EP4103614A1

EP4103614A1 - Agent for treatment and prophylaxis of a post-ischemic tissue damage

Info

Publication number: EP4103614A1
Application number: EP21708141.3A
Authority: EP
Inventors: Peter Rosenberger; Bernhard Nieswandt
Original assignee: Eberhard Karls Universitaet Tuebingen; Julius Maximilians Universitaet Wuerzburg; Universitaetsklinikum Tuebingen
Current assignee: Eberhard Karls Universitaet Tuebingen; Julius Maximilians Universitaet Wuerzburg; Universitaetsklinikum Tuebingen
Priority date: 2020-02-14
Filing date: 2021-02-12
Publication date: 2022-12-21
Also published as: US20230036161A1; DE102020103987A1; WO2021160807A1

Abstract

The present invention relates to an agent for use in the treatment and/or prophylaxis of a post-ischemic tissue damage, a pharmaceutical composition containing said agent, a process for preparing a drug for the treatment and/or prophylaxis of a post-ischemic tissue damage and a method for the treatment and/or prophylaxis of a post-ischemic tissue damage.

Description

Agent for the treatment and prophylaxis of post-ischemic tissue damage

The present invention relates to an agent for use in the treatment and / or prophylaxis of post-ischemic tissue damage, a pharmaceutical composition containing this agent, a method for producing a medicament for the treatment and / or prophylaxis of post-ischemic tissue damage, and a method for Treatment and / or prophylaxis of post-ischemic tissue damage.

FIELD OF THE INVENTION

The invention relates to the field of molecular medicine, in particular the field of prophylaxis and therapy of post-ischemic tissue damage. BACKGROUND OF THE INVENTION

Myocardial infarction (MI) remains one of the most important health problems worldwide. In the treatment of Ml, early reperfusion of the myocardium is currently the most effective therapy for improving clinical outcome. The reperfusion of the previously ischemic myocardium can, however, also induce damage to the tissue. This phenomenon, known as "reperfusion injury" (RI), reduces the positive effects of early reperfusion and is due to the infiltration of immune cells, mainly neutrophils, in previously marked ischemic areas where these contribute to damage through tissue inflammation. Platelets are increasingly recognized as the central orchestrators of inflammatory processes, mainly through the strengthening of immune cell recruitment and the modulation of the endothelial barrier function. This phenomenon is called thrombo-inflammation. In the course of the myocardial IR worsens the formation of complexes of platelets and neutrophils (English: platelet-neutrophil complexes; PNCs). Inflammatory tissue damage and is therefore a marker for tissue inflammation.

Clinically, reperfusion damage leads to general tissue damage in the affected part of the body and to acidosis or acidosis of the entire organism. This locally leads to overheating, reddening and swelling of the affected area, e.g. on the leg or arm up to the development of a compartment syndrome with extensive rhabdomyolysis. In general terms, the symptoms can range from a slight acceleration in spontaneous breathing to a drop in blood pressure, cardiac arrhythmia due to hyperkalemia, coagulation disorders, kidney failure or even cardiovascular arrest.

[0005] The development of reperfusion damage can currently only be counteracted in a poorly satisfactory manner. By cooling down the affected tissue before reperfusion, the activity of the enzymes is reduced. Furthermore, the anesthesiologist counteracts the metabolic acidosis directly by hyperventilation during a surgical procedure. In more severe cases, the acidosis is additionally buffered with sodium bicarbonate. In addition, there may be circulatory support Medicines such as catecholamines and diuretics are used. A targeted and specific treatment of post-ischemic tissue damage and especially reperfusion damage is currently not possible.

Against this background, the invention is based on the object of developing a new prophylaxis or therapeutic approach with which the post-ischemic tissue damage can be counteracted or treated in a targeted manner. Preferably, a pharmaceutically active agent is to be provided with which the pathological mechanisms of post-ischemic tissue damage can be regulated.

SUMMARY OF THE INVENTION

This object is achieved by providing an inhibitor of Semaphorin 7A

(SEMA7A) for use in the treatment and / or prophylaxis of post-ischemic tissue damage.

The inventors have surprisingly found that the inhibition of SEMA7A clearly counteracts post-ischemic tissue damage, possibly even preventing it. This finding was surprising, since SEMA7A was previously described in a different context.

Semaphorin 7A (SEMA7A for the human variant, or Sema7a for the mouse variant, used here synonymously), GPI membrane anchor (John Milton Hagen blood group), also known as CD108 (Cluster of Differentiation 108), is a membrane-bound Sema phorin, which is associated with cell surfaces via a glycosylphosphatidylinositol (GPI) bond [Entrez: 8482 (human); 20361 (mouse)]. SEMA7A is also known as the John Milton-Hagen (JMH) blood group antigen, an 80 kD glycoprotein that is expressed on activated lymphocytes and erythrocytes. It is known that SEMA7A is a receptor for the malaria parasite Plasmodium falciparum. SEMA7A was originally used in the context of axonal growth as a

A messenger protein is described that is involved in the control of synapse formation for the neural circuit. Later work has shown that it increases autoimmune encephalitis through T-cell dependent cytokine production and can increase the infiltration of neutrophils in sites of tissue hypoxia. A role for SEMA7A in the cardiovascular system has recently been described in atherogenesis. It was also shown that a disturbed blood flow leads to an induction of SEMA7A on the vascular endothelium and that this leads to an increased expression of leukocyte adhesion molecules on the endothelial surface.

The role of SEMA7A in platelet function is heretofore unknown.

In WO 2008/024300, WO 2009/133984, WO 2013/052631 and EP 3220447, the inhibition of SEMA7A for the treatment of pulmonary fibrosis is proposed.

In DE 202006007590 and US 2007/0264263 it is disclosed that SEMA7A plays a role in the immune system. It is also disclosed that SEMA7A can activate monocytes by interacting with a1ß1 integrin (VLA-1). It is proposed to use an antibody directed against VLA-1 in order to inhibit the interaction of VLA-1 with SEMA7A. This approach is suggested by the authors for the treatment of cytokine-mediated diseases, such as inflammatory diseases.

The inventors were able to show in an experimental system that soluble SEMA7A is increased in the plasma of patients with acute myocardial infarction and that SEMA7A has a significant influence on the extent of post-ischemic tissue damage or reperfusion damage. They were also able to show that SEMA7A promotes myocardial thrombosis and tissue damage by increasing the thrombotic activity of the platelets and the formation of PNCs through a GPIb-dependent mechanism of the platelets. Conversely, the inventors were able to establish in particular that the inhibition of SEMA7A leads to reduced reperfusion damage. According to the invention, "inhibition" is understood to mean any measure which leads to a reduction in the functionality of SEMA7A. This can be achieved, for example, by reducing the activity of SEMA7A, the amount and / or concentration of SEMA7A in the cellular membrane, transcription or translation or other measures that result in a decrease in SEMA7A functionality. In one embodiment of the invention, the inhibition is directed directly against SEMA7A, but not against a binding partner of SEMA7A or the interaction of SEMA7A with such a binding partner, such as, for example, VLA-1.

According to the invention, “post-ischemic tissue damage” is generally understood to mean a disease process which is triggered after an insufficient blood supply or ischemia in a cellular tissue.

The problem on which the invention is based is thereby completely solved.

In one embodiment of the invention, it is post-ischemic

Tissue damage to reperfusion damage.

This measure has the advantage that a therapeutic and / or prophylactic agent is provided for a particularly important post-ischemic tissue damage, for which no satisfactory specific therapeutic or prophylactic approaches exist in the prior art.

In a further embodiment of the invention, the reperfusion damage is myocardial reperfusion damage.

This measure has the advantage that one of the clinically particularly relevant reperfusion injuries can be effectively treated or prevented.

In a further embodiment of the invention, the inhibitor is designed such that it modifies the interaction of SEMA7A with the platelet surface, and preferably modifies the interaction of SEMA7A with GPIb. This measure has the advantage that the invention directly intervenes in the molecular mechanisms which, according to the inventors' findings, play a decisive role in the development of post-ischemic tissue damage, such as, for example, myocardial reperfusion damage.

According to the invention, “GPIb” is understood to mean glycoprotein Ib, which is a surface protein on platelets that is involved in blood clotting.

According to the invention, “modified” can mean “inhibited” in a first embodiment. In a further embodiment of the invention, “modified” can mean “activated” and / or “stimulated”.

In a further embodiment of the invention, the inhibitor is selected from the group consisting of: antibody, antibody fragment, soluble SEMA7A receptor, antisense nucleic acid, siRNA, low molecular weight compound, and combinations thereof.

The measure has the advantage that those structures are used as inhibitors which are particularly suitable for the targeted inhibition of SEMA7A.

In a further embodiment of the invention, the a-SEMA7A antibody is a function-inhibiting antibody.

With this measure, such an antibody is used, which selectively and in a targeted manner inhibits SEMA7A in its functionality and thus unspecific effects can largely or completely be avoided.

Another object of the invention relates to a pharmaceutical composition which comprises the inhibitor according to the invention.

The features, advantages, further developments and embodiments of the inhibitor according to the invention apply equally to the pharmaceutical composition. Pharmaceutically acceptable carriers are well known to those skilled in the art. They allow a proper formulation of the inhibitor and serve to improve the selectivity, efficacy and / or safety of drug administration. Pharmaceutically acceptable carriers include, but are not limited to, solvents, fillers, binders, lubricants, stabilizers, surfactants, suspensions, thickeners, emulsifiers, preservatives, liposomes, micelles, microspheres, nanoparticles, etc. that are suitable for the particular dosage form . Materials that can serve as pharmaceutically acceptable carriers include, but are not limited to, monosaccharides and oligosaccharides and derivatives thereof; Malt, gelatin; Talc; Auxiliaries such as: cocoa butter and suppository waxes; Oils such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil, and soybean oil; Glycols such as propylene glycol; Esters such as ethyl oleate and ethyl laurate; Agar; Buffer substances such as magnesium hydroxide and aluminum hydroxide; Alginic acid; pyrogen-free water; isotonic saline solution, Ringer's solution; Ethyl alcohol and phosphate buffer solutions. In addition, the composition can contain other non-toxic compatible lubricants, for example sodium lauryl sulfate and magnesium stearate, as well as colorants, separating liquids, film formers, sweeteners, flavor additives and flavorings, preservatives and antioxidants.

According to the invention, the pharmaceutical composition can have the SEMA7A inhibitor as the only active ingredient, or it can be present in combination with further active ingredients for the treatment and / or prophylaxis of post-ischemic tissue damage.

Another object of the present invention relates to the use of the inhibitor according to the invention for the treatment and / or prophylaxis of post-ischemic tissue damage.

The features, advantages, further developments and embodiments of the inhibitor according to the invention apply equally to the use according to the invention. Another object of the invention relates to a method for producing a

A medicament for the treatment and / or prophylaxis of post-ischemic tissue damage which comprises the formulation of an inhibitor of SEMA7A in a pharmaceutically acceptable carrier.

The features, advantages, further developments and embodiments of the inhibitor according to the invention apply equally to the production method according to the invention.

Another object of the present invention relates to a method for the treatment and / or prophylaxis of post-ischemic tissue damage, the administration of a therapeutically effective amount of an inhibitor of SEMA7A in a needy mammal, preferably a human, more preferably a myocardial infarction patient or a risk of myocardial infarction Patient, includes.

In one embodiment of the method according to the invention, the interaction of SEMA7A with the platelet surface is modified by the administration of the inhibitor, and preferably the interaction of SEMA7A with GPIb is modified by the administration of the inhibitor.

This measure has the advantage that the invention directly intervenes in the molecular mechanisms which, according to the inventors' findings, play a decisive role in the development of post-ischemic tissue damage, such as, for example, myocardial reperfusion damage.

According to the invention, “modified” can mean “inhibited” in a first embodiment. In a further embodiment of the invention, “modified” can mean “activated” and / or “stimulated”. Further advantages and features emerge from the following description of preferred embodiments and the accompanying drawings.

It goes without saying that the features mentioned above and yet to be explained below can be used not only in the respectively specified combination, but also in other combinations or on their own, without departing from the scope of the present invention.

BRIEF DESCRIPTION OF THE FIGURES

Fig. 1: Patients with acute myocardial infarction show an increased activation of

PNCs and an increased plasma SEMA7A concentration. The samples were taken from patients with acute myocardial infarction, patients undergoing cardiac surgical operations using a heart-lung machine (HLM) or bypass operations without the use of a heart-lung machine (off-pump), as well as from healthy controls. A) Flow cytometric evaluation the expression of GPIb (CD42b) of the PN Cs in the patient groups shown. b) Flow cytometric evaluation of PNCs for CD62P expression on neutrophils. c) PAC-1 binding to PNCs. d) Representative flow cytometric histograms of the measured groups, and e) Sema7a in the plasma of patients with acute Ml, patients undergoing cardiopulmonary operations with (HLM) or cardiopulmonary bypass operations without heart-lung machines (off-pump), and healthy controls. For comparison, the inventors performed one-way analyzes of variance, followed by Dunnett's tests on the myocardial infarction group (data are means ± SD; * p <0.05, ** p <0.01 and *** p <0.001 as indicated; n > 4 / group).

Fig. 2: Demographic and standard laboratory values of patients with myocardial infarction, heart operations without cardiopulmonary bypass (off-pump), cardio-pulmonary heart operations (HLM) and of healthy people. Fig 3: Expression of SEMA7A (%) on human erythrocytes in relation to the age in years The erythrocytes were analyzed in different age groups in order to determine the degree of SEMA7A expression on their surface. The comparison of SEMA7A (%) on human erythrocytes with the years of the donor by ANOVA showed no significant differences in the change over age, p = 0.1194.

4: Plasma values of Sema7a in WT mice exhibiting myocardial ischemia and 1 minute reperfusion. WT mice were exposed to ischemia for 60 minutes. The samples were taken after 1 minute of reperfusion. The comparisons in Figure 4 were analyzed by Student's t-tests (data are means ± SD; n> 3 / group (* p <0.05 as indicated).

Fig 5: SEMA7A cleavage from human erythrocytes Human erythrocytes were either shear stress, hypoxia (2% 0 ₂ ) or normoxia (21%

0 ₂ ) for the specified times and the SEMA7A concentrations were determined in the supernatant. For comparisons in FIG. 5, the inventors carried out one-way analyzes of variance, followed by Dunnett's tests for the "5min unstimulated" group (data are means ± SD; n = 4 / group; * p <0.05, *** p < 0.01 as indicated).

6 The injection of Sema7a leads to increased myocardial RI damage and PNC formation. Mice were injected with either recombinant Sema phorin 7a (rmSema7a) or Fc control (rmlgG2A Fc) and then an ischemia for 1 h followed by 2 h Subjected to reperfusion. The samples were taken after 1 min or 120 min of reperfusion a) Representative TTC-stained sections of myocardial tissue with infarct area (blue / dark = retrograde Evans blue staining; red and white = AAR, white = infarct tissue; 120 min) with b) systematic evaluation of the infarct sizes and the corresponding troponin I plasma level (120 min) c) representative histological sections of WT animals that were injected with either IgG Fc control or rmSema7a (120 min) and d) number of PNCs that in Myocardial tissue sections of the AAR in animals were counted (120 min) e) Representative flow cytometric PNC plots in the blood of sham animals, rmSema7a or IgG Fc control mice, which after 1 min and 120 min reperfused GPIb (CD42b) and P-selectin (CD62P) presented. Systematic evaluation of the flow cytometric expression of the mean fluorescence intensity (MFI) for f) GPIb (CD42b) and g) P-selectin (CD62P) expression h) Systematic evaluation of the PNCs in% flow cytometry in the blood of animals with rmSema7a or Fc- Control was injected after 1 min and 120 min i) Representative flow cytometric diagrams of PNCs in the AAR, which show the presence of GPIb (CD42b) and P-selectin (CD62P) after 1 min and 120 min of reperfusion. Systematic evaluation of the flow cytometric expression of MFI for j) GPIb (CD42b) and k) P-selectin (CD62P) and I) systematic evaluation of PNCs in% flow cytometry in the AAR of animals injected with rmSema7a or Fc control, namely according to 1 min and 120 min The comparisons in Figure 6b and d were analyzed by Student's t-tests (data are mean ± SD; n> 5 / group; histology n = 9 / group). For Figure 6 f, g, h, j, k and I, the inventors used the log transformation of the data to conform to normality. Tests have been performed on the log values for log-transformed data and the results are displayed as geometric means and their 95% confidence intervals (* p <0.05, ** p <0.01 and *** p <0.001 as indicated) .

Figure 7: SEMA7A does not induce caspase 3 in human heart muscle cells

(HMCs). a) HMCs were exposed to recombinant human SEMA7A (rhSEMA7A), a suitable Fc control (rhlgGI Fc), only BSA or staurosporine for the specified times and the expression of caspase 3 was measured by ELISA b) HMCs were exposed to SEMA7A for 6 h , the Fc control or BSA and stained for caspase 3. Treatment with staurosporine served as a positive control. The data are means ± SD; n> 4 / group, histology n = 3. Fig. 8: The injection of Sema7a leads to an increased allbß3 activation of

PNCs. The animals were injected with either recombinant Semaphorin 7a (rmSema7a) or Fc control (rmlgG2A Fc) and they were then subjected to ischemia for 1 h followed by 2 h reperfusion. Blood and myocardial tissue sections (AAR) were reperfused after 1 min or 120 min taken from. Representative PNC flow cytometric plots in blood and tissue from sham, rmSema7a, or IgG Fc control injections from mice showing allbβ3 (JON / A) activation. Systematic evaluation of the flow cytometric mean fluorescence intensities (MFI) of allbß3 (JON / A) on PNCs of rmSema7a-injected, IgG Fc control or sham mice. For FIG. 8, the inventors used the log transformation of the data to adapt to normality. For log-transformed data, tests were performed on the log values and the results are presented as geometric mean values and their 95% confidence intervals. (** p <0.01 and *** p <0.001 as specified under n> 5).

Fig 9: SEMA7A affects the migration of neutrophils in the river. Whole blood new trophils that have been treated with rhSEMA7A and labeled with rhodamine adhere to glass capillaries coated with E-selectin or E-selectin with ICAM1. a) Representative frame of neutrophil (magenta) traces (cyan) on coated capillaries with flow chamber experiments carried out on whole samples from 4 independent healthy donors and at least 150 cells in each experimental group tracked b) Neutrophil velocity (pm / sec ) on coated capillaries under the influence of rhSEMA7A. c) Neutrophils (magenta) and platelets (cyan), which were imaged in the flow on cremaster tissue before and 15 minutes after iv vaccination by rmSema7a d) The neutrophil speed (pm / sec ) calculated from the tracked cells; the stationary neutrophils were counted (number of cells / mm ² ); the platelet sedimentation on the vessel wall was measured (normalized MFI% / mm); the migrated cells from the vascular system after 15min expo- positions with rmSema7a were counted (number of cells / mm ² ); the distance between the cells migrated is measured in m. e) Representative optosplit image analysis of platelets (cyan) and neutrophils (magenta) moving on the microvasculature of the mouse Kremaster (<40 pm), with clues as to how the data of each 10-second picture slot can be captured; the white cross represents stationary cells; white lines connect (pm) migrated neutrophils with the exit points from the vascular system; red lines describe the intensity profile of the adhesion of the thrombocytes to the vascular system as mean fluorescence intensity (MFI); Green circles track the moving neutrophils over a defined region, which is translated into the speed of the cell path (pm / sec.). Intravital microscopy experiments were performed on n> 4 mice with n> 10 videos per condition with 20 second intervals from rmSema7a groups recorded 15 minutes after the baseline control. The data are presented as the geometric mean with CI, with the P values denoted by * <0.05, ** <0.01, *** <0.001; Intravital microscopy experiments were performed on n = 5 mice with videos of 10 seconds (n> 10 videos per condition with 20 second interval) from rmSema7a groups, which were recorded 15 minutes after the baseline control. The data are presented as a geometric mean with CI with P values denoted by * <0.05, ** <0.01, *** <0.001.

10: Sema7a ^/ - animals show reduced signs of myocardial RI damage and weakened PNC formation. a) Sema7a 'animals and litter sibling controls were evaluated using magnetic resonance imaging (MRT) in order to exclude anatomical and functional changes in Sema7a ^/ animals. b) The left and right ventricular ejection fraction (LVEF or RVEF in%) was measured using MRI determined c) Sema7a 'mice and littermate controls were exposed to ischemia for 60 minutes and reperfusion for 120 minutes, with samples taken after 1 minute or 120 minutes of reperfusion. Representative TTC-stained sections of the myocardial tissue with dar- Position of the infarct area (blue / dark = retrograde Evans blue staining; red and white = AAR, white = infarct tissue, 120 min) with d) systematic evaluation of the infarct sizes and the corresponding troponin I plasma level (120 min) e) Representative histological sections of SemaJa ^ and littermates control hearts (120 min) f) Number of PNCs in myocardial tissue sections in the AAR of SemaJa ^ mice and littermates controls (120 min) g) Representative flow cytometric PNC plots in the blood of Se / T ? a7a- ^A and littermate controls showing GPIb (CD42b) and P-selectin (CD62P) after 1 min and 120 min reperfusion. Mean fluorescence intensity (MFI) for h) GPIb (CD42b) and i) P-selectin ( CD62P) in PNCs and j) systematic evaluation of PNCs in% by flow cytometry in the blood of Sema7a animals and littermate controls. k) Representative flow cytometric representations of PNCs in the AAR and MFI for I) GPIb (CD42b) and m) P-selectin (CD62P) and n) systematic evaluation of PNCs by flow cytometry in% in the AAR of WTs and SemaJa ^ - Animals at 1 min and 120 min. The comparisons in Figure 10 b, d and f were analyzed by Student's t-tests (data are means ± SD; n> 5 / group; histology n = 9 / group). For FIG. 10 h, i, j, I, m and n, the inventors used a log transformation of the data to adapt to normality. Tests were performed on the log values for log-transformed data and the results are displayed as geometric means and their 95% confidence intervals (* p <0.05, ** p <0.01 and *** p <0.001 as specified).

11: SemaJa -'- animals show no changes in comparison to WT siblings

Cardiac output. Short-axis cardiac MRI images were recorded on a 70 / 397T BioSpec scanner using the IntraGateFLASH measurement method with the following parameters: echo time = 2.112 ms, 100 repetitions of 74.352 ms, 128-fold square matrix, spatial resolution of 176 pm. Ten axial sections 1 mm thick and 10 cardiac frames were removed for reconstruction in order to cover RV and LV a) assessment of the left ventricular end-diastolic volume (LVEDV), b) left ventricular end-systolic volume (LVESV), c) left ventricular volume Mass (LV mass) and d) left ventricular stroke volume (LV stroke). e) Assessment of right ventricular end-diastolic volume (RVEDV), f) right ventricular end-systolic volume (RVESV), g) right ventricular mass (RV mass), and h) right ventricular stroke volume (RV stroke). The comparisons were analyzed by Student's t-tests (data are means ± SD; n = 6 / group (* p <0.05 as indicated).

12: Sema7a - 'animals show reduced signs of allbß3 in PNCs

(JON / A) activation. SemaJa ^ and littermate controls were exposed to ischemia for 1 hour and reperfusion for 2 hours. Blood and myocardial tissue samples (AAR) were taken after 1 minute or 120 minutes of reperfusion. Representative flow cytometric plots of PN Cs in the blood and tissue of sham animals, SemaJa ^ and littermate controls showed activated allbß3 (JON / A) activation in PNCs. Systematic evaluation of the mean fluorescence intensities of al-Ibß3 (JON / A) on PNCs from Sema7a ^/ - and littermate controls. For FIG. 12, the inventors used the log transformation of the data to agree with normality. Tests were performed on the log values for log transformed data and the results are displayed as geometric means and their 95% confidence intervals. (* p <0.05 and ** p <0.01 as stated under n> 5 / group).

13: Sema7a expression in tissue from mice and hematopoietic human cells a) Relative Sema7a mRNA expression in mouse tissue compared to the brain b) Densitometry of the Sema7a protein expression in mouse tissue with a representative Western blot image manure. c) Densitometry of the Sema7a protein expression on human hematopoietic cells with a representative Western blot image. RBC = red blood cells, Mono = monocytes, Plt = platelets and PMNs = polymorphonuclear cells (all data are means ± SD; n> 4 / group). 14: The semaphorin 7A derived from RBC drives PNC formation and worsens myocardial RI damage. Sema7a ^{loxP / loxP} HBBCre +, Sema7a ^{! OxP /! OxP} Myh6Cre +, Sema7a ^{loxP / loxP} Tie2Cre + and Sema7a ^{loxP / loxP} LysM- Cre + animals or littermate controls were subjected to ischemia for 60 minutes and T aTC reperfusion for 60 minutes and T aTC reperfusion Sections of myocardial tissue with infarct area (blue / dark = retrograde Evans blue staining; red and white = AAR, white = infarcted tissue) in Sema7a ^{loxP / loxP} HBBCre + or littermate controls with b) systematic evaluation of the infarct sizes and correlating troponin I plasma levels . c) Representative histological sections from Sema7a ^{loxP / loxP} HBBCre + animals or littermate controls, and d) Number of PNCs counted from myocardial AAR sections from Sema7a ^{loxP /! oxP} HBBCre + animals or littermate controls. e) Representative TTC-stained sections of myocardial tissue showing the infarct area with Sema7a ^{loxP / loxP} Myh6Cre + or littermate controls, with f) systematic evaluation of the infarct sizes and the correlating troponin I plasma levels. g) Representative histological sections from Sema7a ^{loxP / loxP} Myh6Cre + animals or littermate controls h) The number of PNCs counted in myocardial AAR sections in Sema7a ^{loxP / loxP} Myh6Cre + animals or littermate controls. i) Representative TTC-stained heart slices showing myocardial infarction in Sema7a ^{loxP / loxP} Tie2Cre + or littermate controls, with j) systematic evaluation of the infarct sizes and the correlating troponin I plasma level. k) Representative histological sections from Sema7a ^{lox /! ox} - pTie2Cre + animals or littermate controls and I) Number of PNCs that were counted in myocardial tissue sections from Sema7a ^{loxP / loxP} Tie2Cre + or littermates controls, which were counted from the infarction area in Sema7a ^{loxP /! oxP} LysM- Cre + or littermate controls show with n) systematic evaluation of the infarct sizes and correlating troponin I plasma levels. o) Representative histological sections of Sema7a ^{loxP / loxP} LysMCre + animals or littermate controls and p) Number of PNCs obtained from myocarial tissue sections of Sema7a ^{! oxP / loxP} LysMCre + or littermates- controls were counted. All comparisons in Figure 14 were analyzed by Student's t-tests (data are means ± SD; n> 5 / group; histology n = 9 / group). (* p <0.05, ** p <0.01 and *** p <0.001 as indicated).

Fig 15: The reconstitution of Sema7a ^{loxP / loxP} HBBCre + leads to an increased

MIRI. Sema7a ^{loxP / ioxP} HBBCre + animals or littermate controls were injected with either recombinant Semaphorin 7a (rmSema7a) or Fc control (rmlgG2A Fc) and then subjected to ischemia for 1 hour, followed by TTC for 2 hours a) Representation Stained sections of myocardial tissue showing the infarct area (blue / dark = retrograde Evans blue staining; red and white = AAR, white = infarcted tissue) b) Systematic evaluation of infarct sizes and correlating troponin I plasma levels. c) Representative histological sections stained for the presence of PNCs and d) Number of PNCs counted from myocardial AAR sections in Sema7a ^{loxP / loxP} HBBCre + animals that were either recombinant Semaphorin 7a (rmSema7a) or Fc control (rmlgG2A Fc) were injected. All comparisons in Figure 15 were analyzed by Student's t-tests (data are means ± SD; n> 5 / group; histology n = 9 / group). (* p <0.05 and *** p <0.001 as indicated).

Fig. 16: Sema7a exerts its function via the platelet glycoprotein Ib (GPIb). a) rmSema7a significantly increases the adhesion and thrombus formation of WT platelets on collagen in the flow at a shear rate of 1000 S ¹ . Blocking the ligand binding site of the platelet glycoprotein GPIb (pOp / B) cancels this thrombus-promoting effect of rmSema7a. b) Representative IF images of the experiment in (a). c) rmSema7a affects neither the adhesion nor the thrombus formation of GPIb-IL-4-tg platelets on collagen in the flow at a shear rate of 1000 s ¹ . d) Representative IF images of the experiment from (c). The representative fluorescence images as well as the mean surface coverage and the relative thrombus volume are shown, measured by the integrated fluorescence rate intensity (IFI) per mm ² ± SEM (n> 3 / group)) e) GP-lb-IL4-tg animals were exposed to ischemia for 60 minutes and reperfusion for 120 minutes. Immediately before the ischemia, they were injected with rmSema7a or rmlgG2A Fc control f) The infarct sizes and the correlated troponin I plasma levels were determined g) Representative histological sections and h) Number of PNCs obtained from myocardial tissue sections of GP-lb-IL4-tg who were injected with either rmSema7a or rmlgG2A Fc (control) i) A coimmunoprecipitation analysis between Sema7a and GPIb in blood and heart (AAR) was carried out. Sema7a was affinity-prepared using an anti-GPIb antibody, and GPIb was affinity-prepared using a Sema7a antibody. Rat or mouse IgG was used as a negative control. Bound proteins were analyzed by immunoblotting. The same amount of protein was used in all initial loads of blood or heart lysates. J) A densitometric analysis was carried out to quantify the immunoblots. For comparisons in FIGS. 16 a and 16 c, the inventors carried out one-way analyzes of variance, followed by Dunnett's tests for the group WT + rmSema7a (data are mean values ± SD; n = 4 / group).

The comparisons in Figure 16 f, h, i and j were analyzed using Student's t-tests (data are means ± SD; n> 7 / group; histology n = 9 / group; densitometric analysis n> 7 / group) . (* p <0.05, ** p <0.01 and *** p <0.001 as indicated).

17: Recombinant Semaphorin 7A (rmSema7a) significantly improves the adhesion and thrombus formation of WT platelets on collagen in the flow at a shear rate of 400 s ¹ . Blocking the ligand binding site of platelet GPIb (pOp / B) abolishes the thrombus-promoting effect of rmSema7a. Representative fluorescence images as well as the mean surface coverage and the relative thrombus volume, measured by the integrated fluorescence intensity (IFI) per mm ² , are shown. For comparisons in Figure 17, the inventors performed one-way analyzes of variance, followed by Dunnett's tests on the group WT + rmSema7a. (Data are means ± SD; n> 3 / group; * p <0.05, ** p <0.01 and *** p <0.001 as indicated).

Fig. 18: Anti-Sema7a reduces myocardial RI damage, platelet activation and PNC formation. The animals were injected with either anti-Semaphorin 7A antibodies (anti-Sema7a) or IgG control 5 minutes before the start of the 120-minute reperfusion after 60 minutes of ischemia, where the samples were taken after 1 minute or 120 minutes of reperfusion a ) Representative TTC-stained heart sections of myocardial infarcts (blue / dark = retrograde Evans blue staining; red and white = AAR, white = infarct tissue) with b) systematic evaluation of the infarct sizes and correlating troponin I plasma levels. c) Representative histological sections from WT animals injected with either IgG control or anti-Sema7a, and d) Number of PNCs counted in myocardial tissue sections e) Representative flow cytometry blots of PNCs in the blood of animals injected with a sham, anti-Sema7a, or IgG control expressing GPIb (CD42b) and P-selectin (CD62P). Systematic evaluation of the flow cytometric expression of the mean fluorescence intensity (MFI) for f) GPIb (CD42b) and g) P-selectin (CD62P) and h) systematic evaluation of the PNCs in% flow cytometry in the blood of animals exposed to anti-Sema7a or IgG -Control le was injected, namely after 1 min and 120 min. I) Systematic evaluation of the flow cytometric expression of MFI for j) GPIb (CD42b) k) P-selectin (CD62P) and I) systematic evaluation of PN Cs in% flow cytometry in the AAR of animals injected with anti-Sema7a or IgG control after 1 min and 120 min The comparisons in Figure 18b and d were analyzed by Student's t-tests (data are means ± SD; n> 6 / group; histology n = 9 / group). For FIGS. 18 f, g, h, j, k and I, the inventors used the log transformation of the data to adapt to normality. Tests were performed on the log values for log transformed data and the results are displayed as geometric means and their 95% confidence intervals. (* p <0.05, ** p <0.01 and *** p <0.001 as indicated). Fig. 19: Anti-Sema7a attenuates the activation of the integrin allbß3 (JON / A). the

Animals were subjected to myocardial ischemia for 1 hour and then to reperfusion for 2 hours and either an anti-Semaphorin 7A antibody (anti-Sema7a) or an IgG control were injected 5 minutes before the reperfusion phase. After 1 minute or 120 minutes of reperfusion, blood and myocardial tissue sections (AAR) were obtained. Representative PNC flow cytometric plots in the blood and tissue of WT animals injected with either IgG control or anti-Sema7a showed integrin allbß3 (JON / A) activation in PNCs after 1 minute and 120 minutes of reperfusion. Systematic evaluation of the flow cytometric mean fluorescence intensities of the activated allbβ3 (JON / A) on PNCs from mice injected with either anti-Sema7a or an IgG control after 1 min and 120 min Log transformation of the data to adjust to normality. Tests were performed on the log values for log transformed data and the results are displayed as geometric means and their 95% confidence intervals (* p <0.05 and *** p <0.001 as indicated, n> 5 / group ).

20: Schematic representation of the role of Sema7a during myocardial ischemia-reperfusion. 1) During myocardial ischemia, shear stress and hypoxia lead to the splitting off of Sema7a from the surface of the erythrocytes (1a) as the main source of Sema7a within the vascular bed. 2) The released Sema7a then engages in the glycoprotein Ib receptor (2a) and activates the platelets, which then exposes the integrin receptors (2b), which leads to platelet and platelet formation. 3) Activated platelets and PNCs migrate from the vascular system into the ischemic tissue, which leads to tissue damage and destruction.

EXAMPLES

material and methods Declaration on ethics

The animal protocols corresponded to the German guidelines for the use of live animals and were approved by the Institutional Animal Care and the regional council of Tübingen and Würzburg as well as the State Office for Consumer Protection Lower Saxony. The approval for the processing of human samples was obtained from the Ethics Committee (Institutional Review Board) of the University of Tübingen. Samples from patients with myocardial infarction were obtained and processed at the presentation in the catheter laboratory (biobank: 266 / 2018BO1; Sema7a subanalysis: 266 / 2018BO2; Clinicaltrial.gov: NCT01417884). As part of the TüSep study (NCT02692118), patient samples were collected before and after heart surgery. Written informed consent was obtained from each patient prior to sampling.

Processing of human blood samples

[0046] Human blood samples were taken during a coronary intervention, at the end of a cardiopulmonary bypass or during the occlusion of the coronary arteries during a heart operation without a heart-lung machine and processed for flow cytometry. In addition, blood was centrifuged to obtain plasma samples, which were then stored and measured. The blood was also used to isolate erythrocytes, which were analyzed for SEMA7A expression or used in further experiments (Ethics Approval 507 / 2017B01).

Mice

As described in the prior art, Sema7a mice were generated, validated and characterized. The corresponding WT controls were bred as littermates of the Sema7a mice. In a subgroup of experiments, a newly generated Sema7a flox mouse line (Sema7a ^{loxP / loxP} l Ozgene) was crossed on a C57BL / 6 background with the following Cre recombinase-positive mouse lines in order to obtain a tissue-specific gene deletion: erythrocyte-specific HbbCre +, myocardial cell-specific Myh6Cre +; Endothelial cell-specific Tie2Cre + and immune cell-spe- specific LysMCre +. In the experiments, tissue-specific gene deletions from Sema7a mouse lines (Sema7a ^{loxP / loxP} HbbCre +; Sema7a ^{! OxP / loxP} Myh6Cre +, Sema7a ^{loxP / lox} - pTie2Cre + and Sema7a ^{loxP / loxP} LysMCre +) were used. ^{Sema7 aloxP / loxp} - Cre-negative (-) littermates were used as controls. In a subset of experiments, the inventors used a functional GPIb knockout mouse line (GPIb-IL4tg) to test the interference of Sema7a with the GPIb receptor. In a subgroup of experiments, Sema7a ^{loxP / loxP} HbbCre + T \ ere were reconstituted with recombinant mouse Sema7a (rmSema7a; R&D SYSTEMS, Minneapolis, USA) or recombinant mouse IgG2A Fc (rmlgG2A Fc; control).

Murine myocardial ischemia and reperfusion model

This animal model has been described in detail in the prior art. Subgroups of animals received either recombinant mouse Sema7a (rmSema7a) or recombinant mouse IgG2A Fc (rmlgG2A Fc; control) or Sema7a antibodies (abcam ab23578, Cambridge, UK; anti-Sema7a) or rabbits as control IgG sc-2027 (Santa Cruz Biotechnology, Santa Cruz, USA) intravenously 5 minutes before the start of reperfusion.

Immunohistochemical detection of neutrophils, platelets and PNCs in myocardial tissue of the mouse

The Vectastain ABC kit (Linaris, Wertheim, Germany) was used for the immunohistochemical staining. After inhibiting the unspecific binding sites with avidin blocking solution (Vector), the sections were incubated with primary antibodies (rabbit anti-mouse CD41, abcam, Cambridge, UK) overnight at 4 ° C. The tissue sections were then incubated with biotinylated rabbit anti-IgG for 1 hour, followed by Vectastain ABC reagent for 30 minutes, then developed over DAB substrate. For the PMN staining, the procedure was repeated using rat anti-mouse neutrophil antibodies (BioRad, Serotec, Puchheim, Germany) and HistoGreen as substrate (Linaris, Wertheim, Germany). The counterstaining was carried out with Nuclear Fast Red (Linaris, Wertheim, Germany). Histological sections were made through manual count within 3 independent tissue sections of each animal at a magnification of 400 x 400 analyzed for the presence of PNCs.

Troponin I measurement

The troponin blood plasma levels of samples which were taken by central venous puncture after 120 minutes of reperfusion were measured for murine troponin I type 3 (TNNI3) using the ELISA kit SEA478Mu (Cloud-Clone Corp., Houston, USA).

Caspase 3 staining and Caspase 3 ELISA

Human cardiac myocytes (HMC-c; PromoCell, Heidelberg, Germany) were grown on chamber slides to confluence, followed by 6-hour stimulation with rhSEMA7A, rhlgGI Fc, BSA or staurosporine (Sigma-Aldrich, Munich, Germany ), each 1 pg / ml. After fixation, the cells were stained with polyclonal rabbit anti-aspase3 (abcam, Cambridge, UK).

Sema7a ELISA

Sema7a ELISAs were according to the manufacturer's instructions using the

ELISA kits SEB448Hu for human and SEB448Mu for murine Sema7a performed (Cloud-Clone Corp., Houston, USA).

RT-qPCR

For the RNA extraction, the inventors used the peqGOLD TriFast ™ (Peqlab; Germany; Erlangen) according to the manufacturer's instructions. The iScri pt kit from Bio-Rad (Bio-Rad; Germany; Munich) was used for the cDNA synthesis. The semiquantitative analysis of murine Sema7a was carried out by real-time PCR using the sense primer 5'-GTG GGT ATG GGC TGC TTT TT-3 '(SEQ ID No. 1) and the antisense primer 5'-CGT GTA TTC GCT TGG TGA CAT-3 '(SEQ ID No. 2) carried out. The reference gene was the murine 18S rRNA gene with the following set of Primers: Sense 5'-GTA ACC CGT TGA ACC CCA TT-3 '(SEQ ID No. 3) and antisense primer 5'-CCA TCC AAT CGG TAG TAG CG-3' (SEQ ID No. 4).

Protein analysis

Murine tissue was homogenized and resuspended in RIPA buffer. The samples were separated using SDS polyacrylamide gels and blotted onto PVDF membranes. The following antibodies were used in murine samples: anti-Sema7a antibodies (ab23578; abcam, Cambridge, UK) and, to control the loading conditions, GAPDH antibodies (sc-25778; Santa Cruz Biotechnology, Santa Cruz, USA). For human samples, the inventors used a polyclonal goat anti-Sema7a antibody (AF2068; R&D SYSTEMS, Minneapolis, USA) and β-actin antibody (sc-130656; Santa Cruz Biotechnology). The bands were detected by chemiluminescence reaction of HRP-conjugated antibodies and developed with the luminol reagent (sc-2048; Santa Cruz Biotechnology).

Coimmunoprecipitation and immunoblotting

The coimmunoprecipitation (Co-IP) was carried out according to the manufacturer's instructions with the Pierce Co-IP kit (Cat. No. 261498, Thermo Fisher Scientific, Waltham, USA). Briefly, mouse samples were collected after 60 minutes of ischemia followed by 1 minute (blood) or 15 minutes (heart tissue, AAR) reperfusion. Then 250 μl of citrate + blood were lysed in 1 ml of IP lysis / washing buffer and kept on ice. The AAR was incubated in 1 ml of IP lysis / washing buffer and homogenized in a Precellys 24 (VWR / Peqlab, Erlangen, Germany) and stored at 4 ° C. for 60 minutes. All samples were ^{centrifuged at 13,000 c} g for 10 minutes. The total protein of the lysates was measured with the Pierce ™ BCA Protein Assay Kit (Thermo Scientific; Cat. No. 23225) and analyzed in an Infinite® M200 Pro Plate Reader (Tecan, Männedorf, Switzerland). Ten micrograms of mouse monoclonal antibodies against Sema7a (sc374432; Santa Cruz Biotechnology, Santa Cruz, USA) or 10 pg rat monoclonal antibodies against GPIb (p0p4) were mobilized on the Amino Link Plus coupling resin. 10 pg rat IgG (sc2016; Santa Cruz Biotechnolo- gy) or mouse IgG (X0943; Dako, Glostrup, Denmark) was used. For the protein analysis, 30 ml per Co-IP eluate were applied to the SDS-PAGE. A polyclonal rabbit antibody against Sema7a (sei 35263; Santa Cruz Biotechnology) and the described monoclonal antibody (p0p5) against GPIb were used for the immunodetection. Species-adapted alkaline phosphatase-conjugated secondary antibodies were used (goat versus rabbit IgG-AP; sc-2007; Santa Cruz Biotechnology; and goat versus rat IgG-AP; A18868; Thermo Fisher Scientific). The protein detection was carried out with a BCIP / NBT substrate.

Cardiac magnetic resonance imaging (MRI) and assessment of RV and LV -EDV, -ESV, -EF and mass using MRI

The animals were subjected to cardiac MRI at 22 weeks of age. The analysis was performed on a clinical workstation with semi-automatic contour tracking software (CVI42, Release 4.1.8 (201), Circle Cardiovascular Imaging Inc., Calgary, Canada).

Flow chamber experiments

The thrombocyte adhesion in the flow was measured by perfusion of murine whole blood on collagen-coated coverslips (200 pg / ml fibrillar type I collagen) at 1000 s ¹ or 400 S ¹ as indicated. The platelets were labeled with a DyLight 488 conjugated anti-GPIX Ig derivative (0.2 pg / ml) and treated with rmSema7a or IgG2A Fc for 5 minutes at 37 ° C. before perfusion. In the case of treatment with GPIb-blocking antibodies, 100 pg / mouse pOp / B Fab were injected intravenously 20 minutes before the blood sample was taken for the experiment. In further experiments, blood from animals with functional GPIb (GPIb-IL4tg) was used.

Flow cytometric analysis

The following antibodies were used for the flow cytometric analysis and freshly prepared before the experiment: Rat anti-mouse Ly6G (Biolegend, clone 1A8), labeled with BV421 (Biolegend 127628), rat anti-mouse CD42b-FITC (Emfret, clone Xia.G5), rat anti-mouse CD62P (BD Pharmingen, clone RB40.34), labeled with Alexa Fluor 647 (BD 563674) , Rat anti-mouse activated GPIIb / llla-PE (Emfret, clone JON / A).

Gating strategy

After staining, the sampling focused on peripheral granulocytes through their granularity and surface expression of the lymphocyte-antigen-6 complex, locus G (Ly-6G), which is referred to as SSC / Ly-6G ⁺ . The presence of the platelet surface marker CD42b on the surface of SSC / Ly-6G + events distinguished the platelet-neutrophil complexes SSC / Ly-6G ⁺ / CD42b ⁺ (PNCs) from the freely circulating PMNs SSC / Ly-6G + / CD42b - These two populations were tested for their presentation of the surface transmembrane glycoprotein P-selectin (CD62P) and the activated GPIIb / llla (clone JON / A) (not shown).

SEMA7A cleavage of erythrocytes

The erythrocytes were separated from human blood samples using MACS beads (MicroBeads Kit, Milenyi Biotec, Germany). The cells were quantified in a Neubauer chamber. ^{8x10 8} erythrocytes were used per sample. The shear stress was induced by pulling and pushing the erythrocytes through a 27-gauge needle. For hypoxia exposure, cells were placed in hypoxic PBS medium that had been _{exposed to hypoxia (8% O 2} ) in an Invivo2400 hypoxia workstation (Ruskin Technology Ltd; Leeds). At the end of each experiment, the samples were centrifuged at RT at 1200 rpm for 10 minutes and the SEMA7A concentration was measured in the supernatant with the ELISA kit SEB448Hu.

Intravital microscopy

The mice were anesthetized and the cremastic tissue was prepared under a Nikon 20x water dip lens (NA = 0.32). The neutrophils were labeled with 20 μl of anti-Ly6G (Biolegend 127608) and the platelets with 20 μl of the platelet-specific FITC X488 antibody (emfret, Eibelstadt, Germany) resuspended in 200 ml and administered iv. Videos of postcapillary kremastervenoia with a diameter of 20-40 pm were recorded with a Hamamatsu Orca Flash 4.0 camera, which was recorded on a dual-emission image splitter (optoSplit II, Cairn Research; UK) at a rate of 16 images / s was mounted (in a video of a total of 10 seconds), and with a resolution of 2048 ^c 1024 pixels, formed on a Nikon Eclipse Ci-L-microscope (Nikon, Dusseldorf, Germany) was mounted, which is operated by the NIS elements Ar-software . The videos were recorded prior to the administration of rmSema7a iv and the videos were recorded after a 15 minute incubation for 5 minutes at 20 second intervals. The neutrophil velocity (pm / sec) was calculated from manually traced cells, the stationary neutrophils were counted (number of cells / mm ² ), the platelet sedimentation on the vessel wall was measured (normalized MFI% / mm), the cells migrated from the vascular system After 15 min exposure to rmSema7a, counting (number of cells / mm ² ), the distance of the migrated cells, measured in pm in all videos, was processed with the NIS elements Ar software 4.20-64 bit (Nikon, Düsseldorf, Germany).

Analysis of the data

The entire data analysis was carried out in cooperation with the Institute for Clinical Epidemiology and Applied Biometry at the University of Tübingen. The data is usually presented as bar graphs with means ± SD. The normal distribution was checked using the skewness. Since testing for normality with small sample sizes can easily lead to statistically insignificant but meaningless results, as was the case in this study, the inventors also performed a visual inspection of the data distributions using histograms and attempted a log transformation of the Data consistent with normal if this inspection found skewed distributions. Tests of the log values were performed for log transformed data; the data is displayed on a logarithmic scale showing geometric means and their 95% confidence intervals. Overall, statistical tests using Student's t-tests were performed when comparing two groups; for the comparison of multiple groups, the inventors performed one-way analyzes of variance, followed by Dunnett's tests. For the Figure 3: The SEMA7A% on human erythrocytes and age as input variables was analyzed by linear regression analysis and displayed point by point with 95% confidence bands, with healthy people as donors and age as input variables. For all comparisons carried out, p-values are displayed and p-values below p <0.05 were considered to be statistically significant, shown as p <0.05 (*); p <0.01 (**) and p <0.001 (***).

Results

Patients with myocardial ischemia show increased PNC formation and plasma SEMA7A

The number of PNCs increases in myocardial tissue during MIRI. The harmful effects of PNCs have been demonstrated in other organs, such as the lungs, where they increase inflammatory tissue damage, which leads to impaired organ function. In an attempt to better understand the interaction of platelets and neutrophils and the formation of PNCs in inflammatory myocardial damage, the inventors took blood samples from patients with active myocardial ischemia and examined them for the presence of PNCs using FACS analysis. The inventors compared these samples with patients who are undergoing cardiac surgery who are also exposed to reperfusion after extracorporeal circulation (HLM). These patients showed no evidence of active ischemia. In addition, the inventors obtained blood from cardiac surgery operations without reperfusion injury as well as healthy controls. The inventors found that the patients with acute MI had significantly more CD42b-positive neutrophils (ie PNCs) compared to healthy controls and patients who underwent cardiac surgery with or without extracorporeal circulation. It is noteworthy that the platelets in the conjugates were fully activated, as demonstrated by the clear activation of integrin Ilb3 (PAC-1 binding) and exposure to CD62P (FIG. 1 ad). Given that reperfusion of ischemic tissue induces inflammation and the inventors' previous finding that SEMA7A has significant pro-inflammatory capacity, the inventors also measured soluble SEMA7A in the blood of these patients. In fact, SEMA7A increased in the plasma of MI patients, but not in any of the other patient groups tested (FIG. 1 e, FIG. 2). The inventors also found that the SEMA7A expression on erythrocytes is not age-dependent (FIG. 3). Experiments on mice showed that plasma Sema7a increased very rapidly during cardiac ischemia, with a significant increase already being found after 1 minute of reperfusion (FIG. 4). SEMA7A was released from erythrocytes in response to shear stress or tissue hypoxia, both of which are present in the affected areas during myocardial ischemia reperfusion (Figure 5).

Injection of Sema7a worsened myocardial IR damage

The sharp increase in Sema7a in the plasma of patients and mice with

Myocardial ischemia has raised the possibility that Sema7a may play a functional role in the progression of myocardial IR injury. To test this directly, the inventors injected recombinant Sema7a (rmSema7a fusion protein, 1 pg / mouse before reperfusion) into WT animals and found that this resulted in a significantly increased infarct size compared to the corresponding IgG Fc control animals (rmlgG2A Fc) led (Figure 6 a, b). This finding correlated with an increased troponin I, a marker of damage to the myocardial tissue. Histological sections showed increased tissue damage in the Sema7a-injected animals compared to the Fc controls and a lower number of PNCs in the tissue areas at risk (FIG. 6 c, d). In cell culture experiments, the inventors found no direct pro-apoptotic effect of human Sema7a (rhSEMA7A) on cardiomyocytes, as was assessed by the activation of caspase 3 (FIGS. 7 a, b). After the inventors observed more PNCs in myocardial tissue and understood the deleterious effects that these PNCs can have, the inventors next used flow cytometry to test for the presence of PNCs. The inventors found significantly increased numbers of PNCs in the blood of mice injected with rmSema7a, and the conjugates (FIG. 6 h) also showed stronger signals for the platelet markers GPIb, CD62P and activated integrin allbß3 (JON / A) (FIG. 6 eg , Figure 8). To check whether this is reflected by PNCs entering the risk area (AAR), the inventors extracted this area and determined the number of PNCs in the myocardial tissue. Using flow cytometry, the inventors found that the animals injected with rmSema7a had more PNCs extravasated into the myocardium in the AAR and that the conjugates in neutrophils had significantly increased signals for GPIb, P-selectin and activated integrin allbß3 (JON / A) showed (FIG. 6 il, FIG. 8). The inventors also tested the influence of rmSema7a on the rolling of neutrophils and found that rmSema7a influenced the adhesion of neutrophils in vitro and in vivo (FIG. 9). This is in agreement with the inventors' previous results, according to which Sema7a, which is expressed on the surface of endothelial cells, increases the transmigration of neutrophils into inflamed tissues.

Significantly reduced myocardial IR damage in SemaJa mice

To further investigate the role of Sema7a in myocardial IR injuries, the inventors used Sema7a animals and their littermate controls. Since Sema7a is involved in the fibrotic transformation of tissue, the inventors first examined the cardiac function in untreated WT and Sema7a ^/ animals using dynamic magnetic resonance imaging. The inventors could not determine any differences in the anatomy or the cardiac performance parameters of Sema7a ^/ - mice compared to throwing spirit controls (FIG. 10 a, b, FIG. 11). Next, the inventors exposed the Sema7a -'- mice to MIR and found that they developed dramatically smaller infarcts and had a reduced plasma troponin I compared to the littermate controls (FIG. 10 c, d). Histological sections showed less tissue damage in Sema7a ^/ - animals compared to the littermate controls and a lower number of PNCs in the tissue areas at risk (FIGS. 10 e, f). The flow cytometric analysis showed a lower number of PNCs (FIG. 10 j) in the blood of Sema7a ^/ - animals compared to the controls, and the conjugates showed lower values of platelet activation markers (surface P-selectin and activated integrin allbß3 (JON / A)) in the early phase after the IR (Figure 10 gi, Figure 12). The inventors again tested whether this was reflected within the PNCs in the AAR. The inventors extracted this area and counted the PNCs within the myocardial tissue. Using flow cytometry, the inventors found a reduced number of PNCs within the AAR and the conjugates showed reduced signals for GPIb, activated integrin allbß3 and P-selectin on neutrophils in the AAR of Sema7a ^/ animals (FIG. 10 kn, FIG. 12 ). The semaphorin 7a obtained from red blood cells is of central importance for myocardial RI damage

Next, the inventors attempted to identify the cellular source of the soluble Sema7a that mediated the observed pathogenic effect. Sema7a is expressed in various organs and tissues, where it is present in large quantities on the erythrocytes (RBCs) and only has a low level of expression in the myocardial tissue (FIG. 13). Therefore, the inventors animals with genetic deletion of Sema7A in endothelial cells (Sema7A ^{loxP / loxP} Tie2Cre +), cardiomyocytes ^(! Sema7A ^{loxP / loxP} Myh6Cre +), erythrocytes (Sema7A ^{loxP / loxP} HbbCre +) and immunocompetent cells have (Sema7A ^{loxP / lox -} pLysMCre +) generated and fed into the MIRI model. In the Sema7a ^{loxP / loxP} Hbb-Cre + animals, the inventors found a significant reduction in the size of the infarct, which correlated well with reduced plasma TnI (FIGS. 14 a, b). The immunohistological analysis showed a reduced number of PNCs in the myocardial tissue of these animals compared to the WT control (FIG. 14 c, d). The injection of rmSema7a showed that these results ^{could be reversed in the Sema7a loxP / loxP} HbbCre + -T \ erer \, although the injection of Sema7a led to higher troponin values in these animals (FIG. 15). In the Sema7a ^{loxP / loxP} Myh6Cre + animals, the inventors found no significant change in the myocardial IR damage (FIG. 14 e, f) and no changes in comparison to the littermate controls if the PNCs in the myocardial tissue are observed (FIG. 14 g, h) . When the Sema7a ^{loxP /! OxP} Tie2Cre + T \ ere was exposed to the same model, the inventors found significantly smaller infarcts compared to the controls (FIGS. 14 i, j).

This protection was also reflected in a reduced number of PNCs, while the reduction in troponin I did not reach statistical significance (FIG. 14 k, l). In contrast, the size of the infarct in Sema7a ^{loxP / loxP} LysMCre mice remained unchanged compared to the controls (FIG. 14 m, n), as did the troponin I concentration and the number of PNCs in the myocardial tissue (FIG. 14 o, p). This approach showed that the expression of Sema7a on RBCs is critical for the induction of PNC formation and myocardial tissue injury.

Sema7a interacts with the platelet glycoprotein Ib The above experiments have shown that Sema7a enhances platelet activation and PNC formation in the myocardial IR environment. In order to test whether Sema7a acts directly on platelets, the inventors first examined its effects on platelet function in standard aggregometry. Unexpectedly, Sema7a induced no detectable platelet activation or aggregation at the concentration of 1 pg / ml. This was also confirmed by the flow cytometric analysis of the platelet activation. Increasing concentrations of Sema7a had no influence on integrin-allbß3 activation (JON / A-PE) or P-selectin exposure under static conditions. In stark contrast, profound prothrombotic activity of Sema7a was observed when thrombus formation was examined for counterparts in the flow with a whole blood perfusion system. At a medium to high shear rate (1000 s ¹ ), which reflects the arterial blood flow, Sema7a significantly increased both the surface area covered by platelets and the thrombus volume (FIGS. 16 a, b), and the same effect was observed with a low Shear rate (400 S ¹ , Figure 17 a, b) observed. The flow dependence of the prothrombotic Sema7a effect indicated a possible involvement of the vWF receptor GPIb-IX in this process, which is particularly important for thrombus formation under conditions of high shear. To test this directly, the inventors inhibited GPIb-IX by adding Fab fragments of the antibody p0p / B, which completely blocks the ligand binding site on the GPIb subunit of the receptor complex. Under these conditions, the thrombus-promoting effect of Sema7a was completely lost both at low and at high shear rates, which shows that it was GPIb-dependent (FIGS. 16 a, b). This result was also confirmed in mice in which the ectodomain of GPIba was replaced by the human IL-4 receptor (GPIb-II-4tg) (FIG. 16 c, d), with Sema7a showing no increase in surface coverage or in thrombus volume induced in the whole blood perfusion system.

In order to test whether the thrombo-inflammatory effect of the Sema7a myocardial RI damage also depends on the platelet GPIb, the inventors first added GPIb-IL-4tg animals to the MIRI model. It was noticeable that these animals had a significantly reduced infarct size compared to the WT controls, which was also reflected in the troponin I measurements. In addition, treatment of these mutant animals with Sema7a did not lead to an increase in the MIRI, indicating that the- se pathogenic activity of Sema7a was completely GPIb-dependent (FIG. 16 e, f). When evaluating the AAR tissue sections of these animals, the inventors found a small number of PNCs within the myocardial tissue sections (FIG. 16 g, h). In order to test a possible interaction of Sema7a with GPIb, the inventors carried out coimmunoprecipitation experiments. In a first step, the inventors immunoprecipitated Sema7a from blood and heart muscle tissue samples and blotted it for the presence of GPIb. Indeed, GPIb coimmunoprecipitated with Sema7a in the blood and particularly the myocardial AAR in response to MIR. The inventors then reversed this approach with immunoprecipitation for GPIb and blotting for Sema7a. Here, too, the inventors established an interaction of Sema7a with GPIb in the blood and the AAR as a reaction to MIR (FIG. 16 ij).

Anti-Sema7a treatment reduces PNC formation and myocardial IR injury

In order to test whether the inhibition of the endogenous Sema7a influences the MIRI, the inventors injected a function-blocking anti-Sema7a antibody or an IgG control (1pg / mouse) before the start of the reperfusion. In fact, the anti-Sema7a treatment led to a reduction in the size of the infarct and a reduction in troponin I compared to the animals which were injected with an IgG control (FIGS. 18 a, b). The histological sections of the AAR showed less tissue damage in the anti-Sema7a-injected animals compared to the IgG control animals, with a lower number of PNCs in the tissue areas at risk (FIG. 18 c, d). Flow cytometry showed an increased number of CD42b-positive and P-selectin-positive neutrophils in the blood of the IgG-injected animals at the beginning of the process after the IR, which was not observed in the anti-Sem7a-injected animals (FIG. 18 eg, Figure 19). In addition, the inventors found a significantly reduced number of PNCs in the blood of these anti-Sema7a-injected animals (FIG. 18 h). The analysis of the AAR showed a clear increase in PNCs with fully activated platelets (recognizable by high signals for GPIb, activated integrin allbß3 and P-selectin) at a later point in time (120 min) in the animals with IgG control, that in the animals with Anti-Sema7a injection practically did not occur (Figure 18jk, Figure 19), and a lower number of PNCs within the AAR (Figure 18I). These data show that PNC formation has adverse effects on the Damage to the myocardial tissue in the experimental myocardial IR and can be effectively prevented by inhibiting the endogenous Sema7a.

3. Discussion

Myocardial ischemia, followed by reperfusion, remains one of the most significant health problems worldwide. An intervention to recanalize the occluded coronary artery is a crucial part of initial therapy for this disease and significantly improves the patient's overall outcome. After closure, the subsequent reperfusion damage to the myocardium is the result of an inflammatory reaction that affects a large proportion of patients with Ml and can then lead to severe myocardial dysfunction. The inventors were able to show that the neuronal lead protein Semaphorin 7a released from the membrane of the red blood cells is a mediator of inflammatory myocardial damage. The inventors also provide evidence that Sema7a interacts with the platelet GPIb and thereby promotes the formation of platelet-neutrophil complexes and their translocation into the affected myocardium, thereby increasing the myocardial injury. In order to illustrate the role of Sema7a on platelets and the effect of Sema7a on MIRI, the inventors have provided a sketch in FIG. The results show that a strategy for influencing the Sema7a-GPIb interaction can lead to reduced heart damage and an improved myocardial result according to MI and should therefore be pursued as a therapeutic strategy in the future.

4. Conclusion

On the basis of their findings on the molecular basis of post-ischemic tissue damage, in particular in the form of reperfusion damage, the inventors were able for the first time to develop an active ingredient that enables targeted prophylaxis and therapy.

Claims

1. Inhibitor of Semaphorin 7A (SE A7A) for use in the treatment and / or prophylaxis of post-ischemic tissue damage.

2. Inhibitor according to claim 1, characterized in that the pos tischemic tissue damage is reperfusion damage.

3. Inhibitor according to claim 2, characterized in that the reperfusion damage is myocardial reperfusion damage.

4. Inhibitor according to one of the preceding claims, which is designed such that it modifies the interaction of SEMA7A with the platelet surface.

5. Inhibitor according to one of the preceding claims, which is designed such that it modifies the interaction of SEMA7A with GPIb.

6. Inhibitor according to one of the preceding claims, wherein the inhibitor is selected from the group consisting of: antibody, antibody fragment, soluble SEMA7A receptor, antisense nucleic acid, siRNA, low molecular compound, and combinations thereof.

7. Inhibitor according to claim 6, characterized in that the Antikör is a function-inhibiting antibody.

8. A pharmaceutical composition comprising the inhibitor according to any one of claims 1-7 and a pharmaceutically acceptable carrier.

9. Use of an inhibitor of SEMA7A for the treatment and / or prophylaxis of post-ischemic tissue damage.

10. A process for the manufacture of a medicament for the treatment and / or prophylaxis of post-ischemic tissue damage which comprises the formulation of an inhibitor of SEMA7A in a pharmaceutically acceptable carrier.

11. A method for the treatment and / or prophylaxis of post-ischemic tissue damage which comprises the administration of a therapeutically effective amount of an inhibitor of SEMA7A to a mammal in need.

12. The method according to claim 11, characterized in that the mammal is a human.

13. The method according to claim 11 or 12, characterized in that the administration of the inhibitor is carried out in a myocardial infarction patient or a patient at risk of myocardial infarction.

14. The method according to any one of claims 11-13, characterized in that the interaction of SEMA7A with the platelet surface is modified by the administration of the inhibitor.

15. The method according to any one of claims 11-14, characterized in that the interaction of SEMA7A with GPIb is modified by the administration of the inhibitor.