CN112654397A - 用于治疗哮喘和过敏性疾病的方法和组合物 - Google Patents
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Abstract
本发明涉及过敏领域。几个独立的小组最近已经研究了PCSK9对炎症和败血症的影响,但是其中没有一个能确定其对过敏和/或哮喘的影响,而过敏和/或哮喘是全球性的健康负担。发明人已经获得了野生型(PCSK9+/+)或PCSK9缺陷型小鼠(PCSK9‑/‑)的初步数据,并发现,在基础条件下和在没有特定刺激的情况下,PCSK9缺乏会显著增加脾脏、肠系膜淋巴结和派尔集合淋巴结(Peyer's patche)中调节性T细胞的百分比。此外,发明人已经发现了过敏性攻击对原代人支气管上皮细胞上PCSK9表达和分泌的影响。非常有趣的是,其通过Q‑PCR获得的首个结果表明,HDM和LPS会增加PCSK9mRNA的水平。因此,本发明涉及用于治疗哮喘和/或过敏性疾病(如食物过敏)的PCSK9抑制剂。
Description
技术领域
本发明涉及过敏领域。更具体地,本发明涉及用于治疗哮喘和过敏性疾病如食物过敏的方法和组合物。
背景技术
PCSK9(前蛋白转化酶枯草杆菌蛋白酶kexin 9型)是胆固醇代谢的关键调节子,已开发出PCSK9抑制剂来治疗高胆固醇血症和心血管疾病。
PCSK9于2003年在常染色体显性遗传性高胆固醇血症患者中发现(1),并迅速确立了其作为低密度脂蛋白受体(LDLR)天然抑制剂的典型(canonical)作用(2)。PCSK9在内质网中自噬后,会被肝脏在血液中分泌为成熟形式。PCSK9结合到LDLR的胞外域,并通过促进其溶酶体降解而不是再循环至膜来干扰LDLR的运输。遗传研究进一步证实,PCSK9缺乏与LDL-胆固醇(LDL-C)水平降低和心血管事件的急剧减少有关(3),从而导致了PCSK9抑制剂的开发。最近,有研究表明,阻断PCSK9胞外形式的PCSK9人单克隆抗体可显著减少高胆固醇血症患者的主要心血管事件(4)。
除了在肝脏LDLR通路中的这种典型作用外,很多研究表明,PCSK9可能在肝外器官上发挥一些生物学功能(综述(5))。PCSK9在肝脏,以及肠道、肾脏、肺和胸腺中大量表达(6)。PCSK9也由肝脏分泌到血液中,并且能够以内分泌方式调控肝外组织中LDLR的表达(7)。
除了其在脂质代谢中的作用以外,一些研究表明,PCSK9也可能与炎症应答有关。例如,在小鼠中PCSK9的肝脏表达响应于脂多糖(LPS)诱导的炎症而增加(8)。最近,一系列独立研究突显了PCSK9与先天性免疫应答和败血性休克结局之间的联系(在(9)中进行了综述)。已证明PCSK9缺乏或抑制与人和小鼠的败血性休克结局改善有关,这可能是由于以LDLR依赖性方式增加了LPS的清除率(9)。最近,一项研究发现高胆固醇血症、PCSK9过表达和T细胞介导的炎性疾病之间存在联系(10)。过表达PCSK9“功能获得性”突变体的小鼠在其肺中显示出血液和脾脏调节性T细胞减少,同时T细胞(CD3+/CD45+)增加。组织学分析还显示,经AAV8PCSK9处理的小鼠血管周围和支气管周围炎症增加(10)。
哮喘是一种常见的慢性呼吸系统疾病,全球约有3亿人受到影响。尽管不同国家的哮喘患病率介于人口的1%至16%之间,但食物过敏的患病率为3%,并且还在不断增加。在各种表型的哮喘中,早期发作的特应性Th2型(11)通常与过敏性病症相关,并且似乎是皮肤或肠道炎症引起的“特应性进行曲(march)”的最后阶段,导致对空气过敏原的致敏并发展为支气管哮喘(12-14)。这种慢性炎性疾病涉及免疫力(IgE特异性过敏原、肥大细胞、细胞因子)和器官(脾脏、淋巴结、肠、肺)中的很多参与者,其功能可以被迅速改变。
几个独立的小组最近研究了PCSK9对败血症的影响,但其中没有一个确定其对过敏和/或哮喘的影响,而过敏和/或哮喘是全球性的健康负担。因此,需要寻找涉及免疫力的新治疗策略以治疗哮喘和食物过敏。
发明内容
本发明涉及用于治疗哮喘和过敏性疾病的PCSK9抑制剂。特别地,本发明由权利要求限定。
具体实施方式
发明人已经获得了野生型(PCSK9+/+)或PCSK9缺陷型小鼠(PCSK9-/-)的初步数据,并发现,在基础条件下和在没有特定刺激的情况下,PCSK9缺乏会显著增加脾脏、肠系膜淋巴结和派尔集合淋巴结(Peyer's patche)中调节性T细胞的百分比。有趣的是,这些细胞在过敏中的激活改变被认为在慢性炎症的发生中至关重要。此外,发明人已经发现了对原代人支气管上皮细胞的过敏性攻击对PCSK9表达和分泌的影响。非常有趣的是,其通过Q-PCR获得的首个结果表明,房屋尘螨(HDM)过敏原和LPS会增加PCSK9 mRNA的水平。同样,HDM引起胞内PCSK9蛋白含量的强烈上升。当使用LPS培养细胞时,其也观察到胞内PCSK9增加的趋势(+53%)。其还发现在HDM或LPS处理后培养基中PCSK9浓度增加。
因此,本发明人发现,PCSK9可能是治疗哮喘和过敏性疾病(如食物过敏)的新的潜在治疗性靶点。
评估或预测哮喘或过敏性疾病严重程度的方法
因此,本发明的第一个目的涉及一种用于在受试者中评估或预测哮喘的严重程度或过敏性疾病的严重程度的方法,包括i)确定从所述受试者获得的生物样品中的PCSK9水平,ii)将在步骤i)中确定的所述水平与预定的参照值进行比较和iii)当所述PCSK9水平高于所述预定的参照值时,得出结论:所述受试者患有或易于患有严重哮喘或严重过敏性疾病,或者当所述PCSK9水平低于所述预定的参照值时,得出结论:所述受试者未患有或不易于患有严重哮喘或严重过敏性疾病。
在一个特定实施方式中,所述方法适于预测受试者是否处于患有哮喘或严重哮喘的风险中。
如本文所用,术语“过敏性疾病”或“过敏”指免疫系统的反应,特别是特异性IgE抗体的反应。通常,IgE抗体和抗原结合肥大细胞和粒细胞的膜受体,抗原-抗体反应释放炎性介质,舒张血管,使毛细血管通透性过高,并引起诸如炎性细胞的组织浸润。通常,过敏性病症包括过敏性炎症和/或慢性炎症。例如,过敏性病症包括过敏性炎症,并选自以下:过敏性鼻炎、特应性皮炎、过敏性哮喘、过敏性结膜炎、胃肠道炎症、荨麻疹和/或食物过敏。在本发明的背景下,过敏性疾病是哮喘、严重哮喘或食物过敏。
如本文所用,术语“哮喘的严重程度”指全球哮喘防治倡议(GINA)对严重哮喘的定义:需要与其他控制物结合使用高剂量吸入的类固醇和/或口服类固醇才能控制,或者尽管使用此类治疗但仍无法控制的哮喘。
如本文所用,术语“风险”指事件将在特定时间段内发生的概率,如严重哮喘发作,并且可以表示受试者的“绝对”风险或“相对”风险。绝对风险可以参照相关时间队列的测量后实际观察结果来测量,或者参照相关时间段内遵循的具有统计学意义的历史数据队列得出的指标值测量。相对风险指受试者的绝对风险与低风险队列的绝对风险或平均人群风险的比率,该比率可能因评估的临床风险因素而异。
如本文所用,术语“受试者”指任何哺乳动物,如啮齿类、猫、犬和灵长类动物。特别地,在本发明中,受试者是人。在一个特定实施方式中,受试者是患有或疑似患有哮喘和/或过敏性疾病的人。更特别地,受试者患有或疑似患有严重哮喘或食物过敏。
如本文所用,术语“生物样品”指从受试者获得的样品,例如血液、唾液、母乳、尿液、精液、血浆、滑液、血清或血浆和支气管肺泡灌洗液(BAL)。在一个特定实施方式中,生物样品是血液样品。术语“血液样品”指来自受试者的任何血液样品。外周血是优选的,并且单核细胞(PBMC)是优选的细胞。通常,这些细胞可以使用Ficoll(一种分离血液层的亲水性多糖)从全血中提取,PBMC在血浆层下形成细胞环。另外,可以使用低渗裂解法从全血中提取PBMC,这将优先裂解红细胞。这样的程序是本领域技术人员公知的。在另一个实施方式中,生物样品是血浆和/或支气管肺泡灌洗液(BAL)。
如本文所用,术语“PCSK9”指前蛋白转化酶枯草杆菌蛋白酶/kexin 9型,也称为神经细胞凋亡调控的转化酶(NARC-1),这是一种蛋白酶K样枯草蛋白酶,其被鉴定为分泌性枯草蛋白酶家族的第9个成员。PCSK9是LDL受体(LDLR)的天然抑制剂,并且在胆固醇代谢中起关键作用。PCSK9结合LDLR的胞外域并触发其胞内降解,从而控制在血液循环中的LDL颗粒的水平。
如本文所用,术语“水平”指PCSK9的表达水平。通常,PCSK9基因的表达水平可以通过本领域技术人员公知的任何技术来确定。特别地,可以在基因组和/或核酸和/或蛋白水平上测量每个基因的表达水平。在一个特定实施方式中,通过测量每个基因的核酸转录物的量来确定基因的表达水平。在另一个实施方式中,通过测量每种基因相应蛋白的量来确定表达水平。核酸转录物的量可以通过本领域技术人员公知的任何技术来测量。特别地,可以直接在提取的信使RNA(mRNA)样品上进行检测,也可以通过本领域众所周知的技术对从提取的mRNA制备的逆转录互补DNA(cDNA)进行检测。从mRNA或cDNA样品中,可以使用本领域技术人员公知的任何技术来测量核酸转录物的量,包括核酸微阵列、定量PCR、微流体卡以及使用标记探针的杂交。在一个特定实施方式中,通过使用定量PCR确定表达水平。定量或实时PCR是本领域技术人员众所周知且容易获得的技术,不需要精确描述。用于确定mRNA的量的方法是本领域众所周知的。例如,首先根据标准方法,例如使用裂解酶或化学溶液或按照生产厂商的说明书通过核酸结合树脂提取生物样品中含有的核酸。然后,通过杂交(例如,Northern印迹分析)和/或扩增(例如,RT-PCR)检测提取的mRNA。优选的定量或半定量RT-PCR是优选的。实时定量或半定量RT-PCR是特别有利的。其他扩增方法包括连接酶链反应(LCR)、转录介导的扩增(TMA)、链置换扩增(SDA)和基于核酸序列的扩增(NASBA)。发现具有至少10个核苷酸并且与本文感兴趣的mRNA表现出序列互补性或同源性的核酸可用作杂交探针或扩增引物。应当理解的是,此类核酸不需要相同,但通常与具有相当尺寸的同源区至少约80%相同,更优选85%相同,以及甚至更优选90-95%相同。在某些实施方式中,有利的是,将核酸与适当手段(如可检测标记)结合使用以检测杂交。各种适当的指示剂是本领域公知的,包括荧光、放射性、酶促或其他配体(例如,抗生物素蛋白/生物素)。探针通常包含长度在10至1000个核苷酸之间的单链核酸,例如10至800个之间,更优选地15至700个之间,通常20至500个之间。引物通常是较短的单链核酸,长度在10至25个核苷酸之间,其被设计为与要扩增的感兴趣核酸完全或几乎完全匹配。探针和引物对其杂交的核酸是“特异性的”,即其优选在高严格杂交条件下杂交(对应于最高解链温度Tm,例如,50%甲酰胺,5x或6x SCC。SCC是0.15M NaCl,0.015M柠檬酸钠)。在上述扩增和检测方法中使用的核酸引物或探针可以组装成试剂盒。此类试剂盒包含共有引物和分子探针。试剂盒还包含确定扩增是否发生所必需的组分。试剂盒还可以包含,例如,PCR缓冲液和酶;阳性对照序列、反应对照引物;以及扩增和检测特定序列的说明书。在一个特定实施方式中,本发明的方法包括提供从生物样品中提取的总RNA并使RNA与特定探针进行扩增和杂交的步骤,尤其是通过定量或半定量RT-PCR。在另一个实施方式中,通过DNA芯片分析确定表达水平。此类DNA芯片或核酸微阵列由化学连接到基材的不同核酸探针组成,其可以是微芯片、载玻片或微球尺寸的小珠。微芯片可以由聚合物、塑料、树脂、多糖、二氧化硅或二氧化硅基材料、碳、金属、无机玻璃或硝酸纤维素组成。探针包含可以是约10至约60个碱基对的核酸,如cDNA或寡核苷酸。为确定表达水平,对来自检测受试者的生物样品进行标记(所述生物样品任选地首先进行逆转录),并使其在杂交条件下与微阵列接触,从而导致在靶核酸之间形成与附着在微阵列表面的探针序列互补的复合物。然后,检测标记的杂交复合物,并可以对其进行定量或半定量。可以通过各种方法来实现标记,例如,通过使用放射性或荧光标记。微阵列杂交技术的很多变体对本领域技术人员而言是可用的(参见例如,Hoheisel,Nature Reviews,Genetics,2006,7:200-210的综述)。
已将孟德尔随机研究用于验证PCSK9抑制与治疗心血管疾病的相关性。例如,已经证明,与PCSK9中功能丧失变体相关的LDL-胆固醇降低10mg/dL,心血管事件降低19%(Ference BA,N Eng J Med,2016;375:2144-53)。
因此,在一个特定实施方式中,可以通过上述方法在患有哮喘或过敏性疾病的患者队列中进行PCSK9的功能丧失变体检测。通常,可以通过如上文所述的方法进行突变R46L检测。如发明人在此前的研究中发现的,已知突变R46L影响约2%的法国人口:BonnefondA,Diabetologia,2015,58:2051-5.
当受试者有PCSK9的功能丧失时,这意味着功能丧失改善了过敏性疾病,更特别地,降低了过敏性疾病的严重程度。
在另一个实施方式中,PCSK9水平的测量通过免疫学检测进行。通常,通过本领域公知的任何方法,使用与PCSK9特异性结合的至少一种抗体,实现了PCSK9水平的免疫学检测或定量。所述方法的实例包括但不限于标准电泳和免疫诊断技术,如western印迹、免疫沉淀测定、放射性免疫测定、ELISA(酶联免疫吸附测定)、“夹心”免疫测定、凝胶扩散沉淀反应、免疫扩散测定、沉淀反应、凝集测定(如凝胶凝集测定、血液凝集测定等)、补体固定测定、蛋白A测定、免疫电泳测定、高效液相色谱、体积排阻色谱、固相亲和性等。在一个特定实施方式中,PCSK9水平是通过ELISA测量的。在一个特定实施方式中,测量了胞内PCSK9蛋白和分泌的PCSK9蛋白水平。
如本文所用,术语“预定的参照值”指阈值或截止值。通常,可以通过实验、经验或理论确定“阈值”或“截止值”。如本领域普通技术人员将认识到的,也可以基于现有的实验和/或临床条件来任意选择阈值。例如,可以将正确存储的历史受试者样品的回顾性测量结果用于建立预定的参照值。必须确定阈值,以便根据测试的功能和收益/风险平衡(假阳性和假阴性的临床结局)获得最佳的灵敏度和特异性。通常,可以使用基于实验数据的受试者工作特征(ROC)曲线确定最佳灵敏度和特异性(因此也需要确定阈值)。例如,在确定一组参照物中所选择的肽的表达水平后,可以使用算法分析对待测样品中确定的表达水平进行统计学处理,从而获得对样品分类具有重要意义的分类标准。ROC曲线的全称是受试者工作者特征曲线,也称为受试者工作特征曲线。其主要用于临床生物化学诊断检测。ROC曲线是反映真实阳性率(灵敏度)和假阳性率(1-特异性)的连续变量的综合指标。其用图像组合方法揭示了灵敏度和特异性之间的关系。将一系列不同的截止值(阈值或临界值,诊断检测的正常和异常结果之间的边界值)设置为连续变量,以计算一系列灵敏度和特异性值。然后,将灵敏度用作垂直坐标,将特异性用作水平坐标以绘制曲线。曲线下面积(AUC)越高,诊断的准确性越高。在ROC曲线上,最靠近坐标图左上角的点是同时具有高灵敏度和高特异性值的临界点。ROC曲线的AUC值在1.0至0.5之间。当AUC>0.5时,随着AUC接近1,诊断结果会越来越好。当AUC在0.5至0.7之间时,准确度较低。当AUC在0.7至0.9之间时,准确度中等。当AUC高于0.9时,准确度较高。该算法方法优选地由计算机来完成。可以使用现有技术中的现有软件或系统来绘制ROC曲线,如:MedCalc 9.2.0.1医学统计软件,SPSS 9.0,ROCPOWER.SAS,DESIGNROC.FOR,MULTIREADER POWER.SAS,CREATE-ROC.SAS,GB STAT VI0.0(DynamicMicrosystems,Inc.Silver Spring,Md.,USA)等。
用于治疗哮喘和/或过敏性疾病的方法和组合物
本发明的第二个目的涉及PCSK9抑制剂,其用于在有需要的受试者中治疗哮喘和/或过敏性疾病。
特别地,本发明涉及一种在有需要的受试者中治疗哮喘和/或过敏性疾病的方法,所述方法包括向所述受试者施用治疗有效量的PCSK9抑制剂的步骤。
在一个特定实施方式中,用于根据本发明的用途的PCSK9抑制剂适于治疗哮喘和/或严重哮喘。
在另一个实施方式中,用于根据本发明的用途的PCSK9抑制剂适于治疗过敏性疾病,如食物过敏。
在一个特定实施方式中,用于根据本发明的用途的PCSK9抑制剂,其包括通过进行本发明的方法预测所述受试者是否处于患有严重哮喘或严重过敏性疾病的风险中的步骤。
如本文所用,术语“治疗(treatment/treat)”指预防性或预防治疗,以及治愈性或改善疾病的治疗,包括治疗处于所述疾病风险中或疑似患有所述疾病的受试者,以及患病或被诊断为患有疾病或医疗状况的受试者,包括抑制临床复发。为了预防、治愈、推迟疾病发作,减轻疾病的严重性,减少疾病的一种或多种症状或疾病复发,或者为了延长受试者的生存期,使其超过在没有这种治疗的情况下所预期的生存期,可以向患有医学病症或最终可能患有所述病症的受试者施用所述治疗。“治疗方案”指疾病的治疗模式,例如,治疗期间使用的给药模式。治疗方案可以包括诱导方案和维持方案。短语“诱导方案”或“诱导期”指用于疾病的初始治疗的治疗方案(或治疗方案的一部分)。诱导方案的总体目标是在治疗方案的初始阶段向受试者提供高水平的药物。诱导方案可以(部分或全部)采用“负荷方案”,所述方案可以包括施用比维持方案期间医生使用的更高剂量的药物,以比维持方案期间医生使用的更高的频率施用药物,或者这两者。短语“维持方案”或“维持期”指用于在疾病治疗期间对受试者进行维持的治疗方案(或治疗方案的一部分),例如,以使得受试者在较长时间段(数月或数年)处于缓解状态。维持方案可以采用连续疗法(例如,定期施用药物,例如,每周、每月、每年等)或间歇性疗法(例如,中断治疗、间歇性治疗、复发时治疗或达到预先确定的标准[例如,疾病表现等]后的治疗)。
如本文所用,术语“受试者”指任何哺乳动物,如啮齿类、猫、犬和灵长类动物。特别地,在本发明中,受试者是患有或疑似患有至少一种过敏性疾病的人。在一个特定实施方式中,受试者是患有或疑似患有食物过敏或哮喘的人。在一个特定实施方式中,受试者患有食物过敏。在一个特定实施方式中,受试者患有严重哮喘。
如本文所用,术语“过敏性疾病”或“过敏”指免疫系统的反应,特别是特异性IgE的反应。通常,IgE抗体和抗原结合肥大细胞和粒细胞的膜受体,抗原-抗体反应释放炎性介质,舒张血管,使毛细血管通透性过高,并引起诸如炎性细胞的组织浸润。通常,过敏性病症包括过敏性炎症和/或慢性炎症。例如,过敏性病症包括过敏性炎症,并选自以下:过敏性鼻炎、特应性皮炎、过敏性哮喘、过敏性结膜炎、胃肠道炎症、荨麻疹和/或食物过敏。
如本文所用,术语“食物过敏”指通过免疫机制介导的对食物的不良反应,涉及特定的IgE(IgE介导的)、细胞介导的机制(非IgE介导的)以及IgE和细胞两者介导的机制(混合的IgE和非IgE介导的)。生物体无法发展或破坏食物耐受性,就会导致食物特异性IgE抗体的过量产生,或者细胞事件发生改变从而导致过敏反应。特别地,食物过敏涉及嗜酸性粒细胞性食管炎、嗜酸性胃炎和胃肠炎、食物蛋白诱发的小肠结肠炎综合征和过敏性原发性结肠炎、食物诱发的肺出血性含铁血黄素沉着病(海纳氏综合征)、食物诱发的过敏反应(急性荨麻疹、过敏性休克和水肿)以及食物相关的特应性皮炎和哮喘。
如本文所用,术语“哮喘”是指慢性呼吸系统疾病,被世界卫生组织(WHO)定义为特征为反复发作的呼吸急促和喘息的慢性疾病,其严重程度和发生频率因人而异。
如本文所用,术语“PCSK9”指前蛋白转化酶枯草杆菌蛋白酶/kexin 9型,也称为神经细胞凋亡调控的转化酶(NARC-1),这是一种蛋白酶K样枯草蛋白酶,其被鉴定为分泌性枯草蛋白酶家族的第9个成员。PCSK9是LDL受体(LDLR)的天然抑制剂,并且在胆固醇代谢中起关键作用。PCSK9结合LDLR的胞外域并触发其胞内降解,从而控制在血液循环中的LDL颗粒的水平。
如本文所用,术语“PCSK9抑制剂”指具有生物学效应以抑制或显著降低PCSK9的活性或表达的天然或合成的化合物。因此,其是指能够直接或间接降低PCSK9的转录、翻译、翻译后修饰或活性的任何化合物。其包括胞内和胞外PCSK9抑制剂。
在一个特定实施方式中,用于本发明的PCSK9活性的抑制剂是有机小分子、适体、抗体或多肽。
如本文所用,术语“有机小分子”指大小与通常在药物中使用的那些有机分子相当的分子。该术语不包括生物大分子(例如,蛋白、核酸等)。通常,有机小分子的尺寸范围可达约5000Da,更优选地可达2000Da和最优选地可达约1000Da。在一个特定实施方式中,有机小分子是DS-9001a,其包含与人工脂蛋白突变蛋白融合的白蛋白结合结构域(ABD融合的Anticalin蛋白)。这种小分子是由Daiichi Sankyo/Pieris Pharmaceuticals开发的(正在进行1期研究)。
如本文所用,术语“适体”指在分子识别方面代表抗体替代物的一类分子。适体是寡核苷酸或多肽序列,其具有以高亲和性和特异性识别实际上任何种类的靶分子的能力。
如本文所用,术语“抗体”指具有抗原结合区的任何抗体样分子,该术语包括包含抗原结合结构域的抗体片段,如Fab'、Fab、F(ab')2、单域抗体(DAB或VHH)、TandAb二聚体、Fv、scFv(单链Fv)、dsFv、ds-scFv、Fd、线性抗体、微型抗体、双抗体、双特异性抗体片段、双体、三体(分别为,scFv-Fab融合蛋白、双特异性或三特异性);sc-双体;κ(λ)体(scFv-CL融合);DVD-Ig(双可变结构域抗体,双特异性形式);SIP(小免疫蛋白,一种微型抗体);SMIP(“小型模块化免疫药物”);scFv-Fc二聚体;DART(ds稳定化的双体“双亲和性ReTargeting”);包含一个或多个CDR的小抗体模拟物等等。制备和使用各种基于抗体的构建体和片段是本领域众所周知的。特别地,在本发明的背景下,抗体是单域抗体。术语“单域抗体”在本领域中具有一般含义,并且是指抗体的单一重链可变结构域,这种类型的抗体可以存在于骆驼属哺乳动物中,其天然缺乏轻链。此类单域抗体也称为VHH或对于(单一)结构域抗体的一般性描述,还参考以上引用的现有技术,以及EP 0 368 684,Ward等(Nature 1989Oct 12;341(6242):544-6),Holt等,Trends Biotechnol.,2003,21(11):484-490;和WO 06/030220,WO 06/003388。在本发明的背景下,单域抗体的氨基酸残基根据国际ImMunoGeneTics信息系统氨基酸编号(http://imgt.cines.fr/)给出的VH结构域的通用编号进行编号。特别地,在本发明的背景下,抗体是单链可变片段。术语“单链可变片段”或“scFv片段”指包含通过接头分子连接的抗体的VH和VL结构域的单折叠多肽。在此类scFv片段中,VH和VL结构域可以是VH-接头-VL或VL-接头-VH顺序。除了促进其生产外,scFv片段还可以包含通过间隔子与scFv连接的标签分子。因此,scFv片段包含涉及抗原识别的VH和VL结构域,而不包含相应抗体的免疫原性恒定结构域。在一个特定实施方式中,PCS9活性的抑制剂是对PCSK9具有特异性的内体。如本文所用,术语“内体”通常指胞内抗体或抗体片段。抗体,特别是单链可变抗体片段(scFv),其可以被修饰以用于胞内定位。例如,此类修饰可能需要融合至稳定的胞内蛋白,比如例如,麦芽糖结合蛋白,或加入胞内运输/定位肽序列,比如例如,内质网保留。在一些实施方式中,内体是单域抗体。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是单克隆抗体。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是阿立单抗,其是Sanofi和Régéneron Pharmaceuticals以商品名Praluent(REGN727或SAR2365553)销售的,并且在本领域中具有以下通式:C6472H9996N1736O2032S42。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是Bococizumab,也称为PF-04950615或RN316,其由PFIZER开发(正在进行3期研究)。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是LGT-209,其由Novartis开发(正在进行2期研究)。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是RG-7652,其由Roche开发(正在进行2期研究)。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是LY3015014,其由EliLilly开发(正在进行2期研究)。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是MEDI 4166,其由AstraZeneca和Medimmune开发。MEDI 4166是一种与GLP1肽融合的PCSK9抗体。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是AT04A或AT06A,其是一种由AFFiRiS AG开发的疫苗(正在进行1期研究),Landlinger C等,Eur Heart J.2017aug21。
如本文所用,术语“多肽”指特异性结合PCSK9的多肽,可用作结合螯合PCSK9蛋白从而阻止其信号传导的PCSK9抑制剂。多肽指长度至少为2个氨基酸残基和至多为10个氨基酸残基的短肽,寡肽(11-100个氨基酸残基),和更长的肽(“多肽”的通常解释,即长度大于100个氨基酸残基)以及蛋白(包含至少一个肽、寡肽或多肽的功能性实体,可以通过糖基化、脂化或包含辅基对其进行化学修饰)。多肽的定义还包括分枝杆菌中肽/蛋白质的天然形式,以及转化任何种类宿主的任何类型表达载体中的重组蛋白或肽,以及化学合成的肽。特别地,PCSK9活性抑制剂是胞内肽。通常,胞内肽主要干扰PCSK9信号在细胞质、线粒体和/或细胞核中的传递。在一个特定实施方式中,抗PCSK9活性的多肽是BMS-962476,其特征是WO 2011130354中公开的氨基酸序列。还在Mitchell等,2010(J Pharmacol ExpTher.2014Aug;350(2):412-24.doi:10.1124/jpet.114.214221.Epub 2014Jun 10.)中描述了该多肽。
在一个特定实施方式中,用于本发明用途的PCSK9抑制剂是PCSK9表达的抑制剂。
如本文所用,“PCSK9表达的抑制剂”是指具有生物学作用以抑制或显著降低编码PCSK9的基因表达的天然或合成的化合物。通常,PCSK9表达的抑制剂对以下一种或多种事件具有生物学作用:(1)从DNA序列产生RNA模板(例如,通过转录);(2)加工RNA转录物(例如,通过剪接、编辑、5’帽形成和/或3’末端形成);(3)将RNA翻译成多肽或蛋白;和/或(4)多肽或蛋白的翻译后修饰。
在一些实施方式中,PCSK9表达的抑制剂反义寡核苷酸。反义寡核苷酸,包括反义RNA分子和反义DNA分子,将通过与其结合直接阻止PCSK9 mRNA的翻译,从而阻止蛋白翻译或增加mRNA降解,进而降低在细胞中PCSK9蛋白的水平和活性。例如,可以例如通过常规磷酸二酯技术合成至少约15个碱基并与编码PCSK9的mRNA转录物序列的独特区域互补的反义寡核苷酸,并通过例如静脉内注射或输注施用。使用反义技术特异性减少序列已知基因的基因表达的方法是本领域众所周知的(参见例如,美国专利号6,566,135;6,566,131;6,365,354;6,410,323;6,107,091;6,046,321;和5,981,732)。
在一个特定实施方式中,PCSK9表达的抑制剂是shRNA。通常使用引入细胞中的载体来表达shRNA,其中该载体利用U6启动子来确保shRNA始终被表达。该载体通常传递给子细胞,从而使基因沉默得以遗传。shRNA发夹结构被细胞机制切割成siRNA,然后与RNA诱导的沉默复合物(RISC)结合。该复合物结合并切割与其结合的siRNA匹配的mRNA。
在一些实施方式中,PCSK9表达的抑制剂是小抑制性RNA(siRNA)。可通过使受试者或细胞与小双链RNA(dsRNA)或引起小双链RNA产生的载体或构建体接触来降低PCSK9的表达,从而特异性抑制PCSK9的表达(即,RNA干扰或RNAi)。对于序列已知的基因,选择合适的dsRNA或编码dsRNA的载体的方法是本领域众所周知的(例如,参见Tuschl,T.等,(1999);Elbashir,S.M.等,(2001);Hannon,GJ.(2002);McManus,MT.等,(2002);Brummelkamp,TR.等,(2002);美国专利号6,573,099和6,506,559;国际专利公开号WO 01/36646、WO 99/32619和WO 01/68836)。在一个特定实施方式中,siRNA是ALN-PCS02,也称为inclisiran,其由Alnylam开发(正在进行3期研究),Ray KK等,N Egnl J Med,Apr 2017。
在一些实施方式中,PCSK9表达的抑制剂是核酶。核酶是能够催化RNA特异性切割的酶促RNA分子。核酶作用机制涉及核酶分子与互补靶RNA的序列特异性杂交,然后进行核酸内切酶裂解。因此,特异且有效地催化PCSK9 mRNA序列的核酸内切酶切的工程化发夹或锤头基序核酶分子在本发明的范围内是有用的。首先,通过扫描靶分子的核酶切割位点来鉴定任何潜在RNA靶点中的特定核酶切割位点,该酶通常包括以下序列GUA、GUU和GUC。一旦被鉴定,就可以评价对应于包含切割位点的靶基因区域的约15至20个核糖核苷酸之间的短RNA序列的预测结构特征,如二级结构,这可能导致寡核苷酸序列不合适。还可以通过使用例如核糖核酸酶保护测定检测候选靶标点与互补寡核苷酸杂交的可及性来评价候选靶点的适用性。
在一些实施方式中,PCSK9表达的抑制剂是核酸内切酶。术语“核酸内切酶”指在多核苷酸链内切割磷酸二酯键的酶。一些(如脱氧核糖核酸酶I)相对非特异性地切割DNA(不考虑序列),而很多通常称为限制性核酸内切酶或限制性内切酶,并且仅在非常特定的核苷酸序列处切割。基于核酸内切酶的基因组失活机制通常需要第一步DNA单链或双链断裂,然后可以触发两种不同的细胞DNA修复机制,这些机制可以用于DNA失活:易错的非同源末端连接(NHEJ)以及高保真同源定向修复(HDR)。
在一个特定实施方式中,核酸内切酶是CRISPR-cas。如本文所用,术语“CRISPR-cas”具有其在本领域中的一般含义,并且指相关的成簇规律间隔的短回文重复序列,其是包含短重复碱基序列的原核DNA区段。在一些实施方式中,核酸内切酶是来自酿脓链球菌的CRISPR-cas9。CRISPR/Cas9系统已在US 8697359 B1和US 2014/0068797中进行了描述。在一些实施方式中,核酸内切酶是CRISPR-Cpf1,这是Zetsche等人最近从Provotella和Francisella 1(Cpf1)表征的CRISPR(“Cpf1 is a Single RNA-guided Endonuclease ofa Class 2CRISPR-Cas System(2015);Cell;163,1-13)。
如本文所用,术语“施用(administering/administration)”指将存在于体外的某种物质(例如,PCSK9的抑制剂)注射或以其他方式物理地递送至受试者,如通过粘膜、皮内、静脉内、皮下、肌内递送和/或本文所述的或本领域公知的任何其他物理递送方法。当治疗疾病或其症状时,通常在疾病或其症状发作之后进行物质的施用。当预防疾病或其症状时,通常在疾病或其症状发作之前施用所述物质。
如本文所用,术语“治疗有效量”指足够量的PCSK9抑制剂以适用于任何药物治疗的合理收益/风险比来治疗疾病(例如,食物过敏和/或哮喘)。应当理解的是,本发明的化合物和组合物的每日总用量将由主治医师在合理的医学判断范围内决定。任何特定患者的具体治疗有效剂量水平将取决于多种因素,包括患者的年龄、体重、总体健康状况、性别和饮食;施用时间、施用途径和所使用的特定化合物的排泄速率;治疗持续时间;与所使用的特定多肽组合或同时使用的药物;以及医学领域众所周知的因素。例如,在本领域技术人员中众所周知的是,化合物的初始剂量应低于达到所需治疗效果所需的剂量,并逐渐增加剂量直至获得所需效果。然而,产品的每日剂量可以在每位成人每天0.01至1,000mg的宽范围内变化。通常,所述组合物包含0.01、0.05、0.1、0.5、1.0、2.5、5.0、10.0、15.0、25.0、50.0、100、250和500mg活性成分,用于对待治疗患者的剂量进行对症调整。药物通常包含从约0.01mg至约500mg的活性成分,通常从1mg至约100mg活性成分。通常以每天0.0002mg/kg至约20mg/kg体重,特别是每天约0.001mg/kg至7mg/kg体重的剂量水平提供有效量的药物。
如上所述的PCSK9抑制剂可以与哮喘或过敏性疾病的经典治疗联合施用。
因此,本发明涉及i)PCSK9抑制剂和ii)作为组合制剂的经典治疗,其用于治疗患有哮喘或过敏性疾病的受试者。
如本文所用,术语“经典治疗”指用于治疗哮喘或过敏性疾病的天然的或合成的任何化合物。
在一个特定实施方式中,哮喘或过敏性疾病的经典治疗指β-肾上腺素受体激动剂,如皮质类固醇,如氟尼缩松、环索奈德、莫米松、氟替卡松、布地奈德、倍氯米松和泼尼松;支气管扩张剂,如肾上腺素、消旋肾上腺素、茚达特罗、沙丁胺醇、左丙丁醇、奥达特罗、福莫特罗、阿福特罗,吡布特罗、特布他林、间肾上腺素、沙美特罗、异丙托溴铵、沙丁胺醇、噻托溴铵、芜地溴铵、格隆溴铵和利福那星;甲基黄嘌呤,如茶碱、二羟丙茶碱和氨茶碱;抗白三烯药,如孟鲁司特、扎非司特和齐留通;白介素抑制剂,如瑞利珠单抗、度匹鲁单抗、贝那利珠单抗、美泊利单抗和奥马珠单抗;肥大细胞稳定剂,如色甘酸;过敏原免疫疗法,如grastek、oralair和ragwitek。
如本文所用,术语“联合治疗”、“联合制剂”、“联合疗法”或“疗法组合”指使用一种以上药物的治疗。联合疗法可以是双重疗法或二重疗法。
根据本发明的联合治疗中使用的药物同时、分别或顺序地施用于受试者。
如本文所用,术语“同时施用”是指通过相同途径,同时或基本上同时施用两种活性成分。术语“分别施用”指通过不同途径同时或基本上同时施用两种活性成分。术语“顺序施用”指在不同时间施用两种活性成分,施用途径相同或不同。
如上所述的PCSK9抑制剂可以与药学上可接受的赋形剂,以及任选地持续释放基质(如可生物降解的聚合物)组合,以形成药物组合物。“药学上”或“药学上可接受的”指当适当地施用于哺乳动物(特别是人)时,不会产生不利、过敏或其他不良反应的分子实体和组合物。药学上可接受的载体或赋形剂指任何类型的无毒固体、半固体或液体填充剂、稀释剂、包封材料或制剂助剂。用于口服、舌下、皮下、肌内、静脉内、透皮、局部或直肠施用的本发明药物组合物,活性成分可以单独或与另一活性成分组合,作为与常规药物支持物的混合物,在单位施用形式中向动物和人类施用。适宜的单位施用形式包括口服形式,如片剂、凝胶胶囊、粉剂、颗粒剂和口服混悬液或溶液剂,舌下和颊部施用形式,气雾剂,植入剂,皮下、透皮、局部、腹膜内、肌内、静脉内、真皮下、透皮、鞘内和鼻内施用形式以及直肠施用形式。通常,药物组合物包含对于能够被注射的制剂而言是药学上可接受的载剂。这些可以特别地是等渗的无菌盐溶液(磷酸二氢钠或磷酸氢二钠,钠、钾、钙或镁的氯化物等等,或者此类盐的混合物),或者干燥的,特别是冻干的组合物,其在根据需要添加无菌水或生理盐水后,可以重构成可注射的溶液。适于可注射用途的药物形式包括无菌水溶液或分散液;包含芝麻油、花生油或丙二醇水溶液的制剂;以及用于临时制备无菌可注射溶液或分散液的无菌粉剂。在所有情况下,该形式都必须是无菌的,并且必须具有一定的流动性,以达到易于注射的目的。其必须在生产和储存条件下保持稳定,并且必须进行防腐以防止微生物(如细菌和真菌)的污染。包含本发明化合物作为游离碱或药理学上可接受的盐的溶液可以在水中适当地与表面活性剂(如羟丙基纤维素)混合而制备。分散液也可以在甘油、液体聚乙二醇及其混合物和在油中制备。在常规储存和使用条件下,这些制剂含有防腐剂以防止微生物的生长。可以将多肽(或其编码核酸)配制成中性或盐形式的组合物。药学上可接受的盐包括酸加成盐(与蛋白的游离氨基形成),其与无机酸(比如,例如,盐酸或磷酸)或有机酸(如乙酸、草酸、酒石酸、扁桃酸等)形成。与游离羧基形成的盐也可以来自无机碱(比如,例如,钠、钾、铵、钙或铁的氢氧化物)和有机碱(如异丙胺,三甲胺,组氨酸,普鲁卡因等)。载体也可以是溶剂或分散介质,其包含,例如,水、乙醇、多元醇(例如,甘油、丙二醇和液态聚乙二醇等),其适宜的混合物和植物油。例如,可以通过使用包衣(如卵磷脂)在分散液的情况下通过维持所需的粒径以及通过使用表面活性剂来维持适当的流动性。可以通过各种抗细菌和抗真菌剂(例如,对羟基苯甲酸酯、氯丁醇、苯酚、山梨酸、硫柳汞等)来预防微生物的作用。在很多情况下,包含等渗剂将是优选的,例如,糖或氯化钠。通过在组合物中使用延迟吸收剂(例如,单硬脂酸铝和明胶)可以使可注射组合物的吸收延长。通过将所需量的活性多肽掺入适当的溶剂中,并根据需要,将上面列举的几种其他成分掺入无菌可注射溶液中,然后过滤灭菌。在通常情况下,通过将各种灭菌的活性成分掺入无菌载剂中来制备分散液,所述无菌载剂包含基本分散介质和以上列举的那些所需的其他成分。在用于制备无菌可注射溶液的无菌粉末的情况下,优选的制备方法是真空干燥和冷冻干燥技术,其从其此前的无菌过滤溶液中产生活性成分和任何其他所需成分的粉末。制剂后,将以与剂型相容的方式和治疗有效量施用溶液。所述制剂易于以多种剂型施用,如上文所述的可注射溶液类型,但是也可以使用药物释放胶囊等。对于在水溶液中的胃肠外使用,例如,如有必要,应适当地缓冲溶液,并且首先用足够的盐水或葡萄糖使液体稀释剂等渗。这些特定水溶液特别适于静脉内、肌内、皮下和腹膜内施用。就此而言,根据本公开内容,本领域技术人员将知晓可以使用无菌水性介质。例如,一剂可以溶解在1mL等渗NaCl溶液中,并且添加到1000mL皮下输液液体中或在预计输注部位注射。剂量的某些变化将必然发生,这取决于所治疗的受试者的状况。在任何情况下,负责施用的人员将确定适用于个体受试者的适当剂量。
筛选方法
在第三个方面中,本发明涉及一种筛选适于抑制PCSK9的药物的方法,其包括i)提供测试化合物和ii)确定所述测试化合物抑制PCSK9的表达或活性的能力。
本领域公知的任何生物学测定法都适合于确定测试化合物抑制PCSK9的活性或表达的能力。在一些实施方式中,测定首先包括确定册数化合物结合PCSK9的能力。在一些实施方式中,然后接触并激活一个细胞群,以确定测试化合物抑制PCSK9活化或表达的能力。特别地,确定相对于在不存在测试化合物的情况下或存在对照剂的情况下(其均为阴性对照条件)平行孵育的细胞群,由待测化合物触发的作用。如本文所用,术语“对照物质”、“对照剂”或“对照化合物”指惰性的或不具有与调节生物学活性或表达的能力相关活性的分子。应当理解的是,如本文所述的使用体外方法所确定的,能够抑制PCSK9的活性或表达的测试化合物可能在体内应用中表现出相似的调节能力。通常,测试化合物选自以下:肽、拟肽、有机小分子、抗体(例如,内抗体)、适体或核酸。例如,根据本发明的测试化合物可以选自此前合成的化合物的库,或者在数据库中确定了其结构的化合物的库,或者来自从头合成的化合物的库。
通过以下附图和实施例将进一步说明本发明。然而,这些实施例和附图不应以任何方式解释为限制本发明的范围。
附图说明
图1:在PCSK9-/-小鼠的脾脏、肠系膜淋巴结和派尔集合淋巴结中,调节性T细胞明显更加丰富。
图2:HDM过敏原会增加胞内PCSK9的表达,并可能增加其分泌。用HDM过敏原或LPS(10μg/ml)培养人原代BEC 48小时。(A)PCSK9 mRNA水平(B)胞内PCSK9蛋白和(C)“分泌的”PCSK9蛋白水平。通过ELISA测定蛋白水平。*P<0,05。
图3:PCSK9缺乏会减弱过敏反应。通过腹膜内注射载剂(白色柱子)或醇溶蛋白(gliadin)(黑色柱子)将PCSK9+/+(白色圆圈)和PCSK9-/-小鼠(黑色圆圈)致敏,然后通过将水或醇溶蛋白灌胃攻击两次。第二次口服过敏攻击1小时后,测量体重(A)、血浆PCSK9浓度(B)、耳厚(C),并以点图和直方图以平均值±SEM表示。第二次口服过敏攻击1小时后,测量脾脏重量(D)、脾脏CD19+IgE+细胞百分比(E)和血浆醇溶蛋白特异性IgE浓度(F),并以点图和柱状图以平均值±SEM表示。使用(Graphpad Software)的非参数Mann-Whitney检验分析统计学显著性。*P<0,05;**P<0,01;***P<0,001;****P<0,0001;NS:不具有显著性。
实施例
我们实验室可通过多中心肺移植队列(COLT–NCT00980967研究/CPP 2009–A00036-51)接触人原代支气管上皮细胞(人原代BEC)。简言之,通过用在HEPES缓冲的RPMI中的XIV型胶原酶在4℃下孵育过夜,将这些细胞从肺供体气管或支气管中解离。然后,将人BEC在含有青霉素和链霉素的cnT17培养基中在人IV型胶原蛋白包被的培养板上进行培养(19)。考虑到PCSK9在肠道和肺中的表达及其在免疫中的潜在作用,我们假设PCSK9可能在食物过敏和向呼吸道病例并发症(如哮喘)的进展中起作用。我们实验室获得的野生型(PCSK9+/+)或PCSK9缺陷型小鼠(PCSK9-/-)的初步数据表明,在基础条件下和在没有特定刺激的情况下,PCSK9缺乏会显著增加脾脏、肠系膜淋巴结和派尔集合淋巴结中调节性T细胞的百分比(图1)。有趣的是,这些细胞在过敏中的激活改变被认为在慢性炎症的发生中至关重要。我们驱动的假设是PCSK9缺乏防止食物过敏和哮喘。
非常有趣的是,我们通过Q-PCR获得的第一个结果表明,HDM和LPS增加了PCSK9mRNA的水平。类似地,HDM引起胞内PCSK9蛋白含量的强烈上升。当用LPS培养细胞时,我们也观察到不显著的胞内PCSK9增加的趋势(+53%)。我们还发现在HDM或LPS处理后培养基中PCSK9浓度增加(图2)。这些最初的结果再次确保该细胞模型的使用具有相关性,并表明PCSK9在支气管上皮细胞中表达并在炎症过程中受到调控。
然后进行了过敏诱导。过敏诱导方案是在l’Institut du Thorax常规设置的,此前已有详细介绍(17)。我们使用了PCSK9+/+和PCSK9-/-雄性和雌性小鼠,这些小鼠是从断奶后就使用无麸质常规鼠饲料喂养的。为了诱导致敏作用,在第0、10和20天,5周龄小鼠接收连续3次腹膜内注射载剂或脱酰胺的小麦醇溶蛋白(10微克)。然后,通过口服施用20毫克脱酰胺的醇溶蛋白对小鼠进行两次攻击。图3和图4所示的结果是在第二次过敏攻击后1h获得的。我们确实观察到,与对照PCSK9+/+小鼠相比,在过敏条件下(饮食过敏,AA)PCSK9+/+小鼠体重减轻(图3A)。我们还观察到PCSK9-/-在过敏条件下体重减轻的趋势很小,且未达到显著水平(图3A)。有趣的是,在PCSK9+/+小鼠中,过敏诱导后血浆PCSK9水平显著升高(图3B)。在PCSK9+/+和PCSK9-/-小鼠两者中,醇溶蛋白攻击增加了脾脏重量(图3D)和IgE+浆细胞%(图3E)。而相比之下,在过敏PCSK9+/+小鼠而非在PCSK9-/-小鼠中,血浆醇溶蛋白特异性IgE+浓度显著升高(图3F),表明PSCK9缺乏减弱了过敏反应。为表征过敏症状,我们在口服攻击后用千分尺测量了耳厚。在对照组中,载剂溶剂灌胃在PCSK9+/+和PCSK9-/-小鼠两者中均不影响耳厚。我们发现,在使用脱酰胺化形式的醇溶蛋白致敏和攻击的PCSK9+/+小鼠中,口服攻击后耳厚显著增加(图3C)。而相比之下,在相同条件下在PCSK9-/-小鼠中未观察到影响(图3C)。
参考文献
在整个本申请中,各种参考文献描述了本发明所属领域的技术水平。这些参考文献的公开内容通过引用并入本公开内容。
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Claims (14)
1.一种用于在受试者中评估或预测哮喘的严重程度或过敏性疾病的严重程度的方法,包括i)确定从所述受试者获得的生物样品中的PCSK9水平,ii)将在步骤i)中确定的所述水平与预定的参照值进行比较和iii)当所述PCSK9水平高于所述预定的参照值时,得出结论:所述受试者患有或易于患有严重哮喘或严重过敏性疾病,或者当所述PCSK9水平低于所述预定的参照值时,得出结论:所述受试者未患有或不易于患有严重哮喘或严重过敏性疾病。
2.根据权利要求1所述的方法,其中所述生物样品是血液样品和/或BAL样品。
3.根据权利要求1或权利要求3所述的方法,其中所述生物样品是PBMC样品。
4.根据权利要求1所述的方法,其中通过ELISA测量所述PCSK9水平。
5.一种PCSK9抑制剂,其用于在有需要的受试者中治疗哮喘和/或过敏性疾病。
6.根据权利要求5所述的PCSK9抑制剂,其中所述过敏性疾病是食物过敏。
7.根据权利要求5至6所述的PCSK9抑制剂,其包括通过进行权利要求1所述的方法预测所述受试者是否处于患有严重哮喘或严重过敏性疾病的风险中的步骤。
8.根据权利要求5和权利要求7所述的PCSK9抑制剂,其中,所述抑制剂是抗体。
9.根据权利要求5至8所述的PCSK9抑制剂,其中,所述抑制剂是阿利库单抗(alirocumab)、依伏库单抗(evolocumab)或bococizumab。
10.根据权利要求5至7所述的PCSK9抑制剂,其中,所述抑制剂是小分子。
11.根据权利要求5至7所述的PCSK9抑制剂,其中,所述抑制剂是siRNA或反义寡核苷酸。
12.一种在有需要的受试者中治疗哮喘和/或过敏性疾病的方法,其包括向所述受试者施用治疗有效量的PCSK9抑制剂的步骤。
13.一种药物组合物,其包含PCSK9的抑制剂。
14.一种筛选适于抑制PCSK9的药物的方法,其包括i)提供测试化合物和ii)确定所述测试化合物抑制PCSK9的表达或活性的能力。
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JP7444858B2 (ja) | 2024-03-06 |
WO2020049026A1 (en) | 2020-03-12 |
EP3846909A1 (en) | 2021-07-14 |
US20210278420A1 (en) | 2021-09-09 |
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