aortas (distal to the left subclavian branch and proximal to the diaphragm) from mice that did not die from aortic rupture and did not have any overt pathology at the time of planned sacrifice (at 2 months of age for all samples unless otherwise stated) were harvested, snap frozen in liquid nitrogen, and stored at −80° C. until processed. Protein was extracted using an automatic bead homogenizer in conjunction with a Protein Extraction Kit (Full Moon Biosystems). All protein lysis buffers for downstream phosphatase assay analysis contained Complete™, Mini, EDTA-free Protease Inhibitor Cocktail (Roche). Lysed protein was subjected to a direct fluorescence-based assay for detecting serine/threonine phosphatase activity (RediPlate™ 96 EnzChek serine/threonine phosphatases Assay Kit, Molecular Probes) according to the manufacturer's instructions. Briefly, appropriate buffers for either the serine/threonine phosphatases PP1 and PP2A were added to a 96-well microplate preloaded with inhibitors of phosphatases other than serine/threonine phosphatases, and with the fluorogenic serine/threonine phosphate substrate DiFMUP (6,8-difluoro-4-methyl-umbelliferyl phosphate), from which DiFMU is generated. The fluorescence emitted by converted DiFMU was measured using a fluorescence microplate reader, with excitation at 355±20 nm and emission at 460±12.5 nm.
All data points are presented for quantitative data, with an overlay of the mean with SEM. All statistical analysis was performed using GraphPad Prism 8 unless otherwise noted. For data that did not pass Shapiro-Wilk normality tests, Kruskal-Wallis (nonparametric) testswere performed to evaluate significance between groups using Dunn's multiple comparison test with a p-value of <0.05 considered statistically significant. For data that did pass normality, two-way or one-way ANOVA was used with multiple comparisons, as noted in each legend.
For single comparisons, if the Shapiro-Wilk normality test was passed, then two-tailed unpaired t-tests were performed. If Shapiro-Wilk normality test did not pass, then Mann-Whitney nonparametric tests were performed.
Kaplan-Meier survival curves were compared using a log-rank (Mantel-Cox) test. Mice were censored only if unrelated to the outcome, such as for planned biochemical or histologic analysis or if the authors were directed to euthanize them by animal care staff, for malocclusion, fight wounds, or genital prolapse.
While the invention has been described in conjunction with the detailed description thereof, the foregoing description is intended to illustrate and not limit the scope of the invention, which is defined by the scope of the appended claims. Other aspects, advantages, and modifications are within the scope of the following claims.
The patent and scientific literature referred to herein establishes the knowledge that is available to those with skill in the art. All references, e.g. ,U U.S. patents, U.S. patent application publications, PCT patent applications designating the U.S., published foreign patents and patent applications cited herein are incorporated herein by reference in their entireties. Genbank and NCBI submissions indicated by accession number cited herein are incorporated herein by reference. All other published references, documents, manuscripts and scientific literature cited herein are incorporated herein by reference. In the case of conflict, the present specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.
While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.
This invention was made with government support under Grant No. 07023, awarded by the Howard Hughes Medical Institute (HHMI); and under Grant No. 5R01AR041135, awarded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institute of Health. The Government has certain rights in the invention. The present application claims the benefit of priority of U.S. provisional application no. 63/075,047 filed Sep. 4, 2020, which is incorporated herein by reference it its entirety.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US21/49168 | 9/3/2021 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 63075047 | Sep 2020 | US |
