EP4623071A2 - Natural killer cells - Google Patents

Natural killer cells

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Publication number
EP4623071A2
EP4623071A2 EP23817198.7A EP23817198A EP4623071A2 EP 4623071 A2 EP4623071 A2 EP 4623071A2 EP 23817198 A EP23817198 A EP 23817198A EP 4623071 A2 EP4623071 A2 EP 4623071A2
Authority
EP
European Patent Office
Prior art keywords
compound
cells
rev
erb
compounds
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
EP23817198.7A
Other languages
German (de)
French (fr)
Inventor
Matthew J FUCHTER
Hugh JM BRADY
Amaia Uriz HUARTE
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Nk io Ltd
Ip2ipo Innovations Ltd
Original Assignee
Nk io Ltd
Imperial College Innovations Ltd
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Application filed by Nk io Ltd, Imperial College Innovations Ltd filed Critical Nk io Ltd
Publication of EP4623071A2 publication Critical patent/EP4623071A2/en
Pending legal-status Critical Current

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    • C12NMICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N5/00Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06Animal cells or tissues; Human cells or tissues
    • C12N5/0602Vertebrate cells
    • C12N5/0634Cells from the blood or the immune system
    • C12N5/0646Natural killers cells [NK], NKT cells
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47Quinolines; Isoquinolines
    • A61K31/472Non-condensed isoquinolines, e.g. papaverine
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47Quinolines; Isoquinolines
    • A61K31/472Non-condensed isoquinolines, e.g. papaverine
    • A61K31/4725Non-condensed isoquinolines, e.g. papaverine containing further heterocyclic rings
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D405/00Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
    • C07D405/02Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
    • C07D405/06Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D413/00Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
    • C07D413/02Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
    • C07D413/06Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D217/00Heterocyclic compounds containing isoquinoline or hydrogenated isoquinoline ring systems
    • C07D217/22Heterocyclic compounds containing isoquinoline or hydrogenated isoquinoline ring systems with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to carbon atoms of the nitrogen-containing ring
    • C07D217/26Carbon atoms having three bonds to hetero atoms with at the most one bond to halogen
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D307/00Heterocyclic compounds containing five-membered rings having one oxygen atom as the only ring hetero atom
    • C07D307/02Heterocyclic compounds containing five-membered rings having one oxygen atom as the only ring hetero atom not condensed with other rings
    • C07D307/34Heterocyclic compounds containing five-membered rings having one oxygen atom as the only ring hetero atom not condensed with other rings having two or three double bonds between ring members or between ring members and non-ring members
    • C07D307/38Heterocyclic compounds containing five-membered rings having one oxygen atom as the only ring hetero atom not condensed with other rings having two or three double bonds between ring members or between ring members and non-ring members with substituted hydrocarbon radicals attached to ring carbon atoms
    • C07D307/52Radicals substituted by nitrogen atoms not forming part of a nitro radical
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07DHETEROCYCLIC COMPOUNDS
    • C07D401/00Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
    • C07D401/02Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
    • C07D401/06Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
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    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12NMICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00Active agents used in cell culture processes, e.g. differentation
    • C12N2501/10Growth factors
    • C12N2501/125Stem cell factor [SCF], c-kit ligand [KL]
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    • C12N2501/00Active agents used in cell culture processes, e.g. differentation
    • C12N2501/20Cytokines; Chemokines
    • C12N2501/23Interleukins [IL]
    • C12N2501/2307Interleukin-7 (IL-7)
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    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12N2501/00Active agents used in cell culture processes, e.g. differentation
    • C12N2501/20Cytokines; Chemokines
    • C12N2501/26Flt-3 ligand (CD135L, flk-2 ligand)
    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12N2501/00Active agents used in cell culture processes, e.g. differentation
    • C12N2501/40Regulators of development
    • C12N2501/42Notch; Delta; Jagged; Serrate
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    • C12N2501/00Active agents used in cell culture processes, e.g. differentation
    • C12N2501/999Small molecules not provided for elsewhere

Definitions

  • NK Natural Killer
  • NK cells are innate lymphoid cells (ILCs), specifically large granular cytotoxic lymphocytes that bridge the innate and the adaptive arms of the immune response.
  • ILCs innate lymphoid cells
  • NK cells 15 also exhibit the highest level of cytotoxic activity within the immune system. Therefore, altered NK cell functionality or numbers impact the functioning of the immune system against infection and cancer. For example, a large scale study in Japan has shown that reduced levels of NK cells in a cohort of people aged over 40 is associated with a significantly higher incidence of cancer.
  • CLP Common Lymphoid Progenitor 20
  • HSCs Haematopoietic Stem Cells
  • NK cells are different from B and T cells as they lack specific cell surface antigen receptors.
  • NK cells may kill cancerous and pathogen ⁇ infected cells without prior sensitisation, making them part of the innate immune response. They also have a critical role in tumour immunosurveillance by directly influencing the adaptive immune response. 25 Activation of NK cells triggers them to release perforin and cytoplasmic granules containing granzymes. Perforin polymerises to form pores on target cells in the presence of Ca2+. Granzymes may enter these pores into target cells, causing DNA fragmentation and apoptosis. NK cells may also secrete cytokines, which trigger the action of other immune cells in the adaptive arm of the immunity. Numerous groups have worked on methods to increase the number of endogenous NK cells.
  • cytokines that are essential for NK cell development.
  • Administration of IL ⁇ 2 and IL ⁇ 15 was predicted to enhance NK cell development.
  • IL ⁇ 2 promotes the proliferation and cytotoxicity of NK cells
  • IL ⁇ 15 promotes the development and expansion of NK cells.
  • the cytokines were found only stimulate a minimal expansion of NK cells with reduced half ⁇ life, even at a very high dose.
  • administered cytokines often leads to systemic toxicity due to inappropriate activation of immune responses and the induction of NK cell apoptosis.
  • producing large numbers of NK cells is difficult, and producing fully functional NK cells with high cytotoxicity is even harder.
  • NK cells have a critical role in the immune system where they destroy 10 cancerous, pathogen ⁇ infected or damaged cells.
  • Boosting NK cell number or functionality is predicted to increase the killing of these cells.
  • Existing therapies such as NK cell adoptive transfer and cytokine enhancement of endogenous NK cells are not very successful in terms of their efficacy.
  • NK cells are differentiated from the HSCs in the bone marrow and distributed throughout lymphoid and non ⁇ lymphoid tissues including lymph nodes, spleen, peripheral blood, lungs and liver.
  • cytokines and transcription factors are needed to encourage HSCs to develop into NK cells. Each cytokine and transcription factor must be present at a precise time and concentration in order to push differentiation from HSCs into NK cells. However, the precise hierarchy of cytokines and transcription factors governing NK cell maturation is still incompletely understood.
  • the present inventors have previously shown that inhibiting the action of REV ⁇ ERB increases 20 NK cell production.
  • the inventors demonstrated that inhibiting the action of REV ⁇ ERB, e.g. using the REV ⁇ ERB antagonist SR8278, increases E4bp4 expression, which in turn increases NK cell production.
  • the structure of SR8278 is shown below: S Many synthetic ligands for REV ⁇ ERB have been generated in the art.
  • the compounds in this library all possess an alkyl ester group or similar attached to the tetrahydroisoquinoline (or open ⁇ ring equivalent) core at position 3 in structure shown below: 10
  • an ethyl ester group is present in this position. Therefore, the research thus far has strongly suggested that an ester moiety, or similar, is important to the REV ⁇ ERB inhibitory action of the compounds.
  • the present inventors have now developed a new library of compounds in which the group previously attached to the tetrahydroisoquinoline (or open ⁇ ring equivalent) core at position 3 has 15 been replaced for instance with a carboxylic acid group.
  • Acid ⁇ form compounds of the present invention have surprisingly been shown to possess activity as REV ⁇ ERB antagonists. Even more surprising is that the activities of these acid ⁇ form compounds have been shown to be enhanced relative to their ethyl ester counterparts. Further beneficial and surprising properties have been shown using acid ⁇ form compounds of 20 the present invention, including good plasma stability, high levels of target engagement and low levels of off ⁇ target effects. Acid ⁇ form compounds of the present invention have also been used to expand an NK cell population.
  • the present invention provides ex vivo method for expanding an NK cell population, comprising the steps of: 25 a) culturing an haematopoietic progenitor cell (HPC) comprising sample obtained from an individual; b) adding a compound that inhibits the action of REV ⁇ ERB to said sample; and c) expanding said cells in vitro to produce an NK cell population; wherein the compound that inhibits the action of REV ⁇ ERB has the formula (I): I) where: represents bonds that are all either present or absent; R 1 is hydrogen; 5 R 2 is selected from 5 ⁇ 10 membered heterocyclyl rings and C 1 ⁇ 6 hydrocarbyl, and is optionally substituted with one or more groups independently selected from C 1 ⁇ 4 hydrocarbyl, ⁇ OR’, ⁇ OC(O)R’, ⁇ C(O)OR’, ⁇ SR’, ⁇ S(O)R’, ⁇ S(O) 2 R’, ⁇ NR’ 2 , ⁇ NR’C(O)R’
  • the method of therapy in which the pharmaceutical composition or products may be used may be: (a) a method of treating a disease or disorder selected from cancer, an infectious disease (acute or chronic), an autoimmune disease or a disease or disorder related to female infertility or pregnancy; or (b) a method of treatment of a viral infection, a bacterial infection, a protest infection, a fungal infection and/or a helminth infection.
  • the invention further provides a method of treatment by increasing the number of NK cells in a patient in need thereof, comprising administering to said patient a therapeutically effective amount of a compound which inhibits the action of REV ⁇ ERB according to the invention, and optionally a Notch ligand, wherein preferably the Notch ligand is delta ⁇ like ligand 4 (DLL4), or a fragment thereof which retains the function of DLL4.
  • a compound which inhibits the action of REV ⁇ ERB according to the invention and optionally a Notch ligand, wherein preferably the Notch ligand is delta ⁇ like ligand 4 (DLL4), or a fragment thereof which retains the function of DLL4.
  • DLL4 delta ⁇ like ligand 4
  • the pharmaceutical composition or pharmaceutical products for use of the invention, or the method of treatment of the invention may be used in combination with antibody ⁇ mediated immunotherapy, wherein optionally said compound or products is for administration before, simultaneously with, or after administration of the antibody ⁇ mediated immunotherapy.
  • the invention also provides an isolated compound of formula (I) as defined herein, provided 30 that the compound is not: , 5 , , a .
  • the invention also provides the use of a compound of formula (I) as defined herein as a REV ⁇ ERB inhibitor, provided that the compound is not: 5 .
  • the invention further provides a pharmaceutical composition comprising a compound of formula (I) as defined herein, and a pharmaceutically acceptable carrier, diluent and/or excipient, provided that the compound is not: 10 , F , , NH 2 ,
  • a composition comprising a compound of formula (I) as defined herein, wherein the composition comprises the compound of formula (I) in an amount of at least 0.01%, preferably at least 0.1%, more preferably at least 1%, such as at least 10% by weight, 10 provided that the compound is not: , or .
  • BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 NK cell developmental pathway. NK cells are differentiated from Hematopoietic Stem Cells (HSCs).
  • NK cells develop from HSC into Common Lymphoid Progenitor (CLP) cells, NK progenitor 5 (NKP) cells, immature NK (iNK) cells, mature NK (mNK) cells and finally into conventional NK (cNK) cells, which circulate in the bloodstream.
  • CLP Common Lymphoid Progenitor
  • iNK immature NK
  • mNK mature NK
  • cNK conventional NK
  • FIG. 1 Schematic representation of example two ⁇ stage culture of NK cell development using a REV ⁇ ERB 15 inhibitory compound and a Notch ligand.
  • an embodiment, description, aspect or disclosure comprises the recited feature(s)
  • the present invention also encompasses said embodiment, description, aspect or disclosure consisting of said feature(s).
  • chemically feasible means a bonding arrangement or a compound where the generally understood rules of organic structure are not violated; for example a structure within a definition of a claim that would contain in certain situations a pentavalent carbon atom that would not exist in nature would be understood to not be within the claim.
  • the structures disclosed herein, in all of their embodiments are intended to include only “chemically feasible” structures, and any recited structures that are not chemically feasible, for example in a structure shown with variable atoms or groups, are not intended to be disclosed herein and do not form part of the present invention.
  • an "analogue” of a chemical structure refers to a chemical 5 structure that preserves substantial similarity with the parent structure, although it may not be readily derived synthetically from the parent structure.
  • a related chemical structure that is readily derived synthetically from a parent chemical structure is referred to as a "derivative.”
  • a substituent is specified to be an atom or atoms of specified identity, "or a bond”, a configuration is referred to when the substituent is "a bond” that the groups that are immediately 10 adjacent to the specified substituent are directly connected to each other in a chemically feasible bonding configuration. All chiral, diastereomeric, racemic forms of a structure are intended, unless a particular stereochemistry or isomeric form is specifically indicated.
  • Hydrocarbyl groups are groups that consist only of carbon and hydrogen, though the groups may be substituted one or more times, as defined herein. Hydrocarbyl groups include straight chain and branched groups.
  • hydrocarbyl groups typically have from 1 to 6 carbon atoms, particularly from 1 to 4 carbon atoms or from 1 to 3 carbon atoms.
  • hydrocarbyl encompasses aromatic and non ⁇ aromatic groups.
  • Preferred hydrocarbyl groups include alkyl, alkenyl and alkynyl groups which are described further below.
  • Alkyl groups include straight chain and branched alkyl groups and cycloalkyl groups having from 1 to about 20 carbon atoms, and typically from 1 to 12 carbons, from 1 to 8 carbon atoms, from 5 1 to 6 carbon atoms.
  • straight chain alkyl groups include those with from 1 to 8 carbon atoms such as methyl, ethyl, n ⁇ propyl, n ⁇ butyl, n ⁇ pentyl, n ⁇ hexyl, n ⁇ heptyl, and n ⁇ octyl groups.
  • branched alkyl groups include, but are not limited to, isopropyl, iso ⁇ butyl, sec ⁇ butyl, t ⁇ butyl, neopentyl, isopentyl, and 2,2 ⁇ dimethylpropyl groups.
  • alkyl encompasses n ⁇ alkyl, isoalkyl, and anteisoalkyl groups as well as other branched chain forms of alkyl. 10 Representative substituted alkyl groups can be substituted one or more times, as defined herein. Cycloalkyl groups are cyclic alkyl groups such as, but not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, and cyclooctyl groups. In some embodiments, the cycloalkyl group can have 3 to about 8 ⁇ 12 ring members, whereas in other embodiments the number of ring carbon atoms range from 3 to 4, 5, 6, or 7.
  • Cycloalkyl groups further include polycyclic cycloalkyl 15 groups such as, but not limited to, norbornyl, adamantyl, bornyl, camphenyl, isocamphenyl, and carenyl groups, and fused rings such as, but not limited to, decalinyl, and the like. Cycloalkyl groups also include rings that are substituted with straight or branched chain alkyl groups as defined above. Representative substituted cycloalkyl groups can be mono ⁇ substituted or substituted more than once, as defined herein. 20 Alkenyl groups are alkyl groups, e.g. as described above, but which comprise at least one carbon ⁇ carbon double bond.
  • alkenyl groups include straight chain and branched alkenyl groups and non ⁇ aromatic cycloalkenyl groups.
  • Alkenyl groups are preferably, but not necessarily, bonded to the rest of a molecule through a carbon which forms part of a double bond.
  • Representative substituted alkenyl groups can be mono ⁇ substituted or substituted more than once, as defined herein.
  • 25 Alkynyl groups are alkyl groups, e.g. as described above, but which comprise at least one carbon ⁇ carbon triple bond.
  • alkynyl groups include straight chain and branched alkynyl groups.
  • Alkynyl groups are preferably, but not necessarily, bonded to the rest of a molecule through a carbon which forms part of a triple bond.
  • Heterocyclyl groups/rings or the term "heterocyclyl” includes aromatic and non ⁇ aromatic ring compounds containing 3 or more ring members, of which, one or more is a heteroatom such as, but not limited to, N, O, and S.
  • a heterocyclyl can be a cycloheteroalkyl, or a heteroaryl, or if polycyclic, any combination thereof.
  • heterocyclyl groups include 3 to about 20 ring members, whereas in compounds of formula (I) heterocyclyl rings typically have 5 to 10 ring members.
  • a heterocyclyl ring can be a 5 ⁇ membered ring with one heteroatom, a 6 ⁇ membered ring with two heteroatoms, and so forth. The number of carbon atoms plus the number of heteroatoms sums up to equal the total number of ring atoms.
  • a heterocyclyl ring can also include one or more double bonds.
  • a heteroaryl ring is an embodiment of a heterocyclyl group.
  • the phrase "heterocyclyl 5 group" includes fused ring species including those comprising fused aromatic and non ⁇ aromatic groups.
  • a dioxolanyl ring and a benzdioxolanyl ring system are both heterocyclyl groups within the meaning herein.
  • the phrase also includes polycyclic ring systems containing a heteroatom as described herein.
  • Heterocyclyl groups can be unsubstituted, or can be substituted as discussed above.
  • 10 Heteroaryl groups are aromatic ring compounds containing 5 or more ring members, of which, one or more is a heteroatom such as, but not limited to, N, O, and S; for instance, heteroaryl rings can have 5 to about 8 ⁇ 12 ring members.
  • heteroaryl rings typically have 5 to about 10 ring members.
  • a heteroaryl group is a variety of a heterocyclyl group that possesses an aromatic electronic structure. Likewise a heteroaryl can be a 5 ⁇ ring with one heteroatom, a 6 ⁇ ring with 15 two heteroatoms, and so forth. The number of carbon atoms plus the number of heteroatoms sums up to equal the total number of ring atoms.
  • Heteroaryl groups include, but are not limited to, groups such as pyrrolyl, pyrazolyl, triazolyl, tetrazolyl, oxazolyl, isoxazolyl, thiazolyl, pyridinyl, thiophenyl, benzothiophenyl, benzofuranyl, indolyl, azaindolyl, indazolyl, benzimidazolyl, azabenzimidazolyl, benzoxazolyl, benzothiazolyl, benzothiadiazolyl, imidazopyridinyl, isoxazolopyridinyl, 20 thianaphthalenyl, purinyl, xanthinyl, adeninyl, guaninyl, quinolinyl, isoquinolinyl, tetrahydroquinolinyl, quinoxalinyl, and quinazolinyl groups.
  • Heteroaryl groups can be unsubstituted, or can be substituted with groups as is discussed above. Representative substituted heteroaryl groups can be substituted one or more times with groups such as those listed above.
  • Halogen refers to fluorine, chlorine, bromine or iodine.
  • a "salt" as is well known in the art includes an organic compound such as a carboxylic acid, a sulfonic acid, or an amine, in ionic form, in combination with a counterion.
  • exhausted NK cells may exhibit altered marker expression, such as an increase in the expression of one or more inhibitory receptor (as described herein) and/or a decrease in the expression of one or more activatory receptor 30 (as described herein).
  • increased expression of NKG2A and/or Tim3 may be used as a marker for NK cell exhaustion. Again, the expression of these markers may be quantified relative to any appropriate control as defined herein.
  • the terms “functional” and “fully functional” in the context of NK cells means that an NK cell or expanded NK cell population has all of the expected effector functions when responding to a given immune challenge.
  • an expanded NK cell population 30 of the invention at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99% or more, up to 100% of the NK cells of an expanded NK cell population of the invention are (fully) functional.
  • at least 80%, preferably at least 90%, more preferably at least 95%, even more preferably at least 98% or more of the NK cells of an expanded NK cell population of the invention are fully functional, according to any definition (e.g. marker and/or effector function definition) herein.
  • An expanded NK cell population of the invention may be produced by any of the methods disclosed herein. Typically an expanded NK cell population of the invention is produced by an ex vivo 5 method as disclosed herein.
  • E4bp4 E4bp4 (also known as Nfil3) is a basic leucine zipper protein transcription factor which is involved in the regulation of IL ⁇ 3 expression, and is involved in the coordinating the circadian clock. 10
  • the genomic DNA sequence of the human E4bp4 gene is given in SEQ ID NO: 1 (Genbank Accession No. X64318, version X64318.1). As shown in Figure 1, E4bp4 is expressed in CLPs and is critical in the production of NK cells from blood stem cell progenitors.
  • E4bp4 is a lineage commitment factor, 15 controlling the development of NKPs from HSCs ( Figure 1).
  • E4bp4 is a lineage commitment factor, 15 controlling the development of NKPs from HSCs ( Figure 1).
  • E4bp4 ’s critical function in NK cells is specific to the early stages of the developmental pathway, as specific ablation of E4bp4 in peripheral mNK cells does not affect NK cell number or response to cytomegalovirus infection.
  • E4bp4 regulates other transcription factors that are essential in NK cell development, such as Id2 and Eomes.
  • E4bp4 Transcription factors such as E4bp4 can be hard to target because of their structure and function. For example, they usually lack enzymatic activity or cofactor binding sites.
  • E4bp4 expression can be increased using a compound which inhibits the activity of REV ⁇ ERB (see PCT/GB2018/050542, particularly the examples, which is herein incorporated by 25 reference in its entirety). Further, the present inventors have demonstrated that the use of a REV ⁇ ERB inhibitor to increase E4bp4 expression results in an increase in NK cell number.
  • REV ⁇ ERB binds to porphyrin heme, and it is this characteristic that is believed to make REV ⁇ ERB a druggable target (see below).
  • the inventors have shown that by targeting REV ⁇ ERB and inhibiting its activity, it is possible to increase E4bp4 expression and hence increase NK 30 cell number.
  • the present invention is concerned with compounds which inhibit the action of REV ⁇ ERB, and their use in increasing E4bp4 expression, and hence NK cell number.
  • Increase in E4bp4 expression Accor ent invention provides ex vivo methods for producing expanded NK cell populations, and therapeutic methods and applications for increasing NK cell number in a patient in need thereof.
  • said methods and applications involve the use of a compound 5 which inhibits the action of REV ⁇ ERB.
  • said compounds act by increasing E4bp4 expression.
  • An increase in E4bp4 expression may be measured relative to a control.
  • the expression of E4bp4 in a sample of HPCs, an expanded NK cell population or in a sample obtained from a patient to be treated according to the invention may be compared with the expression of E4bp4 in a control.
  • Expression may be quantified in terms of gene and/or protein expression, and may be compared with 10 expression of a control (e.g. housekeeping gene or protein).
  • the actual amount of the E4bp4 gene, mRNA transcript and/or protein such as the mass, molar amount, concentration or molarity of the E4bp4 gene, mRNA transcript and/or protein, or the number of mRNA molecules per cell in a sample of HPCs, an expanded NK cell population or in a sample obtained from a patient to be treated according to the invention and the control may be assessed and compared with the corresponding 15 value from the control.
  • the expression of the E4bp4 gene and/or protein in a sample of HPCs, an expanded NK cell population or in a sample obtained from a patient to be treated according to the invention may be compared with that of the control without quantifying the mass, molar amount, concentration or molarity of the one or more gene and/or protein.
  • the control is an equivalent population or sample in which no increase in E4bp4 20 expression has been effected.
  • a suitable control would be a different individual to which the compound has not been administered or the same individual prior to administration of the compound.
  • E4bp4 expression may be understood to mean that, the expression of E4bp4 is increased by at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at least 95%, at least 100%, at least 150%, at least 200% compared with the control.
  • E4bp4 30 expression is increased by at least 50%, preferably at least 70%, more preferably at least 80%, even more preferably at least 90% or more compared with the control.
  • a reference to increasing E4bp4 expression may be understood to mean that, the expression of E4bp4 is increased by at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, at least 4 ⁇ fold, at least 5 ⁇ fold, at least 6 ⁇ fold, at least 7 ⁇ fold, at least 8 ⁇ fold, at least 9 ⁇ fold, at least 10 ⁇ fold or more relative to a control.
  • E4bp4 gene expression is increased by at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, or more compared 5 with the control.
  • E4bp4 protein expression is increased by at least 2 ⁇ fold, at least 3 ⁇ fold, preferably at least 5 ⁇ fold, more preferably at least 6 ⁇ fold or more compared with the control.
  • the expression of the E4bp4 gene and/or protein according to the invention may be determined by quantitative and/or qualitative analysis. Typically, gene expression may be expressed in terms of mRNA levels.
  • the expression level of the E4bp4 gene and/or protein according to the invention encompasses the mass of the E4bp4 mRNA transcript and/or protein, the molar amount of the E4bp4 gene, mRNA transcript and/or protein, the concentration of the E4bp4 gene and/or protein and the molarity of the E4bp4 gene and/or protein.
  • This expression level may be given in any appropriate units.
  • the concentration of the E4bp4 gene and/or protein may be given in pg/ml, ng/ml 15 or ⁇ g/ml.
  • the expression level of the E4bp4 gene and/or protein according to the invention may be measured directly or indirectly.
  • the relative expression of the E4bp4 gene and/or protein according to the invention relative to a control may be determined using any appropriate technique. Suitable standard techniques are 20 known in the art, for example Western blotting, enzyme ⁇ linked immunosorbent assays (ELISAs) and RT ⁇ qPCR.
  • the expression level of the E4bp4 gene and/or protein may be increased compared with a control for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, 25 at least 5 days, at least 6 days, at least 1 week.
  • the expression level of the E4bp4 gene and/or protein is increased for at least 12 to 72 hours. Typically this is assessed relative to the last administration of the compound which inhibits REV ⁇ ERB activity.
  • the expression level of the E4bp4 gene and/or protein may be increased compared with a control for at least one, at least two, at least three, at least four, at least five, at least ten, at least 20, 30 at least 30, at least 40 or more passages of the NK cell precursors in culture.
  • the expression level of the E4bp4 gene and/or protein may be altered indefinitely.
  • REV ⁇ ERB REV ⁇ ERB proteins are members of the nuclear receptor family of intracellular transcription factors.
  • the mRNA sequence of the human REV ⁇ ERB ⁇ gene (Nr1d1) is given in SEQ ID NO: 3 (Genbank Accession No. NM_021724, version NM_021724.4).
  • the mRNA sequence of the human REV ⁇ ERB ⁇ 5 gene (Nr1d2) is given in SEQ ID NO: 5 (Genbank Accession No. AB307693, version AB307693.1).
  • REV ⁇ ERB regulates the circadian clock, and has also been implicated in the regulation of cartilage breakdown.
  • the present inventors have previously demonstrated that inhibition of REV ⁇ ERB activity is sufficient to elicit a significant increase in E4bp4 expression, and that this in turn brings about an 10 expansion of NK cells, resulting in an increase in NK cell number (see PCT/GB2018/050542, particularly the examples, which is herein incorporated by reference in its entirety). Inhibition of REV ⁇ ERB activity can bring about an increase in NK cell number, and that typically the resulting NK cells are (fully) functional as defined herein. The effect of REV ⁇ ERB inhibition is mediated in an E4pb4 ⁇ dependent manner.
  • the present invention relates to the use of compounds to inhibit the action of REV ⁇ ERB, i.e. compounds which inhibit REV ⁇ ERB activity.
  • REV ⁇ REB activity may be inhibited by any appropriate means. Suitable standard techniques are known in the art. Inhibition may take place via any suitable mechanism, depending for example on the nature (see below) of the compound used, e.g. steric interference in any direct or indirect interaction or inhibition of REV ⁇ ERB.
  • a REV ⁇ ERB inhibitor (interchangeably referred to herein as a REV ⁇ ERB antagonist) is any compound which inhibits, decreases, suppresses or ablates the action of REV ⁇ ERB, whether in part or 5 completely.
  • a decrease in REV ⁇ ERB activity may be measured relative to a control.
  • the activity of REV ⁇ ERB in a sample of NK precursor or progenitor cells, an expanded NK cell population or in a sample obtained from a patient to be treated according to the invention may be compared with the activity of REV ⁇ ERB in a control.
  • Activity may be quantified in any appropriate terms, for example binding of 10 REV ⁇ ERB to the E4bp4 gene, or in terms of E4bp4 expression as defined herein. Any appropriate technique or method may be used for quantifying REV ⁇ ERB activity. Suitable techniques are known in the art, for example luciferase assays for quantifying expression of a reporter gene. Typically the control is an equivalent population or sample in which no REV ⁇ ERB inhibitory compound has been added, for example a sample obtained from a different individual to which the 15 compound has not been administered, or the same individual the prior to administration of the compound. Conventional methods for the ex vivo expansion of NK cells, including known methods may be considered control methods according to the present invention.
  • a reference to inhibiting REV ⁇ ERB activity may be understood to mean that, the activity of REV ⁇ ERB is decreased by at least 10%, at least 20%, at least 20 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99%, up to total (100%) inhibition of REV ⁇ ERB activity, as compared with the control.
  • REV ⁇ ERB activity is decreased by at least 50%, preferably at least 70%, more preferably at least 80%, more preferably at least 90%, even more preferably at least 95% or more compared with 25 the control.
  • the activity of REV ⁇ ERB may be determined by quantitative and/or qualitative analysis, and may be measured directly or indirectly.
  • the activity of REV ⁇ ERB relative to a control may be determined using any appropriate technique. Suitable standard techniques are known in the art, such as by quantifying E4bp4 30 expression, and/or luciferase assays.
  • the activity of REV ⁇ ERB may be inhibited compared with a control for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at least 1 week.
  • the activity of REV ⁇ ERB is decreased for at least 12 to 72 hours. Typically this is assessed relative to the last administration of the compound which inhibits REV ⁇ ERB activity.
  • the invention relates to compounds 10 which inhibit REV ⁇ ERB activity, including compounds which inhibit REV ⁇ ERB ⁇ activity (i.e. REV ⁇ ERB ⁇ inhibitors, also referred to as REV ⁇ ERB ⁇ antagonists) and/or to compounds which inhibit REV ⁇ ERB ⁇ activity (i.e. REV ⁇ ERB ⁇ inhibitors, also referred to as REV ⁇ ERB ⁇ antagonists).
  • the invention relates to compounds which inhibit the activity of both REV ⁇ ERB ⁇ and REV ⁇ ERB ⁇ (i.e. REV ⁇ ERB ⁇ and REV ⁇ ERB ⁇ inhibitors, also referred to as REV ⁇ ERB ⁇ and REV ⁇ ERB ⁇ 15 antagonists).
  • R REV ⁇ ERB inhibitory compounds of the invention may be specific for REV ⁇ ERB.
  • the compound binds to REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ , with no significant cross ⁇ 20 reactivity to any other molecule, particularly any other protein.
  • modulator that is specific for REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ will show no significant cross ⁇ reactivity with human neutrophil elastase. Cross ⁇ reactivity may be assessed by any suitable method.
  • Cross ⁇ reactivity of REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ inhibitor with a molecule other than REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ may be considered significant if the inhibitor binds to the other molecule at least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 25 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 100% as strongly as it binds to REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ .
  • An inhibitor that is specific for REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ may bind to another molecule such as human neutrophil elastase at less than 90%, 85%, 80%, 75%, 70%, 65%, 60%, 55%, 50%, 45%, 40%, 35%, 30%, 25% or 20% the strength that it binds to REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ .
  • the inhibitor binds to the other molecule at less than 20%, less than 15%, less than 10% or 30 less than 5%, less than 2% or less than 1% the strength that it binds to REV ⁇ ERB ⁇ and/or REV ⁇ ERB ⁇ .
  • REV ⁇ ERB inhibitory compounds of the invention may have off ⁇ target effects.
  • an off ⁇ target effect is activity against a target other than REV ⁇ ERB.
  • compounds with off ⁇ target effects are encompassed by the present invention if the activity against the non ⁇ REV ⁇ ERB target is not significant compared with the activity against REV ⁇ ERB.
  • an off ⁇ target effect is significant may depend on the intended use of the compound.
  • a compound which may exert an off ⁇ target effect on the central nervous system would not be significant for a compound used in an ex vivo method as disclosed herein, but may be significant (depending on the magnitude of the off ⁇ target effect) for an in vivo therapeutic indication as disclosed herein.
  • the presence and magnitude of any 5 potential off target effects can be readily assessed using standard methods known in the art.
  • a compound that inhibits the action of REV ⁇ ERB according to the present invention is a compound which binds to the porphyrin heme moiety of REV ⁇ ERB, and hence inhibits the activity of REV ⁇ ERB.
  • the small molecule may act via a different mechanism, for example, by binding to a non ⁇ heme portion of REV ⁇ ERB. Standard techniques are known in the art for the production of small molecules, which can then readily be tested for REV ⁇ ERB inhibitory activity as described herein 20 25 30 Structure of porphyrin heme The inventors have generated new library of compounds that inhibit REV ⁇ ERB activity (referred to interchangeably herein as inhibiting the action of REV ⁇ ERB).
  • the compounds used in the present invention have formula (I): I) 10 where: represents bonds that are all either present or absent; R 1 is hydrogen; R 2 is selected from 5 ⁇ 10 membered heterocyclyl rings and C 1 ⁇ 6 hydrocarbyl, and is optionally substituted with one or more groups independently selected from C 1 ⁇ 4 hydrocarbyl, ⁇ OR’, ⁇ OC(O)R’, ⁇ C(O)OR’, ⁇ SR’, ⁇ S(O)R’, ⁇ S(O) 2 R’, ⁇ NR’ 2 , ⁇ NR’C(O)R’, 15 ⁇ C(O)NR’ 2 , ⁇ CN, ⁇ NO 2 , ⁇ Ph, ⁇ CF 3 and halogen; X is selected from ⁇ O ⁇ and NR’; Y is selected from ⁇ C(O) ⁇ and ⁇ CR’ 2 ⁇ ; Z is selected from ⁇ O ⁇ and ⁇ NR’ ⁇ or is absent; each R a is independently selected from H, C 1 ⁇ 4 hydrocarbyl
  • R 25 As described above, represents bonds that are all either present or absent. Accordingly, the present invention relates to both closed ring structures of formula (Ia) and open ring structures of formula (Ib): ) R R ). 5 Preferably, represents bonds that are all present and the compound is a closed ring structure of formula (Ia).
  • R 1 is hydrogen.
  • R 2 is selected from 5 ⁇ 10 membered heterocyclyl rings and C 1 ⁇ 6 hydrocarbyl, and is optionally substituted. Preferably, R 2 is selected from optionally substituted 5 ⁇ 10 10 membered heterocyclyl rings.
  • Non ⁇ limiting examples of 5 ⁇ membered heteroaryl rings include furanyl, thiophenyl, oxazolyl, isooxazolyl, isothiazolyl, thiazolyl, pyrazolyl, imidazolyl, pyrrolyl and triazolyl.
  • Non ⁇ limiting examples of 6 ⁇ membered heteroaryl rings include pyridinyl, pyridazinyl, 20 pyrimidinyl and pyrazinyl.
  • Non ⁇ limiting examples of 9 ⁇ membered heteroaryl rings include indolyl, isoindolyl, indazolyl, benzimidazolyl, azaindolyl, benzofuranyl, isobenzofuranyl, benzisoxazolyl and benzoxazolyl.
  • Optionally substituted 5 ⁇ membered heteroaryl rings are particularly preferred, in particular optionally substituted furanyl and oxazolyl.
  • R 2 is optionally substituted C 1 ⁇ 6 hydrocarbyl, it is preferably selected from optionally substituted phenyl and optionally substituted C 1 ⁇ 6 alkyl. 5 Where R 2 is optionally substituted phenyl, the phenyl group is preferably substituted.
  • R 2 is optionally substituted C 1 ⁇ 6 alkyl
  • the alkyl group is preferably unsubstituted, and as such R 2 is preferably selected from C 2 ⁇ 4 alkyl, such as from ethyl, propyl (e.g. ⁇ iPr) and butyl (e.g. ⁇ tBu).
  • R 2 is optionally substituted with one or more groups independently selected from C 1 ⁇ 4 10 hydrocarbyl (preferably C 1 ⁇ 4 alkyl), ⁇ OR’, ⁇ OC(O)R’, ⁇ C(O)OR’, ⁇ SR’, ⁇ S(O)R’, ⁇ S(O) 2 R’, ⁇ NR’ 2 , ⁇ NR’C(O)R’, ⁇ C(O)NR’ 2 , ⁇ CN, ⁇ NO 2 , ⁇ Ph, ⁇ CF 3 and halogen.
  • R 2 is unsubstituted or substituted with one or two of these groups.
  • substituents for R 2 include ⁇ Me, ⁇ OMe, ⁇ CN, ⁇ NO 2 , ⁇ F, ⁇ Cl, ⁇ I and ⁇ SMe.
  • X is selected from ⁇ O ⁇ and ⁇ NR’ ⁇ .
  • X is preferably ⁇ O ⁇ .
  • Y is selected from ⁇ C(O) ⁇ and ⁇ CR’ 2 ⁇ .
  • Y is preferably ⁇ C(O) ⁇ .
  • Z is selected from ⁇ O ⁇ and ⁇ NR’ ⁇ or is absent.
  • Z is selected from ⁇ O ⁇ or is absent.
  • each R a is independently selected from H, C 1 ⁇ 4 alkyl, ⁇ OR’ and ⁇ NR’ 2 , and more preferably from H and C 1 ⁇ 4 alkyl. More preferably, each R a is preferably H.
  • each R b is independently selected from H, C 1 ⁇ 4 hydrocarbyl (preferably C 1 ⁇ 4 alkyl) and ⁇ OR’.
  • each R b is independently selected from H and C 1 ⁇ 4 alkyl, 25 and more preferably is H.
  • R c is selected from H and C 1 ⁇ 4 hydrocarbyl (preferably C 1 ⁇ 4 alkyl).
  • R c is H.
  • each R’ is independently selected from H and C 1 ⁇ 4 hydrocarbyl (preferably C 1 ⁇ 4 alkyl) and ⁇ Ph.
  • each R’ is independently selected from H and C 1 ⁇ 4 alkyl, more 30 preferably from H, methyl and ethyl, and more preferably from methyl and ethyl.
  • X is ⁇ O ⁇ and the compounds used in the present invention have the formula (II): I) where R 1 , R 2 , R a , R b , R c , Y and Z are as defined previously.
  • R b and R c are all H, and so the compounds used in the present invention have the formula (III): I) where R 1 , R 2 , R a , Y and Z are as defined previously.
  • Y is ⁇ C(O) ⁇ and the compounds used in the present 10 invention have the formula (IV): (IV) where R 1 , R 2 , R a and Z are as defined previously.
  • the compounds used in the present invention are closed ring structures having the formula (V): V) e R 1 , R 2 wher , R a and Z are as defined previously.
  • R a are also all H, and so the compounds used in the present invention have the formula (VI): I) 10 where R 1 , R 2 and Z are as defined previously. It will be appreciated that compounds of formulas (II) ⁇ (VI) may also be used in the form of a pharmaceutically acceptable salt. Specific examples of compounds according to the present invention are set out in Table 1 below: 15 acid7 O OH N O acid66 O OH N O HN acid72 O OH N O O acid73 Table 1: Exemplary compounds of the invention It will be appreciated that each of the compounds depicted in Table 1 may be used in the 5 form of a pharmaceutically acceptable salt.
  • the compound of formula (I) is also not disclosed in either WO 2013/033310 or WO 2015/103527.
  • the compound of formula (I) is preferably not selected from: 10 , , , , , , .
  • a compound in an isolated form is equivalent to a composition which consists 15 substantially of the compound.
  • an isolated compound of formula (I) will contain less than 10%, and typically less than 1% by weight of impurities, i.e. substances other than compounds of formula (I).
  • impurities i.e. substances other than compounds of formula (I).
  • compounds of the present invention contain one or more chiral centres, the compounds may exist in, and may be isolated as pure enantiomeric or 20 diastereomeric forms or as racemic mixtures.
  • the present invention therefore includes any possible enantiomers, diastereomers, racemates or mixtures thereof of the compounds of the invention.
  • compounds of formula (I) may be used in a racemic mixture, or as single enantiomers, i.e.: .
  • the compounds of formula (I) may have rotameric forms, or may not have rotational activity.
  • Rotameric forms include slow rotating forms and fast rotating forms.
  • fast rotating forms of the compounds of formula (I) are preferred.
  • a compound of the formula (I) or a salt thereof may exhibit the phenomenon of tautomerism whereby two chemical compounds that are capable of facile interconversion by exchanging a 10 hydrogen atom between two atoms, to either of which it forms a covalent bond. Since the tautomeric compounds exist in mobile equilibrium with each other they may be regarded as different isomeric forms of the same compound. It is to be understood that the formulae drawings within this specification can represent only one of the possible tautomeric forms.
  • Compounds may be used in the form of salts, hydrates and solvate forms, as defined in the Definitions section herein. It will be appreciated that salt forms of the compound may themselves be in the form of hydrates or solvate forms.
  • the compounds of the present invention typically have improved REV ⁇ ERB inhibitory activity compared with SR8278. This inhibitory activity may be measured by any appropriate means, such as conventional means known in the art and/or the methods described herein.
  • a reference to a compound with improved REV ⁇ ERB inhibitory activity may be 5 understood to mean that, the compound decreases REV ⁇ ERB activity by at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60, at least 70%, at least 80%, at least 85%, at least 90%, at least 95%, at least 100%, at least 150%, at least 200% more than the decrease in REV ⁇ ERB activity obtained using a control REV ⁇ ERB inhibitory compound, such as SR8278.
  • a reference to a compound with improved REV ⁇ ERB inhibitory activity may be understood to mean that, said compound is at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 15 2.9 ⁇ fold, at least 3 ⁇ fold, at least 4 ⁇ fold, at least 5 ⁇ fold, at least 6 ⁇ fold, at least 7 ⁇ fold, at least 8 ⁇ fold, at least 9 ⁇ fold, at least 10 ⁇ fold or more, more effective in inhibiting REV ⁇ ERB activity relative to a control REV ⁇ ERB inhibitory compound, such as SR8278.
  • an improved REV ⁇ ERB inhibitory compound is at least 1.5 ⁇ fold, at least 2 ⁇ fold or more effective in inhibiting REV ⁇ ERB activity relative to a control REV ⁇ ERB inhibitory compound, such as SR8278.
  • the small molecules of the invention may be used in the form of proteolysis targeting 25 chimeras (also referred to as PROTACs or PROTAC reagents).
  • PROTACs are heterobifunctional small molecules that simultaneously bind a target protein and ubiquitin ligase, enabling ubiquitination and degradation of the target.
  • a PROTAC reagent typically comprises a ligand for the target protein (in the case of the present invention, REV ⁇ ERB) and a ligand for an E3 ligase recognition domain.
  • REV ⁇ ERB a ligand for the target protein
  • E3 ligase recognition domain an E3 ligase is recruited to the PROTAC ⁇ bound REV ⁇ ERB, 30 inducing ubiquitin transfer from the E3 ligase complex to the target protein (in the case of the present invention, REV ⁇ ERB).
  • a PROTAC reagent may be produced by conjugating a ligand for an E3 ⁇ ligase to a small molecule inhibitor as described herein via a linker.
  • a PROTAC reagent comprises a ligand for the E3 RING Cullin ligase von ⁇ Hippel Lindau protein (VHL) or cereblon ⁇ a part of a CRL4 E3 RING Cullin ligase complex, connected to a small molecule inhibitor of the invention via a linker.
  • VHL von ⁇ Hippel Lindau protein
  • 5 Notch ligand The Notch signalling pathway is primarily associated with promoting T cell development and repressing concomitant B cell development.
  • Mammals have four types of Notch receptor – Notch1, Notch2, Notch3 and Notch4, all of which are single ⁇ pass heterodimeric transmembrane proteins. Mammals have two types of canonical Notch ligands – Delta type and Jagged type, collectively known 10 as DSL ligands. There are three delta ⁇ like ligands (DLLs), DLL1, DLL3 and DLL4 and two jagged (JAG) ligands, JAG1 and JAG2. DLL and JAG ligands typically comprise the following domains: a module at the N ⁇ terminus of Notch ligand (MNNL) domain and a Delta/Serrate/Lag ⁇ 2 (DSL) domain, together with a number of EGF repeats.
  • MNNL N ⁇ terminus of Notch ligand
  • DSL Delta/Serrate/Lag ⁇ 2
  • DLL3 comprises six EGF repeats.
  • DLL1 and DLL4 comprise eight EGF repeats.
  • JAG1 and JAG2 comprise 16 EGF repeats.
  • a reference herein to a Notch ligand is a reference to any Notch ligand, such as a ligand of Notch1, Notch2, Notch3 and/or Notch 4, preferably a ligand of at least Notch1.
  • the protein sequence of human Notch1 is given in SEQ ID NO: 10 (GenBank Accession No. CR457221, version CR457221.1).
  • the Notch ligand of use in the present invention is a 20 canonical Notch ligand.
  • the Notch ligand is a DLL, more preferably DLL4.
  • the protein sequence of human DLL4 is given in SEQ ID NO: 8 (GenBank Accession No. AF253468, version AF253468.1).
  • a reference herein to a Notch ligand also embraces fragments thereof, provided said fragment retains the Notch ⁇ binding and activatory activity of the Notch ligand from which it is derived.
  • Notch ligands suitable for use in the present invention have previously been described by the present inventors (see PCT/GB2018/050818, which is herein incorporated by reference in its entirety, particularly pages 15 and 16 and the Examples).
  • Preferred examples of Notch ligand fragments include Notch ligand (N ⁇ EGF1) and Notch ligand (N ⁇ EGF2), such as DLL4 (N ⁇ EGF1) and DLL4 (N ⁇ EGF2).
  • N ⁇ EGF1 and Notch ligand such as DLL4 (N ⁇ EGF1) and DLL4 (N ⁇ EGF2).
  • a Notch ligand, fragment thereof, or molecule that mimics the effect e.g.
  • a Notch ligand such as DLL4 may comprise modifications, such as amino acid mutations which alter, typically increase, the affinity of the ligand/fragment/mimetic for its Notch receptor. Techniques for identifying such modifications are known in the art. For example, amino acids which increase the affinity of a Notch ligand/fragment/mimetic can be identified using yeast surface display. Again, such modifications have previously been described by the present inventors (see PCT/GB2018/050818, which is herein incorporated by reference in its entirety, particularly page 16).
  • the DLL4 ligand of the invention comprises the amino acid substitutions, G28S, F107L and L206P, more preferably 5 G28S, F107L, N118I, I143F, H194Y, L206P and/or K215E.
  • a functional fragment of DLL4 comprises at least residues 65 to 114 and 179 to 219 of full ⁇ length DLL4, preferably held in the correct conformation to allow interaction with the Notch ligand.
  • the invention encompasses the use of molecules that would mimic the effect (e.g. 10 activity/function) of a Notch ligand (also referred to herein as mimetics).
  • Peptidomimetics may have advantages over peptides in terms of stability and bioavailability associated with a natural peptide. Peptidomimetics can have main ⁇ or side ⁇ chain modifications of the parent peptide designed for 15 biological function. Examples of classes of peptidomimetics include, but are not limited to, peptoids and ⁇ peptides, as well as peptides incorporating D ⁇ amino acids.
  • peptidomimetics such as peptoids
  • sequences of canonical and non ⁇ canonical Notch ligands are known in the art, as are the sequences of canonical and non ⁇ canonical Notch ligands.
  • suitable molecules which mimic the effect of a desired 20 Notch ligand using known techniques and based on the known Notch ligand sequences.
  • peptidomimetics may be designed to interact with key residues of Notch (e.g.
  • Notch1 that are known to be involved in binding to DLL4, such as one or more of residues 415 (E415), 418 (L418), 420 (A420), 421 (N421), 422 (P422), 424 (E424), 425 (H425), 436 (F436), 447 (P447), 448 (R448), 450 (E450), 452 (D452), 469 (D469), 477 (I477), 480 (P480) of Notch (Notch1), or any 25 combination thereof.
  • methods of the present invention may further comprise a step of contacting an haematopoietic progenitor cell (HPC) comprising sample obtained from an individual/patient with a compound which results in the alteration of post ⁇ translational modification of E4bp4, thereby causing 20 an increase in E4bp4 activity.
  • HPC haematopoietic progenitor cell
  • compounds which alter the post ⁇ translational modification of E4pb4 as described herein may be used in combination with the methods and compounds of the invention which inhibit REV ⁇ ERB activity. This combination may further be used in combination with the use of a Notch ligand (e.g. DLL4) as described herein.
  • a compound which alters or affects the post ⁇ translational modification of E4bp4 may 25 therefore be used according to the invention for increasing production of NK cells in a patient, wherein said compound increases E4bp4 activity, or for use in a method of treatment by increasing the number of NK cells in a patient in need thereof, together with the indications disclosed herein relating to increased E4bp4 expression by decreasing REV ⁇ ERB activity, and optionally the indications disclosed herein relating to increasing NK cell number by culturing HPCs in the presence of a Notch ligand.
  • any of the disclosure herein in relation to methods of increasing NK cell number, methods of expanding NK cells in the context of compounds which inhibit the action of REV ⁇ ERB, and/or Notch ligands, expanded NK cell populations produced by said methods and therapeutic indications relating to said compounds and populations applies inter alia to the disclosed methods of increasing E4bp4 activity to increase NK cell number.
  • the feeder cell layers, growth factors and/or other culture conditions and diseases to be treated may be the same in relation to the post ⁇ translational modification aspects as for the REV ⁇ ERB inhibition and/or Notch ligand aspects disclosed herein.
  • the REV ⁇ ERB inhibitor compound, Notch ligand and/or E4bp4 post ⁇ translational modifier may be used simultaneously, separately or sequentially.
  • a compound which alters the post ⁇ 5 translational modification of E4bp4 is used in combination with a compound which inhibits the action of REV ⁇ ERB
  • the sample is contacted with REV ⁇ ERB inhibitory compound before being contacted with the post ⁇ translational modifier.
  • REV ⁇ ERB inhibitory compound typically the E4bp4 post ⁇ translational modifier is used after the REV ⁇ ERB inhibitory compound and the Notch ligand; preferably the REV ⁇ ERB inhibitory compound are used together, or more preferably the REV ⁇ ERB inhibitory 10 compound is used before the Notch ligand (as described herein).
  • Types of post ⁇ translational modification encompasses any alteration of post ⁇ translational modification which results in an increase in E4bp4 activity.
  • Non ⁇ limiting examples of post ⁇ translation modification include 15 phosphorylation, SUMOylation, the addition of a hydrophobic group (e.g. myristoylation, palmitoylation), addition of a cofactor, the addition of small chemical groups (e.g. acylation, alkylation, amidation, glycosylation), glycation, carbamylation, cabonylation, chemical modifications (e.g. deamidation) and/or structural changes.
  • wild ⁇ type (unmodified) E4bp4 is typically SUMOylated at one or more of residues K10, K116, K219, K337 and/or K394 or residues corresponding 25 thereto, or any combination thereof.
  • wild ⁇ type (unmodified) E4bp4 is SUMOylated at least at residue K219 (or a corresponding residue).
  • wild ⁇ type (unmodified) E4bp4 is typically phosphorylated at residues S286, S301 and S454, or residues corresponding thereto, or any combination thereof.
  • a compound which alters the post ⁇ translational modification of E4bp4 reduces, inhibits or ablates SUMOylation at residue K219 (or a 30 residue corresponding thereto), and/or reduces, inhibits or ablates phosphorylation at residues S286, S301 and S454 (or corresponding residues), or any combination thereof.
  • Non ⁇ limiting examples of suitable kinase inhibitors include 4 ⁇ (4 ⁇ (2,3 ⁇ dihydrobenzo[1,4]dioxin ⁇ 6 ⁇ yl) ⁇ 5 ⁇ pyridin ⁇ 2 ⁇ yl ⁇ 1H ⁇ imidazol ⁇ 2 ⁇ yl)benzamide (D4476) and 4,5,6,7 ⁇ tetrabromo ⁇ 2 ⁇ azabenzimidazole, 4,5,6,7 ⁇ Tetrabromobenzotriazole (TBB).
  • D4476 4 ⁇ (4 ⁇ (2,3 ⁇ dihydrobenzo[1,4]dioxin ⁇ 6 ⁇ yl) ⁇ 5 ⁇ pyridin ⁇ 2 ⁇ yl ⁇ 1H ⁇ imidazol ⁇ 2 ⁇ yl)benzamide
  • TB 4,5,6,7 ⁇ tetrabromo ⁇ 2 ⁇ azabenzimidazole
  • TAB 4,5,6,7 ⁇ Tetrabromobenzotriazole
  • the activity of E4bp4 in a sample of NK precursor or progenitor cells, an expanded NK cell population or in a sample obtained from an individual/patient to be treated according to the invention may be compared with the activity of E4bp4 in a control.
  • Activity may be quantified in any appropriate terms, for example an increase in the expression of any downstream target of E4bp4.
  • Any appropriate technique or method may be used for quantifying E4bp4 activity. Suitable techniques are known in the art, for example luciferase assays for quantifying expression of a reporter gene.
  • the control is an equivalent population or sample which has not been treated 25 according to the present invention.
  • the corresponding control may be a population or sample in which no compound has been added to inhibit the action of REV ⁇ ERB or to alter or effect the post ⁇ translational modification of E4bp4.
  • a control may be a sample obtained from a different individual treated according to the invention, or the same individual the prior to treatment. Conventional methods for the ex vivo expansion of NK cells, including known methods may be considered control methods according to the present invention.
  • a reference to increasing E4bp4 activity may be understood to mean that, the activity of E4bp4 is increased by at least 1.25 ⁇ fold, at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, at least 4 ⁇ fold, at least 5 ⁇ fold, at least 6 ⁇ fold, at least 7 ⁇ fold, at least 8 ⁇ fold, at least 9 ⁇ fold, at least 10 ⁇ fold or more relative to 10 a control.
  • E4bp4 activity is increased by at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, or more compared with the control.
  • E4bp4 activity may be measured indirectly be determining the increase in NK cell number.
  • the number of NK cells may be increased by at least 1.25 ⁇ fold, at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 2.5 ⁇ fold, at least 3 ⁇ fold, at least 15 4 ⁇ fold, at least 5 ⁇ fold, at least 6 ⁇ fold, at least 7 ⁇ fold, at least 8 ⁇ fold, at least 9 ⁇ fold, at least 10 ⁇ fold or more relative to a control.
  • the number of NK cells may be increased by at least 10 ⁇ fold, at least 20 ⁇ fold, at least 30 ⁇ fold, at least 40 ⁇ fold, at least 50 ⁇ fold, at least 100 ⁇ fold, or more relative to a control.
  • the number of NK cells is increased by at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 5 ⁇ fold, or more compared with the control.
  • the activity of E4bp4 may be determined by quantitative and/or qualitative analysis, and may be measured directly or indirectly.
  • the activity of E4bp4 relative to a control may be determined using any appropriate technique. Suitable standard techniques are known in the art.
  • the activity of E4bp4 may be increased compared with a control for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at 25 least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at least 1 week.
  • the activity of E4bp4 is increased for at least 12 to 72 hours.
  • the methods of the invention allow for the rapid expansion of NK cells, reducing the time needed for their culture, and hence the risk of exhaustion, enhancing the cytotoxicity of the NK cells when transfused into a patient.
  • said method is a therapeutic method as described herein.
  • all the disclosure herein in relation to therapeutic indications and 10 applications of the invention is applicable to said methods.
  • the method of the invention is ex vivo.
  • the invention provides an ex vivo method for expanding an NK cell population comprising the steps of: (a) culturing an NK precursor cell comprising sample obtained from an individual; (b) adding a compound that inhibits the action of REV ⁇ ERB to said sample; and (c) expanding said cells in vitro to produce an NK cell population.
  • step (b) the compound is actively added to the sample as a compound of formula (I) and, as such, the method of the invention does not cover embodiments in which the compound is added to the sample in a different form (such as a prodrug) and converts in situ into a compound of formula (I).
  • the compound that inhibits the action of REV ⁇ ERB may be any compound of formula (I) as 20 described herein. Typically said compound increases E4bp4 expression by decreasing REV ⁇ ERB activity as described herein.
  • the compound has the formula (II) as defined herein, more preferably the compound has the formula (III) as defined herein, even more preferably the compound has the formula (IV) as defined herein, and even more preferably, the compound has the formula (V) as defined herein. Examples of specific compounds which may be used in the methods of 25 the invention are described herein, with compounds acid7 and acid11 being particularly preferred. Additional external stimuli, such as growth factors and/or cytokines, may be used to further enhance the production of NK cells.
  • IL ⁇ 7 may be used at a concentration of about 1 ng/ml to about 100 ng/ml, about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 25 ng/ml, about 1 ng/ml to about 10 ng/ml or less. In some embodiments IL ⁇ 7 is used at a concentration of about 50 ng/ml, about 25 ng/ml, about 20 ng/ml, about 15 ng/ml, about 10 ng/ml or about 5 ng/ml, preferably about 10 ng/ml.
  • Flt3L may be used at a concentration of about 1 ng/ml to about 100 ng/ml, about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 25 ng/ml, about 1 ng/ml to about 10 ng/ml or less. In some embodiments Flt3L is used at a concentration of about 50 ng/ml, about 25 ng/ml, about 20 ng/ml, about 15 ng/ml, about 10 ng/ml or about 5 ng/ml, preferably about 10 ng/ml.
  • IL ⁇ 15 may be used at a concentration of about 1 ng/ml to about 100 ng/ml, about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 40 ng/ml, about 1 ng/ml to about 30 ng/ml, about 1 ng/ml to about 20 ng/ml, about 1 ng/ml to about 10 ng/ml or less.
  • IL ⁇ 15 is used at a concentration of about 50 ng/ml, about 40 ng/ml, about 35 ng/ml, about 30 ng/ml, about 25 ng/ml, about 20 ng/ml or about 10 ng/ml, preferably about 30 ng/ml.
  • the HPCs may be cultured on or with suitable support/stromal cells or cell layer. Any appropriate stromal cell may be used, including, but not limited to OP9 stromal cells and/or EL08 ⁇ 1D2 stromal cells.
  • the ex vivo method comprises a single culturing stage.
  • the HPCs in a sample obtained from a patient are cultured, a compound of the 20 invention is added, and the HPCs are expanded to form an NK cell population, typically under substantially constant culture conditions. Typically this involves incubating the HPCs with factors such as IL ⁇ 3, IL ⁇ 7, SCF, Flt3L and/or IL ⁇ 15, preferably all of these factors.
  • the HPCs are preferably also cultured on or with stromal cells/ cell layer, such as EL08 ⁇ 1D2 stromal cells.
  • the medium which induces differentiation of the HPCs to NK cells does not comprise 25 IL ⁇ 3.
  • the ex vivo method comprises two culturing stages.
  • the first is a lymphoid production stage, in which the HPCs in a sample obtained from a patient are cultured. Typically this involves incubating the HPCs with cytokines and growth factors associated with lymphoid production, such as Flt3L, IL ⁇ 7 and/or SCF. This stage may last for at least one, at least two, at least 30 three, at least four, or more days. In some embodiments, this stage lasts for two days.
  • the second stage of the ex vivo method is a stage of NK cell expansion.
  • the HPCs are cultured in medium which does not induce differentiation of the HPCs for between about 2 to about 8 days, such as about 2 days to about 6 days, optionally for between about 4 days to about 6 days.
  • the REV ⁇ ERB inhibitor may be added for (i) all or part of the culture period in medium which does not induce 15 differentiation of the HPCs; and/or (ii) all or part of the culture period in medium which induces differentiation of the HPCs to NK cells.
  • the medium which does not induce differentiation of the HPCs comprises at least one of Flt3L, GM ⁇ CSF, IL ⁇ 3, IL ⁇ 6, TPO and/or stem cell factor (SCF), preferably Flt3L, GM ⁇ CSF, IL ⁇ 3, IL ⁇ 6, TPO and SCF; and/or the medium which induces differentiation of 25 the HPCs to NK cells comprises IL ⁇ 7, Flt3L, IL ⁇ 15, and/or SCF, preferably IL ⁇ 7, Flt3L, IL ⁇ 15 and SCF.
  • SCF stem cell factor
  • the HPC comprising sample may be cultured ex vivo for at least 5 days, at least 6 days, at least 7 days, at least 8 days, at least 9 days, at least 10 days, at least 11 days, at least 12 days, at least 13 30 days, at least 14 days, at least 15 days, at least 16 days, at least 17 days, at least 18 days or more.
  • said sample is cultured for at least 9 days in order to produce an expanded NK cell population.
  • These culture periods are for the total culture period of the ex vivo method, i.e. if there are two stages, these periods are for the total (stage 1 plus stage 2).
  • An example culture scheme for HPCs for the production of NK cells is set out in Figure 2A. Preferred examples of culture schemes are those set out in UK Patent Application No.
  • any reference to a REV ⁇ ERB inhibitor compound in said application may be a REV ⁇ ERB inhibitor compound of the present invention.
  • a compound which inhibits REV ⁇ ERB activity may be added to the medium which does not induce differentiation of the HPCs after a period of time of between about 0 to about 2 days, 5 particularly the compound which inhibits REV ⁇ ERB activity may be added to the medium which does not induce differentiation of the HPCs after about 1 day.
  • the HPCs may be contacted with a REV ⁇ ERB inhibitory compound for at least part of the first culture period in medium which does not induce differentiation of the HPCs, up to the entirety of said first culture period.
  • the HPCs may be contacted with a REV ⁇ ERB inhibitory compound for 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5 or 8 days 10 of this culture period may or a period of any duration between 2 and 8 days.
  • a REV ⁇ ERB inhibitory compound for between about 2 days to about 6 days (e.g. 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5 or 6 days or a period of any duration between 2 and 6 days, such as between about 4 to 6 days) of the first culture period in medium which does not induce differentiation of the HPCs.
  • the HPCs may be contacted with a REV ⁇ ERB inhibitory compound for between 15 about 2 days to about 4 days (e.g. 2, 2.5, 3, 3.5 or 4 days or a period of any duration between 2 and 4 days) of the first culture period in medium which does not induce differentiation of the HPCs.
  • the REV ⁇ ERB inhibitor compound of the invention may be added to the sample comprising HPCs within one week, within six days, within five days, within four days, within three days, within two days, within one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell 20 precursors. Typically this is the same day that the sample is obtained from the patient.
  • the compound of the invention is added to the sample within two days of isolating the HPCs in the sample, even more preferably on day one or two following isolation of the HPCs.
  • the compound is added at multiple time points, for example when the culture medium is changed.
  • the compound of the invention may be added two days after isolating the HPCs, 25 and then added again at day five post ⁇ isolation of the HPCs.
  • This disclosure applies to all methods of the invention, e.g. for one stage and two stage methods as described herein, and/or methods which also use a Notch ligand and/or a compound which alters the posttranslational modification of E4bp4 as described herein.
  • a compound of the invention may be used at a final concentration of about 2 to about 20 ⁇ M, about 2 to about 15 ⁇ M, about 5 to about 15 ⁇ M, about 5 to about 14 ⁇ M, about 4 to about 13 ⁇ M, about 5 to about 12 ⁇ M, about 5 to about 11 ⁇ M, or preferably about 5 to about 10 ⁇ M.
  • the present inventors have previously demonstrated that combining the use of a Notch ligand (such as DLL4) and REV ⁇ ERB inhibition results in a potent means for enhancing NK cell production, allowing for the production of large numbers of functional NK cells that are suitable for in vivo therapeutic use more rapidly than the current methods.
  • a Notch ligand such as DLL4
  • REV ⁇ ERB inhibition results in a potent means for enhancing NK cell production, allowing for the production of large numbers of functional NK cells that are suitable for in vivo therapeutic use more rapidly than the current methods.
  • the invention provides an ex vivo method for expanding an NK cell population comprising the steps of: (a) adding a compound that inhibits the action of REV ⁇ ERB (as described herein) to an HPC comprising sample obtained from an individual/patient and culturing the sample with the compound; (b) culturing said cells in the presence of a Notch ligand (such as DLL4); and (c) expanding said cells in vitro to produce an NK cell population.
  • Step (a) and (b) may be carried out 10 concurrently or in any order. For example, step (a) may be carried out first, followed by step (b), such that the cells are first exposed to a REV ⁇ ERB inhibitory compound and then cultured in the presence of a Notch ligand.
  • step (b) may be carried out first, followed by step (a), such that the cells are first cultured in the presence of a Notch ligand and then in the presence of a REV ⁇ ERB inhibitory compound.
  • steps (a) and (b) may be carried out concurrently, such that the 15 cells are simultaneously cultured in the presence of a REV ⁇ ERB inhibitory compound and a Notch ligand.
  • step (a) may be carried out first, followed by step (b), such that the cells are first cultured in the presence of a REV ⁇ ERB inhibitory compound and then in the presence of a Notch ligand.
  • the invention provides an ex vivo method 20 for expanding an NK cell population comprising the steps of: (a) adding a compound that inhibits the action of REV ⁇ ERB (as described herein) and culturing the sample with the compound; (b) culturing said cells in the presence of a Notch ligand (such as DLL4); and (c) expanding said cells in vitro to produce an NK cell population.
  • step (b) may be carried out first, followed by step (a), such that the cells are first cultured in the presence of a Notch ligand and then in 25 the presence of a REV ⁇ ERB inhibitory compound.
  • the invention provides an ex vivo method for expanding an NK cell population comprising the steps of: (a) adding a Notch ligand (such as DLL4) and culturing the sample with said ligand; (b) culturing said cells in the presence of a compound that inhibits the action of REV ⁇ ERB (as described herein); and (c) expanding said cells in vitro to produce an NK cell population.
  • a Notch ligand such as DLL4
  • culturing said cells in the presence of a compound that inhibits the action of REV ⁇ ERB (as described herein); and (c) expanding said cells in vitro to produce an NK cell population.
  • both the REV ⁇ ERB inhibitory 30 compound and the Notch ligand are present for at least part of the first culture period in medium which does not induce differentiation of the HPCs, and are not present for at least part of, preferably all of the culture period in medium which induces differentiation of the HPCs to NK cells.
  • the Notch ligand is a Notch ligand as described herein.
  • the Notch ligand is DDL4, or a fragment thereof which retains the function of DLL4, as described herein.
  • the Notch ligand e.g. DLL4
  • the Notch ligand may be added for all or part of the culture period in medium which does not induce differentiation of the HPCs; but is not added for 5 all or part of, preferably all of, the culture period in medium which induces differentiation of the HPCs to NK cells.
  • the Notch ligand (such as DLL4) may be present in solution (e.g.
  • the Notch ligand e.g. DLL4 is used to coat the vessel in which the HPCs are cultured.
  • the Notch ligand e.g. DLL4 may be used at a concentration of about 1 ⁇ g/ml to about 100 ⁇ g/ml, about 1 ⁇ g/ml to about 50 ⁇ g/ml, about 1 ⁇ g/ml to about 25 ⁇ g/ml, about 1 ⁇ g/ml to about 10 ⁇ g/ml or less.
  • the Notch ligand e.g.
  • DLL4 is used at a concentration of about 50 ⁇ g/ml, about 25 ⁇ g/ml, about 20 ⁇ g/ml, about 15 ⁇ g/ml, about 10 ⁇ g/ml, or about 5 ⁇ g/ml, preferably about 10 ⁇ g/ml.
  • Additional substrates and/or linkers may be 15 used to facilitate the attachment of the Notch ligand (such as DLL4) to the surface of the culture vessels. Examples of such substrates are known in the art, such as poly ⁇ L ⁇ lysine.
  • HPCs may be cultured in the presence or absence of a stromal support cell or feeder cell, or population thereof.
  • the cells are cultured in the absence of a stromal support cell or population thereof.
  • the ex vivo method comprises a single culturing stage in which the HPCs in a sample obtained from an individual/patient are cultured, a compound of the invention is added, the HPCs are contacted with said compound and a Notch ligand and expanded to form an NK cell population, typically under substantially constant culture conditions (i.e. steps (a) and (b) of the method are carried out concurrently). Typically this involves incubating the HPCs with factors such as 25 IL ⁇ 3, IL ⁇ 7, SCF, Flt3L and/or IL ⁇ 15, preferably all of these factors.
  • the HPCs may be cultured in the presence or absence of stromal cells/ cell layer, such as EL08 ⁇ 1D2 stromal cells.
  • the ex vivo method comprises two culture stages (analogous to the scheme shown in Figure 2).
  • the first is a lymphoid production stage, in which the HPCs in a sample obtained from an individual/patient are cultured. Typically this involves incubating the HPCs with 30 cytokines and growth factors associated with lymphoid production, such as Flt3L, IL ⁇ 7 and/or SCF.
  • This stage may last for at least one, at least two, at least three, at least four, or more days. In some preferred embodiments, this stage lasts for two days.
  • that stage may be further divided so that: (i) the REV ⁇ ERB inhibitory compound is added before the Notch ligand; or (ii) the Notch ligand is added before the REV ⁇ ERB inhibitory compound.
  • the Notch ligand and REV ⁇ ERB inhibitory compound may be 20 added simultaneously in the same stage.
  • Figure 2B illustrates some embodiments of the different method schemes for the REV ⁇ ERB inhibitory compound and Notch ligand combination aspects of the invention.
  • the timings of administration included in Figure 2B are non ⁇ limiting; any appropriate timings for administration, such as those described herein, may be used.
  • the REV ⁇ ERB inhibitor is added in stage 1 (e.g. at day 0 or on day 2), with the Notch 25 ligand being added later (e.g. at day 2 or 4 respectively).
  • the REV ⁇ ERB inhibitory compound may be added during the first stage, and the Notch ligand is added during the second stage, and preferably at the start of this second stage.
  • both the REV ⁇ ERB inhibitory compound and the Notch ligand are present for at least part of the first culture period in medium 30 which does not induce differentiation of the HPCs, and are not present for at least part of, preferably all, of the culture period in medium which induces differentiation of the HPCs to NK cells. This is described in more detail in UK Patent Application No. 2212838.3, which is herein incorporated by reference in its entirety.
  • the HPC comprising sample may be cultured ex vivo for at least 5 days, at least 6 days, at least 7 days, at least 8 days, at least 9 days, at least 10 days, at least 11 days, at least 12 days, at least 13 days, at least 14 days, at least 15 days, at least 16 days, at least 17 days, at least 18 days or more.
  • said sample is cultured for at least 9 days in order to produce an expanded NK cell population. 5
  • These culture periods are for the total culture period of the ex vivo method, i.e. if there are two stages, these periods are for the total (stage 1 plus stage 2).
  • the REV ⁇ ERB inhibitory compound of the invention may be added to the sample comprising HPCs within one week, within six days, within five days, within four days, within three days, within two days, within one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell 10 precursors. Typically this is the same day that the sample is obtained from the patient.
  • the REV ⁇ ERB inhibitory compound of the invention is added to the sample within two days of isolating the HPCs in the sample, such as on the day of isolation of the HPCs, or one day after isolation of the HPCs.
  • the REV ⁇ ERB inhibitory compound of the invention is added to the sample one or two days post isolation of the HPCs.
  • the compound is added at multiple time points, 15 for example when the culture medium is changed.
  • the compound of the invention may be added one or two days after isolating the HPCs, and then added again at day five post ⁇ isolation of the HPCs.
  • the Notch ligand of the invention may be added to the sample comprising HPCs within one week, within six days, within five days, within four days, within three days, within two days, within 20 one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell precursors. Typically this is the same day that the sample is obtained from the patient.
  • the Notch ligand of the invention is added to the sample within four days of isolating the HPCs in the sample, such as on day one or two following isolation of the HPCs. Most preferably the Notch ligand of the invention is added to the sample two or four days post isolation of the HPCs. Thus, typically the Notch ligand is 25 present on or from 4 days after isolating the HPCs.
  • Preferred embodiments of the invention comprise (i) adding the REV ⁇ ERB inhibitory compound and the Notch ligand to the sample on the day of isolation of the HPCs; (ii) adding the REV ⁇ ERB inhibitory compound to the sample on the day of isolation of the HPCs and adding the Notch ligand to the sample on day two post isolation of the HPCs; or (iii) adding the REV ⁇ ERB inhibitory 30 compound to the sample on day two post isolation of the HPCs and adding the Notch ligand to the sample on day four post isolation of the HPCs; with option (iii) being particularly preferred.
  • the cells may be cultured in the presence of additional external stimuli (as described herein) in combination with a Notch ligand.
  • a Notch ligand may be used with IL ⁇ 15.
  • the cells may be first exposed to a Notch ligand and then IL ⁇ 15.
  • the cells may first be cultured in the presence of IL ⁇ 15 and then in the presence of a 5 Notch ligand.
  • the cells may be simultaneously cultured in the presence of a Notch ligand and IL ⁇ 15.
  • the cells are first cultured in the presence of a Notch ligand and then IL ⁇ 15.
  • the HPCs may be cultured in the presence of a Notch ligand (such as DLL4) for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 10 days, at least 1 week. Typically for 72 hours to 1 week.
  • a Notch ligand such as DLL4
  • the cells may be cultured in the presence of IL ⁇ 15 for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at least 1 week, at least 2 weeks, at least 3 weeks or longer, until the desired number of NK cells is produced.
  • the step of culturing in Il ⁇ 15 may be is 1 week 15 or more in length, 7 to 9 days in length, or about two weeks in length. Alternatively, these durations may be measured in terms of the number of cell passages.
  • At least one, at least two, at least three, at least four, at least five, at least ten, at least 20, at least 30, at least 40 or more passages of the cells (either in vivo, or cultured ex vivo or in vitro).
  • the durations of exposure to Notch ligand and IL ⁇ 15 are independent, and any duration for 20 Notch culture may be used in combination with any duration of IL ⁇ 15 culture.
  • Notch exposure/culture is 72 hours to 1 week in length and IL ⁇ 15 exposure/culture is 1 week (or more) in length.
  • IL ⁇ 7, Flt3L and/or SCF are used together with the Notch ligand.
  • the HPCs are cultured in the presence of IL ⁇ 7, Flt3L and SCF together with the Notch 25 ligand.
  • the methods of the invention may further comprise a step of contacting the HPCs with a compound which results in the alteration of post ⁇ translational modification of E4bp4, thereby causing an increase in E4bp4 activity, as described herein.
  • the alteration of post ⁇ translational modification of 30 E4bp4 is a reduction in SUMOylation and/or phosphorylation of E4bp4 as described herein.
  • the compound which results in the alteration of post ⁇ translational modification of E4bp4 reduces SUMOylation at one or more of residues K10, K116, K219, K337 and/or K394 of E4bp4, or a residue corresponding thereto, or any combination thereof; and/or reduces phosphorylation at one or more of residues S286, S301 and/or S454 of E4bp4, or a residue corresponding thereto, or any combination thereof.
  • Any appropriate concentration of a compound which results in the alteration of post ⁇ translational modification of E4bp4 may be used, provided that it increases the activity of E4bp4 as 5 described herein and has utility in expanding an NK cell population.
  • a compound which results in the alteration of post ⁇ translational modification of E4bp4 may be used at a final concentration of about 0.5 to about 5 ⁇ M, more preferably of about 0.5 to about 2 ⁇ M, even more preferable of about 0.5 to about 1 ⁇ M.
  • the REV ⁇ ERB inhibitor compound, Notch ligand and/or compound which alters E4bp4 post ⁇ translational modification may be used simultaneously, separately or sequentially as described herein.
  • Each of the REV ⁇ ERB inhibitor compound, Notch ligand and/or compound which alters E4bp4 post ⁇ translational modification may independently be used as a single treatment or application or in multiple treatments or applications (in both in vitro, ex vivo or in vivo methods as described herein).
  • at least two, at least three, at least four, at least five, at least six, at least seven, at least eight, at least nine or more applications may be used.
  • the multiple applications may 20 be applied at any appropriate time points according to a method or treatment of the invention.
  • a REV ⁇ ERB inhibitory compound of the invention may each independently be applied twice a day, once daily, every other day, once every three days or weekly.
  • the REV ⁇ ERB inhibitory compounds of the invention may independently be applied as necessary when the culture medium is changed.
  • the method of the invention may further comprise modulating (increasing or decreasing the expression and/or activity of one or more additional gene and/or protein in the HPCs in order to enhance NK cell expansion.
  • the sample comprising HPCs obtained from an individual/patient may be a sample obtained from bone marrow, cord blood and/or peripheral blood.
  • the sample may be a cord or peripheral blood sample, or a bone marrow sample or biopsy.
  • a method of the invention may result in an increase in, the number of NK cells of at least 1.5 ⁇ fold, at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, at least 4 ⁇ fold, 15 at least 5 ⁇ fold, at least 6 ⁇ fold, at least 7 ⁇ fold, at least 8 ⁇ fold, at least 9 ⁇ fold, at least 10 ⁇ fold or more relative to a control.
  • the number of NK cells is increased by at least 2 ⁇ fold, at least 2.1 ⁇ fold, at least 2.2 ⁇ fold, at least 2.3 ⁇ fold, at least 2.4 ⁇ fold, at least 2.5 ⁇ fold, at least 2.6 ⁇ fold, at least 2.7 ⁇ fold, at least 2.8 ⁇ fold, at least 2.9 ⁇ fold, at least 3 ⁇ fold, or more compared with the control.
  • a method of the invention may accelerate the production of phenotypically mature NK cells. 20 In other words, the method of the invention may reduce the time taken to arrive at a population of mature NK cells. A reduction in the run time of the method offers a further advantage over the conventional methods for NK cell expansion known in the art.
  • a method of the invention may 25 achieve an equivalent population in 10 days or less, preferably in one week or less.
  • a method of the invention may achieve a population of at least 40% mature NK cells, preferably at least 45%, at least 46%, at least 47%, at least 48%, or at least 49% mature NK cells, even more preferably at least 50% mature NK cells in three weeks or less, 20 days or less, 19 days or less, 18 days or less, 17 days or less, 16 days or less, 15 days or less, two weeks or less, 13 days or less, or 12 days or less.
  • the % of NK cells in the final cell 5 population may be very high (typically greater than 85%, preferably greater than 90%, more preferably greater than 95%, and may approach 100%). In such instances, a final purification step may optionally be omitted.
  • Therapeutic indications 10 The invention provides a REV ⁇ ERB inhibitor, or a pharmaceutic composition which comprises said inhibitor, for use in a method of therapy by increasing the production of NK cells in a patient. Pharmaceutical compositions are those which, with reasonable medical judgment, are suitable for use in contact with the tissues of a patient.
  • the invention also provides pharmaceutical products containing a compound which inhibits the action of REV ⁇ ERB and a Notch ligand as a combined preparation for simultaneous, separate or 25 sequential use in a method of therapy by increasing the production of NK cells in a patient.
  • pharmaceutical products are also, with reasonable medical judgment, products suitable for use in contact with the tissues of a patient.
  • the Notch ligand for use in said method of therapy may be any Notch ligand as described herein.
  • the Notch ligand is DLL4 or a fragment thereof which retains 30 the function of DLL4. Any REV ⁇ ERB inhibitor and any Notch ligand of the invention may be used in combination.
  • a method of therapy relating to said REV ⁇ ERB inhibitor and Notch ligand products comprises administering the products (as described herein) to a patient or subject.
  • the Notch ligand and REV ⁇ ERB inhibitor may be administered simultaneously, separately or sequentially.
  • the Notch ligand may be administered first, followed by the REV ⁇ ERB inhibitor, or vice versa.
  • Sequential administration may mean that the two products are administered immediately one after the other, or that the second product is administered within 1 minute, within two minutes, within 5 three minutes, within four minutes, within five minutes, within 10 minutes, within 15 minutes, within 20 minutes, within 25 minutes, within 30 minutes, within 45 minutes, within one hour, or more of the first product being administered.
  • an increase in the number of NK cells and/or increase in NK cell 30 production may be defined in terms of the absolute number of NK cells in a sample or patient, such as the percentage of NK cells, for example the percentage of NK cells in the circulating lymphocyte population.
  • a compound of the invention may cause an increase in NK number, resulting in a percentage of NK cells of at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least 70%, at least 75%, at least 80% or more.
  • the number of NK cells may be determined by quantitative and/or qualitative analysis, and may be measured directly or indirectly.
  • the number of NK cells relative to a control may be determined 5 using any appropriate technique. Suitable standard techniques, such as flow cytometry, FACS and MACS, are known in the art.
  • the number of NK cells may be increased compared with a control for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at 10 least 1 week, at least 2 weeks, at least 3 weeks, at least 1 month or more. Typically this is assessed relative to the last administration of the compound which inhibits REV ⁇ ERB activity.
  • the number of NK cells may be quantified in terms of the total number of NK cells in a sample from a patient or culture sample (from an ex vivo method of the invention).
  • a “subject” or “patient” 15 (these terms are used interchangeably herein) is any animal patient that would benefit from an increase in the number of NK cells.
  • Typical animal patients are mammals, such as primates.
  • the patient is a human.
  • the present invention provides a method of treatment by increasing the number of NK cells in a patient in need thereof, comprising administering to said patient a therapeutically effective 20 amount of a compound which inhibits the action of REV ⁇ ERB (as described herein), or a pharmaceutical composition comprising said compound.
  • the present invention provides the use of a compound which inhibits the action of REV ⁇ ERB in the manufacture of a medicament.
  • Said medicament increases the number of NK cells in a patient.
  • the present invention provides the use of a compound which inhibits the action of REV ⁇ ERB and a Notch ligand in the manufacture of a medicament.
  • Said medicament 30 increases the number of NK cells in a patient.
  • the term “preventing” includes inducing or providing protective immunity against such 10 diseases or disorders, particularly infectious diseases as described herein. Immunity may be quantified using any appropriate technique, examples of which are known in the art.
  • a compound, pharmaceutic compositions or pharmaceutical products of the invention may be administered to a patient already having a disease or disorder which may be treated by increasing NK cell number.
  • the patient may be suspected of having an infectious disease or cancer 15 as described herein, and may or may not be showing symptoms of said disease or disorder.
  • the compound, compositions or products of the invention can cure, delay, reduce the severity of, or ameliorate one or more symptoms, and/or prolong the survival of a subject beyond that expected in the absence of such treatment.
  • a compound, pharmaceutical compositions or pharmaceutical products of the 20 invention may be administered to a patient who may ultimately be infected with a particular infectious disease, or develop a disease or disorder as described herein, in order to cure, delay, reduce the severity of, or ameliorate one or more symptoms, and/or prolong the survival of a subject beyond that expected in the absence of such treatment, or, in the case of infectious diseases help prevent that patient from transmitting said disease.
  • the treatments and preventative therapies of the present invention are applicable to a variety of different subjects of different ages. In the context of humans, the therapies are applicable to children (e.g. infants, children under 5 years old, older children or teenagers) and adults. In the context of other animal subjects (e.g.
  • Cancers that may be treated according to the present invention include bladder cancer, blood cancers, leukaemia, 5 bone cancers, bowel cancer, brain tumours, breast cancer, kidney cancer, liver cancer, lung cancer, melanoma, ovarian cancer, pancreatic cancer, prostate cancer, skin cancer, stomach cancer, testicular cancer and uterine cancer.
  • Autoimmune diseases that may be treated according to the present invention include systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis and obesity ⁇ induced insulin resistance.
  • the term diseases or disorders related to female infertility 10 or pregnancy includes, but is not limited to, fetal growth restriction, preterm labour, defects in uterine vascular remodelling and preeclampsia.
  • the compounds, pharmaceutical compositions or pharmaceutical products of the invention may be used in combination with one or more additional therapeutic agents or treatments, which typically may be selected from a conventional treatment for the disease or disorder to be treated.
  • additional therapeutic agents or treatments typically may be selected from a conventional treatment for the disease or disorder to be treated.
  • a compound, compositions or products of the invention are for use in the treatment of a cancer, such as lung cancer, then said compound, compositions or products may be used in combination with conventional treatments for lung cancer, such as radiotherapy, chemotherapy or surgery.
  • a compound, compositions or products of the invention may be administered before, 20 simultaneously with, or after the administration of the one or more additional therapeutic agent or treatment.
  • a compound, pharmaceutical compositions or pharmaceutical products of the invention is for use in combination with antibody ⁇ mediated immunotherapy.
  • Antibody ⁇ mediated immunotherapy involves the administration of antibodies to a 25 patient to target disease ⁇ specific antigens. Such antibodies could be used to increase the specificity and killing activity of NK cells, which express receptors for the F C regions of IgG antibodies. Activation of these F C receptors, leads to NK cell activation, resulting in cytokine secretion and release of cytotoxic granules by the activated NK cell, causing lysis of the cell expressing the disease antigen.
  • Such combination therapy is particularly preferred for the treatment of cancer (using antibodies to tumour ⁇ 30 specific antigens). Any antibody used in immunotherapy may be used in combination with a compound of the invention.
  • the present invention provides an expanded NK cell population (as described herein) for use in a method of therapy, for example in the treatment of cancer, an infectious diseases, an autoimmune disease or 10 a disease or disorder related to female infertility or pregnancy.
  • the invention provides a method of treatment by increasing the number of NK cells in a patient in need thereof, comprising administering to said patient a therapeutically effective amount of an expanded NK cell population.
  • compositions and formulations The “compound” and products described herein may be comprised in a “therapeutic/prophylactic composition”, “formulation” or “medicament” of the invention.
  • the compound or expanded NK cell population of the invention (as defined above) can be combined or administered in addition to a pharmaceutically acceptable carrier, diluent and/or 20 excipient.
  • the compound or expanded NK cell population of the invention can further be combined with one or more of a salt, excipient, diluent, adjuvant, immunoregulatory agent and/or antimicrobial compound.
  • the compound of formula (I) may be in the form of a salt, particularly a pharmaceutically acceptable salt.
  • Pharmaceutically acceptable salts include acid addition salts formed with inorganic 25 acids such as, for example, hydrochloric or phosphoric acids, or with organic acids such as acetic, oxalic, tartaric, maleic, and the like. Salts formed with the free carboxyl groups may also be derived from inorganic bases such as, for example, sodium, potassium, ammonium, calcium, or ferric hydroxides, and such organic bases as isopropylamine, trimethylamine, 2 ⁇ ethylamino ethanol, histidine, procaine, and the like.
  • inorganic bases such as, for example, sodium, potassium, ammonium, calcium, or ferric hydroxides, and such organic bases as isopropylamine, trimethylamine, 2 ⁇ ethylamino ethanol, histidine, procaine, and the like.
  • compositions, therapeutic formulations, medicaments and prophylactic formulations are generally by conventional routes e.g. intravenous, subcutaneous, intraperitoneal, or mucosal routes.
  • the administration may be by parenteral injection, for example, a subcutaneous, intradermal or intramuscular injection.
  • formulations comprising antibodies or expanded NK cell populations of the invention may be particularly suited to administration intravenously, intramuscularly, intradermally, or subcutaneously.
  • composition comprises a compound of the invention
  • this may be in lyophilized form, in which case it may include a stabilizer, such as BSA.
  • a preservative such as thiomersal or sodium azide
  • additional adjuvants which may be effective include but are not limited to: 25 complete Freunds adjuvant (CFA), Incomplete Freunds adjuvant (IFA), Saponin, a purified extract fraction of Saponin such as Quil A, a derivative of Saponin such as QS ⁇ 21, lipid particles based on Saponin such as ISCOM/ISCOMATRIX, E.
  • coli heat labile toxin (LT) mutants such as LTK63 and/ or LTK72, aluminium hydroxide, N ⁇ acetyl ⁇ muramyl ⁇ L ⁇ threonyl ⁇ D ⁇ isoglutamine (thr ⁇ MDP), N ⁇ acetyl ⁇ nor ⁇ muramyl ⁇ L ⁇ alanyl ⁇ D ⁇ isoglutamine (CGP 11637, referred to as nor ⁇ MDP), N ⁇ acetylmuramyl ⁇ L ⁇ alanyl ⁇ D ⁇ 30 isoglutaminyl ⁇ L ⁇ alanine ⁇ 2 ⁇ (1' ⁇ 2' ⁇ dipalmitoyl ⁇ sn ⁇ glycero ⁇ 3 ⁇ hydroxyphosphoryl oxy) ⁇ ethylamine (CGP 19835A, referred to as MTP ⁇ PE), and RIBI, which contains three components extracted from bacteria, monophosphoryl lipid A, trehalose dimycolate and cell wall skeleton (MPL+TDM+CWS) in a 2 % squalene/
  • Oral formulations include such normally employed excipients as, for example, pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium 10 carbonate, and the like. These compositions take the form of solutions, suspensions, tablets, pills, capsules, sustained release formulations or powders.
  • the dosage ranges for administration of the compounds or products of the present invention are those which produce the desired therapeutic effect. It will be appreciated that the dosage range required depends on the precise nature of the compound, the route of administration, the nature of 15 the formulation, the age of the patient, the nature, extent or severity of the patient’s condition, contraindications, if any, and the judgement of the attending physician. Variations in these dosage levels can be adjusted using standard empirical routines for optimisation.
  • compositions of the present invention are preferably free from compounds disclosed in either WO 2013/033310 or WO 2015/103527.
  • SEQ ID NOs SEQ ID NO: 1 – E4bp4 gene sequence (X64318.1) 1 gcccctttct ttctcctcgt cggcccgaga gcaggaacac gataacgaag gaggcccaac 10 61 ttcattcaat aaggagcctg acggatttat cccagacggt agaacaaaag gaagaatatt 121 gatggatttt aaaccagagt ttttaaagag cttgagaata cggggaaatt aattgttct 181 cctacacacaca tagatagggt aaggttgtt ctgatgcagc
  • FuGENE was used as transfection reagent in a 5:2 ratio FuGENE:DNA, and after addition, mixture was gently mixed and left to incubate for 20 min at RT. Afterwards, 20 ⁇ L of the DNA mix was 15 transferred into the 24 ⁇ well plate containing the pre ⁇ seeded cells, with each condition in triplicate. 5 h after transfection, cells were treated with compounds 7, 11, 7acid, 11acid, SR8278, GSK1362 or DMSO as a vehicle. For that, 2X stock solutions of the compounds (or DMSO vehicle control) in DMEM were prepared. 0.5 mL of these 2X stock solutions were added to each well.
  • Results The resulting data are shown in Figure 4, expressed as the average and standard error 15 obtained from three independent experiments carried out in triplicate.
  • compounds acid7 and acid11 produced the greatest increase in luciferase expression of all the compounds tested.
  • Compounds acid7 and acid11 also produced a greater increase in luciferase expression than their ethyl ester analogues (compounds 7 and 11) in the REV ⁇ ERB ⁇ experiments.
  • 20 The same experiments were repeated, but with the tested compounds used at concentrations of 5 and 50 ⁇ M.
  • Plasma protein binding experiments were carried out on the compounds of the present invention. Once again, for comparison, tests were also carried out on compounds 7 and 11 and SR8278, as well as warfarin as a literature control.
  • Plasma protein binding 1 mM stock solutions of test compounds were prepared in DMSO and diluted 200 ⁇ fold in mice plasma to prepare a concentration of 5 ⁇ M, with a final DMSO concentration in plasma of 0.5%. Rapid equilibrium dialysis was performed with a rapid equilibrium dialysis (RED) device containing a dialysis membrane with a molecular weight cut ⁇ off of 8,000 Daltons.
  • RED rapid equilibrium dialysis
  • Example 5 screening of acid ⁇ form compounds for off ⁇ target effect
  • Prior art REV ⁇ ERB ligands have been known to exhibit clear off ⁇ target effects, and in particular to activate LXR ⁇ , a nuclear receptor closely related to REV ⁇ ERB and involved in numerous biological pathways. Activity of REV ⁇ ERB ligands on LXR ⁇ would ideally be avoided.
  • a reporter gene assay similar 25 to that described in Example 2 was carried out using LXR ⁇ and compounds of the present invention. For comparison, tests were also carried out using compound 7 and compound 11, SR8278 and GSK1362, and with DMSO as a control.
  • Reporter gene assay for LXR ⁇ activity HEK293T cells were seeded and transfected following the protocol previously described in Example 2.
  • the DNA master mix used was composed of 50 ng 5 LXR ⁇ or pcLXR ⁇ as the empty vector, 100 ng of pGL3 ⁇ LXR REX2 ⁇ luc, 10 ng of Renilla luciferase and 240 ng of BSM. 5 h after transfection compounds (or DMSO vehicle control) were added at 10 ⁇ M concentration. GW3965 was used as LXR ⁇ activator control at 5 ⁇ M. After 24 h, cells were lysed and activity was measured as previously described using Dual ⁇ Luciferase Reporter Assay System. Results: The resulting data are shown in Figure 5, expressed as the average and standard error 10 obtained from three independent experiments carried out in triplicate.
  • Example 6 effect of acid ⁇ form compounds on expression of E4BP4
  • the effect of compounds of the present invention on endogenous REV ⁇ ERB was assessed by 20 looking at the expression of E4BP4 in different cell lines.
  • a first set of experiments was conducted using HepG2 and a second set of experiments was conducted using NK ⁇ 92 cells.
  • Sample preparation HepG2 cells were seeded in 6 ⁇ well plates in DMEM media supplemented with 10% FBS and 1% PSG (2.5 ⁇ 10 6 cells in 3 mL media per well) at 37°C and 5% CO 2 .
  • RNA extraction was isolated using RNeasy Plus Mini Kit (QIAGEN, cat. 74134) according to the manufacture’s protocol. HepG2 cells were harvested directly from the well, by removing media, washing with EDTA, lysed by adding 350 ⁇ L of RLT plus 1% ⁇ ME and homogenized by vortex. NK ⁇ 92 cells were collected into tubes, centrifuged, and the pellets were lysed by adding 350 ⁇ L RLT plus 1% 5 ⁇ ME and homogenized by vortex. Cell lysate was transferred to gDNA Eliminator spin column and centrifuged to remove genomic DNA. 350 ⁇ L 70% ethanol was added and samples were transferred to RNeasy MinElute spin column and centrifuged.
  • cDNA Complementary DNA

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Abstract

This invention relates to Natural Killer (NK) cell populations, to methods of producing the same and therapeutic applications thereof. More specifically, the invention relates to the expansion of NK cells by increasing the expression of specific transcription factors associated with NK cell production using a new library of compounds.

Description

NATURAL KILLER CELLS    FIELD OF THE INVENTION    This  invention  relates  to  expanded  Natural  Killer  (NK)  cell  populations,  to  methods  of  5  producing the same and therapeutic applications thereof.  More specifically, the invention relates to  the use of a new library of compounds for the expansion of NK cells by increasing the expression of  specific  transcription  factors associated with NK cell production.   The compounds  themselves also  form part of the invention.      10  BACKGROUND OF THE INVENTION    There has been an increase in interest in Natural Killer (NK) cells as they are cytotoxic against  cancerous, pathogen‐infected and otherwise damaged cells.  NK cells are innate lymphoid cells (ILCs),  specifically large granular cytotoxic lymphocytes that bridge the innate and the adaptive arms of the  immune response.  They make up 10‐15% of circulating lymphocytes in the peripheral blood.  NK cells 15  also exhibit the highest level of cytotoxic activity within the immune system.  Therefore, altered NK  cell  functionality or numbers  impact  the  functioning of  the  immune  system against  infection and  cancer.  For example, a large scale study in Japan has shown that reduced levels of NK cells in a cohort  of people aged over 40 is associated with a significantly higher incidence of cancer.    Similarly to B cells and T cells, these NK cells are derived from Common Lymphoid Progenitor 20  (CLP) cells that in turn come from Haematopoietic Stem Cells (HSCs).  However, NK cells are different  from B and T cells as they lack specific cell surface antigen receptors.  Due to this, NK cells may kill  cancerous and pathogen‐infected cells without prior sensitisation, making  them part of  the  innate  immune response.  They also have a critical role in tumour immunosurveillance by directly influencing  the adaptive immune response.  25    Activation of NK cells triggers them to release perforin and cytoplasmic granules containing  granzymes.  Perforin polymerises to form pores on target cells in the presence of Ca2+.  Granzymes  may enter these pores into target cells, causing DNA fragmentation and apoptosis.  NK cells may also  secrete cytokines, which trigger the action of other immune cells in the adaptive arm of the immunity.     Numerous groups have worked on methods to increase the number of endogenous NK cells.  30  One  method  is  the  administration  of  cytokines  that  are  essential  for  NK  cell  development.   Administration of IL‐2 and IL‐15 was predicted to enhance NK cell development.  IL‐2 promotes the  proliferation and cytotoxicity of NK cells, whereas IL‐15 promotes the development and expansion of  NK cells.  However, in in vivo studies, the cytokines were found only stimulate a minimal expansion of  NK cells with reduced half‐life, even at a very high dose.  Further, administered cytokines often leads  to systemic toxicity due to inappropriate activation of immune responses and the induction of NK cell  apoptosis.    Thus, using conventional methods and  techniques, producing  large numbers of NK cells  is  difficult, and producing fully functional NK cells with high cytotoxicity is even harder.  Therefore, there  5  is a need to develop new methods of NK cell production; both ex vivo to produce large numbers of  functional NK cells for therapeutic and research use; and in vivo.    SUMMARY OF THE INVENTION  Natural Killer (NK) cells  have  a  critical  role  in  the  immune  system  where  they  destroy 10  cancerous, pathogen‐infected or damaged cells.  Boosting NK cell number or functionality is predicted  to increase the killing of these cells. Existing therapies such as NK cell adoptive transfer and cytokine  enhancement of endogenous NK cells are not very successful in terms of their efficacy.     NK cells are differentiated  from  the HSCs  in  the bone marrow and distributed  throughout  lymphoid and non‐lymphoid tissues including lymph nodes, spleen, peripheral blood, lungs and liver.  15  Specific cytokines and transcription factors are needed to encourage HSCs to develop into NK cells.   Each cytokine and transcription factor must be present at a precise time and concentration in order  to push differentiation  from HSCs  into NK  cells.   However,  the precise hierarchy of  cytokines and  transcription factors governing NK cell maturation is still incompletely understood.  The present inventors have previously shown that inhibiting the action of REV‐ERB increases 20  NK cell production.  In particular, the inventors demonstrated that inhibiting the action of REV‐ERB,  e.g. using the REV‐ERB antagonist SR8278, increases E4bp4 expression, which in turn increases NK cell  production.  The structure of SR8278 is shown below:  S   Many synthetic ligands for REV‐ERB have been generated in the art.  However, on screening 25  the vast majority of these  ligands have been  identified as agonists (with over 300  identified).   The  pharmacological profile of antagonist ligand SR8278 is such that it is not suitable for use in a clinical  setting.  Furthermore, the lack of information on the mechanism of action of SR8278 and the lack of  suitable structure‐activity relationships surrounding this molecule has hindered the discovery of other  antagonistic compounds.  The  present  inventors  have  previously  generated  a  library  of  compounds,  and  have  demonstrated that several such compounds possess improved REV‐ERB inhibitory activity compared  with SR8278, and therefore have potential to improve the ex vivo expansion of NK cells, as well as to  provide  improved  pharmacological  properties, making  them more  appropriate  for  use  in  clinical  5  applications (see WO 2020/002911).    As with SR8278 and other REV‐ERB inhibitors, the compounds in this library all possess an alkyl  ester  group  or  similar  attached  to  the  tetrahydroisoquinoline  (or  open‐ring  equivalent)  core  at  position 3 in structure shown below:    10  In the most promising compounds to date, an ethyl ester group is present in this position.   Therefore, the research thus far has strongly suggested that an ester moiety, or similar, is important  to the REV‐ERB inhibitory action of the compounds.    The present inventors have now developed a new library of compounds in which the group  previously attached  to  the  tetrahydroisoquinoline  (or open‐ring equivalent) core at position 3 has 15  been  replaced  for  instance  with  a  carboxylic  acid  group.  Acid‐form  compounds  of  the  present  invention  have  surprisingly  been  shown  to  possess  activity  as  REV‐ERB  antagonists.  Even  more  surprising  is  that  the  activities  of  these  acid‐form  compounds  have  been  shown  to  be  enhanced  relative to their ethyl ester counterparts.   Further beneficial and surprising properties have been shown using acid‐form compounds of 20  the present invention, including good plasma stability, high levels of target engagement and low levels  of off‐target effects.  Acid‐form compounds of the present invention have also been used to expand  an NK cell population.    Accordingly,  the  present  invention  provides  ex  vivo  method  for  expanding  an  NK  cell  population, comprising the steps of:  25  a) culturing an haematopoietic progenitor cell (HPC) comprising sample obtained from  an individual;  b) adding a compound that inhibits the action of REV‐ERB to said sample; and  c) expanding said cells in vitro to produce an NK cell population;  wherein the compound that inhibits the action of REV‐ERB has the formula (I):  I)    where:   represents bonds that are all either present or absent;    R1 is hydrogen;  5    R2  is  selected  from 5‐10 membered heterocyclyl  rings and C1‐6 hydrocarbyl, and  is  optionally  substituted with  one  or more  groups  independently  selected  from  C1‐4  hydrocarbyl,  ‐OR’,  ‐OC(O)R’,  ‐C(O)OR’,  ‐SR’,  ‐S(O)R’,  ‐S(O)2R’,  ‐NR’2,  ‐NR’C(O)R’,   ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;    X is selected from ‐O‐ and ‐NR’‐;   10    Y is selected from ‐C(O)‐ or ‐CR’2‐;    Z is selected from ‐O‐ and ‐NR’‐ or is absent;    each Ra is independently selected from H, C1‐4 hydrocarbyl, ‐OR’, ‐OC(O)R’, ‐C(O)OR’, ‐ SR’, ‐S(O)R’, ‐S(O)2R’, ‐NR’2, ‐NR’C(O)R’, ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;     each Rb is independently selected from H, C1‐4 hydrocarbyl and ‐OR’;   15    Rc is selected from H and C1‐4 hydrocarbyl; and     each R’ is independently selected from H, C1‐4 hydrocarbyl and ‐Ph;    or a pharmaceutically acceptable salt thereof.  In some embodiments,   represents bonds that are all present and the compound is a  closed ring structure according to formula Ia:  20    (Ia).  R2  may  be  selected  from:  (i)  optionally  substituted  5‐10  membered  heterocyclyl  rings,  preferably optionally substituted 5‐10 membered heteroaryl rings, and the 5‐10 membered heteroaryl  ring is preferably an optionally substituted 5‐, 6‐ or 9‐membered heteroaryl rings, wherein optionally  the 5‐, 6‐, or 9‐membered heteroaryl ring is selected from optionally substituted: furanyl, thiophenyl,  5  oxazolyl,  isooxazolyl,  isothiazolyl,  thiazolyl,  pyrazolyl,  imidazolyl,  pyrrolyl  and  triazolyl,  pyridinyl,  pyridazinyl,  pyrimidinyl  and  pyrazinyl,  indolyl,  isoindolyl,  indazolyl,  benzimidazolyl,  azaindolyl,  benzofuranyl, isobenzofuranyl, benzisoxazolyl and benzoxazolyl; and (ii) optionally substituted phenyl,  preferably substituted phenyl; and/or R2 may be unsubstituted or substituted with one or two groups  independently  selected  from  C1‐4  alkyl,  ‐OR’,  ‐OC(O)R’,  ‐C(O)OR’,  ‐SR’,  ‐S(O)R’,  ‐S(O)2R’,  ‐NR’2,  ‐10  NR’C(O)R’, ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen, preferably R2 is unsubstituted or substituted  with one or two groups independently selected from ‐Me, ‐OMe, ‐CN, ‐NO2, ‐F, ‐Cl,–I and ‐SMe.  X may be ‐O‐; Y may be ‐C(O)‐; Z may be ‐O‐ or is absent, preferably Z is absent; each Ra may  be independently selected from H, C1‐4 alkyl, ‐OR’ and ‐NR’2, preferably from H and C1‐4 alkyl, and more  preferably, each Ra is H; each Rb may be independently selected from H and C1‐4 alkyl, preferably, each 15  Rb is H; Rc may be H; and/or each R’ may be independently selected from H and C1‐4 alkyl, preferably  from H, methyl and ethyl, and more preferably from methyl and ethyl.  In some preferred embodiments, X is ‐O‐, such that the compound has the formula (II):   (II).    In some preferred embodiments, Rb and Rc are all H, such that the compound has the formula 20  (III):   (III);    more preferably, Y is ‐C(O)‐, such that the compound has the formula (IV):  );    still more preferably, the compound is a closed ring structure with the formula (V):  5    );    and yet still more preferably, Ra are all H, such that the compound has the formula (VI):   (VI). 10        In some embodiments of the method of the invention, the compound has the formula:  ;  5  w ,  ,  ,   ,  ;   and wherein more prefer ably the compound has the formula:  .  5    Typically, said compound increases E4bp4 expression by decreasing REV‐ERB activity.  In some  embodiments of the method of the  invention, said compound decreases the activity of REV‐ERB‐α  and/or REV‐ERB‐β, preferably REV‐ERB‐α, and more preferably REV‐ERB‐α and REV‐ERB‐β.   In some  preferred embodiments, said compound  is a REV‐ERB antagonist, preferably an antagonist of REV‐10  ERB‐α and REV‐ERB‐β.  According to the invention, said method may further comprise a step of culturing the HPCs in  the presence of a Notch ligand, wherein optionally the vessel in which the HPCs are cultured is coated  with the Notch ligand.  In some embodiments (a) the Notch ligand is delta‐like ligand 4 (DLL4), or a  fragment thereof which retains the function of DLL4; and/or (b) the Notch ligand is present on or from 15  4 days after isolating said HPCs.  The cells may be cultured in the presence of IL‐15 after the step of  culturing in the presence of the Notch ligand; and/or the HPCs may be cultured in the presence of the  Notch ligand in combination with IL‐7, Flt3L and/or stem cell factor (SCF), preferably the Notch ligand  in combination with IL‐7, Flt3L and SCF; wherein optionally either or both of the step of culturing in  the cells  in the presence of the Notch  ligand and the step of culturing  in the presence of  IL‐15 are 20  carried out in the absence of a stromal support cell, and preferably wherein both steps are carried out  in the absence of a stromal support cell.  The sample of HPCs may be obtained from bone marrow, cord blood and/or peripheral blood.  The invention further provides an expanded NK cell population obtained by the method of the  invention.    The invention further provides a composition comprising an expanded NK cell population of  5  the invention and a pharmaceutically acceptable carrier, diluent and/or excipient.  Also  provided  by  the  invention  is  a  pharmaceutical  composition  comprising  a  compound  which inhibits the action of REV‐ERB activity for use in a method of therapy by increasing production  of natural killer (NK) cells in a patient, wherein said compound is a compound of formula (I) as defined  herein.    10  The invention further provides products containing a compound which inhibits the action of  REV‐ERB and a Notch ligand as a combined preparation for simultaneous, separate or sequential use  in a method of therapy by increasing production of natural killer (NK) cells in a patient, wherein said  compound  is a  compound of  the  invention, and optionally  said Notch  ligand  is delta‐like  ligand 4  (DLL4), or a fragment thereof which retains the function of DLL4.    15  The method of therapy  in which the pharmaceutical composition or products may be used  may be: (a) a method of treating a disease or disorder selected  from cancer, an  infectious disease  (acute or chronic), an autoimmune disease or a disease or disorder related  to  female  infertility or  pregnancy; or (b) a method of treatment of a viral infection, a bacterial infection, a protest infection,  a fungal infection and/or a helminth infection.    20  The invention further provides a method of treatment by increasing the number of NK cells in  a patient in need thereof, comprising administering to said patient a therapeutically effective amount  of a compound which inhibits the action of REV‐ERB according to the invention, and optionally a Notch  ligand, wherein preferably the Notch ligand is delta‐like ligand 4 (DLL4), or a fragment thereof which  retains the function of DLL4.  25  The pharmaceutical composition or pharmaceutical products for use of the invention, or the  method  of  treatment  of  the  invention,  may  be  used  in  combination  with  antibody‐mediated  immunotherapy,  wherein  optionally  said  compound  or  products  is  for  administration  before,  simultaneously with, or after administration of the antibody‐mediated immunotherapy.  The invention also provides an isolated compound of formula (I) as defined herein, provided 30  that the compound is not:       ,  5  ,  ,     a .    The invention also provides the use of a compound of formula (I) as defined herein as a REV‐ ERB inhibitor, provided that the compound is not:   5  .    The  invention  further  provides  a  pharmaceutical  composition  comprising  a  compound  of  formula  (I) as defined herein, and a pharmaceutically acceptable carrier, diluent and/or excipient,  provided that the compound is not:    10  ,   F ,  ,  NH2 ,  
,     5  .    Also provided by  the  invention  is a  composition  comprising a  compound of  formula  (I) as  defined herein, wherein the composition comprises the compound of formula (I) in an amount of at  least 0.01%, preferably at  least 0.1%, more preferably at  least 1%, such as at  least 10% by weight, 10  provided that the compound is not:  ,   or  .  BRIEF DESCRIPTION OF THE DRAWINGS    Figure 1:  NK cell developmental pathway. NK cells are differentiated from Hematopoietic Stem  Cells (HSCs). NK cells develop from HSC into Common Lymphoid Progenitor (CLP) cells, NK progenitor  5  (NKP) cells,  immature NK  (iNK) cells, mature NK (mNK) cells and finally  into conventional NK (cNK)  cells, which circulate  in the bloodstream. Below the diagram of the pathway are the cytokines and  transcription  factors that are required  for NK cell development.  IL‐15  is one of the main cytokines  required for the development of NK cells. Others are transcription factors required for the transitions  shown on the diagram.  10    Figure 2:  (A) Timeline of example one‐stage NK cell expansion method. HPCs may be isolated  and cultured plus Flt3L, IL‐7 and SCF cytokines. At Day 2, they may then transferred onto OP9 stromal  cells plus or minus REV‐ERB inhibitor compound in culture medium, optionally plus the IL‐15 cytokine.  (B) Schematic representation of example two‐stage culture of NK cell development using a REV‐ERB 15  inhibitory compound and a Notch ligand.    Figure 3:   Reporter  gene  assay  screening  activity  of  acid‐form  compounds  of  the  present  invention,  and  other  REV‐ERB modulators,  against  REV‐ERBα.  The  compounds  were  tested  at  a  concentration of 10 µM over 24 h. Compounds acid7 and acid11 displayed strong activity against REV‐20  ERBα, and increased antagonist activity compared to their ethyl ester counterparts (compounds 7 and  11). Represented data for N=3. Welch’s ANOVA t‐test compares compound activity to DMSO control  (* for p<0.05, ** for p<0.01, *** for p<0.001 and **** for p<0.0001).    Figure 4:   Reporter  gene  assay  screening  activity  of  acid‐form  compounds  of  the  present 25  invention, and other REV‐ERB modulators, against REV‐ERBα and REV‐ERBβ. The compounds were  tested at a concentration of 10 µM over 48 h. Compounds acid7 and acid11 displayed strong activity  against both isoforms, and increased antagonist activity compared to their ethyl ester counterparts  (compounds 7 and 11). Represented data for N=3. Welch’s ANOVA t‐test compares compound activity  to DMSO control (* for p<0.05, ** for p<0.01, *** for p<0.001 and **** for p<0.0001).  30    Figure 5:   Reporter gene assay activity of acid‐form compounds of the present  invention, and  other REV‐ERB modulators, on LXRα nuclear receptor. Signal of LXR response element is measured in  the absence (grey) or presence (black) of LXRa, following 24 h treatment  in the presence of 10 μM  dose of the tested compounds. GW3965 was used as LXRa control ligand, at a 5 μM concentration.  Compounds acid7 and acid11 showed a reduction in off‐target effect on LXRa compared to their ethyl  ester counterparts (compounds 7 and 11). Represented data for N=3. Welch’s ANOVA t‐test compares  compound activity  to DMSO control  in  the presence of LXRa  (*  for p<0.05, **  for p<0.01, ***  for  p<0.001 and **** for p<0.0001).  5    Figure 6:   (A) Absolute number of NK cells after treatment with acid‐form compounds of the  present  invention, and other REV‐ERB modulators. The compounds were used at concentrations of  6.0 μM and 15.0 μM. Compounds acid7 and acid11 both showed increased an increase in total number  of NK cells compared with other REV‐ERB modulators. (B)  Absolute number of NK cells after treatment 10  with  acid‐form  compounds  of  the  present  invention,  and  their  ethyl  ester  counterparts.  The  compounds were  used  at  a  concentration  of  2  μM.  Compounds  acid7  and  acid11  both  showed  increased  an  increase  in  total  number  of  NK  cells  compared  to  their  ethyl  ester  counterparts  (compounds 7 and 11).    15  Figure 7:   Percentage of live NK cells CD56+ and CD56+CD16+ at day 17 of differentiation after  treatment with acid‐form compounds of the present invention. All compounds were tested at 1 µM  and compared to DMSO control. All of acid4, acid44, acid73, acid78, acid80 and acid27 show increase  in both percentage of live CD56+ NK cells (shaded region) as well as percentage of live CD56+CD16+  NK cells compared with DMSO control (white region overlayed on shaded region).  20    DETAILED DESCRIPTION OF THE INVENTION    Definitions  As used herein,  the  singular  forms  "a,"  "an" and  "the"  include plural  referents unless  the 25  context clearly dictates otherwise.  The term comprising encompasses both “comprising”  (open definition) and “consisting of”  closed definition).  In other words, if an embodiment, description, aspect or disclosure comprises the  recited feature(s), the present invention also encompasses said embodiment, description, aspect or  disclosure consisting of said feature(s).  30  The  term  "chemically  feasible" means  a bonding  arrangement or  a  compound where  the  generally understood  rules of organic  structure are not violated;  for example a  structure within a  definition of a claim that would contain in certain situations a pentavalent carbon atom that would  not exist in nature would be understood to not be within the claim. The structures disclosed herein,  in all of  their embodiments are  intended  to  include only "chemically  feasible" structures, and any  recited structures  that are not chemically  feasible,  for example  in a structure shown with variable  atoms  or  groups,  are  not  intended  to  be  disclosed  herein  and  do  not  form  part  of  the  present  invention.  An  "analogue"  of  a  chemical  structure,  as  the  term  is  used  herein,  refers  to  a  chemical  5  structure that preserves substantial similarity with the parent structure, although it may not be readily  derived synthetically from the parent structure. A related chemical structure that  is readily derived  synthetically from a parent chemical structure is referred to as a "derivative."  When a substituent is specified to be an atom or atoms of specified identity, "or a bond", a  configuration  is referred to when the substituent  is "a bond" that the groups that are  immediately 10  adjacent  to  the specified substituent are directly connected  to each other  in a chemically  feasible  bonding configuration.  All  chiral,  diastereomeric,  racemic  forms  of  a  structure  are  intended,  unless  a  particular  stereochemistry or isomeric form is specifically indicated. Compounds used in the present invention  can include enriched or resolved optical isomers at any or all asymmetric atoms as are apparent from 15  the depictions, at any degree of enrichment. Both racemic and diastereomeric mixtures, as well as the  individual  optical  isomers  can  be  isolated  or  synthesized  so  as  to  be  substantially  free  of  their  enantiomeric or diastereomeric partners, and these are all within the scope of the invention.  As used herein, the terms "stable compound" and "stable structure" are meant to indicate a  compound that is sufficiently robust to survive isolation to a useful degree of purity from a reaction 20  mixture,  and  formulation  into  an  efficacious  therapeutic  agent.  Only  stable  compounds  are  contemplated herein.    Standard abbreviations for chemical groups such as are well known in the art are used; e.g.,  Me = methyl, Et = ethyl, i‐Pr = isopropyl, Bu = butyl, t‐Bu = tert‐butyl, Ph = phenyl, Bn = benzyl, Ac =  acetyl, Bz = benzoyl, and the like.  25  When a group is recited, wherein the group can be present in more than a single orientation  within  a  structure  resulting  in more  than  single molecular  structure,  e.g.,  a  carboxamide  group  C(=O)NR, it is understood that the group can be present in any possible orientation, e.g., X‐C(=O)N(R)‐ Y or X‐N(R)C(=O)‐Y, unless the context clearly limits the orientation of the group within the molecular  structure.  30  Hydrocarbyl groups are groups that consist only of carbon and hydrogen, though the groups  may be substituted one or more times, as defined herein. Hydrocarbyl groups include straight chain  and branched groups. Compounds of formula (I) typically have hydrocarbyl groups with from 1 to 6  carbon atoms, particularly from 1 to 4 carbon atoms or from 1 to 3 carbon atoms. As used herein, the  term “hydrocarbyl” encompasses aromatic and non‐aromatic groups. Preferred hydrocarbyl groups  include alkyl, alkenyl and alkynyl groups which are described further below.    Alkyl groups  include straight chain and branched alkyl groups and cycloalkyl groups having  from 1 to about 20 carbon atoms, and typically from 1 to 12 carbons, from 1 to 8 carbon atoms, from  5  1 to 6 carbon atoms. Examples of straight chain alkyl groups include those with from 1 to 8 carbon  atoms  such  as  methyl,  ethyl,  n‐propyl,  n‐butyl,  n‐pentyl,  n‐hexyl,  n‐heptyl,  and  n‐octyl  groups.  Examples of branched alkyl groups  include, but are not  limited to,  isopropyl,  iso‐butyl, sec‐butyl, t‐ butyl,  neopentyl,  isopentyl,  and  2,2‐dimethylpropyl  groups.  As  used  herein,  the  term  "alkyl"  encompasses n‐alkyl, isoalkyl, and anteisoalkyl groups as well as other branched chain forms of alkyl. 10  Representative substituted alkyl groups can be substituted one or more times, as defined herein.  Cycloalkyl groups are cyclic alkyl groups such as, but not limited to, cyclopropyl, cyclobutyl,  cyclopentyl,  cyclohexyl,  cycloheptyl,  and  cyclooctyl  groups.  In  some  embodiments,  the  cycloalkyl  group can have 3 to about 8‐12 ring members, whereas  in other embodiments the number of ring  carbon atoms  range  from 3  to 4, 5, 6, or 7. Cycloalkyl groups  further  include polycyclic cycloalkyl 15  groups  such  as,  but  not  limited  to,  norbornyl,  adamantyl,  bornyl,  camphenyl,  isocamphenyl,  and  carenyl groups, and fused rings such as, but not limited to, decalinyl, and the like. Cycloalkyl groups  also include rings that are substituted with straight or branched chain alkyl groups as defined above.  Representative substituted cycloalkyl groups can be mono‐substituted or substituted more than once,  as defined herein.   20  Alkenyl groups are alkyl groups, e.g. as described above, but which comprise at  least one  carbon‐carbon double bond.  Thus, alkenyl groups include straight chain and branched alkenyl groups  and non‐aromatic cycloalkenyl groups.  Alkenyl groups are preferably, but not necessarily, bonded to  the  rest  of  a  molecule  through  a  carbon  which  forms  part  of  a  double  bond.    Representative  substituted alkenyl groups can be mono‐substituted or substituted more than once, as defined herein.   25  Alkynyl groups are alkyl groups, e.g. as described above, but which  comprise at  least one  carbon‐carbon triple bond.  Thus, alkynyl groups include straight chain and branched alkynyl groups.   Alkynyl groups are preferably, but not necessarily, bonded to the rest of a molecule through a carbon  which forms part of a triple bond.  Representative substituted alkynyl groups can be mono‐substituted  or substituted more than once, as defined herein.    30  Heterocyclyl groups/rings or the term "heterocyclyl" includes aromatic and non‐aromatic ring  compounds containing 3 or more ring members, of which, one or more is a heteroatom such as, but  not  limited  to, N, O,  and  S.  Thus  a  heterocyclyl  can  be  a  cycloheteroalkyl,  or  a  heteroaryl,  or  if  polycyclic, any combination thereof. In some embodiments, heterocyclyl groups include 3 to about 20  ring members, whereas  in compounds of  formula  (I) heterocyclyl  rings  typically have 5  to 10  ring  members. A heterocyclyl ring can be a 5‐membered ring with one heteroatom, a 6‐membered ring  with two heteroatoms, and so forth. The number of carbon atoms plus the number of heteroatoms  sums up to equal the total number of ring atoms. A heterocyclyl ring can also  include one or more  double bonds. A heteroaryl ring is an embodiment of a heterocyclyl group. The phrase "heterocyclyl  5  group"  includes  fused  ring  species  including  those  comprising  fused  aromatic  and  non‐aromatic  groups. For example, a dioxolanyl ring and a benzdioxolanyl ring system (methylenedioxyphenyl ring  system) are both heterocyclyl groups within the meaning herein. The phrase also includes polycyclic  ring systems containing a heteroatom as described herein.  Heterocyclyl groups can be unsubstituted,  or can be substituted as discussed above.  10  Heteroaryl groups are aromatic ring compounds containing 5 or more ring members, of which,  one or more is a heteroatom such as, but not limited to, N, O, and S; for instance, heteroaryl rings can  have 5 to about 8‐12 ring members. In compounds of formula (I) heteroaryl rings typically have 5 to  about 10 ring members.   A heteroaryl group  is a variety of a heterocyclyl group that possesses an  aromatic electronic structure. Likewise a heteroaryl can be a 5‐ring with one heteroatom, a 6‐ring with 15  two heteroatoms, and so forth. The number of carbon atoms plus the number of heteroatoms sums  up to equal the total number of ring atoms. Heteroaryl groups include, but are not limited to, groups  such  as pyrrolyl, pyrazolyl,  triazolyl,  tetrazolyl, oxazolyl,  isoxazolyl,  thiazolyl, pyridinyl,  thiophenyl,  benzothiophenyl,  benzofuranyl,  indolyl,  azaindolyl,  indazolyl,  benzimidazolyl,  azabenzimidazolyl,  benzoxazolyl,  benzothiazolyl,  benzothiadiazolyl,  imidazopyridinyl,  isoxazolopyridinyl, 20  thianaphthalenyl,  purinyl,  xanthinyl,  adeninyl,  guaninyl,  quinolinyl,  isoquinolinyl,  tetrahydroquinolinyl, quinoxalinyl, and quinazolinyl groups. Heteroaryl groups can be unsubstituted,  or can be substituted with groups as is discussed above. Representative substituted heteroaryl groups  can be substituted one or more times with groups such as those listed above.  Halogen refers to fluorine, chlorine, bromine or iodine.  25  A "salt" as is well known in the art includes an organic compound such as a carboxylic acid, a  sulfonic acid, or an amine, in ionic form, in combination with a counterion. For example, acids in their  anionic form can form salts with cations such as metal cations, for example sodium, potassium, and  the  like; with ammonium  salts  such as NH4 + or  the  cations of various amines,  including  tetraalkyl  ammonium salts such as tetramethylammonium, or other cations such as trimethylsulfonium, and the 30  like. A "pharmaceutically acceptable" or "pharmacologically acceptable" salt is a salt formed from an  ion that has been approved for human consumption and is generally non‐toxic, such as a chloride salt  or a sodium salt. A "zwitterion" is an internal salt such as can be formed in a molecule that has at least  two ionisable groups, one forming an anion and the other a cation, which serve to balance each other.  For example, amino acids such as glycine can exist in a zwitterionic form. A "zwitterion" is a salt within  the meaning herein. The compounds of the present invention may take the form of salts. The term  "salts" embraces addition salts of free acids or free bases which are compounds of the invention. Salts  can be "pharmaceutically‐acceptable salts. " The  term "pharmaceutically‐acceptable salt" refers  to  salts which possess toxicity profiles within a range that affords utility in pharmaceutical applications.  5  Pharmaceutically  unacceptable  salts  may  nonetheless  possess  properties  such  as  high  crystallinity, which have utility in the practice of the present invention, such as for example utility in  process of synthesis, purification or formulation of compounds of the invention.  Suitable pharmaceutically‐acceptable acid addition salts may be prepared from an inorganic  acid or from an organic acid. Examples of inorganic acids include hydrochloric, hydrobromic, hydriodic, 10  nitric,  carbonic,  sulfuric,  and  phosphoric  acids.  Appropriate  organic  acids may  be  selected  from  aliphatic, cycloaliphatic, aromatic, araliphatic, heterocyclic, carboxylic and sulfonic classes of organic  acids, examples of which  include  formic, acetic, propionic, succinic, glycolic, gluconic,  lactic, malic,  tartaric, citric, ascorbic, glucuronic, maleic, fumaric, pyruvic, aspartic, glutamic, benzoic, anthranilic,  4‐hydroxybenzoic,  phenylacetic,  mandelic,  embonic  (pamoic),  methanesulfonic,  ethanesulfonic, 15  benzenesulfonic, pantothenic, trifluoromethanesulfonic, 2‐hydroxyethanesulfonic, p‐toluenesulfonic,  sulfanilic,  cyclohexylaminosulfonic,  stearic,  alginic,  β‐hydroxybutyric,  salicylic,  galactaric  and  galacturonic acid. Examples of pharmaceutically unacceptable acid addition salts include, for example,  perchlorates and tetrafiuoroborates.  Suitable  pharmaceutically  acceptable  base  addition  salts  of  compounds  of  the  invention 20  include, for example, metallic salts  including alkali metal, alkaline earth metal and transition metal  salts such as, for example, calcium, magnesium, potassium, sodium and zinc salts. Pharmaceutically  acceptable base addition salts also include organic salts made from basic amines such as, for example,  N,N‐dibenzylethylenediamine,  chloroprocaine,  choline,  diethanolamine,  ethylenediamine,  meglumine  (N‐methylglucamine)  and  procaine.  Examples  of  pharmaceutically  unacceptable  base 25  addition salts  include  lithium salts and cyanate salts. Although pharmaceutically unacceptable salts  are not generally useful as medicaments, such salts may be useful, for example as intermediates in  the synthesis of Formula (I) compounds, for example  in their purification by recrystallization. All of  these salts may be prepared by conventional means from the corresponding compound according to  Formula (I) by reacting, for example, the appropriate acid or base with the compound according to 30  Formula (I). The term "pharmaceutically acceptable salts" refers to nontoxic inorganic or organic acid  and/or base addition  salts,  see,  for example, Lit et al., Salt Selection  for Basic Drugs  (1986),  Int  J.  Pharm., 33, 201‐217, incorporated by reference herein.  Since compounds of formula (I) are preferably acids, then they will readily form salts in which  the carboxylic acid group  is present as a carboxylate anion having a cationic counterion.   Suitable  cationic ions are described above.    A "hydrate" is a compound that exists in a composition with water molecules. The composition  5  can include water in stoichiometric quantities, such as a monohydrate or a dihydrate, or can include  water  in  random  amounts. As  the  term  is  used  herein  a  "hydrate"  refers  to  a  solid  form,  i.e.,  a  compound in water solution, while it may be hydrated, is not a hydrate as the term is used herein.   A "solvate" is a similar composition except that a solvent other that water replaces the water.  For example, methanol or ethanol can form an "alcoholate", which can again be stoichiometric or non‐10  stoichiometric. As  the  term  is used herein  a  "solvate"  refers  to  a  solid  form,  i.e.,  a  compound  in  solution in a solvent, while it may be solvated, is not a solvate as the term is used herein.  In addition, where  features or aspects of  the  invention are described  in  terms of Markush  groups, those skilled in the art will recognize that the invention is also thereby described in terms of  any individual member or subgroup of members of the Markush group. For example, if X is described 15  as selected from the group consisting of bromine, chlorine, and iodine, claims for X being bromine and  claims for X being bromine and chlorine are fully described. Moreover, where features or aspects of  the invention are described in terms of Markush groups, those skilled in the art will recognize that the  invention is also thereby described in terms of any combination of individual members or subgroups  of members  of Markush  groups.  Thus,  for  example,  if  X  is described  as  selected  from  the  group 20  consisting of bromine, chlorine, and iodine, and Y is described as selected from the group consisting  of methyl, ethyl, and propyl, claims for X being bromine and Y being methyl are fully described.  If a value of a variable that is necessarily an integer, e.g., the number of carbon atoms in an  alkyl group or the number of substituents on a ring, is described as a range, e.g., 0‐4, what is meant is  that the value can be any integer between 0 and 4 inclusive, i.e., 0, 1, 2, 3, or 4.  25  In various embodiments, the compound or set of compounds, such as are used in the inventive  methods, can be any one of any of  the combinations and/or subcombinations of  the above‐listed  embodiments.  In  various  embodiments,  a  compound  as  shown  in  any  of  the  Examples,  or  among  the  exemplary compounds, is provided.  30  Provisos may apply to any of the disclosed categories or embodiments wherein any one or  more of the other above disclosed embodiments or species may be excluded from such categories or  embodiments.        Natural Killer Cells  Natural  Killer  (NK)  cells  exhibit  the  highest  level  of  cytotoxic  activity within  the  immune  system.   NK cells are similar  to B cells and T cells, but  lack specific cell surface antigen  receptors.   Instead, NK cells have activatory and inhibitory receptors that recognise motifs.    5  NK cells circulate in the blood and the peripheral lymphoid organs such as lymph nodes and  spleen.  They can become activated by cytokines or upon encountering target cells.  The recognition  and  elimination  of  target  cells  is  based  on  balancing  between  inhibitory  and  activatory  signals.   Activatory  signals are generated by activatory  receptors  (NKG2D, NKp46, NKp30) binding  to  ligands,  which  can  be  present  not  only  on  cancerous,  pathogen‐infected  and  damaged  cells,  but  also  on 10  healthy cells.   On  the other hand,  inhibitory signals are generated when  inhibitory  receptors  (KIR,  CD94/NKG2A) on NK cells bind to Major Histocompatability Complex (MHC) Class I molecules that are  normally present on all healthy cells.   MHC Class  I molecules on  target cells are absent or greatly  downregulated, making them ideal NK cell targets.  This allowed NK cells to distinguish between target  and healthy cells.  In order for NK cells to recognise and kill target cells, overall activatory signals must 15  be greater than inhibitory signals.  NK  cells  recognise and  kill  cancerous, pathogen‐infected and damaged  cells without prior  sensitisation, making them part of the  innate  immune response.   For example, NK cells provide an  early response to virus infection, occurring prior to T cell killing of infected cells.  NK cells can kill target  cells within minutes.   NK cells also secrete cytokines and “weaponise” other parts of  the  immune 20  system.  For example, NK cells promote T cell effector function and enhance antibody‐directed cellular  cytotoxicity (ADCC).  NK cells are differentiated from haematopoietic stem cells (HSCs) via the pathway set out in Figure 1.   In more detail, NK cells develop  from HSCs  into Common Lymphoid Progenitor  (CLP) cells, pre‐NK  progenitor (pre‐NKP) cells, NK progenitor (NKP) cells, immature NK (iNK) cells, mature NK (mNK) cells 25  and  finally  into  conventional  NK  (cNK)  cells, which  circulate  in  the  bloodstream.    Although  this  terminology derives from NK cell development in mice, a corresponding pathway occurs in human NK  cell development.  For example, HSCs develop through multiple stages of precursors (stage 1, 2 and  3), before developing into mature NK cells (stages 4 and 5).  For consistency, references HSCs, CLPs,  pre‐NKPs, NKPs, iNK, mNK, cNK and NK cells are used herein.    30  However, in the context of the present invention, these terms are interchangeable with stages  1 to 5 of the human nomenclature. Below the diagram of the pathway in Figure 1 are the cytokines  and transcription factors that are essential for NK cell development. IL‐15 is one of the main cytokines  required for the development of NK cells.  Other extrinsic factors, such as specific stromal cells, are  also required for the development and maturation of NK cells.  According to the present invention,  Hematopoietic Progenitor Cells  (HPCs)  are  a heterogeneous population  containing multi‐potential  progenitors such as HSCs, CLPs and also NKPs. HPCs are referred to as lineage negative cells, as they  have not yet committed  to a developmental pathway.   Accordingly,  in  the context of  the present  invention, HSCs, CLP cells and NKP cells are all HPCs and a reference to HPCs is a reference to any of  5  HSCs, CLP cells and/or CLP cells, or any combination thereof, unless explicitly stated to the contrary.  Due to the importance of NK cells in immune response, multiple clinical trials have tested the  efficacy of NK cells in adoptive transfer protocols.  Typically this is allogenic transfer, with the NK cells  being  isolated  from a healthy donor and expanded.   However,  the downregulation of MHC Class  I  molecules on target cells is partial and the KIR genotype from donors and recipients may be similar.  10  Due to this, NK cells transfused into recipients, even from different individuals may not attach target  cells if their KIRs recognise MHC Class I molecules.  Therefore, it is crucial that NK cell donors must be  screened for their KIR genotype, where the donor must have the appropriate KIR allelic polymorphism  to the recipient to allow recognition of target cells for destruction.  Moreover, the expanded products  were  found  to have  lower clinical success rate  than expected, with  less ability  to kill cancerous or 15  infected cells.  An  NK  cell may  be  defined  in  terms  of  its marker  expression,  its  function/activity,  or  a  combination  thereof.    Such definitions are  standard  in  the art  and methods are  known by which  marker expression and/or NK cell activity may be assessed.  Thus, one of skill in the art would readily  be able to categorise a cell as an NK cell using standard methodology and definitions.  20  For example, mNK and cNK cells may be recognised by their expression of the surface markers  CD16 (FcγRIII) and/or CD56, typically both CD16 and CD56  in humans, and NK1.1 or NK1.2  in some  mice strains.   NKp46 is another marker for mNK and cNK cells, and is expressed in humans and several  mice strains.  Thus, NKp46 may be used as a marker for NK cells either with or without CD16 and/or  CD56 (in humans) or with or without NK1.1 or NK1.2 (in mice).  Other examples of makers which can 25  be  used  to  identify/define  NK  cells  according  to  the  present  invention  include  Ly49,  natural  cytotoxicity  receptors  (NCRs), CD94, NKG2, killer‐cell  immunoglobulin‐like  receptors  (KIRs), and/or  leukocyte inhibitory receptors (ILT or LIR), or any combination thereof, including in combination with  CD16 and or CD56 (in humans) or NK1.1/NK1.2 (in mice).  In some preferred embodiments mature NK  cells according to the  invention (i.e. mNK and cNK cells) are CD56+ and CD45+, and may be also be 30  CD16+. As used herein, the term mature human NK cell encompasses NK cells that are CD56bright (stage  4) and CD56dim (stage 5), both of which are CD56+.  Mature NK cells may also be defined by the absence  of markers, such as CD34, and lymphocyte markers CD3 and/or CD19.  Thus, mature NK cells of the  invention may be CD56+, CD45+, CD16+, CD3 and/or CD19, or any combination thereof, such as CD56+,  CD45+, CD16+, CD3 and CD19.  In addition or alternatively, an NK may be identified by/defined in terms of its activity.  For  example,  an  NK  cell  may  be  identified/defined  by  the  presence  of  cytolytic  granules  within  its  cytoplasm, by its ability to secrete antimicrobial molecules such as α‐defensins, and/or its ability to  secrete cytokines such as TNF‐α, IL‐10, IFN‐γ and TFG‐β.   5    Unless otherwise stated herein, a reference to NK cells includes a reference to iNK, mNK and   cNK cells.  HSCs, CLP cells and NKPs will typically be referred to as such.    Expanded NK cell populations    As disclosed herein, the invention provides methods for generating an expanded population 10  of NK  cells  (referred  to  interchangeably  herein  as  an  expanded NK  cell  population  or  an NK  cell  population).  Any of the disclosure herein in relation to NK cells of the present invention may also be  applied to an expanded NK cell population of the invention.    Accordingly,  the present  invention provides an expanded NK cell population.   Typically an  expanded NK cell population of the  invention comprises  iNK cells, mNK cells and/or cNK cells, or a 15  combination thereof.  Said population may comprise HPCs, such as HSCs, CLP cells and/or NKPs, or a  combination thereof, although the numbers of such cells is typically low relative to the number of NK  cells, as the majority of these HPCs have differentiated into NK cells in the population.  Said population  may comprise other immune and/or non‐immune cells.  Again, the number of any such cells is typically  low relative to the number of NK cells present in the population.   20    As a non‐limiting example, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%,  at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least  98%, at least 99% or more, up to 100% of the cells of an expanded NK cell population of the invention  may be NK cells.  Typically at least 80%, preferably at least 90%, more preferably at least 95% of the  cells of an expanded NK cell population of the invention are NK cells.   25  In some embodiments, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at  least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least  98%, at least 99% or more, up to 100% of the cells of an expanded NK cell population of the invention  are mature NK cells (i.e. mNK cells and/or cNK cells).  Preferably at least 80%, more preferably at least  90%, and even more preferably at least 95%, even more preferably at least 98% or more of the cells 30  of an expanded NK cell population of the invention are mature NK cells.  The number of HPCs (including HSCs, CLP cells and/or NKPs) may be less than 40%, less than  30%, less than 25%, less than 20%, less than 15%, less than 14%, less than 13%, less than 12%, less  than 11 %, less than 10%,  less than 9%, less than 8%, less than 7%, less than 6%, less than 5%, less  than 4%,  less than 3%,  less than 2%,  less than 1% of the cells of the expanded NK cell population.   Typically the number of HPCs (including HSCs, CLP cells and/or NKPs) is less than 20%, preferably less  than 10%, more preferably less than 5%, even more preferably less than 2% or less of the cells of the  expanded NK cell population.   The number of other immune and/or non‐immune cells may be less than 40%, less than 30%,  5  less than 25%, less than 20%, less than 15%, less than 14%, less than 13%, less than 12%, less than 11  %, less than 10%, less than 9%, less than 8%, less than 7%, less than 6%, less than 5%, less than 4%,  less than 3%, less than 2%, less than 1% of the cells of the expanded NK cell population.  Typically the  number of other immune and/or non‐immune cells is less than 20%, preferably less than 10%, more  preferably less than 5% of the cells, even more preferably less than 2%, or less of the expanded NK 10  cell population.   As described herein, the expanded NK cell populations made by the methods of the present  invention offer several advantages over NK cell populations made by conventional adoptive transfer  methods.    In particular,  the methods of  the present  invention enable  the production of expanded  populations with greater number of NK cells compared with conventional methods.  Further, a greater 15  proportion of the NK cells in a population of the invention are functional, preferably fully functional,  compared with populations obtained by conventional methods,  in which a  large number of the NK  cells are “exhausted”.  As used herein,  the  term “exhausted”  in  the context of NK cells means  that an NK cell or  expanded NK cell population has lost at least some of its effector functions, such as cytotoxic function, 20  cytokine production and/or ADCC.  Thus, an exhausted NK cell or expanded NK cell population may  exhibit impaired survival, impaired cytotoxic function, altered or impaired cytokine production and/or  impaired ADCC. For example, an exhausted NK cell or exhausted NK cell population may exhibit at  least a 50% reduction in one of its effector functions.  For example, at least a 50% reduction in cytokine  secretion, at least a 50% reduction in ADCC and/or at least 50% reduction in cytotoxic activity.  These 25  values may be quantified  relative  to any appropriate  control as defined herein.   Any appropriate  technique can be used to determine effector function, and hence to quantify and reduction therein.   Suitable techniques are known  in the art.   Alternatively and/or  in addition, exhausted NK cells may  exhibit altered marker expression, such as an  increase  in the expression of one or more  inhibitory  receptor (as described herein) and/or a decrease in the expression of one or more activatory receptor 30  (as described herein).   In some embodiments,  increased expression of NKG2A and/or Tim3 may be  used as a marker for NK cell exhaustion.  Again, the expression of these markers may be quantified  relative to any appropriate control as defined herein.    In contrast, the terms “functional” and “fully functional” in the context of NK cells means that  an NK cell or expanded NK cell population has all of the expected effector functions when responding  to a given  immune challenge.   Thus, a (fully) functional NK cell or expanded NK cell population will  typically exhibit cytotoxic function, cytokine production and/or ADCC as would be observed  in vivo  when NK cells are activated in response to an immune challenge, and will typically exhibit enhanced  survival  compared  with  NK  cells  produced  using  conventional  methods.  Alternatively  and/or  in  5  addition, (fully) functional NK cells may exhibit altered marker expression, such as an increase in the  expression  of  one  or  more  activatory  receptor  (as  described  herein)  and/or  a  decrease  in  the  expression of one or more  inhibitory receptor  (as described herein).   As a non‐limiting example, a  functional (mature) human NK cell may be CD56+ and/or CD45+, preferably both CD56+ and CD45+.  As  a  non‐limiting  example,  the  cytotoxicity  of  NK  cells  can  be  determined  using  a 10  degranulation  assay  in  NK  cells  co‐incubated  with  ‘target  cells’.  A  degranulation  assay  involves  analysing the expression of CD107a within the NK cell population. The amount of CD107a correlates  with cytokine secretion and NK cell‐mediated lysis of target cells. NK cells can also be analysed for the  expression of Interferon‐γ (IFN‐ γ), which is the main cytokine secreted when functional NK cells are  activated. NK cells that are functional should express similar or higher CD107a as well as IFN‐γ when 15  compared to a control.     Any  increase  in NK cell number/functionality  in an expanded NK cell population made by a  method of the present invention may be compared with the NK cell number/function of an NK cell  population obtained  from  a  control method  as described herein.   A  control method may be  any  standard method known in the art for producing NK cell populations.  For example, a control method 20  may use conventional adoptive transfer techniques, rather than a method using a REV‐ERB inhibitor  according  to  the  present  invention.    NK  cells  and  NK  cell  populations  produced  by  such  control/standard methods may be used as control cells and populations as described herein.  As an expanded NK  cell population of  the present  invention  comprises  significantly  fewer  exhausted NK cells compared to conventionally prepared NK cell populations, but instead contains a 25  higher proportion of fully functional NK cells, this advantageously allows the use of smaller numbers  of cells to treat patients.    As described herein, the methods of the invention produce expanded NK cell populations with  a higher proportion of (fully) functional NK cells compared with conventional methods, which produce  populations with large numbers of “exhausted” NK cells.  Typically, in an expanded NK cell population 30  of the invention at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at  least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least  98%, at  least 99% or more, up  to 100% of  the NK  cells of an expanded NK  cell population of  the  invention are  (fully) functional.   Typically at  least 80%, preferably at  least 90%, more preferably at  least 95%, even more preferably at least 98% or more of the NK cells of an expanded NK cell population  of the invention are fully functional, according to any definition (e.g. marker and/or effector function  definition) herein.     An expanded NK cell population of the  invention may be produced by any of the methods  disclosed herein.  Typically an expanded NK cell population of the invention is produced by an ex vivo  5  method as disclosed herein.    E4bp4    E4bp4  (also  known as Nfil3)  is a basic  leucine  zipper protein  transcription  factor which  is  involved in the regulation of IL‐3 expression, and is involved in the coordinating the circadian clock.  10  The genomic DNA sequence of the human E4bp4 gene is given in SEQ ID NO: 1 (Genbank Accession  No. X64318, version X64318.1). As shown in Figure 1, E4bp4 is expressed in CLPs and is critical in the  production of NK cells from blood stem cell progenitors.  Mice with the E4bp4 gene deleted do not  have functional NK cells, but have normal numbers of T and B cells.   In contrast, overexpression of  E4bp4  in HSCs  in vitro  increases NK cell production.   Thus, E4bp4  is a  lineage commitment  factor, 15  controlling  the development of NKPs  from HSCs  (Figure 1).   E4bp4’s critical  function  in NK cells  is  specific to the early stages of the developmental pathway, as specific ablation of E4bp4 in peripheral  mNK cells does not affect NK cell number or response to cytomegalovirus infection.  In addition E4bp4  regulates other transcription factors that are essential in NK cell development, such as Id2 and Eomes.    Although IL‐7 and IL‐15 have been shown to regulate E4bp4 expression, generally very little is 20  known about how either extrinsic or intrinsic stimuli influence E4bp4.  Transcription factors such as  E4bp4 can be hard to target because of their structure and function.  For example, they usually lack  enzymatic  activity  or  cofactor  binding  sites.    However,  the  present  inventors  have  previously  demonstrated that E4bp4 expression can be increased using a compound which inhibits the activity  of REV‐ERB  (see  PCT/GB2018/050542, particularly  the  examples, which  is  herein  incorporated  by 25  reference in its entirety).  Further, the present inventors have demonstrated that the use of a REV‐ ERB inhibitor to increase E4bp4 expression results in an increase in NK cell number.  Without wishing  to be bound by theory, REV‐ERB binds to porphyrin heme, and it is this characteristic that is believed  to make REV‐ERB a druggable target (see below).  In sum, the inventors have shown that by targeting  REV‐ERB and inhibiting its activity, it is possible to increase E4bp4 expression and hence increase NK 30  cell number.  Accordingly, the present invention is concerned with compounds which inhibit the action  of REV‐ERB, and their use in increasing E4bp4 expression, and hence NK cell number.        Increase in E4bp4 expression    Accor ,    ent invention provides ex vivo methods for producing expanded NK cell  populations, and therapeutic methods and applications for increasing NK cell number in a patient in  need  thereof.   As disclosed herein, said methods and applications  involve  the use of a compound  5  which inhibits the action of REV‐ERB.  Typically said compounds act by increasing E4bp4 expression.  An increase in E4bp4 expression may be measured relative to a control.  Thus, the expression  of E4bp4 in a sample of HPCs, an expanded NK cell population or in a sample obtained from a patient  to be treated according to the invention may be compared with the expression of E4bp4 in a control.   Expression may be quantified in terms of gene and/or protein expression, and may be compared with 10  expression of a control (e.g. housekeeping gene or protein).  The actual amount of the E4bp4 gene,  mRNA transcript and/or protein, such as the mass, molar amount, concentration or molarity of the  E4bp4 gene, mRNA transcript and/or protein, or the number of mRNA molecules per cell in a sample  of HPCs,  an  expanded NK  cell  population  or  in  a  sample  obtained  from  a  patient  to  be  treated  according to the  invention and the control may be assessed and compared with the corresponding 15  value from the control.  Alternatively, the expression of the E4bp4 gene and/or protein in a sample of  HPCs, an expanded NK cell population or in a sample obtained from a patient to be treated according  to  the  invention may be  compared with  that of  the  control without quantifying  the mass, molar  amount, concentration or molarity of the one or more gene and/or protein.    Typically  the  control  is an equivalent population or  sample  in which no  increase  in E4bp4 20  expression has been effected.  As a non‐limiting example, in the case where a patient is treated with  a compound that inhibits REV‐ERB activity in order to increase E4bp4 expression, a suitable control  would  be  a  different  individual  to which  the  compound  has  not  been  administered  or  the  same  individual prior to administration of the compound.  Conventional methods for the ex vivo expansion  of NK cells, including known methods may be considered control methods according to the present 25  invention.    In the context of the present invention, a reference to increasing E4bp4 expression may be  understood to mean that, the expression of E4bp4 is increased by at least 10%, at least 20%, at least  30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at  least 95%, at  least 100%, at  least 150%, at  least 200% compared with the control.   Typically E4bp4 30  expression is increased by at least 50%, preferably at least 70%, more preferably at least 80%, even  more preferably at least 90% or more compared with the control.  A reference to increasing E4bp4 expression may be understood to mean that, the expression  of E4bp4 is increased by at least 1.5‐fold, at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at least 2.3‐ fold, at least 2.4‐fold, at least 2.5‐fold, at least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at least 2.9‐ fold, at least 3‐fold, at least 4‐fold, at least 5‐fold, at least 6‐fold, at least 7‐fold, at least 8‐fold, at least  9‐fold, at least 10‐fold or more relative to a control.  Typically E4bp4 gene expression is increased by  at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at least 2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at  least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at least 2.9‐fold, at least 3‐fold, or more compared  5  with the control.   Typically E4bp4 protein expression  is  increased by at  least 2‐fold, at  least 3‐fold,  preferably at least 5‐fold, more preferably at least 6‐fold or more compared with the control.  The  expression  of  the  E4bp4  gene  and/or  protein  according  to  the  invention  may  be  determined by quantitative and/or qualitative analysis.  Typically, gene expression may be expressed  in terms of mRNA levels.    10  The  expression  level  of  the  E4bp4  gene  and/or  protein  according  to  the  invention  encompasses the mass of the E4bp4 mRNA transcript and/or protein, the molar amount of the E4bp4  gene, mRNA transcript and/or protein, the concentration of the E4bp4 gene and/or protein and the  molarity of the E4bp4 gene and/or protein.   This expression  level may be given  in any appropriate  units. For example, the concentration of the E4bp4 gene and/or protein may be given in pg/ml, ng/ml 15  or μg/ml.   The expression  level of  the E4bp4 gene and/or protein according  to  the  invention may be  measured directly or indirectly.   The relative expression of the E4bp4 gene and/or protein according to the invention relative  to a control may be determined using any appropriate technique.  Suitable standard techniques are 20  known in the art, for example Western blotting, enzyme‐linked immunosorbent assays (ELISAs) and  RT‐qPCR.    The expression  level of the E4bp4 gene and/or protein may be  increased compared with a  control for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at  least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, 25  at least 5 days, at least 6 days, at least 1 week.  Preferably, the expression level of the E4bp4 gene  and/or protein is increased for at least 12 to 72 hours.  Typically this is assessed relative to the last  administration of the compound which inhibits REV‐ERB activity.    The expression  level of the E4bp4 gene and/or protein may be  increased compared with a  control for at least one, at least two, at least three, at least four, at least five, at least ten, at least 20, 30  at least 30, at least 40 or more passages of the NK cell precursors in culture.  The expression level of  the E4bp4 gene and/or protein may be altered indefinitely.         REV‐ERB    REV‐ERB proteins are members of the nuclear receptor  family of  intracellular transcription  factors.  The mRNA sequence of the human REV‐ERBα gene (Nr1d1) is given in SEQ ID NO: 3 (Genbank  Accession No. NM_021724, version NM_021724.4). The mRNA  sequence of  the human REV‐ERBβ  5  gene (Nr1d2) is given in SEQ ID NO: 5 (Genbank Accession No. AB307693, version AB307693.1). REV‐ ERB  regulates  the  circadian  clock,  and  has  also  been  implicated  in  the  regulation  of  cartilage  breakdown.    The present  inventors have previously demonstrated  that  inhibition of REV‐ERB activity  is  sufficient  to elicit a significant  increase  in E4bp4 expression, and  that  this  in  turn brings about an 10  expansion of NK cells, resulting in an increase in NK cell number (see PCT/GB2018/050542, particularly  the examples, which is herein incorporated by reference in its entirety).  Inhibition of REV‐ERB activity  can bring about an  increase  in NK cell number, and  that  typically  the  resulting NK cells are  (fully)  functional as defined herein.   The effect of REV‐ERB  inhibition  is mediated  in an E4pb4‐dependent  manner.   Without wishing  to be bound by  theory,  it  is believed  that  inhibition of REV‐ERB activity 15  results in an increase in E4bp4 expression (E4bp4 expression is normally repressed by REV‐ERB), and  that the E4bp4 acts to stimulate the production of NK cells (as shown in Figure 1).  In particular, the  present  inventors  have  previously  demonstrated  that  the  small  molecule  SR8278  is  capable  of  inhibiting REV‐ERB activity, resulting in an increase in NK cell number.   However, the pharmacological profile of SR8278 is such that it is not ideal for use in a clinical 20  setting.  Furthermore, the lack of information on the mechanism of action of SR8278 and the lack of  suitable structure‐activity relationships surrounding this molecule has hindered the discovery of other  compounds with REV‐ERB  inhibitory activity.    Indeed, although many synthetic  ligands for REV‐ERB  have been generated in the art, the vast majority of these have been identified as agonists, with over  300 REV‐ERB agonists identified.  The present inventors have generated a library of novel compounds, 25  and have demonstrated that such compounds possess improved REV‐ERB inhibitory activity compared  with one known REV‐ERB inhibitor, SR8278.  Accordingly, the present invention is concerned with such improved REV‐ERB antagonists, i.e.  compounds with  improved  inhibitory  activity  against  the  action of REV‐ERB,  and  the use of  such  compounds in increasing E4bp4 expression, and hence NK cell number.    30    Inhibition of REV‐ERB activity  The present invention relates to the use of compounds to inhibit the action of REV‐ERB, i.e.  compounds which  inhibit REV‐ERB activity.   REV‐REB activity may be  inhibited by any appropriate  means.  Suitable standard techniques are known in the art.  Inhibition may take place via any suitable  mechanism, depending  for example on  the nature  (see below) of  the  compound used, e.g.  steric  interference in any direct or indirect interaction or inhibition of REV‐ERB.  In the context of the present  invention a REV‐ERB  inhibitor  (interchangeably  referred  to herein as a REV‐ERB antagonist)  is any  compound which inhibits, decreases, suppresses or ablates the action of REV‐ERB, whether in part or  5  completely.  A decrease in REV‐ERB activity may be measured relative to a control.  Thus, the activity of  REV‐ERB in a sample of NK precursor or progenitor cells, an expanded NK cell population or in a sample  obtained from a patient to be treated according to the invention may be compared with the activity  of REV‐ERB in a control.  Activity may be quantified in any appropriate terms, for example binding of 10  REV‐ERB  to  the E4bp4 gene, or  in  terms of E4bp4 expression  as defined herein. Any appropriate  technique or method may be used for quantifying REV‐ERB activity.  Suitable techniques are known in  the art, for example luciferase assays for quantifying expression of a reporter gene.  Typically  the control  is an equivalent population or sample  in which no REV‐ERB  inhibitory  compound has been added, for example a sample obtained from a different individual to which the 15  compound  has  not  been  administered,  or  the  same  individual  the  prior  to  administration  of  the  compound.   Conventional methods for the ex vivo expansion of NK cells,  including known methods  may be considered control methods according to the present invention.    In  the context of  the present  invention, a  reference  to  inhibiting REV‐ERB activity may be  understood to mean that, the activity of REV‐ERB is decreased by at least 10%, at least 20%, at least 20  30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 85%, at least 90%, at  least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least  98%, at  least 99%, up to total (100%)  inhibition of REV‐ERB activity, as compared with the control.   Typically REV‐ERB activity  is decreased by at  least 50%, preferably at  least 70%, more preferably at  least 80%, more preferably at least 90%, even more preferably at least 95% or more compared with 25  the control.  The activity of REV‐ERB may be determined by quantitative and/or qualitative analysis, and  may be measured directly or indirectly.   The  activity  of  REV‐ERB  relative  to  a  control may  be  determined  using  any  appropriate  technique.    Suitable  standard  techniques  are  known  in  the  art,  such  as  by  quantifying  E4bp4 30  expression, and/or luciferase assays.     The activity of REV‐ERB may be inhibited compared with a control for at least 6 hours, at least  12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at  least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at  least 1 week.  Preferably, the activity of REV‐ERB is decreased for at least 12 to 72 hours.  Typically this  is assessed relative to the last administration of the compound which inhibits REV‐ERB activity.   The activity of REV‐ERB may be  inhibited compared with a control for at  least one, at  least  two, at least three, at least four, at least five, at least ten, at least 20, at least 30, at least 40 or more  5  passages of the cells (either in vivo, or cultured ex vivo or in vitro).  The activity of REV‐ERB may be  inhibited and/or the expression level of the E4bp4 gene and/or protein may be altered indefinitely.    In the context of the present  invention any reference to  inhibiting REV‐ERB activity may be  understood to mean inhibiting the activity of REV‐ERBα and/or REV‐ERBβ.  In preferred embodiments,  the activity of both REV‐ERBα and REV‐ERBβ is inhibited.  Thus, the invention relates to compounds 10  which  inhibit REV‐ERB activity,  including compounds which  inhibit REV‐ERBα activity (i.e. REV‐ERBα  inhibitors, also referred to as REV‐ERBα antagonists) and/or to compounds which  inhibit REV‐ERBβ  activity  (i.e.  REV‐ERBβ  inhibitors,  also  referred  to  as  REV‐ERBβ  antagonists).    In  preferred  embodiments, the  invention relates to compounds which  inhibit the activity of both REV‐ERBα and  REV‐ERBβ  (i.e.  REV‐ERBα  and  REV‐ERBβ  inhibitors,  also  referred  to  as  REV‐ERBα  and  REV‐ERBβ 15  antagonists).    R REV‐ERB inhibitory compounds of the invention may be specific for REV‐ERB.  By specific, it  will be understood that the compound binds to REV‐ERBα and/or REV‐ERBβ, with no significant cross‐20  reactivity  to  any  other molecule,  particularly  any  other  protein.    For  example, modulator  that  is  specific for REV‐ERBα and/or REV‐ERBβ will show no significant cross‐reactivity with human neutrophil  elastase.   Cross‐reactivity may be  assessed by  any  suitable method. Cross‐reactivity of REV‐ERBα  and/or REV‐ERBβ inhibitor with a molecule other than REV‐ERBα and/or REV‐ERBβ may be considered  significant  if the  inhibitor binds to the other molecule at  least 5%, 10%, 15%, 20%, 25%, 30%, 35%, 25  40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90% or 100% as strongly as it binds to REV‐ERBα  and/or REV‐ERBβ.   An inhibitor that is specific for REV‐ERBα and/or REV‐ERBβ may bind to another  molecule such as human neutrophil elastase at less than 90%, 85%, 80%, 75%, 70%, 65%, 60%, 55%,  50%, 45%, 40%, 35%, 30%, 25% or 20%  the  strength  that  it binds  to REV‐ERBα and/or REV‐ERBβ.   Preferably, the inhibitor binds to the other molecule at less than 20%, less than 15%, less than 10% or 30  less than 5%, less than 2% or less than 1% the strength that it binds to REV‐ERBα and/or REV‐ERBβ.  REV‐ERB  inhibitory compounds of  the  invention may have off‐target effects.   An off‐target  effect is activity against a target other than REV‐ERB.  Typically compounds with off‐target effects are  encompassed by the present invention if the activity against the non‐REV‐ERB target is not significant  compared with the activity against REV‐ERB.  Whether an off‐target effect is significant may depend  on the intended use of the compound.  As a non‐limiting example, a compound which may exert an  off‐target effect on the central nervous system would not be significant for a compound used in an ex  vivo method as disclosed herein, but may be significant (depending on the magnitude of the off‐target  effect) for an in vivo therapeutic indication as disclosed herein.  The presence and magnitude of any  5  potential off target effects can be readily assessed using standard methods known in the art.    Small molecules    The compounds of the invention used to inhibit REV‐ERB activity as described herein are small  molecules.  As defined herein, small molecules are low molecular weight compounds, typically organic 10  compounds.  Typically, a small molecule has a maximum molecule weight of 900 Da, allowing for rapid  diffusion across cell membranes.  In some embodiments, the maximum molecular weight of a small  molecule is 500 Da.    According to the present invention, small molecules may be able to exert an inhibitory effect  on REV‐ERB activity by binding to the porphyrin heme moiety of REV‐ERB. Thus  in some preferred 15  embodiments, a compound that inhibits the action of REV‐ERB according to the present invention is a  compound which binds to the porphyrin heme moiety of REV‐ERB, and hence inhibits the activity of  REV‐ERB.  Alternatively, the small molecule may act via a different mechanism, for example, by binding  to a non‐heme portion of REV‐ERB.  Standard techniques are known in the art for the production of  small molecules, which can then readily be tested for REV‐ERB inhibitory activity as described herein 20            25            30      Structure of porphyrin heme    The  inventors  have  generated  new  library  of  compounds  that  inhibit  REV‐ERB  activity  (referred to interchangeably herein as inhibiting the action of REV‐ERB).  These compounds are based  on  the  structure  of  compounds  from  their  previous  work  (see  WO  2020/002911),  but  lack  a  hydrocarbyl substituent at R1, a group previously thought to be fundamental to the inhibitory action  of the compounds.  Rather than having the expected reduced REV‐ERB inhibitory activity compared  to their hydrocarbyl ester analogues, compounds of the present invention have been shown to exhibit  5  an enhanced inhibitory action.  This outcome was entirely unexpected for the present inventors.      Accordingly, the compounds used in the present invention have formula (I):    I)    10  where:   represents bonds that are all either present or absent;  R1 is hydrogen;  R2  is  selected  from 5‐10 membered heterocyclyl  rings and C1‐6 hydrocarbyl, and  is  optionally  substituted with  one  or more  groups  independently  selected  from  C1‐4  hydrocarbyl,  ‐OR’,  ‐OC(O)R’,  ‐C(O)OR’,  ‐SR’,  ‐S(O)R’,  ‐S(O)2R’,  ‐NR’2,  ‐NR’C(O)R’,  15  ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;  X is selected from ‐O‐ and NR’;   Y is selected from ‐C(O)‐ and ‐CR’2‐;  Z is selected from ‐O‐ and ‐NR’‐ or is absent;  each Ra is independently selected from H, C1‐4 hydrocarbyl, ‐OR’, ‐OC(O)R’, ‐C(O)OR’, ‐20  SR’, ‐S(O)R’, ‐S(O)2R’, ‐NR’2, ‐NR’C(O)R’, ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;   each Rb is independently selected from H, C1‐4 hydrocarbyl and ‐OR’;   Rc is selected from H and C1‐4 hydrocarbyl; and   each R’ is independently selected from H, C1‐4 hydrocarbyl and ‐Ph;    or a pharmaceutically acceptable salt thereof.  25  As  described  above,    represents  bonds  that  are  all  either  present  or  absent.   Accordingly, the present invention relates to both closed ring structures of formula (Ia) and open ring  structures of formula (Ib):    )  R R   ).    5  Preferably,   represents bonds that are all present and the compound  is a closed ring  structure of formula (Ia).  In compounds of formula (I), R1 is hydrogen.    In compounds of formula (I), R2 is selected from 5‐10 membered heterocyclyl rings and C1‐6  hydrocarbyl, and is optionally substituted.  Preferably, R2 is selected from optionally substituted 5‐10 10  membered heterocyclyl rings.    The  5‐10  membered  heterocyclyl  ring  of  R2  preferably  contains  one  to  four,  and  more  preferably one or two, heteroatoms.  The heteroatoms are preferably selected from oxygen, nitrogen  and  sulfur.    It  will  be  appreciated  that  a  heterocyclyl  ring may  comprise multiple  of  the  same  heteroatom, e.g. two nitrogen atoms, or a mixture of heteroatoms, e.g. a nitrogen atom and an oxygen 15  atom.    R2 is preferably selected from 5‐10 membered heteroaryl rings, and more preferably from 5‐,  6‐ or 9‐membered heteroaryl rings.  Non‐limiting examples of 5‐membered heteroaryl rings include  furanyl,  thiophenyl,  oxazolyl,  isooxazolyl,  isothiazolyl,  thiazolyl,  pyrazolyl,  imidazolyl,  pyrrolyl  and  triazolyl.    Non‐limiting  examples  of  6‐membered  heteroaryl  rings  include  pyridinyl,  pyridazinyl, 20  pyrimidinyl and pyrazinyl.   Non‐limiting examples of 9‐membered heteroaryl  rings  include  indolyl,  isoindolyl,  indazolyl,  benzimidazolyl,  azaindolyl,  benzofuranyl,  isobenzofuranyl,  benzisoxazolyl  and  benzoxazolyl.    Optionally  substituted  5‐membered  heteroaryl  rings  are  particularly  preferred,  in  particular optionally substituted furanyl and oxazolyl.   Where R2  is optionally substituted C1‐6 hydrocarbyl,  it  is preferably selected from optionally  substituted phenyl and optionally substituted C1‐6 alkyl.     5  Where R2 is optionally substituted phenyl, the phenyl group is preferably substituted.   Where R2 is optionally substituted C1‐6 alkyl, the alkyl group is preferably unsubstituted, and  as such R2 is preferably selected from C2‐4 alkyl, such as from ethyl, propyl (e.g. ‐iPr) and butyl (e.g.   ‐tBu).    R2  is  optionally  substituted  with  one  or  more  groups  independently  selected  from  C1‐4 10  hydrocarbyl (preferably C1‐4 alkyl), ‐OR’, ‐OC(O)R’, ‐C(O)OR’, ‐SR’, ‐S(O)R’, ‐S(O)2R’, ‐NR’2, ‐NR’C(O)R’,   ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen.  Preferably, R2 is unsubstituted or substituted with one or  two of  these groups.   Particularly preferred  substituents  for R2  include  ‐Me,  ‐OMe,  ‐CN,  ‐NO2,  ‐F,   ‐Cl, ‐I and ‐SMe.    In compounds of formula (I), X is selected from ‐O‐ and ‐NR’‐.  X is preferably ‐O‐.    15  In compounds of formula (I), Y is selected from ‐C(O)‐ and ‐CR’2‐.  Y is preferably ‐C(O)‐.    In compounds of formula (I), Z  is selected from  ‐O‐ and  ‐NR’‐ or  is absent.   Preferably, Z  is  selected from ‐O‐ or is absent.  Where R2 is an alkyl group, Z is preferably selected ‐O‐ and ‐NR'‐ and  preferably is ‐O‐.  Where R2 is a heterocyclyl ring, Z is preferably absent.      In  compounds  of  formula  (I),  each  Ra  is  independently  selected  from H,  C1‐4  hydrocarbyl 20  (preferably C1‐4 alkyl),  ‐OR’,  ‐OC(O)R’,  ‐C(O)OR’,  ‐SR’,  ‐S(O)R’,  ‐S(O)2R’,  ‐NR’2,  ‐NR’C(O)R’,  ‐C(O)NR’2,   ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen.  Preferably, each Ra is independently selected from H, C1‐4 alkyl, ‐OR’  and ‐NR’2, and more preferably from H and C1‐4 alkyl.  More preferably, each Ra is preferably H.   In  compounds  of  formula  (I),  each  Rb  is  independently  selected  from H,  C1‐4  hydrocarbyl  (preferably C1‐4 alkyl) and ‐OR’.   Preferably, each Rb is independently selected from H and C1‐4 alkyl, 25  and more preferably is H.   In compounds of formula (I), Rc is selected from H and C1‐4 hydrocarbyl (preferably C1‐4 alkyl).   Preferably, Rc is H.     In compounds of formula (I), each R’ is independently selected from H and C1‐4 hydrocarbyl  (preferably C1‐4 alkyl) and ‐Ph.  Preferably, each R’ is independently selected from H and C1‐4 alkyl, more 30  preferably from H, methyl and ethyl, and more preferably from methyl and ethyl.      In preferred embodiments, X  is ‐O‐ and the compounds used  in the present  invention have  the formula (II):  I)  where R1, R2, Ra , Rb, Rc, Y and Z are as defined previously.   5  In  further preferred embodiments, Rb and Rc are all H, and so  the compounds used  in  the  present invention have the formula (III):  I)  where R1, R2, Ra, Y and Z are as defined previously.  In  further  preferred  embodiments,  Y  is  ‐C(O)‐  and  the  compounds  used  in  the  present 10  invention have the formula (IV):       (IV)  where R1, R2, Ra and Z are as defined previously.       In a further preferred embodiment, the compounds used in the present invention are closed  ring structures having the formula (V):  V)  e R1, R2 wher , Ra and Z are as defined previously.  5  In further preferred embodiments, Ra are also all H, and so the compounds used in the present  invention have the formula (VI):          I)    10  where R1, R2 and Z are as defined previously.   It will be appreciated that compounds of formulas (II)‐(VI) may also be used in the form of a  pharmaceutically acceptable salt.      Specific examples of compounds according to the present invention are set out in Table 1  below:  15      acid7  O OH N O   acid66  O OH N O HN   acid72  O OH N O O   acid73    Table 1: Exemplary compounds of the invention        It will be appreciated that each of the compounds depicted in Table 1 may be used in the 5  form of a pharmaceutically acceptable salt.    Compounds acid4, acid7, acid11, acid27, acid 44, acid72, acid73, acid78, acid79 and acid 80  are preferred.        Compounds acid7 and acid11 are particularly preferred:  (compound acid11).    Compound acid4, acid27, acid44, acid 73, acid78 and acid 80 are also particularly preferred.    5  In  some  embodiments,  the  compound  of  formula  (I)  is  also  not  disclosed  in  either WO  2013/033310 or WO 2015/103527.  For instance, in some instances, e.g. in relation to the compounds  and  compositions per  se of  the present  invention,  the  compound of  formula  (I)  is preferably not  selected from:   10  ,  ,  ,  ,  ,  ,  .    5    It will be understood  that, where  stereochemistry  is not  shown,  the disclaiming of  these  compounds  disclaims  any  enantiomeric  form  of  the  compounds,  including  the  R‐  and  the  S‐ enantiomer,  as well  as  racemic  (or  other  enantiomeric) mixtures.   Where  the  stereochemistry  is  shown, it is only the depicted stereoisomer that is disclaimed though in preferred embodiments all  stereoisomeric forms of the compound are disclaimed.  Although the disclaimed compounds are not 10  products per se of the present invention, these compounds may nevertheless be used in the methods  and medical uses/therapeutic indications described herein.  However, in preferred embodiments, they  are not used at all in the present invention.     The  compounds  per  se  of  the  invention may  be  provided  in  an  isolated  form.    It will  be  appreciated  that  a  compound  in  an  isolated  form  is  equivalent  to  a  composition which  consists 15  substantially of the compound.   For  instance, an  isolated compound of formula (I) will contain  less  than 10%, and typically less than 1% by weight of impurities, i.e. substances other than compounds of  formula (I).    It will be understood that when compounds of the present  invention contain one or more  chiral  centres,  the  compounds  may  exist  in,  and  may  be  isolated  as  pure  enantiomeric  or 20  diastereomeric forms or as racemic mixtures. The present invention therefore includes any possible  enantiomers, diastereomers, racemates or mixtures thereof of the compounds of the invention. Thus,  compounds of formula (I) may be used in a racemic mixture, or as single enantiomers, i.e.:    .    The compounds of formula (I) may have rotameric forms, or may not have rotational activity.   Rotameric  forms  include  slow  rotating  forms  and  fast  rotating  forms.    In  some  preferred  embodiments, fast rotating forms of the compounds of formula (I) are preferred.  For example,  5    .    A compound of the formula (I) or a salt thereof may exhibit the phenomenon of tautomerism  whereby  two  chemical  compounds  that  are  capable  of  facile  interconversion  by  exchanging  a 10  hydrogen atom between two atoms, to either of which it forms a covalent bond. Since the tautomeric  compounds exist in mobile equilibrium with each other they may be regarded as different isomeric  forms  of  the  same  compound.  It  is  to  be  understood  that  the  formulae  drawings  within  this  specification  can  represent  only  one  of  the  possible  tautomeric  forms. However,  it  is  also  to  be  understood that the invention encompasses any tautomeric form, and is not to be limited merely to 15  any one tautomeric form utilized within the formulae drawings. The formulae drawings within this  specification can represent only one of the possible tautomeric forms and it is to be understood that  the specification encompasses all possible tautomeric forms of the compounds drawn not just those  forms which  it has been convenient  to  show graphically herein.     Thus, compounds of  formula  (I)  according to the invention encompass tautomers (including keto‐enol and amide‐imidic acid forms).   20    Accordingly, a structure depicted herein as one tautomer is intended to also include the other  tautomer.  Compounds may be used in the form of salts, hydrates and solvate forms, as defined in the  Definitions section herein. It will be appreciated that salt forms of the compound may themselves be  in the form of hydrates or solvate forms.   The compounds of the present invention typically have improved REV‐ERB inhibitory activity  compared with SR8278.  This inhibitory activity may be measured by any appropriate means, such as  conventional means known  in the art and/or the methods described herein.    In the context of the  present  invention,  a  reference  to  a  compound with  improved REV‐ERB  inhibitory  activity may be  5  understood to mean that, the compound decreases REV‐ERB activity by at least 10%, at least 20%, at  least 30%, at least 40%, at least 50%, at least 60, at least 70%, at least 80%, at least 85%, at least 90%,  at least 95%, at least 100%, at least 150%, at least 200% more than the decrease in REV‐ERB activity  obtained using a control REV‐ERB inhibitory compound, such as SR8278.  Typically REV‐ERB activity is  decreased by at least 40%, at least 50%, preferably at least 70%, more preferably at least 80%, even 10  more preferably at least 90% or more compared with the decrease in REV‐ERB activity obtained using  a control REV‐ERB inhibitory compound, such as SR8278.   A reference to a compound with improved REV‐ERB inhibitory activity may be understood to  mean that, said compound is at least 1.5‐fold, at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at least  2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at least 15  2.9‐fold, at least 3‐fold, at least 4‐fold, at least 5‐fold, at least 6‐fold, at least 7‐fold, at least 8‐fold, at  least 9‐fold, at least 10‐fold or more, more effective in inhibiting REV‐ERB activity relative to a control  REV‐ERB inhibitory compound, such as SR8278.  In other words, that the inhibition of REV‐ERB by the  improved REV‐ERB antagonist is at least 1.5‐fold, at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at  least 2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at 20  least 2.9‐fold, at least 3‐fold, at least 4‐fold or at least 5‐fold or more greater than the inhibition in  REV‐ERB activity by a control REV‐ERB inhibitory compound, such as SR8278.  Typically an improved  REV‐ERB inhibitory compound is at least 1.5‐fold, at least 2‐fold or more effective in inhibiting REV‐ ERB activity relative to a control REV‐ERB inhibitory compound, such as SR8278.   The  small molecules  of  the  invention may  be  used  in  the  form  of  proteolysis  targeting 25  chimeras (also referred to as PROTACs or PROTAC reagents).  PROTACs are heterobifunctional small  molecules that simultaneously bind a target protein and ubiquitin ligase, enabling ubiquitination and  degradation of the target.  In more detail, a PROTAC reagent typically comprises a ligand for the target  protein  (in  the  case of  the present  invention, REV‐ERB)  and  a  ligand  for  an  E3  ligase  recognition  domain. Through the use of such a PROTAC, an E3 ligase is recruited to the PROTAC‐bound REV‐ERB, 30  inducing ubiquitin transfer from the E3 ligase complex to the target protein (in the case of the present  invention, REV‐ERB). Once the PROTAC has induced a sufficient degree of ubiquitination of the target,  it is then recognised and degraded by the proteasome.      As a non‐limiting example, a PROTAC reagent may be produced by conjugating a ligand for an  E3‐ligase to a small molecule inhibitor as described herein via a linker.  In a preferred embodiment, a  PROTAC reagent comprises a ligand for the E3 RING Cullin ligase von‐Hippel Lindau protein (VHL) or  cereblon ‐ a part of a CRL4 E3 RING Cullin ligase complex, connected to a small molecule inhibitor of  the invention via a linker.     5  Notch ligand    The Notch signalling pathway is primarily associated with promoting T cell development and  repressing concomitant B cell development.  Mammals have four types of Notch receptor – Notch1,    Notch2, Notch3  and Notch4,  all of which  are  single‐pass heterodimeric  transmembrane proteins.   Mammals have two types of canonical Notch ligands – Delta type and Jagged type, collectively known 10  as DSL ligands.  There are three delta‐like ligands (DLLs), DLL1, DLL3 and DLL4 and two jagged (JAG)  ligands, JAG1 and JAG2.  DLL and JAG ligands typically comprise the following domains: a module at  the N‐terminus of Notch  ligand  (MNNL) domain and a Delta/Serrate/Lag‐2  (DSL) domain,  together  with a number of EGF repeats.   DLL3 comprises six EGF repeats.  DLL1 and DLL4 comprise eight EGF  repeats.  JAG1 and JAG2 comprise 16 EGF repeats.  There are also numerous non‐canonical ligands, 15  which may be membrane‐bound or secreted.    Unless explicitly stated herein, a reference herein to a Notch ligand is a reference to any Notch  ligand, such as a  ligand of Notch1, Notch2, Notch3 and/or Notch 4, preferably a  ligand of at  least  Notch1.  The protein sequence of human Notch1 is given in SEQ ID NO: 10 (GenBank Accession No.  CR457221,  version  CR457221.1).    Typically  the Notch  ligand  of  use  in  the  present  invention  is  a 20  canonical Notch ligand.  In some preferred embodiments, the Notch ligand is a DLL, more preferably  DLL4.    The  protein  sequence  of  human  DLL4  is  given  in  SEQ  ID  NO:  8  (GenBank  Accession  No.  AF253468, version AF253468.1).  A reference herein to a Notch ligand also embraces fragments thereof, provided said fragment  retains  the  Notch‐binding  and  activatory  activity  of  the  Notch  ligand  from  which  it  is  derived.  25  Fragments of Notch ligands suitable for use in the present invention have previously been described  by the present inventors (see PCT/GB2018/050818, which is herein incorporated by reference in its  entirety,  particularly  pages  15  and  16  and  the  Examples).    Preferred  examples  of  Notch  ligand  fragments include Notch ligand (N‐EGF1) and Notch ligand (N‐EGF2), such as DLL4 (N‐EGF1) and DLL4  (N‐EGF2).  30  Alternatively or  in addition, a Notch  ligand, fragment thereof, or molecule that mimics the  effect  (e.g.  function/activity) of a Notch  ligand, such as DLL4 may comprise modifications, such as  amino acid mutations which alter, typically increase, the affinity of the ligand/fragment/mimetic for  its Notch receptor.  Techniques for identifying such modifications are known in the art.  For example,  amino acids which  increase the affinity of a Notch  ligand/fragment/mimetic can be  identified using  yeast  surface  display.    Again,  such modifications  have  previously  been  described  by  the  present  inventors  (see  PCT/GB2018/050818,  which  is  herein  incorporated  by  reference  in  its  entirety,  particularly page 16).  In some preferred embodiments, the DLL4 ligand of the invention, a fragment  or mimetic thereof comprises the amino acid substitutions, G28S, F107L and L206P, more preferably  5  G28S, F107L, N118I, I143F, H194Y, L206P and/or K215E.   As a further non‐limiting example, a functional fragment of DLL4 comprises at least residues  65 to 114 and 179 to 219 of full‐length DLL4, preferably held  in the correct conformation to allow  interaction with the Notch ligand.   In addition, the invention encompasses the use of molecules that would mimic the effect (e.g. 10  activity/function) of a Notch  ligand  (also referred to herein as mimetics).   For example, the use of  peptides, stapled peptides, peptoids and peptidomimetics that would mimic the effect of the desired  Notch  ligand  (such  as DLL4)  is  embraced  by  the  present  invention.    Peptidomimetics may    have  advantages over peptides  in terms of stability and bioavailability associated with a natural peptide.  Peptidomimetics  can  have main‐  or  side‐chain modifications  of  the  parent  peptide  designed  for 15  biological function.   Examples of classes of peptidomimetics include, but are not limited to, peptoids  and β‐peptides, as well as peptides incorporating D‐amino acids.  Methods for producing synthetic peptides and peptidomimetics (such as peptoids) are known  in  the art, as are  the  sequences of canonical and non‐canonical Notch  ligands.   Thus,  it would be  routine for one of skill in the art to produce suitable molecules which mimic the effect of a desired 20  Notch  ligand using known  techniques and based on  the known Notch  ligand sequences. As a non‐ limiting  example,  peptidomimetics may  be  designed  to  interact with  key  residues  of Notch  (e.g.  Notch1) that are known to be involved in binding to DLL4, such as one or more of residues 415 (E415),  418 (L418), 420 (A420), 421 (N421), 422 (P422), 424 (E424), 425 (H425), 436 (F436), 447 (P447), 448  (R448),  450  (E450),  452  (D452),  469  (D469),  477  (I477),  480  (P480)  of  Notch  (Notch1),  or  any 25  combination thereof.     The methods of the invention may encompass the use of any Notch ligand or fragment thereof  which  is  capable  of  increasing NK  cell  production  or molecule which mimics  the  effects  thereof,  particularly which may act synergistically with a compound of the invention which inhibits REV‐ERB  activity  as  disclosed  herein,  or  a  compound which  results  in  the  alteration  of  post‐translational 30  modification of E4bp4, and hence an increase in E4bp4 activity as disclosed herein.  The present  inventors have previously  shown  that  E4bp4 directly binds  to  the  regulatory  region of the Notch1 gene in vivo and so could enhance the transcriptional regulation of Notch, and  that Notch1 expression E4bp4‐/‐ mice  is significantly  reduced.   Following on  from  this,  the present  inventors found that short‐term exposure of Notch ligands to murine HSCs and very early progenitors  can promote NK  cell development, even  in  the absence of  the  critical  transcription  factor E4bp4.   Further,  the  present  inventors  have  shown  that  the  Notch  ligand  Delta‐like  ligand  4  (DLL4)  is  particularly effective in stimulating the expansion of NK cells.   Accordingly,  the present  invention relates  to  the expansion of NK cells by exposure of  the  5  HPCs to a Notch ligand in combination with the use of a compound which inhibits the action of REV‐ ERB as described herein.  In ex vivo or in vitro methods of the invention, this can comprise  a step of  culturing  the  HPCs  in  the  presence  of  a  Notch  ligand.    For  in  vivo methods,  this may  comprise  administering  the compound  together with a Notch  ligand.    In preferred embodiments,  the Notch  ligand is DLL4, or a fragment or variant thereof which retains the function of DLL4.  10    Post‐translational modification of E4bp4    The  present  inventors  have  previously  shown  that  alteration  of  post‐translational  modification  of  E4bp4  can  increase  E4bp4  activity  (see  PCT/GB2018/050818,  which  is  herein  incorporated  by  reference  in  its  entirety,  particularly  pages  33  to  36  and  Examples  1  to  5).  15  Furthermore,  increasing E4bp4 activity by alteration of post‐translational modification results  in an  increase in NK cell number (as defined herein).    Accordingly, methods of the present invention may further comprise a step of contacting an  haematopoietic progenitor cell (HPC) comprising sample obtained from an individual/patient with a  compound which results in the alteration of post‐translational modification of E4bp4, thereby causing 20  an  increase  in E4bp4 activity.   Thus, compounds which alter  the post‐translational modification of  E4pb4 as described herein may be used  in combination with  the methods and compounds of  the  invention which inhibit REV‐ERB activity.  This combination may further be used in combination with  the use of a Notch ligand (e.g. DLL4) as described herein.  Similarly, a compound which alters or affects the post‐translational modification of E4bp4 may 25  therefore be used according to the invention for increasing production of NK cells in a patient, wherein  said compound increases E4bp4 activity, or for use in a method of treatment by increasing the number  of NK cells  in a patient  in need  thereof,  together with  the  indications disclosed herein  relating  to  increased E4bp4 expression by decreasing REV‐ERB activity, and optionally the indications disclosed  herein relating to increasing NK cell number by culturing HPCs in the presence of a Notch ligand. 30  Any of the disclosure herein in relation to methods of increasing NK cell number, methods of  expanding NK cells in the context of compounds which  inhibit the action of REV‐ERB, and/or Notch  ligands, expanded NK cell populations produced by said methods and therapeutic indications relating  to said compounds and populations applies inter alia to the disclosed methods of increasing E4bp4  activity to increase NK cell number.  As non‐limiting examples, the feeder cell layers, growth factors  and/or other culture conditions and diseases to be treated may be the same in relation to the post‐ translational modification aspects as for the REV‐ERB inhibition and/or Notch ligand aspects disclosed  herein.  The REV‐ERB inhibitor compound, Notch ligand and/or E4bp4 post‐translational modifier may  be  used  simultaneously,  separately  or  sequentially.    When  a  compound  which  alters  the  post‐ 5  translational modification of E4bp4 is used in combination with a compound which inhibits the action  of  REV‐ERB,  typically  the  sample  is  contacted  with  REV‐ERB  inhibitory  compound  before  being  contacted with the post‐translational modifier.  If a Notch ligand is also used, typically the E4bp4 post‐ translational modifier is used after the REV‐ERB inhibitory compound and the Notch ligand; preferably  the  REV‐ERB  inhibitory  compound  are  used  together,  or more  preferably  the  REV‐ERB  inhibitory 10  compound is used before the Notch ligand (as described herein).    Types of post‐translational modification  Said method encompasses any alteration of post‐translational modification which results in  an  increase  in  E4bp4  activity.    Non‐limiting  examples  of  post‐translation  modification  include 15  phosphorylation,  SUMOylation,  the  addition  of  a  hydrophobic  group  (e.g.  myristoylation,  palmitoylation), addition of a cofactor, the addition of small chemical groups (e.g. acylation, alkylation,  amidation,  glycosylation),  glycation,  carbamylation,  cabonylation,  chemical  modifications  (e.g.  deamidation)  and/or  structural  changes.  Typically  alteration  of  post‐translational  modification  according to the invention results in a reduction in phosphorylation at one or more phosphorylation 20  site  within  wild‐type  (unmodified)  E4bp4  and/or  a  reduction  in  SUMOylation  at  one  or  more  SUMOylation  site within wild‐type  (unmodified)  E4bp4,  or  a  combination  thereof.   As  previously  shown by the  inventors (see PCT/GB2018/050818, which  is herein  incorporated by reference  in  its  entirety, particularly pages 33 to 36 and Examples 1 to 5), wild‐type (unmodified) E4bp4 is typically  SUMOylated at one or more of residues K10, K116, K219, K337 and/or K394 or residues corresponding 25  thereto, or any combination thereof.  Typically wild‐type (unmodified) E4bp4 is SUMOylated at least  at  residue K219  (or a corresponding  residue).   Alternatively or  in addition, wild‐type  (unmodified)  E4bp4 is typically phosphorylated at residues S286, S301 and S454, or residues corresponding thereto,  or any combination thereof.  Accordingly, in some embodiments, a compound which alters the post‐ translational modification of E4bp4 reduces,  inhibits or ablates SUMOylation at residue K219  (or a 30  residue corresponding thereto), and/or reduces, inhibits or ablates phosphorylation at residues S286,  S301  and  S454  (or  corresponding  residues),  or  any  combination  thereof.    Thus,  according  to  the  present invention, a compound may be used to (a) reduce SUMOylation at one or more of residues  K10, K116, K219, K337 and/or K394 of E4bp4, or a residue corresponding thereto, or any combination  thereof; and/or  reduce phosphorylation at one or more of  residues S286, S301 and/or S454, or a  residue corresponding thereto, or any combination thereof.     Any compound which is capable of altering or affecting the post‐translational modification of  E4bp4, wherein said alteration increases the activity of E4bp4 may be used according to the present  5  invention.    In some embodiments, said compound  inhibits, reduces or ablates the phosphorylation  and/or SUMOylation that occurs in wild‐type (unmodified) E4bp4.  Any appropriate kinase inhibitor  may be used  to  inhibit,  reduce or ablate phosphorylation of E4bp4.   Suitable kinase  inhibitors are  known in the art and their selection would be routine to one of skill in the art.  For example, based on  current understanding of kinases which phosphorylate E4bp4, it may be appropriate to use inhibitors 10  of phosphoinositide‐dependent protein kinase‐1 (PDK1) and/or casein kinase 1epsilon (CK1epsilon).   Non‐limiting examples of suitable kinase inhibitors include 4‐(4‐(2,3‐dihydrobenzo[1,4]dioxin‐6‐yl)‐5‐ pyridin‐2‐yl‐1H‐imidazol‐2‐yl)benzamide  (D4476)  and  4,5,6,7‐tetrabromo‐2‐azabenzimidazole,  4,5,6,7‐Tetrabromobenzotriazole (TBB).     15  Increase in E4 An  increase  in  E4bp4  activity  (e.g.  as brought  about by post‐translational modification of  E4bp4) may be measured relative to a control.  Thus, the activity of E4bp4 in a sample of NK precursor  or progenitor cells, an expanded NK cell population or in a sample obtained from an individual/patient  to be treated according to the  invention may be compared with the activity of E4bp4  in a control.  20  Activity may be quantified in any appropriate terms, for example an increase in the expression of any  downstream  target of E4bp4. Any appropriate  technique or method may be used  for quantifying  E4bp4 activity.  Suitable techniques are known in the art, for example luciferase assays for quantifying  expression of a reporter gene.    Typically  the  control  is  an  equivalent  population  or  sample which  has  not  been  treated 25  according to the present invention.  For example, in instances where a compound is used to alter or  affect the post‐translational modification of E4bp4, the corresponding control may be a population or  sample in which no compound has been added to alter or affect the post‐translational modification  of E4bp4.  As another example, in instances where a compound is used to inhibit the action of REV‐ ERB, the corresponding control may be a population or sample in which no compound has been added 30  to inhibit the action of REV‐ERB.  As another example, in instances where a compound is used to inhibit  the action of REV‐ERB and a compound is used to alter or effect the post‐translational modification of  E4bp4, the corresponding control may be a population or sample  in which no compound has been  added  to  inhibit  the action of REV‐ERB or  to alter or effect  the post‐translational modification of  E4bp4.  A  control may be  a  sample obtained  from  a different  individual  treated  according  to  the  invention,  or  the  same  individual  the  prior  to  treatment.    Conventional methods  for  the  ex  vivo  expansion of NK cells, including known methods may be considered control methods according to the  present invention.  5    In  the  context  of  the  present  invention,  a  reference  to  increasing  E4bp4  activity may  be  understood to mean that, the activity of E4bp4 is increased by at least 1.25‐fold, at least 1.5‐fold, at  least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at least 2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at  least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at least 2.9‐fold, at least 3‐fold, at least 4‐fold, at least  5‐fold, at least 6‐fold, at least 7‐fold, at least 8‐fold, at least 9‐fold, at least 10‐fold or more relative to 10  a control.  Typically E4bp4 activity is increased by at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at  least 2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at  least 2.9‐fold, at  least 3‐fold, or more compared with the control. E4bp4 activity may be measured  indirectly be determining  the  increase  in NK  cell number.    Thus,  the number of NK  cells may be  increased by at least 1.25‐fold, at least 1.5‐fold, at least 2‐fold, at least 2.5‐fold, at least 3‐fold, at least 15  4‐fold, at least 5‐fold, at least 6‐fold, at least 7‐fold, at least 8‐fold, at least 9‐fold, at least 10‐fold or  more relative to a control. The number of NK cells may be increased by at least 10‐fold, at least 20‐ fold, at least 30‐fold, at least 40‐fold, at least 50‐fold, at least 100‐fold, or more relative to a control.  Typically the number of NK cells is increased by at least 1.5‐fold, at least 2‐fold, at least 5‐fold, or more  compared with the control.  20  The activity of E4bp4 may be determined by quantitative and/or qualitative analysis, and may  be measured directly or indirectly. The activity of E4bp4 relative to a control may be determined using  any appropriate technique.  Suitable standard techniques are known in the art.     The activity of E4bp4 may be increased compared with a control for at least 6 hours, at least  12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at 25  least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at  least 1 week.  Preferably, the activity of E4bp4 is increased for at least 12 to 72 hours.  Typically this is  assessed  relative  to  the  last  administration  of  the  compound which  post‐translationally modified  E4bp4.   The activity of E4bp4 may be increased compared with a control for at least one, at least two, 30  at  least  three, at  least  four, at  least  five, at  least  ten, at  least 20, at  least 30, at  least 40 or more  passages of the cultured cells.  The activity of E4bp4 may be increased indefinitely.          Methods of expanding NK cells    The present invention relates to a method for expanding an NK cell population.  Said method  may be in vitro, in vivo or ex vivo.  Said method comprises adding a compound that inhibits the action  of REV‐ERB (as described herein) to HPCs and expanding said cells to produce an NK cell population.     5  The methods of the invention allow for the rapid expansion of NK cells, reducing the time needed for  their  culture,  and  hence  the  risk  of  exhaustion,  enhancing  the  cytotoxicity  of  the NK  cells when  transfused into a patient.    When said method is carried out in vivo, said method is a therapeutic method as described  herein.    In  such embodiments, all  the disclosure herein  in  relation  to  therapeutic  indications and 10  applications of the invention is applicable to said methods.    Typically the method of the invention is ex vivo.  Accordingly, the invention provides an ex vivo  method for expanding an NK cell population comprising the steps of: (a) culturing an NK precursor cell  comprising sample obtained from an individual; (b) adding a compound that inhibits the action of REV‐ ERB to said sample; and (c) expanding said cells in vitro to produce an NK cell population.  It will be 15  appreciated that, in step (b), the compound is actively added to the sample as a compound of formula  (I) and, as such, the method of the invention does not cover embodiments in which the compound is  added to the sample in a different form (such as a prodrug) and converts in situ into a compound of  formula (I).    The compound that  inhibits the action of REV‐ERB may be any compound of formula (I) as 20  described herein.  Typically said compound increases E4bp4 expression by decreasing REV‐ERB activity  as described herein.  In a preferred embodiment, the compound has the formula (II) as defined herein,  more preferably  the  compound has  the  formula  (III) as defined herein, even more preferably  the  compound has the formula (IV) as defined herein, and even more preferably, the compound has the  formula (V) as defined herein.  Examples of specific compounds which may be used in the methods of 25  the invention are described herein, with compounds acid7 and acid11 being particularly preferred.    Additional external stimuli, such as growth factors and/or cytokines, may be used to further  enhance the production of NK cells.  Non‐limiting examples of suitable external stimuli include IL‐7, IL‐ 15, Flt3L, stem cell factor (SCF), thrombopoietin (TPO), IL‐3 and/or IL‐6, or any combination thereof.  In some preferred embodiments, IL‐7, Flt3L and/or SCF, or any combination thereof  is used.   More 30  preferably IL‐7, Flt3L and SCF are used.  As a non‐limiting example, IL‐7 may be used at a concentration of about 1 ng/ml to about 100  ng/ml, about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 25 ng/ml, about 1 ng/ml to about 10  ng/ml or less.  In some embodiments IL‐7 is used at a concentration of about 50 ng/ml, about 25 ng/ml,  about 20 ng/ml, about 15 ng/ml, about 10 ng/ml or about 5 ng/ml, preferably about 10 ng/ml.  As a  non‐limiting example, Flt3L may be used at a concentration of about 1 ng/ml to about 100 ng/ml,  about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 25 ng/ml, about 1 ng/ml to about 10 ng/ml  or less.   In some embodiments Flt3L is used at a concentration of about 50 ng/ml, about 25 ng/ml,  about 20 ng/ml, about 15 ng/ml, about 10 ng/ml or about 5 ng/ml, preferably about 10 ng/ml.    As a  5  non‐limiting example, SCF may be used at a concentration of about 1 ng/ml to about 200 ng/ml, about  1 ng/ml to about 150 ng/ml, about 1ng/ml to about 100 ng/ml, about 1 ng/ml to about 50 ng/ml or  less.  In some embodiments SCF is used at a concentration of about 150 ng/ml, about 125 ng/ml, about  120 ng/ml, about 110 ng/ml, about 100 ng/ml, about 90 ng/ml, about 80 ng/ml or about 75 ng/ml,  preferably about 100 ng/ml.  10  As a non‐limiting example, IL‐15 may be used at a concentration of about 1 ng/ml to about  100 ng/ml, about 1 ng/ml to about 50 ng/ml, about 1 ng/ml to about 40 ng/ml, about 1 ng/ml to about  30 ng/ml,  about 1 ng/ml  to  about 20 ng/ml,  about 1 ng/ml  to  about 10 ng/ml or  less.    In  some  embodiments IL‐15  is used at a concentration of about 50 ng/ml, about 40 ng/ml, about 35 ng/ml,  about 30 ng/ml, about 25 ng/ml, about 20 ng/ml or about 10 ng/ml, preferably about 30 ng/ml.   15    Alternatively or  in addition, the HPCs may be cultured on or with suitable support/stromal  cells or cell layer.  Any appropriate stromal cell may be used, including, but not limited to OP9 stromal  cells and/or EL08‐1D2 stromal cells.    In  some  embodiments,  the  ex  vivo method  comprises  a  single  culturing  stage.  In  these  embodiments,  the  HPCs  in  a  sample  obtained  from  a  patient  are  cultured,  a  compound  of  the 20  invention  is  added,  and  the  HPCs  are  expanded  to  form  an  NK  cell  population,  typically  under  substantially constant culture conditions.  Typically this involves incubating the HPCs with factors such  as  IL‐3,  IL‐7, SCF, Flt3L and/or  IL‐15, preferably all of  these  factors.   The HPCs are preferably also  cultured  on  or with  stromal  cells/  cell  layer,  such  as  EL08‐1D2  stromal  cells.    In  some  preferred  embodiments, the medium which induces differentiation of the HPCs to NK cells does not comprise 25  IL‐3.  In  some embodiments,  the ex vivo method  comprises  two  culturing  stages.   The  first  is a  lymphoid production  stage,  in which  the HPCs  in  a  sample obtained  from a patient are  cultured.   Typically this involves incubating the HPCs with cytokines and growth factors associated with lymphoid  production, such as Flt3L, IL‐7 and/or SCF.  This stage may last for at least one, at least two, at least 30  three, at least four, or more days.  In some embodiments, this stage lasts for two days.  The second  stage of the ex vivo method  is a stage of NK cell expansion.   Typically this  involves transferring the  cultured HSCs  to a suitable stromal  (support) cell  layer, such as OP9 stromal cells and culturing  in  cytokines and growth factors associated with NK cell development, such as IL‐15.  A compound of the  invention is typically added during this second stage, and preferably at the start of this second stage.   The second stage lasts for the remainder of the ex vivo culture period (as defined above).  The culture  medium may be changed as often as required during this second stage in order to facilitate NK cell  expansion.  This second stay may last for at least one, at least two, at least three, at least four, at least  five, at least six, at least seven, at least eight, at least nine, at least ten, at least 11, at least 12, at least  5  13, at least 14 or more days.  In some preferred embodiments, this stage lasts for at least one week.  The  inventors have recently developed new methods to  increase the number of CD16+ NK  cells within an expanded NK cell population.  These methods comprise carefully controlled durations  of culture of HPCs  first  in medium which does not  induce differentiation of  the HPCs,  followed by  culture in medium which induces differentiation of the HPCs to NK cells.  These methods are described 10  in detail  in UK Patent Application No. 2212838.3, which  is herein  incorporated by  reference  in  its  entirety.   By way  of  non‐limiting  example,  in  some  preferred methods,  the HPCs  are  cultured  in  medium which does not induce differentiation of the HPCs for between about 2 to about 8 days, such  as about 2 days to about 6 days, optionally for between about 4 days to about 6 days.  The REV‐ERB  inhibitor may be added  for  (i) all or part of  the  culture period  in medium which does not  induce 15  differentiation of  the HPCs; and/or  (ii) all or part of  the  culture period  in medium which  induces  differentiation of the HPCs to NK cells.  In some preferred embodiments, the REV‐ERB inhibitor may  be added for all or part of the culture period in medium which does not induce differentiation of the  HPCs; but is not added for all or part of, preferably all of, the culture period in medium which induces  differentiation of the HPCs to NK cells.  20  The medium which does not induce differentiation of the HPCs and the medium which induces  differentiation of  the HPCs  to NK  cells may  comprise different  factors  (e.g. growth  factors and/or  cytokines), or combinations thereof.  Typically, the medium which does not induce differentiation of  the  HPCs  comprises  at  least  one  of  Flt3L, GM‐CSF,  IL‐3,  IL‐6,  TPO  and/or  stem  cell  factor  (SCF),  preferably Flt3L, GM‐CSF, IL‐3, IL‐6, TPO and SCF; and/or the medium which induces differentiation of 25  the HPCs to NK cells comprises IL‐7, Flt3L, IL‐15, and/or SCF, preferably IL‐7, Flt3L, IL‐15 and SCF.  These  media are described in detail in UK Patent Application No. 2212838.3, which is herein incorporated by  reference in its entirety.  The HPC comprising sample may be cultured ex vivo for at least 5 days, at least 6 days, at least  7 days, at least 8 days, at least 9 days, at least 10 days, at least 11 days, at least 12 days, at least 13 30  days, at  least 14 days, at  least 15 days, at  least 16 days, at  least 17 days, at  least 18 days or more.   Typically said sample is cultured for at least 9 days in order to produce an expanded NK cell population.   These culture periods are for the total culture period of the ex vivo method, i.e. if there are two stages,  these periods are for the total (stage 1 plus stage 2).   An example culture scheme for HPCs for the  production of NK cells is set out in Figure 2A.  Preferred examples of culture schemes are those set  out in UK Patent Application No. 2212838.3, and any reference to a REV‐ERB inhibitor compound in  said application may be a REV‐ERB  inhibitor compound of  the present  invention.   By way of non‐ limiting example, a compound which  inhibits REV‐ERB activity may be added to the medium which  does not induce differentiation of the HPCs after a period of time of between about 0 to about 2 days,  5  particularly the compound which inhibits REV‐ERB activity may be added to the medium which does  not induce differentiation of the HPCs after about 1 day.    The HPCs may be contacted with a REV‐ERB  inhibitory compound  for at  least part of the  first culture period  in medium which does not  induce  differentiation of  the HPCs, up  to  the entirety of said  first culture period.   Thus,  the HPCs may be  contacted with a REV‐ERB inhibitory compound for 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5 or 8 days 10  of this culture period may or a period of any duration between 2 and 8 days.  Preferably the HPCs may  be contacted with a REV‐ERB inhibitory compound for between about 2 days to about 6 days (e.g. 2,  2.5, 3, 3.5, 4, 4.5, 5, 5.5 or 6 days or a period of any duration between 2 and 6 days, such as between  about 4 to 6 days) of the first culture period in medium which does not induce differentiation of the  HPCs.  More preferably the HPCs may be contacted with a REV‐ERB inhibitory compound for between 15  about 2 days to about 4 days (e.g. 2, 2.5, 3, 3.5 or 4 days or a period of any duration between 2 and 4  days) of the first culture period in medium which does not induce differentiation of the HPCs.   The REV‐ERB  inhibitor compound of the  invention may be added to the sample comprising  HPCs within one week, within six days, within five days, within four days, within three days, within two  days, within one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell 20  precursors. Typically this is the same day that the sample is obtained from the patient.  Preferably the  compound of the invention is added to the sample within two days of isolating the HPCs in the sample,  even more preferably on day one or two following isolation of the HPCs.  In some embodiments the  compound is added at multiple time points, for example when the culture medium is changed.  As a  non‐limiting example, the compound of the invention may be added two days after isolating the HPCs, 25  and then added again at day five post‐isolation of the HPCs.  This disclosure applies to all methods of  the invention, e.g. for one stage and two stage methods as described herein, and/or methods which  also use a Notch ligand and/or a compound which alters the posttranslational modification of E4bp4  as described herein.  Any appropriate concentration of a compound of the invention may be used, provided that it 30  inhibits the action of REV‐ERB as described herein and has utility in expanding an NK cell population.   As a non‐limiting example, in any aspect of the invention, a compound of the invention may be used  at a final concentration of about 2 to about 20 µM, about 2 to about 15 µM, about 5 to about 15 µM,  about 5 to about 14 µM, about 4 to about 13 µM, about 5 to about 12 µM, about 5 to about 11 µM,  or preferably about 5 to about 10 µM.  The present inventors have previously demonstrated that combining the use of a Notch ligand  (such as DLL4) and REV‐ERB  inhibition results  in a potent means for enhancing NK cell production,  allowing  for  the  production  of  large  numbers  of  functional NK  cells  that  are  suitable  for  in  vivo  therapeutic use more rapidly than the current methods.    5  Thus,  the  invention  provides  an  ex  vivo  method  for  expanding  an  NK  cell  population  comprising  the  steps of:  (a) adding a  compound  that  inhibits  the action of REV‐ERB  (as described  herein) to an HPC comprising sample obtained from an  individual/patient and culturing the sample  with the compound; (b) culturing said cells in the presence of a Notch ligand (such as DLL4); and (c)  expanding said cells  in vitro to produce an NK cell population.   Step (a) and (b) may be carried out 10  concurrently or in any order.  For example, step (a) may be carried out first, followed by step (b), such  that the cells are first exposed to a REV‐ERB inhibitory compound and then cultured in the presence  of a Notch ligand.  Alternatively, step (b) may be carried out first, followed by step (a), such that the  cells  are  first  cultured  in  the presence of  a Notch  ligand  and  then  in  the presence of  a REV‐ERB  inhibitory compound.  Alternatively, steps (a) and (b) may be carried out concurrently, such that the 15  cells are  simultaneously  cultured  in  the presence of a REV‐ERB  inhibitory  compound and a Notch  ligand.    In some preferred embodiments, step (a) may be carried out first, followed by step (b), such  that the cells are first cultured  in the presence of a REV‐ERB  inhibitory compound and then  in the  presence of a Notch ligand.  Thus, in those embodiments the invention provides an ex vivo method 20  for expanding an NK cell population comprising the steps of: (a) adding a compound that inhibits the  action of REV‐ERB (as described herein) and culturing the sample with the compound; (b) culturing  said cells  in  the presence of a Notch  ligand  (such as DLL4); and  (c) expanding said cells  in vitro  to  produce an NK cell population.    In other preferred embodiments, step (b) may be carried out first,  followed by step (a), such that the cells are first cultured in the presence of a Notch ligand and then in 25  the presence of a REV‐ERB inhibitory compound.  Thus, in those embodiments the invention provides  an ex vivo method for expanding an NK cell population comprising the steps of: (a) adding a Notch  ligand (such as DLL4) and culturing the sample with said ligand; (b) culturing said cells in the presence  of a compound that inhibits the action of REV‐ERB (as described herein); and (c) expanding said cells  in  vitro  to produce an NK  cell population.    In either  case, preferably both  the REV‐ERB  inhibitory 30  compound and the Notch  ligand are present for at  least part of the first culture period  in medium  which does not induce differentiation of the HPCs, and are not present for at least part of, preferably  all of  the culture period  in medium which  induces differentiation of  the HPCs  to NK cells.   This  is  described  in more detail  in UK Patent Application No. 2212838.3, which  is herein  incorporated by  reference in its entirety.  Typically the Notch ligand is a Notch ligand as described herein.  Preferably, the Notch ligand  is DDL4, or a fragment thereof which retains the function of DLL4, as described herein.  In some preferred embodiments, the Notch ligand (e.g. DLL4) may be added for all or part of  the culture period in medium which does not induce differentiation of the HPCs; but is not added for  5  all or part of, preferably all of, the culture period in medium which induces differentiation of the HPCs  to NK cells.  The Notch  ligand (such as DLL4) may be present  in solution (e.g.  in the culture medium) or  used to coat the vessel in which the HPCs are cultured.  Preferably the Notch ligand (e.g. DLL4) is used  to coat the vessel  in which the HPCs are cultured.   As a non‐limiting example,  in any aspect of the 10  invention where a Notch ligand is used, the Notch ligand (e.g. DLL4) may be used at a concentration  of about 1 µg/ml to about 100 µg/ml, about 1 µg/ml to about 50 µg/ml, about 1 µg/ml to about 25  µg/ml, about 1 µg/ml to about 10 µg/ml or less.  In some embodiments the Notch ligand (e.g. DLL4) is  used at a concentration of about 50 µg/ml, about 25 µg/ml, about 20 µg/ml, about 15 µg/ml, about  10 µg/ml, or about 5 µg/ml, preferably about 10 µg/ml.  Additional substrates and/or linkers may be 15  used  to  facilitate  the attachment of  the Notch  ligand  (such as DLL4)  to  the  surface of  the culture  vessels.  Examples of such substrates are known in the art, such as poly‐L‐lysine.   As described above, HPCs may be cultured in the presence or absence of a stromal support  cell or feeder cell, or population thereof.   In some preferred embodiments where a Notch  ligand  is  used, the cells are cultured in the absence of a stromal support cell or population thereof.  20  In some embodiments, the ex vivo method comprises a single culturing stage  in which the  HPCs  in a sample obtained from an  individual/patient are cultured, a compound of the  invention  is  added, the HPCs are contacted with said compound and a Notch ligand and expanded to form an NK  cell population, typically under substantially constant culture conditions (i.e. steps (a) and (b) of the  method are carried out concurrently).  Typically this involves incubating the HPCs with factors such as 25  IL‐3,  IL‐7, SCF, Flt3L and/or  IL‐15, preferably all of these factors.   The HPCs may be cultured  in the  presence or absence of stromal cells/ cell layer, such as EL08‐1D2 stromal cells.  In some embodiments, the ex vivo method comprises two culture stages (analogous to the  scheme shown in Figure 2).  The first is a lymphoid production stage, in which the HPCs in a sample  obtained  from an  individual/patient are cultured.   Typically  this  involves  incubating  the HPCs with 30  cytokines and growth factors associated with lymphoid production, such as Flt3L, IL‐7 and/or SCF.  This  stage may  last  for at  least one, at  least  two, at  least  three, at  least  four, or more days.    In  some  preferred embodiments, this stage lasts for two days.    This is followed by a stage of NK cell expansion.  Typically this involves culturing the cells in  cytokines and growth factors associated with NK cell development, such as  IL‐15, and may  involve  transferring the cultured HSCs to a suitable stromal (support) cell layer, such as OP9 stromal cells.  The  second stage  lasts for the remainder of the ex vivo culture period (as defined herein).   The culture  medium may be changed as often as required during this second stage in order to facilitate NK cell  expansion.   Any REV‐ERB  inhibitory compounds, Notch  ligands and/or compounds which alter  the  5  posttranslational modification of E4bp4 that are present in the culture medium before it is replaced  may  be  administered  again  with  the  fresh  culture  medium,  either  at  the  same  or  different  concentration.   As a non‐limiting example,  if a compound of the  invention  is added two days after  isolating the HPCs, and the medium changed at day five post‐isolation of the HPCs, the compound may  be administered again at day 5 post‐isolation with the fresh medium.  10  In some embodiments, the REV‐ERB inhibitory compound of the invention is added in stage 1  (lymphoid  production)  and  the  Notch  ligand  in  the  second  stage  (NK  cell  expansion).    In  other  embodiments, the Notch ligand is added in stage 1 (lymphoid production) and the REV‐EB inhibitory  compound  in  the  second  stage  (NK  cell expansion).  In yet other embodiments, both  the REV‐ERB  inhibitory compound and the Notch ligand added in the first stage (lymphoid production).  In further 15  embodiments, both the REV‐ERB inhibitory compound and the Notch ligand added in the second (NK  cell expansion phase).  If the REV‐ERB inhibitory compound and the Notch ligand added in the same  stage (either stage 1 or stage 2), that stage may be further divided so that: (i) the REV‐ERB inhibitory  compound  is added before  the Notch  ligand; or  (ii)  the Notch  ligand  is added before  the REV‐ERB  inhibitory  compound.   Alternatively,  the Notch  ligand  and  REV‐ERB  inhibitory  compound may  be 20  added simultaneously  in the same stage.   Figure 2B  illustrates some embodiments of the different  method schemes for the REV‐ERB inhibitory compound and Notch ligand combination aspects of the  invention.    The  timings of  administration  included  in  Figure  2B  are non‐limiting;  any  appropriate  timings  for  administration,  such  as  those  described  herein,  may  be  used.    In  some  preferred  embodiments the REV‐ERB  inhibitor  is added  in stage 1 (e.g. at day 0 or on day 2), with the Notch 25  ligand being added later (e.g. at day 2 or 4 respectively).  The REV‐ERB inhibitory compound may be added during the first stage, and the Notch ligand  is added during the second stage, and preferably at the start of this second stage.    Whether the REV‐ ERB  inhibitory  compound  or Notch  ligand  is  added  first,  preferably  both  the  REV‐ERB  inhibitory  compound and the Notch  ligand are present for at  least part of the first culture period  in medium 30  which does not induce differentiation of the HPCs, and are not present for at least part of, preferably  all, of  the culture period  in medium which  induces differentiation of  the HPCs  to NK cells.   This  is  described  in more detail  in UK Patent Application No. 2212838.3, which  is herein  incorporated by  reference in its entirety.  The HPC comprising sample may be cultured ex vivo for at least 5 days, at least 6 days, at least  7 days, at least 8 days, at least 9 days, at least 10 days, at least 11 days, at least 12 days, at least 13  days, at  least 14 days, at  least 15 days, at  least 16 days, at  least 17 days, at  least 18 days or more.   Typically said sample is cultured for at least 9 days in order to produce an expanded NK cell population.   5  These culture periods are for the total culture period of the ex vivo method, i.e. if there are two stages,  these periods are for the total (stage 1 plus stage 2).  The REV‐ERB inhibitory compound of the invention may be added to the sample comprising  HPCs within one week, within six days, within five days, within four days, within three days, within two  days, within one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell 10  precursors. Typically this is the same day that the sample is obtained from the patient.  Preferably the  REV‐ERB inhibitory compound of the invention is added to the sample within two days of isolating the  HPCs in the sample, such as on the day of isolation of the HPCs, or one day after isolation of the HPCs.   Most preferably the REV‐ERB inhibitory compound of the invention is added to the sample one or two  days post isolation of the HPCs.  In some embodiments the compound is added at multiple time points, 15  for example when the culture medium is changed.  As a non‐limiting example, the compound of the  invention may be added one or two days after isolating the HPCs, and then added again at day five  post‐isolation of the HPCs.  The Notch ligand of the invention may be added to the sample comprising HPCs within one  week, within six days, within five days, within four days, within three days, within two days, within 20  one day of isolating the HPCs in the sample, or on the same day as isolating the NK cell precursors.  Typically this is the same day that the sample is obtained from the patient.  Preferably the Notch ligand  of the invention is added to the sample within four days of isolating the HPCs in the sample, such as  on day one or two following isolation of the HPCs.  Most preferably the Notch ligand of the invention  is added to the sample two or four days post isolation of the HPCs. Thus, typically the Notch ligand is 25  present on or from 4 days after isolating the HPCs.  Preferred  embodiments  of  the  invention  comprise  (i)  adding  the  REV‐ERB  inhibitory  compound and the Notch ligand to the sample on the day of isolation of the HPCs; (ii) adding the REV‐ ERB  inhibitory compound  to the sample on the day of  isolation of the HPCs and adding the Notch  ligand  to  the  sample on day  two post  isolation of  the HPCs; or  (iii) adding  the REV‐ERB  inhibitory 30  compound to the sample on day two post isolation of the HPCs and adding the Notch ligand to the  sample  on  day  four  post  isolation  of  the HPCs; with  option  (iii)  being  particularly  preferred.   As  demonstrated previously by the inventors, these particular conditions maximise the synergy between  the REV‐ERB inhibition and the Notch ligand, and hence maximising the expansion of NK cells.  Additionally,  the  cells may  be  cultured  in  the  presence  of  additional  external  stimuli  (as  described herein) in combination with a Notch ligand.  As a non‐limiting example, a Notch ligand may  be used with  IL‐15.   For example, the cells may be  first exposed to a Notch  ligand and  then  IL‐15.   Alternatively, the cells may first be cultured  in the presence of  IL‐15 and then  in the presence of a  5  Notch ligand.  Alternatively, the cells may be simultaneously cultured in the presence of a Notch ligand  and IL‐15. Preferably the cells are first cultured in the presence of a Notch ligand and then IL‐15.    The HPCs may be cultured in the presence of a Notch ligand (such as DLL4) for at least 6 hours,  at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48  hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 10  days, at least 1 week.  Typically for 72 hours to 1 week.  The cells may be cultured in the presence of  IL‐15 for at least 6 hours, at least 12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at  least 42 hours, at least 48 hours, at least 54 hours, at least 60 hours, at least 72 hours, at least 4 days,  at least 5 days, at least 6 days, at least 1 week, at least 2 weeks, at least 3 weeks or longer, until the  desired number of NK cells is produced.  For example, the step of culturing in Il‐15 may be is 1 week 15  or more in length, 7 to 9 days in length, or about two weeks in length.  Alternatively, these durations may be measured in terms of the number of cell passages.  For  example, at least one, at least two, at least three, at least four, at least five, at least ten, at least 20, at  least 30, at least 40 or more passages of the cells (either in vivo, or cultured ex vivo or in vitro).    The durations of exposure to Notch ligand and IL‐15 are independent, and any duration for 20  Notch culture may be used  in combination with any duration of  IL‐15 culture.    In  some preferred  embodiments, Notch exposure/culture is 72 hours to 1 week in length and IL‐15 exposure/culture is 1  week (or more) in length.   Typically IL‐7, Flt3L and/or SCF are used together with the Notch ligand.  In some preferred  embodiments, the HPCs are cultured in the presence of IL‐7, Flt3L and SCF together with the Notch 25  ligand.    The methods of the  invention (both those  including and excluding a step of contacting the  HPCs with a Notch ligand) may further comprise a step of contacting the HPCs with a compound which  results  in the alteration of post‐translational modification of E4bp4, thereby causing an  increase  in  E4bp4 activity, as described herein.   Optionally  the alteration of post‐translational modification of 30  E4bp4 is a reduction in SUMOylation and/or phosphorylation of E4bp4 as described herein.  In some  preferred  embodiments  the  compound  which  results  in  the  alteration  of  post‐translational  modification of E4bp4: reduces SUMOylation at one or more of residues K10, K116, K219, K337 and/or  K394  of  E4bp4,  or  a  residue  corresponding  thereto,  or  any  combination  thereof;  and/or  reduces  phosphorylation  at  one  or  more  of  residues  S286,  S301  and/or  S454  of  E4bp4,  or  a  residue  corresponding thereto, or any combination thereof.  Any  appropriate  concentration  of  a  compound  which  results  in  the  alteration  of  post‐ translational modification of E4bp4 may be used, provided that it increases the activity of E4bp4 as  5  described herein and has utility in expanding an NK cell population.  As a non‐limiting example, in any  aspect of the invention, a compound which results in the alteration of post‐translational modification  of E4bp4 may be used at a final concentration of about 0.1 to about 20 µM, about 0.1 to about 15 µM,  about 0.5 to about 15 µM, about 0.5 to about 14 µM, about 0.5 to about 12 µM, about 0.5 to about  11 µM, or  about 0.5  to  about 10 µM,  such  as  from  about 5  to  about 10 µM.  In  some preferred 10  embodiments, a compound which results in the alteration of post‐translational modification of E4bp4  may be used at a final concentration of about 0.5 to about 5 µM, more preferably of about 0.5 to  about 2 µM, even more preferable of about 0.5 to about 1µM.  The REV‐ERB  inhibitor compound, Notch  ligand and/or compound which alters E4bp4 post‐ translational modification may be used simultaneously, separately or sequentially as described herein.   15  Each of the REV‐ERB inhibitor compound, Notch ligand and/or compound which alters E4bp4  post‐translational modification may independently be used as a single treatment or application or in  multiple treatments or applications (in both in vitro, ex vivo or in vivo methods as described herein).   For multiple applications, at least two, at least three, at least four, at least five, at least six, at least  seven, at least eight, at least nine or more applications may be used.  The multiple applications may 20  be applied at any appropriate time points according to a method or treatment of the invention.  By  way of non‐limiting example, a REV‐ERB inhibitory compound of the invention, a Notch ligand and/or  a compound which alters E4bp4 post‐translational modification may each independently be applied  twice a day, once daily, every other day, once every  three days or weekly.   Typically  the REV‐ERB  inhibitory compounds of the invention, the Notch ligand and/or a compound which alters E4bp4 post‐25  translational modification may  independently be applied as necessary when the culture medium  is  changed.  The method of the invention may further comprise modulating (increasing or decreasing the  expression and/or activity of one or more additional gene and/or protein  in  the HPCs  in order  to  enhance NK cell expansion.  This modulation may be elicited by a compound of the invention, including 30  the same compound of the invention as used to inhibit the activity of REV‐ERB.  Alternatively, one or  more additional compounds may be used to modulate the expression and/or activity of the one or  more  additional  gene  and/or protein.    Said modulation may occur directly or  indirectly.    Indirect  modulation encompasses downstream effects caused by a compound of the invention inhibiting the  activity of REV‐ERB.  In  all  methods  of  the  invention,  the  sample  comprising  HPCs  obtained  from  an  individual/patient may be a sample obtained from bone marrow, cord blood and/or peripheral blood.   Thus, the sample may be a cord or peripheral blood sample, or a bone marrow sample or biopsy.  The  sample may be obtained from the individual who is to be treated with the NK cell population produced  5  by a method of the  invention (i.e. a patient).   Alternatively, the sample  is obtained from a healthy  individual.  According to the present invention, a sample comprising HPCs is any sample from an individual  which comprises a sufficient number of HPCs (as described herein), such that an expanded NK cell  population can be obtained by adding a compound according to the present invention to said sample.  10  Typically the sample comprises HSCs.  Preferably said sample is enriched for HSCs, such as a cord or  peripheral blood sample or a bone marrow sample or biopsy as described herein.  A method of the invention may result in an increase in, the number of NK cells of at least 1.5‐ fold, at least 2‐fold, at least 2.1‐fold, at least 2.2‐fold, at least 2.3‐fold, at least 2.4‐fold, at least 2.5‐ fold, at least 2.6‐fold, at least 2.7‐fold, at least 2.8‐fold, at least 2.9‐fold, at least 3‐fold, at least 4‐fold, 15  at least 5‐fold, at least 6‐fold, at least 7‐fold, at least 8‐fold, at least 9‐fold, at least 10‐fold or more  relative to a control. Typically the number of NK cells is increased by at least 2‐fold, at least 2.1‐fold,  at least 2.2‐fold, at least 2.3‐fold, at least 2.4‐fold, at least 2.5‐fold, at least 2.6‐fold, at least 2.7‐fold,  at least 2.8‐fold, at least 2.9‐fold, at least 3‐fold, or more compared with the control.  A method of the invention may accelerate the production of phenotypically mature NK cells.  20  In other words, the method of the invention may reduce the time taken to arrive at a population of  mature NK  cells.   A  reduction  in  the  run  time of  the method offers a  further advantage over  the  conventional methods  for NK cell expansion known  in  the art.   As a non‐limiting example, current  clinical procedures for the expansion of NK cells can take more than two weeks to generate an NK cell  population that comprises about 20% mature NK cells.  In contrast, a method of the invention may 25  achieve an equivalent population in 10 days or less, preferably in one week or less.  A method of the  invention may achieve a population of at least 40% mature NK cells, preferably at least 45%, at least  46%, at least 47%, at least 48%, or at least 49% mature NK cells, even more preferably at least 50%  mature NK cells in three weeks or less, 20 days or less, 19 days or less, 18 days or less, 17 days or less,  16 days or less, 15 days or less, two weeks or less, 13 days or less, or 12 days or less.  Preferably a 30  method of the invention can achieve a population of at least 45% mature NK cells within two weeks  or less.  Typically  an  ex  vivo method  of  the  present  invention  involves  a  final  step  to  purify  the  expanded NK  cell  population.    This  ensures  a  pure  population  for  therapeutic  administration  as  described herein.  Purification of the expanded NK cell population may be by any appropriate means.   Standard cell purification methods are known in the art, such as cell sorting, including fluorescence‐ activated cell sorting (FACS) and magnetic‐activated cell sorting (MACS).  In  some  methods  of  the  invention,  including  but  not  limited  to  those  involving  the  combination of a Notch ligand and a REV‐ERB inhibitory compound, the % of NK cells in the final cell  5  population may be very high (typically greater than 85%, preferably greater than 90%, more preferably  greater than 95%, and may approach 100%).  In such instances, a final purification step may optionally  be omitted.    Therapeutic indications  10  The invention provides a REV‐ERB inhibitor, or a pharmaceutic composition which comprises  said  inhibitor, for use  in a method of therapy by  increasing the production of NK cells  in a patient.   Pharmaceutical compositions are those which, with reasonable medical judgment, are suitable for use  in contact with the tissues of a patient.   The REV‐ERB  inhibitor  for use  in said method of  therapy may be any REV‐ERB  inhibitor as 15  described herein.  Typically the REV‐ERB inhibitor for use in said method increases E4bp4 expression  by decreasing REV‐ERB activity.  Typically  the method  of  therapy  comprises  administering  a  compound which  inhibits  the  action of REV‐ERB (as described herein) to a patient or subject.   It will be appreciated that  it  is the  compounds  themselves,  or  a  pharmaceutical  composition  comprising  said  compounds,  that  are 20  administered to a patient and, as such, any method of therapy does not cover embodiments in which  the compound is administered to a patient in a different form (such as a prodrug) and converts in vivo  into a compound of formula (I).    The invention also provides pharmaceutical products containing a compound which inhibits  the action of REV‐ERB and a Notch ligand as a combined preparation for simultaneous, separate or 25  sequential use in a method of therapy by increasing the production of NK cells in a patient.  As with  pharmaceutical compositions, pharmaceutical products are also, with reasonable medical judgment,  products suitable for use in contact with the tissues of a patient.    The Notch  ligand  for use  in said method of therapy may be any Notch  ligand as described  herein.  In some preferred embodiments, the Notch ligand is DLL4 or a fragment thereof which retains 30  the function of DLL4.   Any REV‐ERB  inhibitor and any Notch  ligand of the  invention may be used  in  combination.    Typically a method of therapy relating to said REV‐ERB  inhibitor and Notch  ligand products  comprises administering the products (as described herein) to a patient or subject.  The Notch ligand  and REV‐ERB inhibitor may be administered simultaneously, separately or sequentially.  For separate  or sequential administration, the Notch  ligand may be administered first, followed by the REV‐ERB  inhibitor, or vice versa.  Sequential administration may mean that the two products are administered immediately one  after the other, or that the second product is administered within 1 minute, within two minutes, within  5  three minutes, within four minutes, within five minutes, within 10 minutes, within 15 minutes, within  20 minutes, within 25 minutes, within 30 minutes, within 45 minutes, within one hour, or more of the  first product being administered.  Separate administration may mean that the second product is administered within one hour,  within two hours, within three hours, within six hours, within 12 hours, within 24 hours, within 2 days, 10  within 3 days, within 4 days, within 5 days, within 6 days, within 7 days or more of the first product  being administered.  As used herein, the term “increasing the number of NK cells” and “increasing production of  NK cells” can be understood to mean that the compound of the invention elicits a significant increase  in the number of NK cells in a patient.  This increase in NK cell number may be measured relative to a 15  control  (as described herein  in  the context of  increasing E4bp4 expression and  inhibiting REV‐ERB  activity).    A reference to an increase in the number of NK cells and/or increasing NK cell production may  be quantified in terms of a fold increase relative to a control.  Typically a compound of the invention  can increase the number of NK cells, or give rise to an increase in NK cell production, of at least 1.5 20  fold, at least 1.6 fold, at least 1.7 fold, at least 1.8 fold, at least 1.9 fold, at least 2 fold, at least 2.1 fold,  at least 2.2 fold, at least 2.3 fold, at least 2.4 fold, at least 2.5 fold, at least 3 fold or more relative to a  control.  Alternatively,  a  reference  to  increasing  the  number  of NK  cells  and/or  increasing NK  cell  production may be understood to mean that, the number of NK cells is increased by at least 10%, at 25  least 20%, at least 30%, at least 40%, at least 50%, at least 60, at least 70%, at least 80%, at least 85%,  at least 90%, at least 95%, at least 100%, at least 150%, at least 200%, at least 300% or more compared  with the control.  Typically the number of NK cells is increased by at least 50%, preferably at least 70%,  more preferably at least 80%, even more preferably at least 90% or more compared with a control.  In  some  embodiments,  an  increase  in  the  number  of NK  cells  and/or  increase  in NK  cell 30  production may be defined in terms of the absolute number of NK cells in a sample or patient, such as  the percentage of NK  cells,  for example  the percentage of NK  cells  in  the  circulating  lymphocyte  population. For example, a compound of the invention may cause an increase in NK number, resulting  in a percentage of NK cells of at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at  least 35%, at least 40%, at least 45%, at least 50%, at least 55%, at least 60%, at least 65%, at least  70%, at least 75%, at least 80% or more.  The number of NK cells may be determined by quantitative and/or qualitative analysis, and  may be measured directly or indirectly. The number of NK cells relative to a control may be determined  5  using any appropriate technique.   Suitable standard techniques, such as flow cytometry, FACS and  MACS, are known in the art.    The number of NK cells may be increased compared with a control for at least 6 hours, at least  12 hours, at least 24 hours, at least 30 hours, at least 36 hours, at least 42 hours, at least 48 hours, at  least 54 hours, at least 60 hours, at least 72 hours, at least 4 days, at least 5 days, at least 6 days, at 10  least 1 week, at least 2 weeks, at least 3 weeks, at least 1 month or more.  Typically this is assessed  relative to the last administration of the compound which inhibits REV‐ERB activity.    The number of NK cells may be quantified in terms of the total number of NK cells in a sample  from a patient or culture sample (from an ex vivo method of the invention).    In the context of the therapeutic uses and methods of the invention, a “subject” or “patient” 15  (these  terms  are  used  interchangeably  herein)  is  any  animal  patient  that would  benefit  from  an  increase in the number of NK cells.  Typical animal patients are mammals, such as primates.  Preferably  the patient is a human.   Thus, the present invention provides a method of treatment by increasing the number of NK  cells in a patient in need thereof, comprising administering to said patient a therapeutically effective 20  amount of a compound which inhibits the action of REV‐ERB (as described herein), or a pharmaceutical  composition comprising said compound.   Also provided  is a method of treatment by  increasing the  number  of  NK  cells  in  a  patient  in  need  thereof,  comprising  administering  to  said  patient  a  therapeutically effective amount of a compound which inhibits the action of REV‐ERB (as described  herein) , or a pharmaceutical composition comprising said compound, and a Notch ligand (as described 25  herein).  Additionally, the present invention provides the use of a compound which inhibits the action  of REV‐ERB in the manufacture of a medicament.  Said medicament increases the number of NK cells  in a patient. Additionally, the present  invention provides the use of a compound which  inhibits the  action  of  REV‐ERB  and  a  Notch  ligand  in  the manufacture  of  a medicament.    Said medicament 30  increases the number of NK cells in a patient.  It will be appreciated that the compound is present in  the final medicament product that is manufactured and subsequently used on a patient.    The therapeutic use or method of the invention may comprise administering a therapeutically  effective amount of a compound, or a pharmaceutical composition comprising said compound, or  pharmaceutical  products  of  the  invention,  either  alone or  in  combination with other  therapeutic  agents, to a subject.  As  used  herein,  the  term  “treatment”  or  “treating”  embraces  therapeutic  or  preventative/prophylactic measures.  5  The compounds of the invention, pharmaceutic compositions comprising said compounds, or  pharmaceutical products may  also be  used  as  a preventative  therapy.   As used herein,  the  term  “preventing”  includes preventing the onset of symptoms associated with a disease or disorder that  may  be  treated  by  increasing  NK  cell  number  and/or  reducing  the  severity  or  intensity  of  said  symptoms.  The term “preventing” includes inducing or providing protective immunity against such 10  diseases  or  disorders,  particularly  infectious  diseases  as  described  herein.    Immunity  may  be  quantified using any appropriate technique, examples of which are known in the art.  A compound, pharmaceutic compositions or pharmaceutical products of the  invention may  be administered to a patient already having a disease or disorder which may be treated by increasing  NK cell number.  For example, the patient may be suspected of having an infectious disease or cancer 15  as described herein, and may or may not be showing symptoms of said disease or disorder.   When  administered to such a patient, the compound, compositions or products of the invention can cure,  delay, reduce the severity of, or ameliorate one or more symptoms, and/or prolong the survival of a  subject beyond that expected in the absence of such treatment.  Alternatively, a compound, pharmaceutical compositions or pharmaceutical products of the 20  invention may be administered to a patient who may ultimately be infected with a particular infectious  disease, or develop a disease or disorder as described herein,  in order  to  cure, delay,  reduce  the  severity of, or ameliorate one or more symptoms, and/or prolong the survival of a subject beyond that  expected  in the absence of such treatment, or,  in the case of  infectious diseases help prevent that  patient from transmitting said disease.  25  The treatments and preventative therapies of the present invention are applicable to a variety  of different  subjects of different ages.    In  the  context of humans,  the  therapies are applicable  to  children  (e.g.  infants,  children under 5  years old, older  children or  teenagers) and adults.    In  the  context of other animal subjects  (e.g. mammals such as primates),  the  therapies are applicable  to  immature subjects and mature/adult subjects.    30  The invention relates to the treatment of any disease or disorder which may be beneficially  treated with by increasing the number of NK cells in a patient.  Such diseases and disorders include  cancer,  infectious  diseases  (acute  and  chronic),  autoimmune  diseases  and  diseases  or  disorders  related to female  infertility or pregnancy.  Infectious diseases that may be treated according to the  present invention include viral infection, and infection by other pathogens, including bacteria, protists,  fugal, or helminth pathogens.  Typically said pathogens are intracellular pathogens which have at least  one intracellular phase in their life cycle.  Infections of particular interest include viral infections, and  zoonotic infections that are of particular importance from a public health perspective.  Cancers that  may be treated according to the present invention include bladder cancer, blood cancers, leukaemia,  5  bone cancers, bowel cancer, brain tumours, breast cancer, kidney cancer, liver cancer,  lung cancer,  melanoma, ovarian cancer, pancreatic cancer, prostate cancer, skin cancer, stomach cancer, testicular  cancer  and  uterine  cancer.   Autoimmune  diseases  that may  be  treated  according  to  the  present  invention include systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis and obesity‐ induced insulin resistance.  As used herein, the term diseases or disorders related to female infertility 10  or pregnancy includes, but is not limited to, fetal growth restriction, preterm labour, defects in uterine  vascular remodelling and preeclampsia.     The compounds, pharmaceutical compositions or pharmaceutical products of the  invention  may be used  in combination with one or more additional therapeutic agents or treatments, which  typically may be selected from a conventional treatment for the disease or disorder to be treated.  As 15  a non‐limiting example, if a compound, compositions or products of the invention are for use in the  treatment of a cancer, such as lung cancer, then said compound, compositions or products may be  used  in  combination  with  conventional  treatments  for  lung  cancer,  such  as  radiotherapy,  chemotherapy or surgery.  When used in combination with one or more additional therapeutic agent  or treatment, a compound, compositions or products of the invention may be administered before, 20  simultaneously with, or after the administration of the one or more additional therapeutic agent or  treatment.  In  some  preferred  embodiments,  a  compound,  pharmaceutical  compositions  or  pharmaceutical  products  of  the  invention  is  for  use  in  combination  with  antibody‐mediated  immunotherapy.  Antibody‐mediated immunotherapy involves the administration of antibodies to a 25  patient to target disease‐specific antigens.  Such antibodies could be used to increase the specificity  and killing activity of NK cells, which express receptors for the Fregions of IgG antibodies.  Activation  of these Freceptors, leads to NK cell activation, resulting in cytokine secretion and release of cytotoxic  granules  by  the  activated  NK  cell,  causing  lysis  of  the  cell  expressing  the  disease  antigen.  Such  combination therapy is particularly preferred for the treatment of cancer (using antibodies to tumour‐30  specific  antigens).    Any  antibody  used  in  immunotherapy  may  be  used  in  combination  with  a  compound of the invention.  Non‐limiting examples of such antibodies include anti‐CD20 mAbs (non‐ Hodgkin’s  lymphoma,  chronic  lymphocytic  lymphoma),  anti‐ganglioside  D2  (anti‐GD2)  mAbs  (neuroblastoma, melanoma),  anti‐human  epidermal  growth  factor  (anti‐HER2) mAbs  (breast  and  gastric cancers), anti‐epidermal growth  factor receptor  (anti‐EGFR) mAbs  (colorectal and head and  neck cancer).  In  other  aspects,  the  invention  provides  the  use  of  an  expanded  NK  cell  population  (as  described herein) in a therapeutic use or method as described herein.  Any and all of the disclosure  5  herein  in  relation  to  therapeutic  indications  of  a  compound,  pharmaceutical  composition  or  pharmaceutical  products  of  the  invention  may  apply  equally  and  independently  to  therapeutic  applications of the expanded NK cell populations of the  invention.   As a non‐limiting example, the  present invention provides an expanded NK cell population (as described herein) for use in a method  of therapy, for example in the treatment of cancer, an infectious diseases, an autoimmune disease or 10  a disease or disorder related to female infertility or pregnancy. As another non‐limiting example, the  invention provides a method of treatment by increasing the number of NK cells in a patient in need  thereof, comprising administering to said patient a therapeutically effective amount of an expanded  NK cell population.    15  Compositions and formulations  The  “compound”  and  products  described  herein  may  be  comprised  in  a  “therapeutic/prophylactic composition”, “formulation” or “medicament” of the invention.  The compound or expanded NK cell population of the  invention  (as defined above) can be  combined  or  administered  in  addition  to  a  pharmaceutically  acceptable  carrier,  diluent  and/or 20  excipient.  Alternatively or in addition the compound or expanded NK cell population of the invention  can further be combined with one or more of a salt, excipient, diluent, adjuvant, immunoregulatory  agent and/or antimicrobial compound.  The compound of  formula  (I) may be  in  the  form of a salt, particularly a pharmaceutically  acceptable salt.  Pharmaceutically acceptable salts include acid addition salts formed with inorganic 25  acids  such as,  for example, hydrochloric or phosphoric acids, or with organic acids  such as acetic,  oxalic, tartaric, maleic, and the like.  Salts formed with the free carboxyl groups may also be derived  from  inorganic  bases  such  as,  for  example,  sodium,  potassium,  ammonium,  calcium,  or  ferric  hydroxides,  and  such  organic  bases  as  isopropylamine,  trimethylamine,  2‐ethylamino  ethanol,  histidine, procaine, and the like.  As mentioned above, since compounds of the present invention are 30  preferably acids, then they will readily form salts  in which the carboxylic acid group  is present as a  carboxylate anion having a cationic counterion.    Administration of  immunogenic compositions,  therapeutic  formulations, medicaments and  prophylactic  formulations  is  generally  by  conventional  routes  e.g.  intravenous,  subcutaneous,  intraperitoneal, or mucosal routes.  The administration may be by parenteral injection, for example, a  subcutaneous,  intradermal  or  intramuscular  injection.    For  example,  formulations  comprising  antibodies  or  expanded  NK  cell  populations  of  the  invention  may  be  particularly  suited  to  administration  intravenously,  intramuscularly,  intradermally, or  subcutaneously. Administration of  small  molecule  REV‐ERB  inhibitors  may  be  injection,  such  as  intravenously,  intramuscularly,  5  intradermally, or subcutaneously, or by oral administration (small molecules with molecule weight of  less than 500 Da typically exhibiting oral bioavailability).  Accordingly,  immunogenic  compositions,  therapeutic  formulations,  medicaments  and  prophylactic formulations of the invention may be prepared as injectables, either as liquid solutions  or suspensions.   Solid  forms suitable  for solution  in, or suspension  in,  liquid prior to  injection may 10  alternatively be prepared.   The preparation may also be emulsified, or the peptide encapsulated  in  liposomes or microcapsules.  The active immunogenic ingredients (such as the compounds or expanded NK cell populations  of  the  invention)  are  often  mixed  with  excipients  which  are  pharmaceutically  acceptable  and  compatible with the active ingredient.  Suitable excipients are, for example, water, saline, dextrose, 15  glycerol, ethanol, or the like and combinations thereof.  In addition, if desired, the vaccine may contain  minor amounts of auxiliary substances such as wetting or emulsifying agents, pH buffering agents,  and/or adjuvants which enhance the effectiveness of the vaccine.  Generally,  the  carrier  is  a  pharmaceutically‐acceptable  carrier.   Non‐limiting  examples  of  pharmaceutically acceptable carriers include water, saline, and phosphate‐buffered saline.  In some 20  embodiments, however, where the composition comprises a compound of the invention, this may be  in lyophilized form, in which case it may include a stabilizer, such as BSA.  In some embodiments, it  may be desirable  to  formulate  the composition with a preservative, such as  thiomersal or sodium  azide, to facilitate long term storage.     Examples  of  additional  adjuvants which may  be  effective  include  but  are  not  limited  to: 25  complete  Freunds  adjuvant  (CFA),  Incomplete  Freunds  adjuvant  (IFA),  Saponin,  a  purified  extract  fraction of Saponin such as Quil A, a derivative of Saponin such as QS‐21,  lipid particles based on  Saponin  such as  ISCOM/ISCOMATRIX, E.  coli heat  labile  toxin  (LT) mutants  such as  LTK63 and/ or  LTK72, aluminium hydroxide, N‐acetyl‐muramyl‐L‐threonyl‐D‐isoglutamine  (thr‐MDP), N‐acetyl‐nor‐ muramyl‐L‐alanyl‐D‐isoglutamine (CGP 11637, referred to as nor‐MDP), N‐acetylmuramyl‐L‐alanyl‐D‐30  isoglutaminyl‐L‐alanine‐2‐(1'‐2'‐dipalmitoyl‐sn‐glycero‐3‐hydroxyphosphoryl  oxy)‐ethylamine  (CGP  19835A, referred to as MTP‐PE), and RIBI, which contains three components extracted from bacteria,  monophosphoryl  lipid  A,  trehalose  dimycolate  and  cell wall  skeleton  (MPL+TDM+CWS)  in  a  2 %  squalene/ Tween 80 emulsion,  the MF59  formulation developed by Novartis, and  the AS02, AS01,  AS03 and AS04 adjuvant formulations developed by GSK Biologicals (Rixensart, Belgium).  Examples of buffering agents include, but are not limited to, sodium succinate (pH 6.5), and  phosphate buffered saline (PBS; pH 6.5 and 7.5).  Additional  formulations  which  are  suitable  for  other  modes  of  administration  include  suppositories  and,  in  some  cases,  oral  formulations  or  formulations  suitable  for  distribution  as  5  aerosols. For suppositories, traditional binders and carriers may  include,  for example, polyalkylene  glycols  or  triglycerides;  such  suppositories  may  be  formed  from  mixtures  containing  the  active  ingredient in the range of 0.5% to 10%, preferably 1%‐2%.  Oral formulations include such normally employed excipients as, for example, pharmaceutical  grades of mannitol,  lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium 10  carbonate, and  the  like. These compositions  take  the  form of solutions, suspensions,  tablets, pills,  capsules, sustained release formulations or powders.  The dosage ranges for administration of the compounds or products of the present invention  are those which produce the desired therapeutic effect.  It will be appreciated that the dosage range  required depends on the precise nature of the compound, the route of administration, the nature of 15  the  formulation,  the age of  the patient,  the nature, extent or  severity of  the patient’s  condition,  contraindications,  if any, and the  judgement of the attending physician. Variations  in these dosage  levels can be adjusted using standard empirical  routines  for optimisation.   Similarly,  the dose of a  compound or products of the invention for use in a method of the invention, particularly an ex vivo  method, can be readily determined by one of skill in the art, and is any dose that produces the desired 20  increase in NK cell number and/or elicits the desired expansion in NK cells, to produce an expanded  NK cell population.  As a non‐limiting example, doses of compound acid7 or acid11 according to the  present invention may give rise to a final concentration of about 2 to about 20 µM, about 2 to about  15 µM, about 5 to about 15 µM, about 5 to about 14 µM, about 4 to about 13 µM, about 5 to about  12 µM, about 5 to about 11 µM, or preferably about 5 to about 10 µM.  25  The invention also provides the use of an expanded NK cell population (as described herein)  in a pharmaceutical formulation.  Any and all of the disclosure herein in relation to formulations of a  compound of the invention may apply equally and independently to therapeutic applications of the  expanded NK cell populations of the invention.      The compounds of the present invention may also be used as part of a composition that is not 30  intended for pharmaceutical applications, for instance a composition that may be used in ex vivo cell  (e.g. NK  cell) expansion methods,  such as  the ex vivo methods of  the present  invention.  In  these  instances, the composition comprises the compound of formula (I)  in an amount of at  least 0.01%,  preferably at least 0.1%, more preferably at least 1%, such as at least 10% by weight.      As mentioned  above,  compositions  of  the  present  invention, whether  pharmaceutical  or  otherwise,  are  preferably  free  from  compounds  disclosed  in  either  WO  2013/033310  or  WO  2015/103527.      5  Key to SEQ ID NOs    SEQ ID NO: 1 – E4bp4 gene sequence (X64318.1)    1 gcccctttct ttctcctcgt cggcccgaga gcaggaacac gataacgaag gaggcccaac 10  61 ttcattcaat aaggagcctg acggatttat cccagacggt agaacaaaag gaagaatatt 121 gatggatttt aaaccagagt ttttaaagag cttgagaata cggggaaatt aatttgttct 181 cctacacaca tagatagggt aaggttgttt ctgatgcagc tgagaaaaat gcagaccgtc 241 aaaaaggagc aggcgtctct tgatgccagt agcaatgtgg acaagatgat ggtccttaat 301 tctgctttaa cggaagtgtc agaagactcc acaacaggtg aggacgtgct tctcagtgaa 15  361 ggaagtgtgg ggaagaacaa atcttctgca tgtcggagga aacgggaatt cattcctgat 421 gaaaagaaag atgctatgta ttgggaaaaa aggcggaaaa ataatgaagc tgccaaaaga 481 tctcgtgaga agcgtcgact gaatgacctg gttttagaga acaaactaat tgcactggga 541 gaagaaaacg ccactttaaa agctgagctg ctttcactaa aattaaagtt tggtttaatt 601 agctccacag catatgctca agagattcag aaactcagta attctacagc tgtgtacttt 20  661 caagattacc agacttccaa atccaatgtg agttcatttg tggacgagca cgaaccctcg 721 atggtgtcaa gtagttgtat ttctgtcatt aaacactctc cacaaagctc gctgtccgat 781 gtttcagaag tgtcctcagt agaacacacg caggagagct ctgtgcaggg aagctgcaga 841 agtcctgaaa acaagttcca gattatcaag caagagccga tggaattaga gagctacaca 901 agggagccaa gagatgaccg aggctcttac acagcgtcca tctatcaaaa ctatatgggg 25  961 aattctttct ctgggtactc acactctccc ccactactgc aagtcaaccg atcctccagc 1021 aactccccga gaacgtcgga aactgatgat ggtgtggtag gaaagtcatc tgatggagaa 1081 gacgagcaac aggtccccaa gggccccatc cattctccag ttgaactcaa gcatgtgcat 1141 gcaactgtgg ttaaagttcc agaagtgaat tcctctgcct tgccacacaa gctccggatc 1201 aaagccaaag ccatgcagat caaagtagaa gcctttgata atgaatttga ggccacgcaa 30  1261 aaactttcct cacctattga catgacatct aaaagacatt tcgaactcga aaagcatagt 1321 gccccaagta tggtacattc ttctcttact cctttctcag tgcaagtgac taacattcaa 1381 gattggtctc tcaaatcgga gcactggcat caaaaagaac tgagtggcaa aactcagaat 1441 agtttcaaaa ctggagttgt tgaaatgaaa gacagtggct acaaagtttc tgacccagag 1501 aacttgtatt tgaagcaggg gatagcaaac ttatctgcag aggttgtctc actcaagaga 35  1561 cttatagcca cacaaccaat ctctgcttca gactctgggt aaattactac tgagtaagag 1621 ctgggcattt agaaagatgt catttgcaat agagcagtcc attttgtatt atgctgaatt 1681 ttcactggac ctgtgatgtc atttcactgt gatgtgcaca tgttgtctgt ttggtgtctt 1741 tttgtgcaca gattatgatg aagattagat tgtgttatca ctctgcctgt gtatagtcag 1801 atagtcatat gcgtaaggct gtatatatta agnttttatt tttgttgttc tattataaag 40  1861 tgtgtaagtt accagtttca ataaaggatt ggtgacaaac acagaaaaaa aaaaaaaaaa 1921 aaa SEQ ID NO: 2 – E4bp4 amino acid sequence (X64318.1)    45  MQLRKMQTVKKEQASLDASSNVDKMMVLNSALTEVSEDSTTGEDVLLSEGSVGKNKSSACRRKREFIPDEKKDAM YWEKRRKNNEAAKRSREKRRLNDLVLENKLIALGEENATLKAELLSLKLKFGLISSTAYAQEIQKLSNSTAVYFQ DYQTSKSNVSSFVDEHEPSMVSSSCISVIKHSPQSSLSDVSEVSSVEHTQESSVQGSCRSPENKFQIIKQEPMEL ESYTREPRDDRGSYTASIYQNYMGNSFSGYSHSPPLLQVNRSSSNSPRTSETDDGVVGKSSDGEDEQQVPKGPIH SPVELKHVHATVVKVPEVNSSALPHKLRIKAKAMQIKVEAFDNEFEATQKLSSPIDMTSKRHFELEKHSAPSMVH 50  SSLTPFSVQVTNIQDWSLKSEHWHQKELSGKTQNSFKTGVVEMKDSGYKVSDPENLYLKQGIANLSAEVVSLKRL IATQPISASDSG SEQ ID NO: 3 – REV‐ERBα gene sequence (NM_021724.4)    1 gggcacgagg cgctccctgg gatcacatgg tacctgctcc agtgccgcgt gcggcccggg 61 aaccctgggc tgctggcgcc tgcgcagagc cctctgtccc agggaaaggc tcgggcaaaa 121 ggcggctgag attggcagag tgaaatatta ctgccgaggg aacgtagcag ggcacacgtc 181 tcgcctcttt gcgactcggt gccccgtttc tccccatcac ctacttactt cctggttgca 5  241 acctctcttc ctctgggact tttgcaccgg gagctccaga ttcgccaccc cgcagcgctg 301 cggagccggc aggcagaggc accccgtaca ctgcagagac ccgaccctcc ttgctacctt 361 ctagccagaa ctactgcagg ctgattcccc ctacacactc tctctgctct tcccatgcaa 421 agcagaactc cgttgcctca acgtccaacc cttctgcagg gctgcagtcc ggccacccca 481 agaccttgct gcagggtgct tcggatcctg atcgtgagtc gcggggtcca ctccccgccc 10  541 ttagccagtg cccagggggc aacagcggcg atcgcaacct ctagtttgag tcaaggtcca 601 gtttgaatga ccgctctcag ctggtgaaga catgacgacc ctggactcca acaacaacac 661 aggtggcgtc atcacctaca ttggctccag tggctcctcc ccaagccgca ccagccctga 721 atccctctat agtgacaact ccaatggcag cttccagtcc ctgacccaag gctgtcccac 781 ctacttccca ccatccccca ctggctccct cacccaagac ccggctcgct cctttgggag 15  841 cattccaccc agcctgagtg atgacggctc cccttcttcc tcatcttcct cgtcgtcatc 901 ctcctcctcc ttctataatg ggagcccccc tgggagtcta caagtggcca tggaggacag 961 cagccgagtg tcccccagca agagcaccag caacatcacc aagctgaatg gcatggtgtt 1021 actgtgtaaa gtgtgtgggg acgttgcctc gggcttccac tacggtgtgc acgcctgcga 1081 gggctgcaag ggctttttcc gtcggagcat ccagcagaac atccagtaca aaaggtgtct 20  1141 gaagaatgag aattgctcca tcgtccgcat caatcgcaac cgctgccagc aatgtcgctt 1201 caagaagtgt ctctctgtgg gcatgtctcg agacgctgtg cgttttgggc gcatccccaa 1261 acgagagaag cagcggatgc ttgctgagat gcagagtgcc atgaacctgg ccaacaacca 1321 gttgagcagc cagtgcccgc tggagacttc acccacccag caccccaccc caggccccat 1381 gggcccctcg ccaccccctg ctccggtccc ctcacccctg gtgggcttct cccagtttcc 25  1441 acaacagctg acgcctccca gatccccaag ccctgagccc acagtggagg atgtgatatc 1501 ccaggtggcc cgggcccatc gagagatctt cacctacgcc catgacaagc tgggcagctc 1561 acctggcaac ttcaatgcca accatgcatc aggtagccct ccagccacca ccccacatcg 1621 ctgggaaaat cagggctgcc cacctgcccc caatgacaac aacaccttgg ctgcccagcg 1681 tcataacgag gccctaaatg gtctgcgcca ggctccctcc tcctaccctc ccacctggcc 30  1741 tcctggccct gcacaccaca gctgccacca gtccaacagc aacgggcacc gtctatgccc 1801 cacccacgtg tatgcagccc cagaaggcaa ggcacctgcc aacagtcccc ggcagggcaa 1861 ctcaaagaat gttctgctgg catgtcctat gaacatgtac ccgcatggac gcagtgggcg 1921 aacggtgcag gagatctggg aggatttctc catgagcttc acgcccgctg tgcgggaggt 1981 ggtagagttt gccaaacaca tcccgggctt ccgtgacctt tctcagcatg accaagtcac 35  2041 cctgcttaag gctggcacct ttgaggtgct gatggtgcgc tttgcttcgt tgttcaacgt 2101 gaaggaccag acagtgatgt tcctaagccg caccacctac agcctgcagg agcttggtgc 2161 catgggcatg ggagacctgc tcagtgccat gttcgacttc agcgagaagc tcaactccct 2221 ggcgcttacc gaggaggagc tgggcctctt caccgcggtg gtgcttgtct ctgcagaccg 2281 ctcgggcatg gagaattccg cttcggtgga gcagctccag gagacgctgc tgcgggctct 40  2341 tcgggctctg gtgctgaaga accggccctt ggagacttcc cgcttcacca agctgctgct 2401 caagctgccg gacctgcgga ccctgaacaa catgcattcc gagaagctgc tgtccttccg 2461 ggtggacgcc cagtgacccg cccggccggc cttctgccgc tgcccccttg tacagaatcg 2521 aactctgcac ttctctctcc tttacgagac gaaaaggaaa agcaaaccag aatcttattt 2581 atattgttat aaaatattcc aagatgagcc tctggccccc tgagccttct tgtaaatacc 45  2641 tgcctccctc ccccatcacc gaacttcccc tcctccccta tttaaaccac tctgtctccc 2701 ccacaaccct cccctggccc tctgatttgt tctgttcctg tctcaaatcc aatagttcac 2761 agctgagctg gcttcaaaaa aaaaaaaaaa aaa   SEQ ID NO: 4 – REV‐ERBα amino acid sequence (NM_021724.4)  50    MTTLDSNNNTGGVITYIGSSGSSPSRTSPESLYSDNSNGSFQSLTQGCPTYFPPSPTGSLTQDPARSFGSIPPSL SDDGSPSSSSSSSSSSSSFYNGSPPGSLQVAMEDSSRVSPSKSTSNITKLNGMVLLCKVCGDVASGFHYGVHACE GCKGFFRRSIQQNIQYKRCLKNENCSIVRINRNRCQQCRFKKCLSVGMSRDAVRFGRIPKREKQRMLAEMQSAMN LANNQLSSQCPLETSPTQHPTPGPMGPSPPPAPVPSPLVGFSQFPQQLTPPRSPSPEPTVEDVISQVARAHREIF TYAHDKLGSSPGNFNANHASGSPPATTPHRWENQGCPPAPNDNNTLAAQRHNEALNGLRQAPSSYPPTWPPGPAH HSCHQSNSNGHRLCPTHVYAAPEGKAPANSPRQGNSKNVLLACPMNMYPHGRSGRTVQEIWEDFSMSFTPAVREV VEFAKHIPGFRDLSQHDQVTLLKAGTFEVLMVRFASLFNVKDQTVMFLSRTTYSLQELGAMGMGDLLSAMFDFSE 5  KLNSLALTEEELGLFTAVVLVSADRSGMENSASVEQLQETLLRALRALVLKNRPLETSRFTKLLLKLPDLRTLNN MHSEKLLSFRVDAQ SEQ ID NO: 5 – REV‐ERBβ gene sequence (AB307693.1)    10  1 atggaggtga atgcaggagg tgtgattgcc tatatcagtt cttccagctc agcctcaagc 61 cctgcctctt gtcacagtga gggttctgag aatagtttcc agtcctcctc ctcttctgtt 121 ccatcttctc caaatagctc taattctgat accaatggta atcccaagaa tggtgatctc 181 gccaatattg aaggcatctt gaagaatgat cgaatagatt gttctatgaa aacaagcaaa 241 tcgagtgcac ctgggatgac aaaaaatcat agtggtgtga caaaatttag tggcatggtt 15  301 ctactgtgta aagtctgtgg ggatgtggcg tcaggattcc actatggagt tcatgcttgc 361 gaaggctgta agggtttctt tcggagaagt attcaacaaa acatccagta caagaagtgc 421 ctgaagaatg aaaactgttc tataatgaga atgaatagga acagatgtca gcaatgtcgc 481 ttcaaaaagt gtctgtctgt tggaatgtca agagatgctg ttcggtttgg tcgtattcct 541 aagcgtgaaa aacagaggat gctaattgaa atgcaaagtg caatgaagac catgatgaac 20  601 agccagttca gtggtcactt gcaaaatgac acattagtag aacatcatga acagacagcc 661 ttgccagccc aggaacagct gcgacccaag ccccaactgg agcaagaaaa catcaaaagc 721 tcttctcctc catcttctga ttttgcaaag gaagaagtga ttggcatggt gaccagagct 781 cacaaggata cctttatgta taatcaagag cagcaagaaa actcagctga gagcatgcag 841 ccccagagag gagaacggat tcccaagaac atggagcaat ataatttaaa tcatgatcat 25  901 tgcggcaatg ggcttagcag ccattttccc tgtagtgaga gccagcagca tctcaatgga 961 cagttcaaag ggaggaatat aatgcattac ccanatggcc atgccatttg tattgcaaat 1021 ggacattgta tgaacttctc caatgcttat actcaaagag tatgtgatag agttccgata 1081 gatggatttt ctcagaatga gaacaagaat agttacctgt gcaacactgg aggaagaatg 1141 catctggttt gtccaatgag taagtctcca tatgtggatc ctcataaatc aggacatgaa 30  1201 atctgggaag aattttcgat gagcttcact ccagcagtga aagaagtggt ggaatttgca 1261 aagcgtattc ctgggttcag agatctctct cagcatgacc aggtcaacct tttaaaggct 1321 gggacttttg aggttttaat ggtacggttc gcatcattat ttgatgcaaa ggaacgtact 1381 gtcacctttt taagtggaaa gaaatatagt gtggatgatt tacactcaat gggagcaggg 1441 gatctgctaa actctatgtt tgaatttagt gagaagctaa atgccctcca acttagtgat 35  1501 gaagagatga gtttgtttac agctgttgtc ctggtatctg cagatcgatc tggaatagaa 1561 aacgtcaact ctgtggaggc tttgcaggaa actctcattc gtgcactaag gaccttaata 1621 atgaaaaacc atccaaatga ggcctctatt tttacaaaac tgcttctaaa gttgccagat 1681 cttcgatctt taaacaacat gcactctgag gagctcttgg cctttaaagt tcacccttaa   40  SEQ ID NO: 6 – REV‐ERBβ amino acid sequence (AB307693.1)    MEVNAGGVIAYISSSSSASSPASCHSEGSENSFQSSSSSVPSSPNSSNSDTNGNPKNGDLANIEGILKNDRIDCS MKTSKSSAPGMTKNHSGVTKFSGMVLLCKVCGDVASGFHYGVHACEGCKGFFRRSIQQNIQYKKCLKNENCSIMR MNRNRCQQCRFKKCLSVGMSRDAVRFGRIPKREKQRMLIEMQSAMKTMMNSQFSGHLQNDTLVEHHEQTALPAQE 45  QLRPKPQLEQENIKSSSPPSSDFAKEEVIGMVTRAHKDTFMYNQEQQENSAESMQPQRGERIPKNMEQYNLNHDH CGNGLSSHFPCSESQQHLNGQFKGRNIMHYPXGHAICIANGHCMNFSNAYTQRVCDRVPIDGFSQNENKNSYLCN TGGRMHLVCPMSKSPYVDPHKSGHEIWEEFSMSFTPAVKEVVEFAKRIPGFRDLSQHDQVNLLKAGTFEVLMVRF ASLFDAKERTVTFLSGKKYSVDDLHSMGAGDLLNSMFEFSEKLNALQLSDEEMSLFTAVVLVSADRSGIENVNSV EALQETLIRALRTLIMKNHPNEASIFTKLLLKLPDLRSLNNMHSEELLAFKVH 50    SEQ ID NO: 7 – Delta‐like ligand 4 gene sequence (AF253468.1)    1 atggcggcag cgtcccggag cgcctctggc tgggcgctac tgctgctggt ggcactttgg 61 cagcagcgcg cggccggctc cggcgtcttc cagctgcagc tgcaggagtt catcaacgag 121 cgcggcgtac tggccagtgg gcggccttgc gagcccggct gccggacttt cttccgcgtc 181 tgccttaagc acttccaggc ggtcgtctcg cccggaccct gcaccttcgg gaccgtctcc 241 acgccggtat tgggcaccaa ctccttcgct gtccgggacg acagtagcgg cggggggcgc 5  301 aaccctctcc aactgccctt caatttcacc tggccgggta ccttctcgct catcatcgaa 361 gcttggcacg cgccaggaga cgacctgcgg ccagaggcct tgccaccaga tgcactcatc 421 agcaagatcg ccatccaggg ctccctagct gtgggtcaga actggttatt ggatgagcaa 481 accagcaccc tcacaaggct gcgctactct taccgggtca tctgcagtga caactactat 541 ggagacaact gctcccgcct gtgcaagaag cgcaatgacc acttcggcca ctatgtgtgc 10  601 cagccagatg gcaacttgtc ctgcctgccc ggttggactg gggaatattg ccaacagcct 661 atctgtcttt cgggctgtca tgaacagaat ggctactgca gcaagccagc agagtgcctc 721 tgccgcccag gctggcaggg ccggctgtgt aacgaatgca tcccccacaa tggctgtcgc 781 cacggcacct gcagcactcc ctggcaatgt acttgtgatg agggctgggg aggcctgttt 841 tgtgaccaag atctcaacta ctgcacccac cactccccat gcaagaatgg ggcaacgtgc 15  901 tccaacagtg ggcagcgaag ctacacctgc acctgtcgcc caggctacac tggtgtggac 961 tgtgagctgg agctcagcga gtgtgacagc aacccctgtc gcaatggagg cagctgtaag 1021 gaccaggagg atggctacca ctgcctgtgt cctccgggct actatggcct gcattgtgaa 1081 cacagcacct tgagctgcgc cgactccccc tgcttcaatg ggggctcctg ccgggagcgc 1141 aaccaggggg ccaactatgc ttgtgaatgt ccccccaact tcaccggctc caactgcgag 20  1201 aagaaagtgg acaggtgcac cagcaacccc tgtgccaacg ggggacagtg cctgaaccga 1261 ggtccaagcc gcatgtgccg ctgccgtcct ggattcacgg gcacctactg tgaactccac 1321 gtcagcgact gtgcccgtaa cccttgcgcc cacggtggca cttgccatga cctggagaat 1381 gggctcatgt gcacctgccc tgccggcttc tctggccgac gctgtgaggt gcggacatcc 1441 atcgatgcct gtgcctcgag tccctgcttc aacagggcca cctgctacac cgacctctcc 25  1501 acagacacct ttgtgtgcaa ctgcccttat ggctttgtgg gcagccgctg cgagttcccc 1561 gtgggcttgc cgcccagctt cccctgggtg gccgtctcgc tgggtgtggg gctggcagtg 1621 ctgctggtac tgctgggcat ggtggcagtg gctgtgcggc agctgcggct tcgacggccg 1681 gacgacggca gcagggaagc catgaacaac ttgtcggact tccagaagga caacctgatt 1741 cctgccgccc agcttaaaaa cacaaaccag aagaaggagc tggaagtgga ctgtggcctg 30  1801 gacaagtcca actgtggcaa acagcaaaac cacacattgg actataatct ggccccaggg 1861 cccctggggc gggggaccat gccaggaaag tttccccaca gtgacaagag cttaggagag 1921 aaggcgccac tgcggttaca cagtgaaaag ccagagtgtc ggatatcagc gatatgctcc 1981 cccagggact ccatgtacca gtctgtgtgt ttgatatcag aggagaggaa tgaatgtgtc 2041 attgccacgg aggtataa 35    SEQ ID NO: 8– Delta‐like ligand 4 amino acid sequence (AF253468.1)    MAAASRSASGWALLLLVALWQQRAAGSGVFQLQLQEFINERGVLASGRPCEPGCRTFFRVCLKHFQAVVSPGPCT FGTVSTPVLGTNSFAVRDDSSGGGRNPLQLPFNFTWPGTFSLIIEAWHAPGDDLRPEALPPDALISKIAIQGSLA 40  VGQNWLLDEQTSTLTRLRYSYRVICSDNYYGDNCSRLCKKRNDHFGHYVCQPDGNLSCLPGWTGEYCQQPICLSG CHEQNGYCSKPAECLCRPGWQGRLCNECIPHNGCRHGTCSTPWQCTCDEGWGGLFCDQDLNYCTHHSPCKNGATC SNSGQRSYTCTCRPGYTGVDCELELSECDSNPCRNGGSCKDQEDGYHCLCPPGYYGLHCEHSTLSCADSPCFNGG SCRERNQGANYACECPPNFTGSNCEKKVDRCTSNPCANGGQCLNRGPSRMCRCRPGFTGTYCELHVSDCARNPCA HGGTCHDLENGLMCTCPAGFSGRRCEVRTSIDACASSPCFNRATCYTDLSTDTFVCNCPYGFVGSRCEFPVGLPP 45  SFPWVAVSLGVGLAVLLVLLGMVAVAVRQLRLRRPDDGSREAMNNLSDFQKDNLIPAAQLKNTNQKKELEVDCGL DKSNCGKQQNHTLDYNLAPGPLGRGTMPGKFPHSDKSLGEKAPLRLHSEKPECRISAICSPRDSMYQSVCLISEE RNECVIATEV SEQ ID NO: 9 – Human Notch1 cDNA sequence (CR457221.1)  50    1 atgtcaaaca tgagatgtgt ggactgtggc acttgcctgg gtcacacacg gaggcatcct 61 acccttttct ggggaaagac actgcctggg ctgaccccgg tggcggcccc agcacctcag 121 cctgcacagt gtcccccagg ttccgaagaa gatgctccag caacacagcc tgggccccag 181 ctcgcgggac ccgacccccc gtgggctccc gtgttttgta ggagacttgc cagagccggg 241 cacattgagc tgtgcaacgc cgtgggctgc gtcctttggt cctgtccccg cagccctggc 301 agggggcatg cggtcgggca ggggctggag ggaggcgggg gctgcccttg ggccacccct 5  361 cctagtttgg gaggagcaga tttttgcaat accaagtata gcctatggca gaaaaaatgt 421 ctttaa   SEQ ID NO: 10 – Human Notch1 protein sequence (CR457221.1)  10  MSNMRCVDCGTCLGHTRRHPTLFWGKTLPGLTPVAAPAPQPAQCPPGSEEDAPATQPGPQLAGPDPPWAPVFCRR LARAGHIELCNAVGCVLWSCPRSPGRGHAVGQGLEGGGGCPWATPPSLGGADFCNTKYSLWQKKCL   EXAMPLES    15  The invention will be further illustrated by the following examples, which are intended to be purely  exemplary of the invention and are in no way limiting.  In addition to the data presented below, the  contents of WO 2020/002911, and in particular the examples section, is incorporated herein by  reference.  Although this case concerns compounds having a different structure from those of  formula (I), it nevertheless contains data obtained from compounds with structural features in 20  common with those of the present invention, as well as relevant synthetic methods.      Example 1 – design of new acid‐form compounds    Compounds  of  formula  (I)  were  obtained  by  hydrolysing  ethyl  ester  analogues  of  the  compounds of formula  (I).   The use of 1.0 M NaOH at room temperature for 16 hours yielded the 25  desired acid compounds as the major product.  Methods for preparing ethyl ester analogues of the compounds of formula (I) are disclosed in  detail in WO 2020/002911.    All compounds were synthesised and studied as racemate (consistent with literature on this  class of REV‐ERB modulators).  30      Scheme 1: General synthesis scheme for compounds of formula (I):          Reaction conditions : NaOH 1.0M, THF/H2O, rt, 16h    Ethyl 1,2,3,4‐tetrahydroisoquinoline‐3‐carboxylate, Intermediate (Int.)    A  solution  of  1,2,3,4‐tetrahydroisoquinoline‐3‐carboxylic  acid  (1.00  g,  4.68mmol)  in  anhydrous ethanol (25 mL) at room temperature (rt) and under N2 atmosphere was treated with cc.  5  H2SO4 (1.00 mL, 7.15 mmol) and the reaction mixture was stirred under reflux for 18 h in the presence  of molecular sieves 4 Å. The solvent was removed under vacuo and the residue resuspended in ethyl  acetate (EtOAc) (30 mL) and washed with saturated NaHCO3 (aq, 3 x 15 mL) and brine (3 x 15 mL),  dried  (MgSO4),  filtered,  and  evaporated  under  reduced  pressure.  The  crude  was  purified  by  chromatography (n‐Hex to EtOAc, 3:1, Rf: 0.51) to yield Int. as a yellow oil (650 mg, 67%). 1H‐NMR 10  (CDCl3) δ = 7.20 – 7.12 (m, 3H), 7.09 – 7.04 (m, 1H), 4.26 (q, J = 7.1, 2H), 4.17 (d, J = 16.2, 1H), 4.11(d,  J = 16.2, 1H), 3.76 (m, 1H), 3.12 (dd, J = 18.0, 16.2 , 1H), 2.98 (dd, J = 18.0, 16.2, 1H), 2.13 (s, 1H, NH),  1.33 (t, J = 7.1, 3H); LC‐MS (20‐98% MeCN) rt = 1.73 min; m/z 206.29 ([M+H]+ ); HRMS (m/z): calcd for  [M+H]+ C12H16NO2: 206.1181; found: 206.1175.    15  Ethyl 2‐(furan‐2‐carbonyl)‐1,2,3,4‐tetrahydroisoquinoline‐3‐ carboxylate, compound 7.   A solution of 2‐furoic acid (161 mg, 1.44 mmol) in DMF (20 mL) was treated with TEA (0.27  mL, 1.9 mmol), EDC coupling agent  (257 mg, 1.34 mmol) and HOBt  (181 mg, 1.34 mmol) and  left  stirring at rt for 5 min. To this mixture, Int. (200 mg, 0.960 mmol) was added and the reaction mixture  was left stirring rt overnight under N2 atmosphere. 60 mL of dH2O were added to quench the reaction 20  and the product was extracted with EtOAc (3 x 15 mL). All organic fractions were mixed together and  washed with LiCl 5% (3 x 15 mL) to eliminate traces of DMF, NaHCO3 (3 x 15 mL) and brine (3 x 15 mL),  dried  (MgSO4),  filtered,  and  evaporated  under  reduced  pressure.  The  crude  was  purified  by  chromatography (n‐Hex to EtOAc, 3.5:1, Rf: 0.22) to obtain 7 as a pale‐yellow oil (266 mg; yield: 93%).  A ratio of rotamers was present in the NMR and the characterisation refers to this mixture. 1H‐NMR 25  (DMSO‐d6) δ = 8.16 – 7.77 (m, 1H), 7.37 – 7.00 (m, 5H), 6.69 (m, 1H), 5.44 (br, 0.4H), 5.13 (br, 0.6H),  5.11 – 5.07 (m, 0.6H), 4.93 ‐ 4.89 (m, 0.6H), 4.83 ‐ 4.79 (m, 0.4H), 4.59 ‐ 4.55 (m, 0.4H), 4.00 (m, 2H),  3.24 (br, 2H), 1.02 (s, 3H); LC‐MS (20‐98% MeCN) rt = 4.16 min; m/z 300.33 ([M+H]+ ); HRMS (m/z):  calcd for [M+H]+ C17H18NO4: 300.1236; found: 300.1247.     30  2‐(Furan‐2‐carbonyl)‐1,2,3,4‐tetrahydroisoquinoline‐3‐carboxylic acid, compound acid7.  Compound 7 (200 mg, 0.70 mmol) was dissolved in THF (1.0 mL) and H2O (1 mL). To the stirred  solution, NaOH 1.0 M (0.70 mL, 0.70 mmol) was added, and the mixture stirred at RT for 16 h. The  reaction mixture was diluted with NaOH 1.0 M and extracted with EtOAc (3 x 10 mL). HCl 1.0 M was  added to the combined aqueous layers until pH~4, and then extracted with EtOAc (3 x 10 mL), washed  with brine (3 x 10 mL), dried (MgSO4), filtered and evaporated under reduced pressure. AU‐acid7 was  obtained a pure white powder without need of further purification. (Pent:EtOAc 6:4 + 1% Acetic acid,  Rf. 0.22) (135 mg, yield: 78%). A ratio of rotamers was present in the NMR and the characterisation  refers to this mixture. 1H‐NMR (400 MHz, DMSO‐d6) δ = 12.80 (s, 1H), 7.91 (m, 1H), 7.22 (m, 5H), 6.71  5  (m, 1H), 5.39 (br, 0.5H), 5.16 (br, 0.5H), 5.09 (m, 0.5H), 4.89 (m, 0.5H), 4.83 (m, 0.5H), 4.55 (m, 0.5H),  3.23 (m, 2H); m/z 300.33 ([M+H]+); HRMS (m/z): calculated for [M+H]+ C15H14NO4: 272.0923; found:  272.0919; purity by LC‐MS: 96%.    Ethyl 2‐(4‐methyloxazole‐5‐carbonyl)‐1,2,3,4‐tetrahydroisoquinoline‐3‐carboxylate, compound 11.  10  Compound 11 was prepared  from  Int.  (291 mg, 1.42 mmol) according to  the EDC coupling  procedure described for compound 7, using 4‐methyloxazole‐5‐carboxylic acid (150 mg, 1.52 mmol).  The crude was purified by chromatography (nHex to EtOAc, 1:1, Rf: 0.20) to obtain 11 as a transparent  oil (216 mg; yield: 58%). A ratio of rotamers was present in the NMR and the characterisation refers  to this mixture. 1H‐NMR (DMSO‐d6) δ = 8.53 (s, 0.5H), 8.42 (s, 0.5H), 7.23 (br, 4H), 5.26 (br, 0.5H), 5.07 15  (br, 0.5H), 4.92 (m, 0.5H), 4.80 (m, 1H), 4.56 (m, 0.5H), 4.03 (br, 2H), 3.25 (m, 2H), 2.33 (s, 3H), 1.08 ‐  0.99 (m, 3H); LC‐MS (20‐98% MeCN) rt = 9.55 min; m/z 315.28 ([M+H]+ ); HRMS (m/z): calcd for [M+H]+  C17H19N2O4: 315.1345; found: 315.1352.     2‐(4‐Methyloxazole‐5‐carbonyl)‐1,2,3,4‐tetrahydroisoquinoline‐3‐carboxylic  acid,  compound 20  acid11.  Compound 11  (200 mg, 0.70 mmol) was dissolved  in THF  (1.0 mL) and H2O  (1 mL). To  the  stirred solution, NaOH 1.0 M (0.70 mL, 0.70 mmol) was added, and the mixture stirred at RT for 16 h.  The reaction mixture was diluted with NaOH 1.0 M and extracted with EtOAc (3 x 10 mL). HCl 1.0 M  was added to the combined aqueous layers until pH~4, and then extracted with EtOAc (3 x 10 mL), 25  washed with brine (3 x 10 mL), dried (MgSO4), filtered and evaporated under reduced pressure. AU‐ acid11 was obtained a pure white powder without need of further purification. (Pent:EtOAc 6:4 + 1%  Acetic  acid, Rf. 0.24)  (118 mg,  yield:  69%). A  ratio of  rotamers was present  in  the NMR  and  the  characterisation refers to this mixture. 1H‐NMR (400 MHz, MeOD) δ = 8.28 (m, 1H), 7.25 (m, 4H), 5.27  (m, 1H), 5.02  (m, 1H), 4.70  (m, 1H), 3.33  (m, 2H), 2.43  (s, 3H); HRMS  (m/z): calculated  for  [M+H]+ 30  C15H15N2O4: 287.1032; found: 287.14401; purity by LC‐MS: 100%.    Example 2 – screening of acid‐form compounds for REV‐ERBα antagonist activity    Experiments were conducted to screen compounds of the present invention for REV‐ERBα  antagonist activity.  For comparison, compounds 7 and 11, SR8278 and GSK1362 were also tested,  with DMSO used as a control.  The structures of compounds 7 and 11, SR8278 and GSK1362 are  shown below:  Co 11    5    Dual‐Luciferase  gene  assay  titration  for  DNA  ratios:  HEK293T  cells  were  defrosted  and  maintained in DMEM supplemented with 10% FCS and 1% PSG at 37°C and 5% CO2. Cells were plated  in a 24‐well plate (8.104 cells/well in 0.5 mL of media without antibiotics). 24 h after seeding, when  cells reached 80% confluency, they were transfected with 100 ng of pGL4‐Bmal‐luc, 10 ng of pRL‐CMV 10  Renilla  luciferase as an  internal control, and 10 ng of REV‐ERBα, or the empty vector pcDNA3 as a  control. All conditions were equalled to a total of 400 ng of DNA by using BSM. Opti‐MEM was added  in order to dilute the mixture to 0.02 μg of DNA per μL. Mixtures were vortexed at this stage to assure  homogeneity. FuGENE was used as transfection reagent in a 5:2 ratio FuGENE:DNA, and after addition,  mixture was gently mixed and left to incubate for 20 min at RT. Afterwards, 20 μL of the DNA mix was 15  transferred into the 24‐well plate containing the pre‐seeded cells, with each condition in triplicate. 5  h after  transfection, cells were  treated with compounds 7, 11, 7acid, 11acid, SR8278, GSK1362 or  DMSO as a vehicle.  For that, 2X stock solutions of the compounds (or DMSO vehicle control) in DMEM  were prepared. 0.5 mL of these 2X stock solutions were added to each well. 24 h after transfection,  cells were  lysed and  luciferase activity was measured using Dual‐Luciferase Reporter Assay System 20  (Promega, E2920). Cells were lysed using Passive Lysis buffer 5X (Promega, E1941) (PLB) by addition  of 50 mL of PLB (1:5 dilution in water) to each well and gently stirring for 30 min. Each cell lysate was  transferred to a flat bottom white opaque 96‐well plate. 50 mL of Dual‐Glo reagent were dispensed  into each well, tapped gently to mix and incubated for 10 min at RT. Luminescence of firefly luciferase  was measured using a Tecan VICTOR Light Luminescent counter equipment. Then, 50 mL of Stop&Glo 25  reagent were dispensed to quench firefly activity and activate Renilla luciferase, incubated for 10 min  and measured. Firefly activity was normalized to Renilla luciferase activity.   Results: The resulting data are shown in Figure 3, expressed as the average and standard error  obtained from three independent experiments carried out in triplicate.  It can be seen that compounds  7 and 11, as expected, produced significant increase in luciferase expression compared with the DMSO  control  (*  for  p<0.05,  **  for  p<0.01,  ***  for  p<0.001  and  ****  for  p<0.0001),  and  also  SR8278.  5  Surprisingly, compounds acid7 and acid11 also produced a significant increase in luciferase expression,  in spite of the removal of the ester substitution from the tetrahydroisoquinoline core.   Even more  surprising is that the increase was greater than that observed in compounds 7 and 11, suggesting that  acid form compounds are even stronger REV‐ERBα antagonists than their ethyl ester counterparts.      10  Example 3 – screening of acid‐form compounds for REV‐ERBα and REV‐ERBβ antagonist activity over  48 hours     The method of Example 2 was repeated, but with the cells lysed after 48 hours.  The method  was carried out REV‐ERBα (as in Example 1) and also with REV‐ERBβ.      Results: The resulting data are shown in Figure 4, expressed as the average and standard error 15  obtained from three independent experiments carried out in triplicate.  As in Example 2, in the REV‐ ERBα  experiments,  compounds  acid7  and  acid11  produced  the  greatest  increase  in  luciferase  expression  of  all  the  compounds  tested.    Compounds  acid7  and  acid11  also  produced  a  greater  increase in luciferase expression than their ethyl ester analogues (compounds 7 and 11) in the REV‐ ERBβ experiments.    20    The same experiments were repeated, but with the tested compounds used at concentrations  of  5  and  50  µM.    In  both  the  REV‐ERBα  and  REV‐ERBβ  experiments  and  at  all  concentrations,  compounds acid7 and acid11 produced a greater increase in luciferase expression compared to DMSO  than their ethyl ester analogues (compounds 7 and 11).      25  Example 4 – plasma protein binding of acid‐form compounds  It is widely believed that only the free concentration rather than the total drug concentration  that  is pharmacologically active.  Ideally, a  compound  is neither  fully bound nor  fully  free. Plasma  protein binding (PPB) data is a useful tool to design optimal dose regimens for efficacy studies and to  estimate  safety margins during drug development. Many  lead molecules with high affinities  for a 30  therapeutic target in vitro exhibit a reduced efficacy in vivo. Therefore, the determination of the free  fraction (unbound drug) of the drug becomes an important issue for both, in vitro and in vivo screening  of potential drug candidates.  As such, plasma protein binding experiments were carried out on the  compounds of  the present  invention.   Once again,  for comparison,  tests were also carried out on  compounds 7 and 11 and SR8278, as well as warfarin as a literature control.    Plasma protein binding: 1 mM stock solutions of test compounds were prepared  in DMSO  and  diluted  200‐fold  in  mice  plasma  to  prepare  a  concentration  of  5  μM,  with  a  final  DMSO  concentration in plasma of 0.5%. Rapid equilibrium dialysis was performed with a rapid equilibrium  dialysis (RED) device containing a dialysis membrane with a molecular weight cut‐off of 8,000 Daltons.  5  Each dialysis  insert  contained  two  chambers: a  red  chamber  for plasma and a white  chamber  for  buffer. A 200 μL aliquot of positive controls and test compounds at 5 μM (triplicates) were separately  added to the plasma chamber and 350 μL of phosphate buffer saline (pH 7.4) was added to the buffer  chamber of the inserts. After sealing the RED device with an adhesive film, dialysis was performed in  an  incubator at 37°C with shaking at 100 RPM  for 4 h. Following dialysis, an aliquot of 50 μL was 10  removed from each well  (both plasma and buffer side) and diluted with equal volume of opposite  matrix  (dialyzed with  the other matrix)  to nullify  the matrix effect. A  final  aliquot of 100  μL was  submitted for LC‐MS/MS analysis.       Results: The resulting data are shown in the following table:  15    Compound  % bound protein  Warfarin  98.2 ± 0.5  SR8278  NR  AU‐7  NR  AU‐acid7  94.1 ± 0.1  AU‐11  NR  AU‐acid11  89.6 ± 0.6  NR: not reportable as compound is unstable in mice plasma    It can be seen that no compound 7 or compound 11 were detected in the mice plasma.  In  contrast, compound acid7 and compound acid11 appear relatively stable in mice plasma, with some  compound bound to plasma proteins and some free.    20    Example 5 – screening of acid‐form compounds for off‐target effect     Prior art REV‐ERB ligands have been known to exhibit clear off‐target effects, and in particular  to activate LXRα, a nuclear receptor closely related to REV‐ERB and involved in numerous biological  pathways. Activity of REV‐ERB ligands on LXRα would ideally be avoided. A reporter gene assay similar 25  to that described in Example 2 was carried out using LXRα and compounds of the present invention.  For  comparison,  tests were  also  carried  out  using  compound  7  and  compound  11,  SR8278  and  GSK1362, and with DMSO as a control.      Reporter gene assay for LXRα activity: HEK293T cells were seeded and transfected following  the protocol previously described  in Example 2. The DNA master mix used was composed of 50 ng  5  LXRα or pcLXRα as the empty vector, 100 ng of pGL3‐LXR REX2‐luc, 10 ng of Renilla luciferase and 240  ng  of  BSM.  5  h  after  transfection  compounds  (or  DMSO  vehicle  control) were  added  at  10  μM  concentration. GW3965 was used as LXRα activator control at 5 μM. After 24 h, cells were lysed and  activity was measured as previously described using Dual‐Luciferase Reporter Assay System.  Results: The resulting data are shown in Figure 5, expressed as the average and standard error 10  obtained from three independent experiments carried out in triplicate.      It can be seen that the effect of compounds 7, 11, acid7 and acid11 on LXRα was minimally  changed compared with the DMSO control, with a smaller change an observed for compounds acid7  and acid11 than their ethyl ester analogues, compounds 7 and 11 (* for p<0.05, ** for p<0.01, *** for  p<0.001 and **** for p<0.0001).  In contrast, SR8278 and GSK1362 can be seen to notably decrease 15  luciferase expression as compared to the DMSO control, thereby suggesting that these compounds  exhibit a greater off‐target effect than compounds of the present invention.      Example 6 – effect of acid‐form compounds on expression of E4BP4    The effect of compounds of the present invention on endogenous REV‐ERB was assessed by 20  looking at the expression of E4BP4 in different cell lines.      A first set of experiments was conducted using HepG2 and a second set of experiments was  conducted using NK‐92 cells.      Sample preparation: HepG2 cells were seeded in 6‐well plates in DMEM media supplemented  with 10% FBS and 1% PSG (2.5∙106 cells in 3 mL media per well) at 37°C and 5% CO2. When cells reached 25  70% confluency, they were changed to media without serum for 24 h, in order to deplete intracellular  heme concentration, and then switched to DMEM supplemented with DMSO or compound, at 10 μM  concentration. Cells were grown in the presence of compound for 24 h and then harvested for gene  expression by RT‐qPCR.      NK‐92 cells were seeded in 6‐well plates in αMEM media supplemented with 12.5% FCS, 12.5% 30  horse serum, 2mM Glutamax, 0.1 mM β‐ME, 1X NEAA, 100U IL‐2, 0.01 mM folic acid and 0.2 mM myo‐ inositol (3∙106 cells in 3 mL media per well) at 37°C and 5% CO2. 24 h after seeding, wells were topped  up  with  1  mL  supplemented media  with  40  μM  concentration  of  compound  or  DMSO  vehicle,  achieving a final concentration of 1 or 10 μM. Cells were grown in the presence of compound for 24 h  and then harvested for gene expression by RT‐qPCR.  RNA extraction: RNA was isolated using RNeasy Plus Mini Kit (QIAGEN, cat. 74134) according  to the manufacture’s protocol. HepG2 cells were harvested directly from the well, by removing media,  washing with EDTA, lysed by adding 350 μL of RLT plus 1% β‐ME and homogenized by vortex. NK‐92  cells were collected into tubes, centrifuged, and the pellets were lysed by adding 350 μL RLT plus 1%  5  β‐ME and homogenized by vortex. Cell  lysate was transferred to gDNA Eliminator spin column and  centrifuged to remove genomic DNA. 350 μL 70% ethanol was added and samples were transferred  to RNeasy MinElute spin column and centrifuged. Next 700 μL buffer RW1 and 2x 500 μL RPE were  added to the column with centrifugation (8,000 g) following each addition. After that, samples were  centrifuged at full speed for 2 min to dry the membrane. Finally, RNA was eluted by adding 40 μL of 10  RNase‐free water  to  the  column and  centrifuging at  full  speed  for 1 min. RNA  concentration was  determined using Nanodrop.   Complementary DNA (cDNA) synthesis by reverse transcription: 2 μg of RNA were converted  to cDNA.  RNA was mixed with the following reagents from Thermo Fisher in thin‐wall PCR tubes: 5x  Reaction buffer for RT, 4.0 μL; dNTP mix (10 mM each), 2.0 μL; random hexamer primer (0.2 μg/μL), 15  1.0 μL; RevertAid Reverse Transcriptase, 1.0 μL; 2.0 μg RNA, decided according to concentration; and  ddH2O, (12 – RNA volume) μL.  Reverse  transcriptase‐quantitative  polymerase  chain  reaction  (RT‐qPCR):  Samples  were  gently mixed, and reactions were carried out in an Applied Biosystems VeritiTM 96 well thermal cycler  (Life  Technologies)  at  42  °C  for  1  h,  followed  by  5 min  at  95  °C  to  heat  inactivate  the  reverse 20  transcriptase. The resulting cDNA was then diluted 1 in 10 with DNase‐free ddH2O.   RNA expression of REV‐ERB target genes was quantified using RT‐qPCR. Each reaction included  10 μL of TaqMan Fast Universal PCR Master Mix (Applied Biosystem), 1 μL of TaqMan assay probe (see  table), 2 μL of cDNA (previously diluted 1:10) and 7 μL of RNase‐free water, making a total volume of  20 μL. Triplicates were made for each sample and reactions were run using the following method: 20 25  s at 95 °C, followed by 40 cycles with 3 s at 95 °C and 30 s at 60 °C in an Applied Biosystems QuantStudio  7  Flex  Real‐Time  PCR  System  (Life  Technologies).  PCR  probe  for  E4bp4  (catalog  number:  Hs00993282_m1,  Life  Technologies)  and  GAPDH  (catalog  number:  Hs99999905_m1,  Life  Technologies).   Data analysis: Analysis was done following the comparative CT method. For that, the CT value 30  of all samples was obtained by setting up a threshold at 0.2, making sure the PCR is in the exponential  phase of amplification. First, the expression of all genes was normalised to the housekeeping gene  GADPH, by dividing the sample’s CT value for a given gene by the CT value of the same sample for the  GAPDH gene, this way obtaining the δCT value. Next, δδCT was obtained by subtracting δCT of the  treated sample from the δCT of the DMSO control, for one given gene. Finally, fold change  in gene  expression is calculated via 2‐δδCT, by assuming that there is at least 100% PCR amplification.    Results: Samples tested with AU‐acid7 and AU‐acid11 were shown to significantly enhance  gene expression of E4bp4 as compared to GAPDH in both HepG2 and NK‐92 cell lines.  5    Example 7 – effect of acid‐form compounds on NK cell population    The efficacy of the compounds of the present invention in promoting NK cells expansion was  tested using HSCs.  A first set of experiments were carried out at 6 µM and 15 µM concentrations and,  for comparison, tests were also carried out using SR8278 and GSK1362.  A second set of experiments 10  were carried out at 2 µM and, for comparison, tests were also carried out using compounds 7 and 11.      Mice:  C57BI/6  mice  were  purchased  from  Charles  River  Laboratories  UK  and  sacrificed  between twelve and fifteen weeks old.     OP9 cell line and cell culture: OP9‐GFP cells were cultured in IMDM supplemented with 20%  FCS and 1% PSG. 2500 cells were seeded in 24‐well plates two days before the addition of Lin‐ cells 15  and incubated at 37 °C with 5% CO2 conditions.     Lineage negative cells isolation from bone marrow: Legs and hip from the mice were crushed  in a mortar with PBS + 2% FBS to release bone marrow cells and filtered through 40 μm Strainer. The  process  was  repeated  until  no  more  blood  was  released,  and  the  samples  were  collected  and  centrifuged  at  500  g  for  4 min.  Cells were  resuspended  in  2 mL  PBS  +  2%  FBS  and  stained with 20  phycoerythrin(PE)‐conjugated cocktail  (from eBioscience)  for 5 min at 4  °C. Antibodies used  in PE‐ cocktail: anti‐B220 (RA3/6B2), 20 µL; anti‐CD2 (RM2‐5), 20 µL; anti‐Ter119 (TER119), 20 µL; anti‐NK1.1  (PK136),  20  µL;  anti‐CD11b  (M1/70),  5  µL;  Gr1  (RB6‐8C5),  5  µL.    Then,  the  cells  were  washed,  centrifuged, and incubated with anti‐PE Microbeads (Miltenyi Biotech) for 15 min at 4 °C. Next, the  cells were washed with PBS and passed through LD column (Miltenyi Biotech), negatively selecting 25  unstained Lin‐ cells that flowed through the column. 50 μL of cells were taken to check the purity after  depletion using flow cytometry. Only samples with a Lin‐ population greater than 80% were used in  further studies.      In vitro NK cell development  from  lineage negative cells: Lin‐cells were plated  in 24‐well  plates with 5.105 cells in 1 mL DMEM supplemented with 10% embryonic stem cell‐qualified FBS, 1% 30  PSG, 50 μM β‐ME, 10 ng/mL Flt3‐ligand, 10 ng/mL IL‐7 and 100 ng/mL stem cell factor (SCF) per well  and cultured for 3 days. Cells were transferred for co‐culture with OP9‐GFP stromal cells in 24‐well  plates with 3.104 cells in 1 mL of αMEM supplemented with 20% ES‐FBS, 1% PSG, 50 μM β‐ME and 10  ng/mL  IL‐15 per well and cultured  for 6‐8 days. Compounds were added  in  two  stages: 48 h pre‐ differentiation, and on the day of differentiation. On day 3 after differentiation, half of the media was  carefully  removed  and  topped  up with  fresh  supplemented media.  Cells were  kept  in  a  5%  CO2  humidified atmosphere at 37 °C.    Flow cytometry: After being cultured for 6‐8 days, cells were harvested, filtered through 40  μm strainers to remove detached OP9‐GFP cells and washed with PBS. Cells were centrifuging at 500  5  g for 5 min at 4 °C and the pellet was resuspended  in 100 μL FACS buffer (PBS + 1% BSA) with the  appropriate  fluorochrome  conjugated  antibodies  cocktail  (all  obtained  from  eBiosciences)  and  incubated for 15 min at 4 °C in the dark. Cells were then washed in 1 mL FACS buffer, centrifuged and  resuspended  in 300 μL FACS buffer. Counting beads (from Calibrite 3‐colour kit BD) were added to  determine the absolute cell number based on the percentage of beads detected and the total number 10  added. Cells were analysed on a Fortessa system (Becton Dickinson) and sorted using the FACSAria III  (Becton Dickinson) while data analysis was performed using FlowJo analysis software.    Results: The resulting data are shown  in Figure 6.   It can be seen from Figure 6(A) that the  acid‐form compounds of the present invention showed a significant increase in the total number of  NK‐cells compared with reference compounds SR8278 and GSK1362.  This effect was observed at both 15  6 µM and 15 mM.    It can be seen  from Figure 6(B)  that compounds acid7 and acid11 produced a  greater increase in the total number of NK‐cells than their ethyl ester analogues (compounds 7 and  11).      Example 8 ‐ effect of further acid‐form compounds on NK cell differentiation  20  Further compounds of the present invention were tested for their efficacy in promoting NK  cells differentiation using HPCs. CD34+ HPCs were  isolated  from human umbilical  cord blood and  frozen prior to testing.  Isolated CD34+ HPCs were thawed, allowed to recover overnight.  In vitro NK cell differentiation from CD34+ HPCs   Pre‐differentiation stage:  25  CD34+ HPCs were plated in 24‐well plates (7.103 cells in 500  ^L per well) in pre‐differentiation  StemSpan media supplemented with penicillin/streptomycin, Glutamax, hGM‐CSF (10 ng/ml), hSCF  (100 ng/ml), hTPO (100 ng/ml), hFLT3L (100 ng/ml), hIL‐3 (10 ng/ml) and hIL‐6 (10 ng/ml). Cells were  treated with the acid‐form compounds (acid4, acid44, acid73, acid78, acid80 and acid27) to a final  concentration of 1  ^M.  DMSO was used as the control.  Cells were then cultured for 5 days in a 5% 30  CO2 humidified atmosphere at 37 °C.  Differentiation stage:  At  day  0,  treated  cells  were  washed  and  transferred  to  24‐well  plates  pre‐seeded  with  ELO8‐1D2 stromal cells on gelatine (12 wells for each condition, 10.103 cells in 500  ^L per well). Cells  were then incubated in NK cell differentiation αMEM media supplemented with Sodium Selenite (4  ng/ml), Ethanolamine (40  ^M), bME (40  ^M), 20% Human AB serum, Ascorbic acid (20  ^g/ml), hSCF  (20  ng/ml),  hFLT3L  (10  ng/ml),  hIL‐7  (20  ng/ml)  and  hIL‐15  (10  ng/ml)  in  a  5%  CO2  humidified  atmosphere at 37 °C for 5 days. At day 5, half of the NK cell differentiation αMEM media was carefully  removed and topped up with fresh supplemented media and cells were further incubated in a 5% CO2  5  humidified atmosphere at 37 °C for 4 days. At day 9, again half of the NK cell differentiation αMEM  media was carefully removed and topped up with fresh supplemented media and cells were incubated  in a 5% CO2 humidified atmosphere at 37 °C for a further 2 days. At day 11, half of each culture was  transferred to a new well pre‐seeded with ELO8‐1D2 stromal cells on gelatine.  Each well was topped  up  with  fresh  supplemented  media  and  cells  were  further  incubated  in  a  5%  CO2  humidified  10  atmosphere at 37 °C for 6 days.  Flow cytometry: At day 17, cells were harvested and supplemented with 250  ^L of FACS buffer  (PBS with 2% HI‐FBS) then the appropriate fluorochrome conjugated antibodies cocktail (all obtained  from Biolegend) was added and the cells were incubated for 15 min at 4 °C in the dark. Stained cells  were then centrifugated at 500 x g for 5 min and pellets were resuspended with 250  ^L of DAPI diluted  15  in FACS buffer and supplemented with 50.103 counting beads (BD Calibrite 3‐color kit, BD Bioscience).  Cells were analysed on a Fortessa system (Becton Dickinson) and sorted using the FACSAria III (Becton  Dickinson) while data analysis was performed using FlowJo analysis software.  Results: The resulting data are shown  in Figure 7.   It can be seen from Figure 7 that the all  acid‐form compounds tested showed an increase in the percentage live NK‐cells (CD56+) compared  20  with DMSO control.    It can also be observed  that an  increase  is seen  for all acid‐form compounds  tested in the percentage live NK‐cells (CD56+CD16+) compared with DMSO control.   

Claims

CLAIMS    1. An ex vivo method for expanding an NK cell population, comprising the steps of:  a) culturing an haematopoietic progenitor cell (HPC) comprising sample obtained from  5  an individual;  b) adding a compound that inhibits the action of REV‐ERB to said sample; and  c) expanding said cells in vitro to produce an NK cell population;  wherein the compound that inhibits the action of REV‐ERB has the formula (I):    10  I)    where:   represents bonds that are all either present or absent;    R1 is hydrogen;    R2  is  selected  from 5‐10 membered heterocyclyl  rings and C1‐6 hydrocarbyl, and  is 15  optionally  substituted with  one  or more  groups  independently  selected  from  C1‐4  hydrocarbyl,  ‐OR’,  ‐OC(O)R’,  ‐C(O)OR’,  ‐SR’,  ‐S(O)R’,  ‐S(O)2R’,  ‐NR’2,  ‐NR’C(O)R’,   ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;    X is selected from ‐O‐ and ‐NR’‐;     Y is selected from ‐C(O)‐ or ‐CR’2‐;  20    Z is selected from ‐O‐ and ‐NR’‐ or is absent;    each Ra is independently selected from H, C1‐4 hydrocarbyl, ‐OR’, ‐OC(O)R’, ‐C(O)OR’, ‐ SR’, ‐S(O)R’, ‐S(O)2R’, ‐NR’2, ‐NR’C(O)R’, ‐C(O)NR’2, ‐CN, ‐NO2, ‐Ph, ‐CF3 and halogen;     each Rb is independently selected from H, C1‐4 hydrocarbyl and ‐OR’;     Rc is selected from H and C1‐4 hydrocarbyl; and   25    each R’ is independently selected from H, C1‐4 hydrocarbyl and ‐Ph;    or a pharmaceutically acceptable salt thereof.   
2. The  method  of  claim  1,  wherein    represents  bonds  that  are  all  present  and  the  compound is a closed ring structure according to formula Ia:    ).  5
3. The method of claim 1 or claim 2, wherein:  R2 is selected from:  (i)  optionally  substituted  5‐10  membered  heterocyclyl  rings,  preferably  optionally  substituted 5‐10 membered heteroaryl rings, and the 5‐10 membered heteroaryl ring is 10  preferably  an  optionally  substituted  5‐,  6‐  or  9‐membered  heteroaryl  rings, wherein  optionally  the  5‐,  6‐,  or  9‐membered  heteroaryl  ring  is  selected  from  optionally  substituted:  furanyl,  thiophenyl,  oxazolyl,  isooxazolyl,  isothiazolyl,  thiazolyl,  pyrazolyl,  imidazolyl, pyrrolyl and triazolyl, pyridinyl, pyridazinyl, pyrimidinyl and pyrazinyl, indolyl,  isoindolyl,  indazolyl,  benzimidazolyl,  azaindolyl,  benzofuranyl,  isobenzofuranyl, 15  benzisoxazolyl and benzoxazolyl; and   (ii)  optionally substituted phenyl, preferably substituted phenyl; and/or  R2  is unsubstituted or substituted with one or two groups  independently selected from C1‐4  alkyl, ‐OR’, ‐OC(O)R’, ‐C(O)OR’, ‐SR’, ‐S(O)R’, ‐S(O)2R’, ‐NR’2, ‐NR’C(O)R’, ‐C(O)NR’2, ‐CN, ‐NO2,  ‐Ph, ‐CF3 and halogen, preferably R2 is unsubstituted or substituted with one or two groups 20  independently selected from ‐Me, ‐OMe, ‐CN, ‐NO2, ‐F, ‐Cl,–I and ‐SMe.   
4. The method of any one of claims 1 to 3, wherein:  a) X is ‐O‐;   b) Y is ‐C(O)‐;  25  c) Z is ‐O‐ or is absent, preferably Z is absent;  d) each Ra is independently selected from H, C1‐4 alkyl, ‐OR’ and ‐NR’2, preferably from H and  C1‐4 alkyl, and more preferably, each Ra is H;    e) each Rb is independently selected from H and C1‐4 alkyl, preferably, each Rb is H;  f) Rc is H; and/or  g) each R’  is  independently selected from H and C1‐4 alkyl, preferably from H, methyl and  ethyl, and more preferably from methyl and ethyl.   
5  5. The method of any one of the preceding claims, wherein X is ‐O‐, such that the compound has  the formula (II):  );    preferably Rb and Rc are all H, such that the compound has the formula (III):  10   ( I);    more preferably, Y is ‐C(O)‐, such that the compound has the formula (IV):   (IV);    15      still more preferably, the compound is a closed ring structure with the formula (V):    );    5  and yet still more preferably, Ra are all H, such that the compound has the formula (VI):  ).   
6. The method of any one of claims 1 to 5, wherein the compound has the formula:  10  ,  ,    or  .   
7. The method of any one of claims 1 to 6, wherein said compound increases E4bp4 expression  by decreasing REV‐ERB activity.   
8. The method of any one of claims 1 to 7, wherein said compound decreases the activity of REV‐ 5  ERB‐α and/or REV‐ERB‐β, preferably REV‐ERB‐α, and more preferably REV‐ERB‐α and REV‐ ERB‐β.   
9. The method of any one of claims 1 to 8, wherein said compound  is a REV‐ERB antagonist,  preferably an antagonist of REV‐ERB‐α and REV‐ERB‐β. 
10    10. The method of any one of claims 1 to 9, which further comprises a step of culturing the HPCs  in the presence of a Notch ligand, wherein optionally the vessel in which the HPCs are cultured  is coated with the Notch ligand.    15
11. The method of claim 10, wherein:  a) the Notch  ligand  is delta‐like  ligand 4  (DLL4), or a  fragment  thereof which  retains  the  function of DLL4; and/or  b) the Notch ligand is present on or from 4 days after isolating said HPCs.    20
12. The method of claim 10 or claim 11, wherein:  a) the cells are cultured in the presence of IL‐15 after the step of culturing in the presence  of the Notch ligand; and/or  b) the HPCs are cultured in the presence of the Notch ligand in combination with IL‐7, Flt3L  and/or stem cell factor (SCF), preferably the Notch ligand in combination with IL‐7, Flt3L 25  and SCF;  wherein optionally either or both of the step of culturing in the cells in the presence of the  Notch ligand and the step of culturing in the presence of IL‐15 are carried out in the absence  of a stromal support cell, and preferably wherein both steps are carried out in the absence of  a stromal support cell.  30
13. The method of any one of claims 1 to 12, wherein the sample of HPCs is obtained from bone  marrow, cord blood and/or peripheral blood.   
14. An expanded NK cell population obtained by the method of any one of claims 1 to 13.   
15. A  composition  comprising  an  expanded NK  cell  population  as  defined  in  claim  14  and  a  pharmaceutically acceptable carrier, diluent and/or excipient.   
16. A pharmaceutical composition comprising a compound which inhibits the action of REV‐ERB  5  activity for use in a method of therapy by increasing production of natural killer (NK) cells in a  patient, wherein said compound is a compound of formula (I) as defined in any one of claims  1 to 9.     
17. Pharmaceutical products containing a compound which inhibits the action of REV‐ERB and a 10  Notch  ligand as a combined preparation  for simultaneous, separate or sequential use  in a  method of therapy by increasing production of natural killer (NK) cells in a patient, wherein  said  compound  is a  compound of  formula  (I) as defined  in any one of  claims 1  to 9, and  optionally said Notch ligand is delta‐like ligand 4 (DLL4), or a fragment thereof which retains  the function of DLL4.  15    18. The pharmaceutical composition or the pharmaceutical products for use of claims 16 and 17,  wherein said method of therapy is:  a) a method of  treating a disease or disorder selected  from cancer, an  infectious disease  (acute or  chronic), an autoimmune disease or a disease or disorder  related  to  female 20  infertility or pregnancy; or  b) a method of  treatment of a viral  infection, a bacterial  infection, a protest  infection, a  fungal infection and/or a helminth infection.      19. A method of  treatment by  increasing  the number of NK cells  in a patient  in need  thereof, 25  comprising administering to said patient a therapeutically effective amount of a compound  which inhibits the action of REV‐ERB, wherein said compound is a compound of formula (I) as  defined  in any one of claims 1  to 9, and optionally a Notch  ligand, wherein preferably  the  Notch ligand is delta‐like ligand 4 (DLL4), or a fragment thereof which retains the function of  DLL4.  30    20. The pharmaceutical composition or the pharmaceutical products for use of any one of claims  16 to 18, or the method of treatment of claim 19, which is used in combination with antibody‐ mediated  immunotherapy,  wherein  optionally  said  pharmaceutical  composition  is  for  administration before, simultaneously with, or after administration of the antibody‐mediated  immunotherapy.    21. An isolated compound of formula (I) as defined in any one of claims 1 to 9, provided that the  5  compound is not:     10  ,  ,  , ,  
    5  22. Use of a compound of formula (I) as defined in any one of claims 1 to 9 as a REV‐ERB inhibitor,  provided that the compound is not:   .    23. A pharmaceutical composition  comprising a compound of  formula  (I) as defined  in any of 10  claims 1 to 9, and a pharmaceutically acceptable carrier, diluent and/or excipient, provided  that the compound is not:    ,  ,  ,  ,   OMe ,  5    .    24. A  composition  comprising  a  compound  of  formula  (I)  as  defined  in  any  of  claims  1  to  9,  wherein  the composition comprises  the compound of  formula  (I)  in an amount of at  least 10  0.01%, preferably at least 0.1%, more preferably at least 1%, such as at least 10% by weight,  provided that the compound is not: 
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WO2012128622A1 (en) * 2011-03-18 2012-09-27 Ipd-Therapeutics B.V. Generation of nk cells and nk-cell progenitors
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