NZ563583A - Oligonucleotides that induce apoptosis for treating B cell neoplasm - Google Patents

Oligonucleotides that induce apoptosis for treating B cell neoplasm

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Publication number
NZ563583A
NZ563583A NZ563583A NZ56358306A NZ563583A NZ 563583 A NZ563583 A NZ 563583A NZ 563583 A NZ563583 A NZ 563583A NZ 56358306 A NZ56358306 A NZ 56358306A NZ 563583 A NZ563583 A NZ 563583A
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cell
cells
oligonucleotides
oligo
lymphoma
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NZ563583A
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Li-Ying Wang
Mu-Sheng Bao
Yong-Li Yu
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Changchun Huapu Biotechnology
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Priority claimed from PCT/CN2006/000215 external-priority patent/WO2006122463A1/en
Publication of NZ563583A publication Critical patent/NZ563583A/en

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Abstract

Disclosed is a use of an oligonucleotide having any one of the sequences of SEO ID NO:1-9 in the manufacture of a medicament for treating B cell neoplasm in a mammalian subject in need of treating. The oligonucleotides induce the apoptosis of B cell neoplastic cells, up-regulate CD40 on B cell neoplastic cells and stimulate the production of IL-10 from B cell neoplastic cells.

Description

563583 Received at IPONZ on 6 July 2010 Oligonucleotides or their functional homologues, a composition comprising the same and a method of treating B cell neoplasm TECHNICAL FIELD The present invention provides nine oligonucleotides with the sequences as shown in SEQ ID NO:1 to 9, or their functional homologues, a composition comprising the same and a method for treating B-cell neoplasm using the oligonucleotides by inducing apoptosis of B cell neoplastic cells, up-regulating CD40 on B cell neoplastic cells and by stimulating B cell neoplastic cells to produce IL-10. The oligonucleotides or their functional homologues can be used individually or together, or be used in combination with chemotherapeutics, immunotherapeutics and radiation to treat B cell neoplasm.
BACKGROUND Based WHO classification system (American Journal of Surgical Pathology, 1997, 21(1): 114-121), lymphoid malignancies are grouped into three major classes: B-ceil neoplasm, T-cell/natural killer (NK)-cell neoplasm and Hodgkin's lymphomas.
The B-cell neoplasm is further divided into two groups: precursor B-cell neoplasm and peripheral B-cell neoplasm. Precursor B-cell neoplasm includes precursor B-acute lymphoblastic leukemia (B cell-acute lymphoblastic leukemia, B-ALL) I lymphoblastic lymphoma (LBL). Peripheral B-cell neoplasm includes B-cell chronic lymphocytic leukemia (B-CLL), small lymphocytic lymphoma, B-cell prolymphocyte leukemia, lympho plasmacytic lymphoma/immunocytoma, Mantle cell lymphoma, Follicular lymphoma, cutaneous follicular lymphoma, extranodal marginal zone B-cell lymphoma of MALT type, nodal marginal zone B-cell lymphoma (+/-monocytoid B-cells), splenic marginal zone lymphoma (+/- villous lymphocytes), hairy cell leukemia, plasmacytoma/plasma cell myeloma, diffuse large B-cell l 563583 Received at IPONZ on 6 July 2010 lymphoma, mediastinal (thymic) large B cell lymphoma, intravascular large B-cell lymphoma, primary effusion lymphoma and Burkitt's lymphoma.
B-cell chronic lymphocytic leukemia (B-CLL) and B cell-acute 5 lymphoblastic/lymphocytic leukemia (B-ALL) are two types of B cell leukemia. The B-CLL cells express CD19, CD5 and CD23 (Nicholas Chiorazzi, M.D., et al. N Engl J Med 2005;352:804-15). The B-ALL cells express CD19 and CD10 markers.
Small lymphocytic lymphoma is a B cell neoplasm. The small lymphocytic 10 lymphoma cells express CD19, CD5 and CD23 (Catherine Thieblemont.et al. Blood. 2004;103:2727-2737).
Depending on the B-cell neoplasm diagnosed, current treatment options are chemotherapy, radiotherapy and immunotherapy.
CD40, expressed on the cell surface of normal B lymphocytes and dentritic cells, is a member of tumor necrosis factor receptor (TNFR) family. CD40L (CD154), expressed on T lymohocytes, is a member of tumor necrosis factor family (Castle BE, et al. J Immunol 1993; 151: 1777-1788). Interaction of CD40L and CD40 20 promotes the proliferation, differentiation and antigen presentation of B lymphocytes, dendritic cells and monocytes (Ranheim EA, et al. J Exp Med 1993; 177: 925-935; Yellin MJ, etal. J Immunol 1994; 153: 666-674; Banchereau J, etal. Annu Rev Immunol 1994; 12: 881-922; M.von Bergwelt-Baildon MS, et al. Blood 2002;99:3319-3325).
CD40 also expresses on the B cell neoplastic cells. It has been demonstrated that enhancing the CD40 expression promotes the apoptosis of B cell neoplastic cells (Peter Chu, et al. PNAS, March 19, 2002, vol.99, nos 6 3854-3859; Frank Dicker, etal. BLOOD, 15 April 2005 Volume 105, Number 8: 3193-3198). 2 563583 Received at IPONZ on 6 July 2010 WO 2006/122463 PCT/CN2006/000215 Both in vitro and in vivo experiments indicated that stimulation and up-regulation of CD40 induced growth inhibition of B-cell neoplastic cells (Funakoshi et al., Blood 83: 2787-2794,1994; Murphy et al., Blood 86: 1946-1953 ,1995; Eliopoulos, A. G., etal. 1996. Oncogene 13:2243; Hirano, A.,et al. 1999. Blood 93:2999; Tong, A. W., 5 M et al. 2001.Clin. Cancer Res. 7:691).
Promoting CD40 expression on B cell neoplastic cells was reported to enhance the antigenicity of B cell neoplastic cells and consequently fostered the generation of cytotoxic T lymphocyte (CTL) specific to the cells. The CTL can efficiently kill B cell 10 neoplastic cells (Dilloo D, et al. Blood. 1997;90:1927-1933; Kato K, et al. J Clin Invest. 1998;101:1133-1141; Wierda WG, et al. Blood. 2000;96:2917-2924; Takahashi S, et al. Hum Gene Ther. 2001;12:659-670; Takahashi S, et al. Cancer Gene Ther.2001;8:378-387). In the presence of CD40L, CD40 expressing B cell chronic lymphocytic leukemia cells can be killed by CD4 cytotoxic T lymphocytes 15 (Frank Dicker, et al. Blood, 15 April 2005 Vol 105, Num 8: 3193-3198). Interaction of D40L and CD40 on cells of Burkett's lymphoma could promote the cell to present tumor antigens to specific CTLs (Khanna, R.et al. 1997. J. Immunol. 159:5782). In vivo experiments and clinical trials also demonstrated that activation of CD40 could enhance the immunogenicity of B cell chronic lymphocytic leukemia (B-CLL) cell and 20 consequently induce the generation of CTLs specific to the cells (Kato, K.,et al. 1998.J. Clin. Invest. 101:1133; Wierda, W. G.,et al. 2000. Blood 96: 2917).
Together, these data indicate that enhancing CD40 expression on B cell neoplastic cells can stimulate the anti-tumor immunity against B cell neoplasm. The 25 anti-tumor immunity includes but not limits to the following: 1 .promoting the apoptosis of B cell neoplastic cells; 2.inhibiting the growth of B cell neoplastic cells; 3.enhancing the immunogenicity of B cell neoplastic cells and therefore fostering the generation of CTLs specific to the cells. 3 563583 Received at IPONZ on 6 July 2010 lnterleukin-10 (IL-10) is a homodimer cytokine produced by certain T cell cells, monocytes, macrophages and some of neoplastic cells developed from B cells, T cells or NK cells (Kitabayashi et al., 1995; Masood et al., 1995; Sjoberg et al., 19.96; Beatty et al., 1997; Boulland et al., 1998; Jones et al., 1999). IL-10 activity is 5 mediated by its specific cell surface receptor expressed on antigen-presenting cells, lymphocytes B-cell and chronic lymphocytic leukemia (B-CLL) cells. It was found that addition of exogenous IL-10 inhibited the proliferation of B-CLL cells freshly isolated from patients (Jesper Jurlander, Chun-Fai Lai, Jimmy Tan, et al. Characterization of interleukin-10 receptor expression on B-cell chronic 10 lymphocytic leukemia cells. Blood, Vol 89, No 11 (June 1), 1997: pp 4146-4152). IL-10 was also reported to inhibit the proliferation of B-CLL cells and enhance the apoptosis of B-CLL cells (Anne-Catherine Fluckiger, Isabelle Durand, and Jacques Banchereau. Interleukin 10 Induces Apoptotic Cell Death of B-Chronic Lymphocytic Leukemia Cells. J. Exp. Med. Volume 179 January 1994 91-99). 15 Immunostimulating anticancer properties of IL-10 have been discussed in a review from which it is speculated that IL-10 over-expression within the tumor microenvironment may catalyze cancer immune rejection (Simone Mocellin, Francesco M. Marincola and Howard A. Young, lnterleukin-10 and the immune response against cancer: a counterpoint. Journal of Leukocyte Biology. 2005; 20 78:1043-1051).
SUMMARY OF THE INVENTION In the first embodiment, the present invention provides a use of an oligonucleotide 25 having any one of the sequences of SEQ ID NO:1-9, in the manufacture of a medicament for treating B cell neoplasm in a mammalian subject in need of treating. 563583 Received at IPONZ on 6 July 2010 Also described is a use of an oligonucleotide having any one of the sequences of SEQ ID NO: 1-9, in the manufacture of a medicament for treating a disease or disorder responsive to the induction of apoptosis of B-cell neoplastic cells in a subject in need thereof.
Also described is a use of an oligonucleotide having any one of the sequences of SEQ 1D NO: 1-9, in the manufacture of a medicament for treating a disease or disorder responsive to the enhancement of the expression of CD40 on B cell neoplastic cells in a subject in need thereof.
Also described is a use of an oligonucleotide having any one of the sequences of SEQ ID NO: 1-9, in the manufacture of a medicament for treating a disease or disorder responsive to the induction of B cell neoplastic cells to produce IL-10 in a subject in need thereof.
In a second embodiment, the invention provides a pharmaceutical composition comprising: (1) an oligonucleotide having any one of the sequences of SEQ ID NO:. 1-9 and (2) anti-B cell neoplasm agent.
Also described are nine oligonucleotides also designated as Oligo1T Oligo3, Oligo4, Oligo5, Oligo6, Oligo7, OIigo8, Oligo9t OligolO with the sequences shown in SEQ ID N01, 2, 3, 4, 5, 6, 7, 8. 9 respectively and their functional homologues. The oligonucleotides or their functional homologues can have a phosphate backbone modification that is a phosphorothioate or phosphorodithioate modification partial or complete. The oligonucleotides or their functional homologues can have chemical modifications or 4a 563583 Received at IPONZ on 6 July 2010 have substitutions with rare bases. The oligonucleotides or their functional homologues can be functional parts of any other DNA fragments or be cloned into a plasmid, bacterial vector, viral vector or DNA vaccine respectively. The oligonucleotides with the sequences of the SEQ ID NO: 1-9 can be modified by 5 adding one or more bases (preferable 1 to 10 bases) to their each end or by changing one to more bases in them. Those skilled in the art can determine to use the oligonucleotides with the sequences of SEQ ID NO: 1-9 or their functional homologues individually or together, or to use DNA fragments comprising the oligonucleotides with the sequences (SEQ ID NO: 1-9) respectively to achieve the object of the present invention based on the well-knowledge in the art and the teaching of the present invention.
Also described is a method for treatment of B cell neoplasm by using the oligonucleotides or their functional homologues of the present invention individually or together or by using the composition comprising the same in a subject. The subject is a human or animal. The B cell neoplasm includes but not limited to B cell leukemia, B cell lymphoma and myeloma.
Also described is a method for treating B cell neoplasm using the oligonucleotides or their functional homologues of the present invention individually or together or using the composition comprising the same by inducing the apoptosis of B cell neoplastic cells.
Also described is a method for treating B cell neoplasm using the oligonucleotides or their functional homologues of the present invention individually or together or using the composition comprising the same by up-regulating CD40 on B-cell neoplastic cells.
Also described is a method for treating B cell 563583 Received at IPONZ on 6 July 2010 neoplasm using the oligonucleotides or their functional homologues of the present invention individually or together or using the composition comprising the same by stimulating B-cell neoplastic cells to produce IL-10.
Also described is a composition comprising therapeutically effective amount of the oligonucleotides or their functional homologues of the present invention alone or in/with one or more pharmaceutically acceptable carriers. The composition is administered through enteral, parenteral and topical administration or by inhalation.
Also described is a method for the treatment of B cell neoplasm, comprising administering a therapeutically effective amount of the oligonucleotides or their functional homologues of the present invention individually or together or a composition comprising the same or with at 15 least one of anti-B cell neoplasm agents including chemotherapeutics, immunotherapeutics and the agents used in radiotherapy.
BRIEF DESCRIPTION OF THE DRAWINGS Figure-1. The effect of the oligonucleotides on the up-regulation of CD40 on B-CLL cells The B-CLL cells were incubated with or without the oligonucleotides for 7 days and then were stained with FITC-CD40 antibody for analysis of CD40 expression using flow cytometry. The expression level was indicated with MFi number.
Figure-2. The effect of oligonucleotides on the up-regulation of CD40 on small lymphocytic lymphoma cells The small lymphocytic lymphoma cells were incubated with or without the oligonucleotides. On day 7, the cells were stained with FITC-CD40 antibody for analysis of CD40 expression using flow cytometry. The expression level was 6 563583 Received at IPONZ on 6 July 2010 indicated with MFI number.
Figure 3. The effect of the oligonucleotides on the proliferation of normal human PBMC The normal human PBMCs were cultured with or without the oligonucleotides and then incorporated with [3H] thymidine for determining the proliferation of the cells. The proliferation of cells was expressed as cpm.
DETAILED DESCRIPTION OF THE INVENTION Definitions In the present invention, the following terms shall have the meanings below: An "oligonucleotide" means multiple nucleotides (i.e. molecules comprising a sugar (e.g. deoxyribose) linked to a phosphate group and to an exchangeable organic base). There are four organic bases cytosine (C), thymine (T), adenine (A) and guanine (G). The oligonucleotide can be synthesized by an automated oligonucleotide synthesizer available in the market or be prepared from existing 20 nucleic acid sequences using known techniques.
A "back bone modification" of oligonucleotide shall mean that an oligonucleotide can have a phosphorothioate modified phosphate backbone (i.e. at least one of the oxygens of the phosphate is replaced by sulfur) or other modified backbone.
A "chemical modification" of oligonucleotide shall mean the modification by utilizing the active groups of the nucleotide or creating nucleotide analogues. The modifications can occur either during or after synthesis of the oligonucleotide. During the synthesis, modified bases (including but not limited to Thymidine analogues) can be incorporated internally or on the 5' end. After the synthesis, the 7 563583 Received at IPONZ on 6 July 2010 modification can be carried out using the active groups (via an amino modifier, via the 3' or 5' hydroxyl groups, or via the phosphate group).
A "B cell neoplasm" shall mean diseases developed from the abnormal proliferation of the cells of B lymphocyte lineage. The B cell neoplasm can be grouped into B cell 5 leukemia, B cell lymphoma and myeloma (plasmacytoma/plasma cell myeloma). B cell leukemia includes B-cell chronic lymphocytic leukemia (B-CLL), precursor B-acute lymphoblastic leukemia (B cell acute lymphocytic leukemia, B-ALL), B-cell prolymphocyte leukemia and hairy cell leukemia. B cell lymphoma includes small lymphocytic lymphoma, lympho plasmacytic lymphoma/immunocytoma, Mantle cell 10 lymphoma, Follicular lymphoma, cutaneous follicular lymphoma, extranodal marginal zone B-cell lymphoma of MALT type, nodal marginal zone B-cell lymphoma (+/- monocytoid B-cells),splenic marginal zone lymphoma (+/- villous lymphocytes),diffuse large B-cell lymphoma, mediastinal (thymic) large B cell lymphoma, intravascular large B-cell lymphoma, primary effusion lymphoma and 15 Burkitt's lymphoma.
A "subject" shall mean a mammal including but not limited to human, monkey, dog, cat, horse, cow, pig, goat, sheep, mouse and rat. The oligonucleotides of the present invention can be administered to a subject with B cell neoplasm.
An "anti-B cell neoplasm agent" shall mean a agent used to treat B cell neoplasm in a subject. The agent includes the oligonucleotides of the present invention, chemotherapeutics, immunotherapeutics and the agents used in radiotherapy. The oligonucleotides of the present invention can be administered prior to, along with or after administration of one or more other anti-B cell neoplasm agents to achieve 25 synergistic effect in treating a B cell neoplasm.
The "chemotherapeutics" shall mean the chemotherapeutics that treat B cell neoplasm in combination with the oligonucleotides of the present invention. The oligonucleotides of the present invention can be used with one or more 8 563583 Received at IPONZ on 6 July 2010 chemotherapeutics in the treatment of B ceil neoplasm. The chemotherapeutics include, but not limited to alkylating agents such as cyclophosphamide or chlorambucil, vinca alkaloids (e.g., vincristine and vinblastine), procarbazine, methotrexate, prednisone, anthracycline, L-asparaginase, purine analogs (e.g., fludarabine monophosphate, 2-chlorodeoxyadenosine and pentostatin), cytosine, arabinoside, cisplatin, etoposide and ifosfamide. The oligonucleotides of the present invention can also be used with one or more chemotherapeutic combinations in the chemotherapy. The combinations include, but not limited to CVP (cyclophosphamide, vincristine and prednisone), CHOP (CVP and doxorubicin), C-MOPP (cyclophosphamide, vincristine, prednisone and procarbazine), CAP-BOP (CHOP plus procarbazine and bleomycin), m-BACOD (CHOP plus methotrexate, bleomycin and leucovorin), ProMACE-MOPP (prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide and leucovorin plus standard MOPP), ProMACE-CytaBOM (prednisone, doxorubicin, cyclophosphamide, etoposide, cytarabine, bleomycin, vincristine, methotrexate and leucovorin), MACOP-B (methotrexate, doxorubicin, cyclophosphamide, vincristine, fixed dose prednisone, bleomycin and leucovorin), IMVP-16 (ifosfamide, methotrexate and etoposide), MIME (methyl-gag, ifosfamide, methotrexate and etoposide), DHAP (dexamethasone, high dose cytarabine and cisplatin), ESHAP (etoposide, methylpredisolone, HD cytarabine, cisplatin), CEPP(B) (cyclophosphamide, etoposide, procarbazine, prednisone and bleomycin), CAMP (lomustine, mitoxantrone, cytarabine and prednisone), CHOP plus bleomycin, methotrexate, procarbazine, nitrogen mustard, cytosine arabinoside and etoposide. MOPP (mechlethamine (nitrogen mustard), vincristine (Oncovin), procarbazine and prednisone), ABVD (e.g., adriamycin, bleomycin, vinblastine and dacarbazine), ChlVPP (chlorambucil, vinblastine, procarbazine and prednisone), CABS (lomustine, doxorubicin, bleomycin and streptozotocin), MOPP plus ABVD, MOPP plus ABV (doxorubicin, bleomycin and vinblastine) or BCVPP (carmustine, cyclophosphamide, vinblastine, procarbazine and prednisone) and CAP (cyclophosphamide, doxorubicin and prednisone). 563583 Received at IPONZ on 6 July 2010 The "immunotherapeutics" shall mean the immunotherapeutics that treat B cell neoplasm in combination with the oligonucleotides of the present invention. The oligonucleotides of the present invention can be used with one or more 5 immunotherapeutics in the treatment of B cell neoplasm. The immunotherapeutics include, but not limited to anti-CD20 antibodies. The CD20 antibody includes immunoglobulins and its fragments that are specifically reactive with a CD20 protein on cell surface of B cell neoplastic cells. CD20 antibodies can be polyclonal and monoclonal antibodies, chimeric antibodies, bi-specific antibodies and 10 humanized antibodies. A "CD2Q" is a B-cell membrane protein (Tedder et al., Immunology Today 15: 450-454 (1994)) and is expressed on both normal and neoplastic B-cell (John C. Byrd,et al. J Clin Oncol 2001; 19: 2165-2170; Huhn D, et al. Blood 2001, 98: 1326-1331).
A "pharmaceutically acceptable carrier" denotes one or more solid or liquid filler, diluents or encapsulating substances that are suitable for administering the oligonucleotides of the present invention to a subject. The carrier can be organic, inorganic, natural or synthetic. The carrier includes any and all solutions, diluents, solvents, dispersion media, liposome, emulsions, coatings, antibacterial and 20 anti-fungal agents, isotonic and absorption delaying agents, and any other carrier suitable for administering the oligonucleotides of the present invention and their use is well known in the art.
The "therapeutically effective amount" of the oligonucleotides of the present 25 invention shall refer to a dose used to achieve a desired result of treating B cell neoplasm in a subject. The dose can be determined by standard techniques well known to those skilled in the art and can vary depending the factors including, but not limited to the size or/and overall health of the subject or the severity of the disease. Introduction of the oligonucleotides of the invention can be carried out as a 30 single treatment or over a series of treatments. Subject doses of the 563583 Received at IPONZ on 6 July 2010 oligonucleotides of the present invention for the administration range from about 1 ng to 100 mg per administration. However, doses for the treatment of B cell neoplasm may be used in a range of 10 to 1,000 times higher than the doses described above. The dosage regimen can be adjusted to provide the optimum 5 therapeutic effect by those skilled in the art.
The "route" of administering the oligonucleotides of the present invention shall mean the enteral, parenteral and topical administration or inhalation. The term "enteral" as used herein includes oral, gastric, intestinal and rectal administration. The term 10 "parenteral" includes intravenous, intraperitoneal, intramuscular, subcutaneous, rectal or vaginal administration. The term "topical" denotes the application of the oligonucleotides externally to the epidermis, to the buccal cavity and into the ear, eye and nose.
A " pharmaceutical composition " shall mean the composition containing an therapeutically effective amount of the oligonucleotides with or without a pharmaceutical^ acceptable carrier. The composition includes but not limited to aqueous or saline solutions, particles, aerosols, pellets, granules, powders, tablets, coated tablets, (micro) capsules, suppositories, syrups, emulsions, suspensions, 20 creams, drops and other pharmaceutical compositions suitable for use in a variety of drug delivery systems. The compositions are suitable for injection, oral, buccal, rectal and vaginal use, inhalation and application in depot. In all cases, the composition must be sterile and stable under the conditions of manufacture and storage and preserved against the microbial contamination. For injection, the 25 composition will include aqueous solutions or dispersions and powders for the extemporaneous preparation of injectable solutions or dispersion. "Powder" in this invention refers to a composition that contains finely dispersed solid particles containing the oligonucleotides. The powder may be formulated with other pharmaceutical^ accepted carriers (e.g., water, PBS, saline and other 30 pharmaceutical^ accepted buffers) before use. The solutions can be prepared by 563583 Received at IPONZ on 6 July 2010 incorporating the oligonucleotides in one or more appropriate solvents and other required ingredients. Dispersions can be prepared by incorporating the oligonucleotides into a vehicle, which contains a dispersion medium (e.g, glycerol, liquid polyethylene glycols and oils) and the other required ingredients. For oral 5 administration, the composition will be formulated with edible carriers to form tablets, piiis, dragees, capsules, liquids, gels, syrups, slurries, suspensions and the like. For buccal administration, the composition will be tablets or lozenges in conventional manner. For inhalation, the composition will be an aerosol spray from pressurized packs or a nebulizer or a dry powder and can be selected by one of skill in the art. 10 The oligonucleotides may also be formulated as pharmaceutical acceptable compositions for rectal or vaginal applications and for depot application. The oligonucleotides in the composition can be used alone or in combination with one or more other agents including but not limited to chemotherapeutics, immunotherapeutics and a ligand recognized by a specific receptor or molecule of 15 target cell. The oligonucleotides in combination with another agent can be separate compositions and used as the following: (1) the oligonucleotides are mixed with a second agent before administration; (2) the oligonucleotides and a second agent are administered to a subject at different times; (3) the oligonucleotides and a second agent are administered to different sites of a subject. In addition, the 20 composition may contain plasmid, bacterial vectors, viral vectors and nucleic acid vaccines carrying the sequence of the oligonucleotides of the present invention.
The term "comprising" as used in this specification means "consisting at least in part of. When interpreting each statement in this specification that includes the 25 term "comprising", features other than that or those prefaced by the term may also be present. Related terms such as "comprise" and "comprises" are to be interpreted in the same manner. 563583 Received at IPONZ on 6 July 2010 EXAMPLES The following examples are illustrative, and should not be viewed as limiting the scope of the present invention. Reasonable variations, such as those occur to reasonable artisan, can be made herein without departing from the scope of the present invention.
Example 1. Synthesis of the oligonucleotide - 4 SEP 2009 , PECElVPnl 563583 Received at IPONZ on 6 July 2010 We have designed and synthesized the oligonucleotides with the following sequences and the nomenclatures: Oligo 1: 5'-TCgACgTTCgTCgTTCgTCgTTC-3' (indicated in the SEQ ID NO:1) Oligo 3: 5'-TCggCACgCgACgTgCTggCCgTCgTTTCC-3' (indicated in the SEQ ID NO:2) Oligo 4: 5'-TCgTCgTCgTCgTTgTCgTTgggg-3' (indicated in the SEQ ID NO:3) Oligo 5: 5'-TCgTTgCCgTCgg-3' (indicated in the SEQ ID NO:4) Oligo 6: 5'-TCgTCgggTgCgACgTCgCAgggggg-3' (indicated in the SEQ ID NO:5) Oligo 7: 5'-TCgTCgggTgCgATCgCAgggggg-3' (indicated in the SEQ ID NO:6) Oligo 8 S'-TCgTCgggTgCATCgATgCAgggggg-S1 (indicated in the SEQ ID NO:) Oligo 9: 5'-tcgtcgggtgcgacgtcgca-3' (indicated in the SEQ ID NO:8) Oligo 10: 5'-TCggggACgATCgTCgggggg-3' (indicated in the SEQ ID NO:9) To analyze the functions of the above Oligos, two control oligonucleotides of 2006 with the sequence of 5'-tcgtcgttttgtcgttttgtcgtt-3' and 2216 with the sequence of 5'-gggggacgatcgtcgggggg-3' were also synthesized.
All of the oligonucleotides were synthesized in Sangon Biotech Company (Shanghai, 20 China), tested for endotoxin by using the Limulus amebocyte lysate assay (Associates of Cape Cod, Inc) and manipulated in pyrogen-free reagents. 2006 ( J Immunol 2000: 164: 1617) is a well studied oligonulceotide that strongly activates normal B cells. 2216 (Eur J Immunol 2001; 31:2154) is another well studied oligonuleotide that induces high amounts of type I interferon in plasmacytoid 25 dendritic cells.
The methods for synthesizing the oligonucleotide are well known for those skilled in the art and among others, solid-phase synthesis is generally used. Specifically, in the process of the synthesis, the solid support used is controlled pore glass (CPG) 30 bead. This bead has a surface with holes and channels and it is in these that the protected nucleotide is attached. The oligonucleotide synthesis begins with the 3'-most nucleotide and proceeds through a series of cycles composed of five steps that are repeated until the 5'-most nucleotide is attached. These steps are deprotection, activation, coupling, capping and stabilization. 13 563583 Received at IPONZ on 6 July 2010 Stepl .Deprotection The protective group in the protected nucleoside attached to a CPG (controlled pore glass) bead is removed by trichloroacetic acid (TCA) leaving a reactive 5 5-hydroxyl group.
Step2. Activation In this step, tetrazole attacks the coupling phosphoramidite nucleoside forming a tetrazolyl phosphoramidite intermediate.
Step3. Coupling The tetrazolyl phosphoramidite intermediate reacts with the hydroxyl group of the recipient and the 5' to 3' linkage is formed. The tetrazole is reconstituted and the process continues.
Step 4. Capping In this step, an acetylating reagent composed of acetic anhydride and N-methyl imidazole is used to block the reactive hydroxyl group on its 5-most end of the oligonucleotide to avoid of coupling failure.
Step 5.Stabilization Once the capping step is accomplished, the last step in the cycle is oxidation which stabilizes the phosphate linkage between the growing oligonucleotide chain and the most recently added base. This step is carried out in the presence of Iodine as a 25 mild oxidant in tetrahydrofuran (THF) and water.
Following this final step the cycle is repeated for each nucleotide in the sequence. After the completion of the synthesis, the single stranded DNA molecule is purified by methods such as HAP, PAGE, HPLC, C18andOPC. 14 563583 Received at IPONZ on 6 July 2010 Example 2. Apoptosis of human B-CLL cells induced by the oligonucleotides 1. Preparation of human B-CLL cells Blood samples from untreated B-CLL (pathologically identified) patients (The First 5 Hospital, Jilin University, China) were drawn after obtaining written informed consent approved. Peripheral blood mononuclear cells (PBMCs) were isolated by Ficoll-Paque (Pharmacia) density gradient centrifugation. CD5+CD19+CD23+ B-CLL cells in PBMCs were purified using B-cell isolation kit (Miltenyi Biotec, Bergisch Gladbach, Germany) to > 95% of CD5+CD19+ CD23+cells (B-CLL cells). 10 The cell preparation was performed under the guidance of Miltenyi Biotec. 2. Apoptosis of human B-CLL cells induced by the oligonucleotides The B-CLL cells were incubated with Oligol, Oligo3, Oligo4, Oligo5, Oligo6, Oligo?, Oligo8, Oligo9, Oligol0, 2006 or 2216 respectively at a final concentration of 3u 15 g/ml in 10% human AB serum RPMI 1640 medium (HyClone) at 106 cells/well in a 48-well plate. The oligonucleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPM11640 medium (HyClone)) was used as a control (Medium).
On day 3, 5 and 7 after incubation, the cells were counted and stained with tetramethyl-rhodamine ethylester (TMRE) (Molecular Probes lnc)(Lena Thyrell, et al. The Journal of Biological Chemistry Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The TMRE positive (viable) and TMRE-negative (apoptotic) B-CLL cells were determined by flow cytometry (B.D. 25 FACS Aria). Viable B-CLL cell number was calculated by multiplying total cell count with the TMRE-positive cell percentage at each time point. The experiment was repeated with ten blood samples from B-CLL patients and the averaged result (n=10) showed that the oligonucleotides significantly induced the apoptosis of B-CLL cells (Table-1). 563583 Received at IPONZ on 6 July 2010 Viable B-cell chronic lymphocytic leukemia cells (%) (n=10) Groups Time of incubation (day) 3 7 Oligo 1 55.7 27.7 19 Oligo 3 85.5 37.3 31.6 Oligo 4 60.1 38.8 27.5 Oligo 5 58.1 38.1 23.2 Oligo 6 52.3 34.9 31.7 Oligo 7 59.6 38.4 .2 Oligo 8 51.1 34.2 29.6 Oligo 9 52.8 37.9 24.3 Oligo 10 54.6 .4 28.3 Medium 82.2 79.5 81.3 2006. 66.5 • 44.4 ' '40.2 2216 67.7 57.7 50.7 Table-1. Apoptosis of B-CLL cells induced by the oligonucleotides Example 3. Up-regulation of CD40 on human B-CLL cells by the 5 oligonucleotides 1. Preparation of human B-CLL cells Human B-CLL cells were isolated from B-CLL patients with the procedures as described as in example 2. io 2. Up-regulation of CD40 on human B-CLL cells by the oligonucleotides The B-CLL cells were incubated with Oligol, Oligo3, Oligo4, Oligo5, Oligo6, Oligo7, Oligo8, Oligo9, Oligol 0, 2006 or 2216 respectively at a final concentration of 3 p. g/ml in 10% human AB serum RPMI 1640 medium (HyClone) at 106cells/well in a 15 48-well plate. The oligonulceotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPMI 1640 medium (HyClone)) was used as a control (Medium).
On day 7 after the incubation, the cells were counted and stained with FITC-CD40 20 antibody (Becton ickinson) (Molecular Probes Inc) (Lena Thyrell, et al. The Journal 16 563583 Received at IPONZ on 6 July 2010 of Biological Chemistry Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The CD40 antibody stained B-CLL cells were determined by flow cytometry (B.D. FACS Aria). The result (Figure-1) showed that the oligonucleotides significantly up-regulate the expression of CD40 on B-CLL cells, indicating that the 5 oligonucleotides can be used to treat B-CLL through the up-regulation of CD40 on the ceils. The up-regulation of CD40 promotes the apoptosis of B-CLL cells, induces the growth inhibition of B-CLL cells and renders the B-CLL cells more immunogenic to stimulate the generation of CTLs specific to B-CLL cells. The experiment was repeated with at least ten blood samples from B-CLL patients with similar results.
Example 4. The apoptosis of human small lymphocytic lymphoma cells induced by the oligonucleotides 1. Preparation of human small lymphocytic lymphoma cells The small lymphocytic lymphoma cells were isolated from the biopsy tissue of lymph node from patients (The First Hospital, Jilin University, China) with small lymphocytic lymphoma (pathologically identified) after obtaining written informed consent approved. The biopsy tissue was minced by rough surface glass slides to release the cells into 5 ml of 10% human AB serum RPMI 1640 medium (HyClone) in a 6 cm culture plate. The released cells were filtered through stainless steel mesh and collected into a 50 ml conical tube containing 15 ml serum free RPMI 1640 media. The tube was centrifuged at 300 Xg for10 minutes and then the supernatant was discarded. CD5+CD19+CD23+ small lymphocytic lymphoma cells were purified using B-cell isolation kit (Miltenyi Biotec, Bergisch Gladbach, Germany) to > 95% of CD5+CD19+ CD23+cells (small lymphocytic lymphoma cells). The cell preparation was performed under the guidance of Miltenyi Biotec. 2. Apoptosis of small lymphocytic lymphoma cells induced by the oligonucleotides The small lymphocytic lymphoma cells were incubated with Oligol, Oligo3, Oligo4, Oligo5, Oligo6, Oligo7, Oligo8, Oligo9, Oligol0, 2006 or 2216 respectively at a final 17 563583 Received at IPONZ on 6 July 2010 concentration of 3 y. g/ml in 10% human AB serum RPM11640 medium (HyClone) at 106 cells/well in a 48-well plate. The oligonucleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPMI 1640 medium (HyClone)) was used as a control (Medium).
On day 3, 5 and 7 after the incubation, the cells were counted and stained with tetramethyl-rhodamine ethylester (TMRE) (Molecular Probes Inc) (Lena Thyreil, et al. THE JOURNAL OF BIOLOGICAL CHEMISTRY Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The TMRE positive (viable) and 10 TMRE-negative (apoptotic) small lymphocytic lymphoma cells were determined by flow cytometry (B.D. FACS Aria). Viable small lymphocytic lymphoma cell number was calculated by multiplying total cell count with the TMRE-positive cell percentage at each time point. The experiment was repeated with five samples from the patients with small lymphocytic lymphoma and the averaged result (n=5) showed 15 that the oligonucleotides significantly induce the apoptosis of the small lymphocytic lymphoma cells (Table-2), indicating that the oligonucleotides can be used to treat small lymphocytic lymphoma by inducing the apoptosis of the cells.
Viable small lymphocytic lymphoma cells (%) (n=5) Groups Time of Incubation (day) 3 7 Oligo 1 53.5 26.7 18 Oligo 3 83.9 38.4 29.1 Oligo 4 61.1 36.9 29.7 Oligo 5 57.2 37.4 21.3 Oligo 6 56.2 36.1 32.1 Oligo 7 60.5 40.3 31.1 Oligo 8 50.2 37.4 .2 Oiigo 9 54.2 39.7 .4 Oligo 10 56.5 37.6 29.3 Medium 81.2 78.4 77.1 18 563583 Received at IPONZ on 6 July 2010 2006 67.6 45.3 41.1 2216 68.5 58.7 52.1 Tabel-2. Apoptosis of small lymphocytic lymphoma cells induced by the oligonucleotides Example 5. Up-regulation of CD40 of small lymphocytic lymphoma cells induced by the oligonucleotides 1. Preparation of human small lymphocytic lymphoma cells Human small lymphocytic lymphoma cells were isolated from patients with the procedures as described in example 4. 2. Up-regulation of CD40 of small lymphocytic lymphoma cells induced by the oligonucleotides The small lymphocytic lymphoma cells were incubated with Oligol, 01igo3, Oligo4, Oligo5, Oligo6, Oligo7, Oligo8, Oligo9, Oligol0, 2006 or 2216 respectively at a final concentration of 3 y- g/ml in 10% human AB serum RPMI 1640 medium 15 (HyClone) at 106 cells/well in a 48-well plate. The oligonucleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPMI 1640 medium (HyClone)) was used as a control (Medium).
On day 7 after the incubation, the cells were counted and stained with FITC-CD40 20 antibody (Becton ickinson) (Molecular Probes Inc) (Lena Thyrell, et al. The Journal of Biological Chemistry Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The CD40 antibody stained small lymphocytic lymphoma cells were determined by flow cytometry (B.D. FACS Aria). The result (Figure-2) showed that the oligonucleotides significantly up-regulate the expression of CD40 on small 25 lymphocytic lymphoma cells, indicating that the oligonucleotides can be used to treat small lymphocytic lymphoma through the up-regulation of CD40 on the cells. The up-regulation of CD40 promotes the apoptosis of small lymphocytic lymphoma cells, induces the growth inhibition of small lymphocytic lymphoma cells and renders 563583 Received at IPONZ on 6 July 2010 the small lymphocytic lymphoma cells more immunogenic to stimulate the generation of CTLs specific to small lymphocytic lymphoma cells. The experiment was repeated with five samples with similar results.
Example 6. Apoptosis of human B-ALL cells induced by the oligonucleotides 1. Preparation of human B-ALL cells Blood samples from untreated B-ALL (pathologically identified) patients (The First Hospital, Jlin University, China) were drawn after obtaining written informed consent 10 approved. PBMCs were isolated by Ficoll-Paque (Pharmacia) density gradient centrifugation. CD19+CD10+ B-ALL cells in PBMCs were purified using B-cell isolation kit (Miltenyi Biotec, Bergisch Gladbach, Germany) to > 95% of CD19+CD10+ cells (B-ALL cells). The cell preparation was performed under the guidance of Miltenyi Biotec. 2. Apoptosis of B-ALL cells induced by the oligonucleotides The B-ALL cells were incubated with Oligol, Oligo3, Oligo4, Oligo5, OIigo6, Oligo7, Oligo8, Oligo9, OligolO, 2006 or 2216 respectively at a final concentration of 3u g/ml in 10% human AB serum RPMI 1640 medium (HyClone) at 106 cells/well in 20 a 48-well plate. The oligonucleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPM11640 medium (HyClone)) was used as a control (Medium).
On day 3, 5 and 7 after the incubation, the cells were counted and stained with 25 tetramethyl-rhodamine ethylester (TMRE) (Molecular Probes Inc) (Lena Thyrell, et al. The Journal of Biological Chemistry Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The TMRE positive (viable) and TMRE-negative (apoptotic) B-ALL cells were determined by flow cytometry (B.D. FACS Aria). Viable B-ALL cell number was calculated by multiplying total cell count with the TMRE-positive cell percentage at each time point. The experiment was 563583 Received at IPONZ on 6 July 2010 performed with ten blood samples from B-ALL patients and the averaged result (n=10) showed that the oligonucleotides significantly induced the apoptosis of B-ALL cells (Table-3), demonstrating that the oligonucleotides can be used to treat B-ALL by inducing the apoptosis of B-ALL cells.
Viable B-ALL cells <%) (n=10) Groups Time of Incubation (days) 3 7 Oligo 1 66.9 60.1 59.5 Oligo 3 67.9 64.1 65 Oligo 4 69.2 66.2 65.7 Oligo 5 70.6 68.2 67 Oligo 6 66.4 61 60.3 Oligo 7 75.9 70.1 69.2 Oligo 8 80.1 74.9 72.3 Oligo 9 67.2 63.1 62.9 Oligo 10 72.6 68.1 65.3 Medium 91.5 92.7 93.1 2216 94.9 95 93.5 2006 62.9 58.4 59 Table-3. The apoptosis of B-ALL cells induced by the oligonucleotides Example 7. The up-regulation of CD40 on B-ALL cells by the oligonucleotides 1. Preparation of human B-ALL cells Human B-ALL cells were prepared from the blood samples of patients with the procedures as described in example 6.
The B-ALL cells were incubated with or without the Oligol, Oligo3, Oligo4, OligoS, 15 Oligo6, Oligo7, Oligo8, Oligo9, OligolO, 2006 or 2216 respectively at a final concentration of 3 n g/ml in 10% human AB serum RPMI 1640 medium (HyClone) at 106 cells/well in a 48-well plate. The oligonucleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPMI 1640 medium (HyClone)) was used as a control (Medium). 21 563583 Received at IPONZ on 6 July 2010 On day 3, 5, 7 after the incubation, the cells were counted and stained with FITC-CD40 antibody (Becton ickinson) (Molecular Probes Inc) (Lena Thyrell, et al. The Journal of Biological Chemistry Vol. 279, No. 23, Issue of June 4, pp. 24152-24162, 2004) for 10 minutes. The CD40 antibody stained small lymphocytic lymphoma cells were determined by flow cytometry (B.D. FACS Aria). The experiment was repeated with ten samples and the averaged result (Table-4) showed that the oligonucleotides significantly up-regulate the expression of CD40 on B-ALL cells, indicating that the oligonucleotides can be used to treat B-ALL by 10 up-regulating CD40 on the cells. The up-regulation of CD40 promotes the apoptosis of B-ALL cells, induces the growth inhibition of B-ALL cells and renders the B-ALL cells more immunogenic to stimulate the generation of CTLs specific to B-ALL cells.
CD40 expression on B-cell acute lymphocytic leukemia cells (MFI) (n=10) Groups Time of Incubation (days) 3 7 Oligo 1 33.6 33.9 34.2 Oligo 3 29.9 29.1 .2 Oligo 4 .1 29.9 31.6 Oligo 5 ,3 26.6 26.9 Oligo 6 32.9 32.8 33.1 Oligo 7 27.8 28.1 29.2 Oligo 8 .9 17.2 17.8 Oligo 9 28.2 28.1 29.2 Oligo 10 26.9 27.4 27.8 Medium 7.2 7.9 8.5 2216 9.9 9.5 .6 2006 33.7 33.8 34.1 Table-4. Up-regulation of CD40 on B-ALL cells by the oligonucleotides Example 8. The production of IL-10 from B-CLL induced by the oligonucleotides 1. Preparation of human B-CLL cells 22 563583 Received at IPONZ on 6 July 2010 Human B-CLL cells were isolated from B-CLL patients with the procedures as described as in example 2. 2. The production of IL-10 from B-CLL induced by the oligonucleotides 5 The B-CLL cells were culture with or without the Oligol, Oligo3, Oligo4, Oligo5, OligoB, Oligo7, Oligo8, Oligo9, Oligol 0 respectively at a final concentration of 3p g/ml in serum-free RPMI 1640 medium (HyClone) at 106 cells/well in a 48-well plate in triplicates. The oligonuleotides were diluted in serum free RPMI 1640 medium (HyClone). An equal volume of the dilute (serum free RPMI 1640 medium 10 (HyClone)) was used as a control (Medium).
The culture supernatants were collected at 24 h or the indicated time points and assessed for IL-10 in Fluorokine MAP Immunoarray (R&D Systems) system. Our data showed that triggering with the oligonucleotides led to the production of a high 15 level of IL-10 from B-CLL cells (Table-5). In addition, our data further showed that adding exogenous rh-IL-10 (Schering Corp) into B-CLL cell cultures induced apoptotic B-CLL cells in an IL-10 dose-dependent manner, which could be specifically blocked by anti-lL-10 antibody (R&D Systems). These findings demonstrate that the oligonucleotides can be used to treat B-CLL by inducing the 20 production of IL-10 that provokes the apoptosis of B-CLL cells in an autocrine manner. The experiment was repeated with at least ten samples from B-CLL patients with similar results. 23 563583 Received at IPONZ on 6 July 2010 IL-10 production by B-CLL cells Group pg/ml Oligo 1 800 Oligo 3 621 Oligo 4 469 Oligo 5 523 Oligo 6 112 Oligo 7 576 Oligo 8 502 Oligo 9 455 Oligo 10 752 Medium 01.2 Table-S. lnterleukin-10 production from B-CLL cells induced by the oligonucleotides Example 9. The effect of the oligonucleotides on the proliferation of human 5 normal PBMC Human PBMCs were isolated from buffy coats of normal blood donors (The Blood Center of Jilin Province, China) by Ficoll-Hypaque density gradient centrifugation (Pharmacia). The viability of the PBMCs was 95-99% as determined by trypan blue 10 exclusion.
The PBMCs (6X105/well) were plated in 96-well U-bottomed plates (Costar) and cultured with or without the Oligol, Oligo3, Oligo4, Oligo5, Oligo6, Oligo7, Oligo8, Oligo9, Oligol0, 2006 or 2216 respectively at a final concentration of 6 |xg/ml in 15 triplicates for 36 h, followed by pulsing with [3H] thymidine (New England Nuclear, Boston, MA) for 16 h. The cells were harvested on glass fiber filters and detected in a scintillation counter. The cell proliferation was expressed as cpm (counts per minute) (from triplet wells). Data from five normal blood samples are shown. 2006 and 2216 were used in controls. The results showed that the oligonucleotides could 20 stimulate the PBMCs to proliferate obviously (Figure-3), indicating that the oligonucleotides, instead of inducing the apoptosis, are proliferation-stimulatory to 24 563583 Received at IPONZ on 6 July 2010 normal human PBMCs and isn't toxic to the cultured cells.
Having described the invention in detail and by reference to the preferred embodiments it will be apparent to those skilled in the art that modifications and 5 variations are possible without departing from the scope of the invention as defined in the following appended claims. 563583 Received at IPONZ on 6 July 2010 normal human PBMCs and isn't toxic to the cultured cells.
Having described the invention in detail and by reference to the preferred embodiments it will be apparent to those skilled in the art that modifications and 5 variations are possible without departing from the scope of the invention as defined in the following appended claims.
In the description in this specification reference may be made to subject matter which is not within the scope of the claims of the current application. That subject matter should be readily identifiable by a person skilled in the art and may assist in putting into practice the invention as defined in the claims of this application. 563583 Received at IPONZ on 6 July 2010

Claims (17)

WHAT WE CLAIM IS:
1. A use of an oligonucleotide having any one of the sequences of SEQ ID NO:1-9, in the manufacture of a medicament for treating B cell neoplasm in a mammalian subject in need of treating.
2. The use according to claim 1, wherein said medicament acts to induce apoptosis of B-cell neoplastic cells.
3. The use according to claim 1, wherein said medicament acts to un-regulate CD40 on B-cell neoplastic cells.
4. The use according to claim 1, wherein said medicament acts to stimulate B-cell neoplastic cells to produce 1L-10.
5. The use according to claim 1, wherein said B cell neoplasm is B cell leukemia, B cell lymphoma or myeloma.
6. The use according to claim 5, wherein said B cell leukemia is B cell chronic lymphocytic leukemia or B cell acute lymphocytic leukemia.
7. The use according to claim 5, wherein said B cell lymphoma is small lymphocytic lymphoma.
8. The use according to claim 1, wherein said mammalian subject is a human subject.
9. The use according to claim 1, wherein said medicament is formulated for enteral, parenteral, or topical administration or for administration by inhalation.
10. A pharmaceutical composition comprising: (1) an oligonucleotide having any one of the sequences of SEQ ID NO: I-9 and (2) anti-B cell neoplasm agent.
11. The composition according to claim 10, wherein said anti-B cell neoplasm agent is chemotherapeutics, immunotherapeutics, or agents used in radiotherapy. 26 563583 Received at IPONZ on 6 July 2010
12. The composition according to claim 11, wherein said chemotherapeutics is selected from the group consisting of: tludarabine, pentostatin, vincristine, cyciophosphamide, and prednisone.
13. The composition according to claim 11, wherein said chemotherapeutics is selected from the group consisting of: CVP (cyclophosphamide, vincristine and prednisone), and CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)
14. The composition according to claim 11, wherein said immunotherapeutics is an anti-CD20 antibody.
15. The composition according to claim 11, wherein said radio therapy is external radiation or a radiolabeled antibody treatment.
16. A use as claimed in claim 1, substantially as herein described with reference to any example thereof.
17. A pharmaceutical composition as claimed in claim 10 substantially as herein described with reference to any example thereof. 27
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