US20150010581A1 - Combined therapy of alpha-1-antitrypsin and temporal t-cell depletion for preventing graft rejection - Google Patents

Combined therapy of alpha-1-antitrypsin and temporal t-cell depletion for preventing graft rejection Download PDF

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US20150010581A1
US20150010581A1 US14/380,118 US201314380118A US2015010581A1 US 20150010581 A1 US20150010581 A1 US 20150010581A1 US 201314380118 A US201314380118 A US 201314380118A US 2015010581 A1 US2015010581 A1 US 2015010581A1
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aat
temporary
transplantation
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graft
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Eli LEWIS
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Ben Gurion University of the Negev Research and Development Authority Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
    • A61K35/37—Digestive system
    • A61K35/39—Pancreas; Islets of Langerhans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/04—Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/14—Peptides containing saccharide radicals; Derivatives thereof, e.g. bleomycin, phleomycin, muramylpeptides or vancomycin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/19—Cytokines; Lymphokines; Interferons
    • A61K38/191—Tumor necrosis factors [TNF], e.g. lymphotoxin [LT], i.e. TNF-beta
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/19—Cytokines; Lymphokines; Interferons
    • A61K38/21—Interferons [IFN]
    • A61K38/217—IFN-gamma
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/55—Protease inhibitors
    • A61K38/57—Protease inhibitors from animals; from humans
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/39541—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against normal tissues, cells
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A61P37/06—Immunosuppressants, e.g. drugs for graft rejection
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/40—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against enzymes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies

Definitions

  • the present invention relates to compositions and methods for the prevention and treatment of graft rejection, including xenograft rejection, and for attenuating host responses in transplantation of cells, pancreatic islets, tissues and organs. More specifically, the compositions and methods of the present invention relate to combined therapies comprising treatment of alpha-1-antitryp sin and temporary T-cell depletion in the graft recipient.
  • Transplantation systems such as organ transplantations have become important, effective and at times the sole therapies for many life-threatening end-stage diseases.
  • injurious immune responses are still the major barrier for successful transplantation. This is manifested in irreversible and life-threatening graft failure (host-versus-graft response, or HVG) or pathological immune reactivity of bone-marrow transplants graft-versus-host disease (GVHD).
  • HVG host-versus-graft response
  • GVHD pathological immune reactivity of bone-marrow transplants graft-versus-host disease
  • Pancreatic islet transplantation can provide type-1 diabetes patients with functional islets and physiological circulating glucose levels.
  • shortage of human donors represents a critical obstacle.
  • Islet xenograft transplantation from non-human donors provides an alternative for human islet allotransplantation; in addition to providing an array of islet sources, xenografts offer the advantage of elective procedures (that is, the donor is recruited upon availability rather than the patient), and potentially manipulating donor cells towards superior islet function.
  • elective procedures that is, the donor is recruited upon availability rather than the patient
  • xenograft rejection is distinct to allograft. Xenograft rejection is largely attributed to vast antigen disparity between species, thus triggering multiple arms of the immune response. Indeed, in addition to host CD4 + T cell involvement, evidence suggests that CD8 + T cells and B cells partake in xenograft rejection. Additionally, inflammation limits islet xenograft survival, particularly in early days post-transplantation, a challenging therapeutic obstacle considering that diabetogenic corticosteroids are excluded from current islet transplantation protocols. Within this context, the desired emergence of protective regulatory T cells (Tregs) appears further intangible.
  • Tregs protective regulatory T cells
  • T cell debulking therapy a regimen comprised of polyclonal antibodies that temporarily deplete T cells, is currently used for prevention of acute rejection in organ transplantation.
  • Combination of anti-CD4 and anti-CD8 antibodies in mice may represent the use of ATG in patients, as it achieves a similar temporary decline in T-cell numbers (Tchorsh-Yutsis et al. Transplantation 2011; 91(4):398-405; Tchorsh-Yutsis et al.
  • Temporal T cell depletion delays clonal T cell activation in the associated draining lymph nodes (DLN) and allows grafted islets to evade T cell-mediated destruction in the first ⁇ 2 weeks post-transplantation.
  • DNN draining lymph nodes
  • anti-CD8 and anti-CD4 antibodies extend islet xenograft survival, albeit not indefinitely (Koulmanda et al. Xenotransplantation 2004; 11(6):525-530).
  • hAAT Human a 1-antitrypsin
  • hAAT also targets anti-islet autoimmune responses in animals (Koulmanda et al., Proc Natl Acad Sci USA 2008; 105(42):16242-16247).
  • the cellular targets of hAAT include non-T cells such as dendritic cells, B lymphocytes, macrophages and neutrophils, resulting in reduced levels and activity of inflammatory mediators such as IL-1 ⁇ , tumor necrosis factor (TNF) ⁇ , monocyte chemotactic protein (MCP)-1 and nitric oxide, as well as elevating levels of IL-10 and IL-1 receptor antagonist.
  • hAAT has been shown to directly protect islets from inflammatory injury, apoptosis and isolation-related damage.
  • US Pat. Appl. No. 20090220518 to an inventor of the current invention and co-workers, relates to treating, reducing or preventing transplantation rejection and/or side effects associated with transplantation.
  • xenograft rejection may be prevented by combination therapy comprising AAT and temporary T cell depletion, particularly, anti-CD4 and anti-CD8 antibodies administration.
  • the present invention provides compositions and methods for the prevention and treatment of xenograft rejection, and for attenuating host responses in xenotransplantation of tissues, organs and cells. More specifically, the present invention provides compositions and methods of combined therapies comprising treatment of alpha-1-antitrypsin (AAT) and temporary T-cell depletion in the graft recipient.
  • AAT alpha-1-antitrypsin
  • islet xenotransplant survival is remarkably extended by a combination therapy of AAT treatment and temporary T cell depletion.
  • xenograft recipients were treated separately with AAT or T cell depletion, however, this resulted in acute rejection, or delayed-onset acute rejection of the graft, respectively.
  • combination therapy of AAT with co-stimulation blockade using anti-CD154/LFA-1 antibodies did not result in significant change in xenotransplant rejection.
  • co-administration of AAT and T cell depletion using anti-CD4 and anti-CD8 antibodies resulted in prolonging xenograft survival.
  • the present invention provides a method of preventing or treating xenotransplant rejection in a subject in need thereof, the method comprises administering to said subject a therapeutically effective amount of AAT in combination with a therapeutically effective amount of at least one temporary T cell depleting agent.
  • the at least one temporary T cell depleting agent is selected from anti-CD4 and anti-CD8 antibodies, or an antigen binding fragment thereof.
  • the at least one temporary T cell depleting agent is an anti-CD4 antibody, or an antigen binding fragments thereof.
  • the at least one temporary T cell depleting agent is an anti-CD8 antibody, or an antigen binding fragment thereof.
  • the at least one temporary T cell depleting agent is anti-CD4 and anti-CD8 antibodies, or antigen binding fragments thereof.
  • the at least one temporary T cell depleting agent is selected from the group consisting of anti-CD3, anti-CD4, anti-CD25, anti-CD8a, anti-TCR, anti-TCR-gamma-delta and anti-thymocyte-globulin (ATG), or an antigen binding fragment thereof.
  • AGT anti-thymocyte-globulin
  • the temporary T cell depleting agent is administered prior to transplantation. According to another embodiment, said temporary T cell depleting agent is administered no more than 14 days prior to transplantation. According to another embodiment, said temporary T cell depleting agent is administered no more than 3 days prior to transplantation. According to another embodiment, said temporary T cell depleting agent administration is concomitant.
  • the AAT is human AAT (hAAT).
  • said hAAT comprises an amino acid sequence as set forth in SEQ ID NO: 1.
  • said hAAT consists of an amino acid sequence as set forth in SEQ ID NO: 1.
  • said AAT is recombinant hAAT.
  • said AAT is an analog, derivative or fragment of hAAT.
  • AAT administration is a long term administration. According to another embodiment, said AAT administration is sequential. According to another embodiment, said AAT administered is a single-dose administration. According to another embodiment, AAT is administered prior to transplantation, following transplantation or a combination thereof. According to another embodiment, administering AAT prior to treatment is for no more than 10 days prior to transplantation.
  • the subject is a human.
  • the xenotransplant is from a nonhuman mammal.
  • the nonhuman mammal is a nonhuman primate.
  • the nonhuman mammal is selected from the group consisting of a pig, dog or cow.
  • the nonhuman mammal is a pig.
  • the graft is genetically modified.
  • said xenotransplant is selected from the group consisting of pancreatic islet cells, pancreas, heart, lung, kidney, liver or skin. According to another embodiment, the xenotransplant is pancreatic islet cells. According to another embodiment, the xenotransplant is skin.
  • the present invention provides a method of preventing or treating graft rejection in a subject afflicted with graft dysfunction, the method comprises administering to the recipient a therapeutically effective amount of AAT in combination with a therapeutically effective amount of a temporary T cell depleting agent.
  • said graft is selected from the group consisting of pancreatic islet cells, hematopoietic cells, stem cells, pancreas, heart, lung, kidney, liver or skin.
  • the graft is pancreatic islet cells.
  • the graft is hematopoietic cell.
  • said graft is a xenograft.
  • FIG. 1 depicts human AAT monotherapy during pancreatic islet xenotransplantation.
  • Rat pancreatic islets were grafted into the renal subcapsular space of hyperglycemic mice. Recipients were treated with saline (CT) or human AAT throughout the experiment.
  • CT saline
  • C Mouse gene expression at graft site. Grafts were explanted at indicated times after transplantation.
  • FIG. 2 is a graphic illustration of draining lymph nodes (DLN) response to human AAT monotherapy after skin xenografting.
  • Mice were either SHAM operated (CT) or recipients of rat skin (Tx) in the absence or presence of human AAT monotherapy.
  • CT SHAM operated
  • Tx rat skin
  • FIG. 2 is a graphic illustration of draining lymph nodes (DLN) response to human AAT monotherapy after skin xenografting.
  • Mice were either SHAM operated (CT) or recipients of rat skin (Tx) in the absence or presence of human AAT monotherapy.
  • CT 14-day DLN.
  • B 72-h DLN.
  • FIG. 3 depicts graft survival following AAT treatment combined with debulking therapy.
  • A CD45 + CD3 + cells from peripheral blood, as monitored by FACS analysis. Results presented as the percent out of initial amount prior to injection. Representative follow-up out of 10 mice.
  • C The percentage of mice having functional islet xenograft following CT, DB/AAT, anti-CD8, and anti-CD8/AAT treatments.
  • mice having functional islet xenograft following CT, DB/AAT, anti-CD4, and anti-CD4/AAT treatments.
  • E Glucose follow-up. Representative mouse. Milestones indicated: hAAT treatment stopped, therapy withdrawn followed by glucose follow-up; nephrectomy, graft explantation followed by glucose follow-up; second xenograft, rat islets grafted into the right renal subcapsular space followed by glucose follow-up.
  • FIG. 4 illustrates AAT treatment combined with debulking therapy; histology and gene expression.
  • A Graft site histology. K, kidney tissue; G, graft site. From left to right, representative syngeneic mouse islet graft (day 35), xenograft (debulking therapy alone, day 25), black arrows indicate immune cell mononuclear infiltration, xenograft (debulking therapy combined with AAT, day 11 after rejection) and xenograft (debulking therapy combined with AAT, day 90).
  • (C) Mouse (recipient) gene expression profiles. RT-PCR. CT vs. AAT monotherapy on day 7 shown over gray background, next to day 90 explants from mice treated by the combination of debulking therapy and AAT (DB/AAT). Results expressed as fold change from CT, mean ⁇ SEM from n 3/group; *p ⁇ 0.05, **p ⁇ 0.01, ***p ⁇ 0.001.
  • FIG. 5 are graphs showing that hAAT promotes expansion of foxp3 positive CD4 T-cells and delays CD8 T-cell re-population after T-cell depletion.
  • C57BL/6 (WT) and hAAT transgenic mice (hAAT +/+ ) n 5 per group underwent systemic T-cell depletion using the combination of anti-CD4 and anti-CD8 depleting antibodies.
  • (A) shows the interplay between CD3 and CD45 expression;
  • B) shows the interplay between CD8 and CD3 expression;
  • C shows the interplay between CD4 and CD3 expression;
  • B shows the interplay between FOxp3 and CD4 expression.
  • the invention is directed to compositions and methods for the prevention and treatment of xenograft rejection, and for attenuating host immune responses following xenograft transplantation of tissues, organs and cells. Further, the present invention provides compositions and methods for suppressing the immune response of a graft recipient non-responsive or resistant to a first line treatment, including, but not limited to subjects afflicted with graft dysfunction.
  • hAAT Human AAT
  • hAAT monotherapy has been recently shown to protect islet allografts from acute rejection and facilitates strain-specific immune tolerance, however, hAAT monotherapy appears insufficient to allow xenograft acceptance.
  • AAT monotherapy resulted in xenografts rejection despite attempts to prolong the treatment and/or extend its time course. Considering that xenograft rejection is difficult to control, this would seem the final option for involvement of AAT in this context.
  • an attempt to combine AAT therapy with co-stimulation blockade using anti-CD154/LFA-1 did not result in significant change in xenotransplant rejection as well. Unexpectedly, prevention of xenograft rejection was achieved using a combination therapy of AAT and temporary T cell depletion using anti-CD4/CD8 antibodies.
  • AAT and anti-CD4 and anti-CD8 antibodies administered to xenograft recipients resulted in a synergistic effect of prolonging islet xenograft survival. Since AAT does not directly inhibit T cell responses, these findings indicate that AAT directs the immune response in the first stages post-transplantation in a manner that is compromised by the presence of uninterrupted activated T cells. Therefore, without wishing to be bound by any particular theory or mechanism of action, the temporary elimination of T cells together with hAAT, affords xenografts improved conditions for recovery and survival, and provides the re-emerging T cells with less danger signals.
  • the present invention provides a pharmaceutical composition comprising a therapeutically effective amount of AAT and a therapeutically effective amount of at least one temporary T cell depleting agent, including but not limited to, anti-CD4 and/or anti-CD8 antibodies.
  • the present invention provides synergistic compositions of AAT and at least one temporary T cell depleting agent for use in the prevention and treatment of xenograft rejection.
  • the present invention provides synergistic compositions of AAT and at least one temporary T cell depleting agent for use in preventing or treating graft rejection in a subject non-responsive or resistant to a first-line immunosuppressive treatment.
  • the present invention provides synergistic compositions of AAT and at least one temporary T cell depleting agent for use in preventing or treating graft rejection in a subject initially afflicted with graft dysfunction.
  • a subject afflicted with graft dysfunction refers to the earliest point of detection of an ongoing graft's failure.
  • a subject afflicted with graft dysfunction is, in some embodiment, a graft recipient non-responsive to first-line immunosuppressive protocol or, in additional embodiments, any subsequent immunosuppressive treatment.
  • said subject is a treatment-resistant subject.
  • said first-line immunosuppressive treatment is steroid treatment, including but not limited to corticosteroids.
  • Corticosteroid therapy is typically administered at a high dose at the time of transplantation and then gradually reduced to a maintenance dose, which is given indefinitely. The approach ablates immune responses, but does not alter the profile of the immune cells that recover from the effects of steroids.
  • said first-line immunosuppressive treatment is selected from the group consisting of: calcineurin inhibitors (CNIs), cyclosporine, tacrolimus, purine metabolism inhibitors, azathioprine, mycophenolate mofetil, rapamycins, sirolimus, everolimus and immunosuppressive immunoglobulin (including antilymphocyte globulin (ALG) and antithymocyte globulin (ATG)).
  • CNIs calcineurin inhibitors
  • cyclosporine cyclosporine
  • tacrolimus purine metabolism inhibitors
  • azathioprine mycophenolate mofetil
  • rapamycins rapamycins
  • sirolimus everolimus
  • immunosuppressive immunoglobulin including antilymphocyte globulin (ALG) and antithymocyte globulin (ATG)
  • the methods of the present invention are useful for preventing or treating the rejection of an organ transplant and/or a non-organ transplant.
  • an organ transplant and/or a non-organ transplant For example lung, kidney, heart, liver, cornea, skin, bone marrow, pancreatic islet, pancreas transplant or combinations thereof are contemplated.
  • the methods of the present invention are useful for preventing or treating the rejection of transplanted cells, tissues or organs selected from hematopoietic cells, stem cells, pancreatic islet cells, heart, lung, kidney, liver, skin and other cells, organs or tissues transplanted from donor to recipient.
  • the transplanted cells are genetically modified cells.
  • genetically modified cells as referred to herein relates to cells being transfected by a vector, as exemplified by an expression vector comprising the coding sequence of a gene of interest, said cells capable of expressing said gene.
  • Methods for genetically modifying cells such as hematopoietic cells, stem cells or pancreatic islet cells are well known in the art.
  • therapeutically effective amounts is intended to qualify the amount of each agent for use in the combination therapy which will achieve the goal of improvement in severity and the frequency of incidence over treatment of each agent by itself, while avoiding adverse side effects typically associated with alternative therapies.
  • the therapeutically effective amount of at least one agent of the invention (AAT or T cell depleting agent) is lower than the amount used in monotherapy using said agent.
  • the therapeutically effective amount of AAT is lower than the amount used in monotherapy using said agent.
  • AAT is administered at a dose of 5-300 mg/kg. According to some embodiments, AAT is administered at a dose of 10-280 mg/kg. According to some embodiments, AAT is administered at a dose of 15-260 mg/kg. According to another embodiment, AAT is administered at a dose of 45-240 mg/kg.
  • the T cell depleting agent is an antibody or antigen binding fragment thereof, and is administered at a dose effective for temporarily depleting T cell.
  • antibodies are administered at a dose of 0.1-20 mg/kg.
  • said T cell depleting antibody is administered at a dose of 0.5-10 mg/kg.
  • phrase “combination therapy” in defining the use of AAT in combination with at least one T cell depleting agent, is intended to embrace administration of each agent in a distinct manner in a regimen that will provide beneficial effects of the drug combination.
  • “combination therapy” is a single composition of AAT and at least one T cell depleting agent.
  • “combination therapy” is a single kit comprising a composition comprising AAT and at least one composition comprising at least one T cell depleting agent.
  • the T cell depleting agent and AAT are administered separately prior to transplantation. In some embodiments, the T cell depleting agent and AAT are administered concomitantly prior to transplantation. In some embodiments, the T cell depleting agent is administered prior to transplantation. In some embodiments, the T cell depleting agent is administered after transplantation. In some embodiments, AAT is administered prior to transplantation. In some embodiments, AAT is administered after transplantation. In some embodiments, the T cell depleting agent is administered prior to transplantation and after transplantation. In some embodiments, AAT is administered prior to transplantation and after transplantation.
  • anti-CD4 and anti-CD8 antibodies prior to transplantation results in temporal T cell depletion in said subject and, without wishing to be bound by any particular theory or mechanism of action, is coordinated with an elective transplantation session to optimally fit the absence of T cells.
  • said anti-CD4 and anti-CD8 antibodies are administered no more than 7 days, no more than 6 days, no more than 5 days, no more than 4 days, no more than 3 days, or no more than 2 days prior to transplantation.
  • the anti-CD4 antibody is GK1.5. In another embodiment, the anti-CD8 antibody is 53.6.72. Said antibodies are commercially available such as from BioXCell. In another embodiment, the anti-CD4 antibody exhibits similar T cell depleting activity as the GK1.5 antibody. In another embodiment, the anti-CD8 antibody exhibits similar T cell depleting activity as the 53.6.72 antibody.
  • T cell depleting agents are known to one skilled in the art.
  • Non limiting examples for T cell depleting agents include anti-CD3, anti-CD4, anti-CD25, anti-CD8, anti-CD8a, anti-TCR, anti-TCR-gamma-delta and anti-thymocyte-globulin (ATG).
  • TAG anti-thymocyte-globulin
  • temporary T-cell depletion relates to reduced circulating T cells for about 14 days.
  • the temporary T-cell depleting agent may be administered prior to transplantation, or in other embodiments, when the graft recipient is diagnosed as being non-responsive to a first line of immunosuppressive treatment including but not limited to a recipient initially diagnosed as having graft dysfunction.
  • AAT administration is a long term administration.
  • said AAT administration is selected from single-dose administration or sequential administration.
  • AAT is administered prior to transplantation, following transplantation or a combination thereof.
  • administering AAT prior to treatment is for no more than 10 days prior to transplantation.
  • the AAT is human AAT (hAAT).
  • said hAAT comprises an amino acid sequence as set forth in SEQ ID NO: 1.
  • said hAAT consists of an amino acid sequence as set forth in SEQ ID NO: 1 (MPSSVSWGILLAGLCCLVPVSLAEDPQGDAAQKTDTSHHDQDHPTFNKITPNLAE FAFSLYRQLAHQSNSTNIFFSPVSIATAFAMLSLGTKADTHDEILEGLNFNLTEIPEA QIHEGFQELLRTLNQPDS QLQLTTGNGLFLSEGLKLVDKFLEDVKKLYHSEAFTVN FGDHEEAKKQINDYVEKGTQGKIVDLVKELDRDTVFALVNYIFFKGKWERPFEVK DTEDEDFHVDQVTTVKVPMMKRLGMFNIQHCKKLSSWVLLMKYLGNATAIFFLP DEGKLQHLENELTHDIITKFLENEDRRSASLHLPKLSITGTYDLKSVLG
  • said AAT is an analog, derivative or fragment of hAAT. According to another embodiment, said AAT is a recombinant AAT. According to another embodiment, said AAT is a plasma-derived AAT.
  • substitutions, deletions or additions to a peptide, or protein sequence which alters, adds or deletes a single amino acid or a small percentage of amino acids in the encoded sequence is a conservatively modified variant where the alteration results in the substitution of an amino acid with a similar charge, size, and/or hydrophobicity characteristics, such as, for example, substitution of a glutamic acid (E) to aspartic acid (D).
  • Conservative substitution tables providing functionally similar amino acids are well known in the art.
  • analog includes any peptide having an amino acid sequence substantially identical to one of the sequences specifically shown herein in which one or more residues have been conservatively substituted with a functionally similar residue and which displays the abilities as described herein.
  • conservative substitutions include the substitution of one non-polar (hydrophobic) residue such as isoleucine, valine, leucine or methionine for another, the substitution of one polar (hydrophilic) residue for another such as between arginine and lysine, between glutamine and asparagine, between glycine and serine, the substitution of one basic residue such as lysine, arginine or histidine for another, or the substitution of one acidic residue, such as aspartic acid or glutamic acid for another.
  • a non-polar (hydrophobic) residue such as isoleucine, valine, leucine or methionine for another
  • one polar (hydrophilic) residue for another such as between arginine and lysine, between glutamine and
  • a peptide derived from hAAT can be an analog, fragment, conjugate (e.g. a lipopeptide conjugate) or derivative of a native hAAT, and salts thereof, as long as said peptide retains its ability to protect the transplant from inflammation.
  • the present invention encompasses derivatives of AAT.
  • the term “derivative” or “chemical derivative” includes any chemical derivative of AAT having one or more residues chemically derivatized by reaction of side chains or functional groups.
  • Such derivatized molecules include, for example, those molecules in which free amino groups have been derivatized to form amine hydrochlorides, p-toluene sulfonyl groups, carbobenzoxy groups, t-butyloxycarbonyl groups, chloroacetyl groups or formyl groups.
  • Free carboxyl groups may be derivatized to form salts, methyl and ethyl esters or other types of esters or hydrazides.
  • Free hydroxyl groups may be derivatized to form O-acyl or O-alkyl derivatives.
  • the imidazole nitrogen of histidine may be derivatized to form N-im-benzylhistidine.
  • chemical derivatives are those peptides, which contain one or more naturally occurring amino acid derivatives of the twenty standard amino acid residues. For example: 4-hydroxyproline may be substituted for proline; 5-hydroxylysine may be substituted for lysine; 3-methylhistidine may be substituted for histidine; homoserine may be substituted or serine; and ornithine may be substituted for lysine.
  • a derivative can differ from the natural sequence of the peptides of the invention by chemical modifications including, but are not limited to, terminal-NH 2 acylation, acetylation, or thioglycolic acid amidation, and by terminal-carboxlyamidation, e.g., with ammonia, methylamine, and the like.
  • Peptides can be either linear, cyclic or branched and the like, which conformations can be achieved using methods well known in the art.
  • the derivatives and analogs according to the principles of the present invention can also include side chain bond modifications, including but not limited to —CH 2 —NH—,— 13 CH 2 —S—, —CH 2 —S ⁇ O, O ⁇ C—NH—, —CH 2 —O—, —CH 2 —CH 2 —, S ⁇ C—NH—, and —CH ⁇ CH—, and backbone modifications such as modified peptide bonds.
  • Peptide bonds (—CO—NH—) within the peptide can be substituted, for example, by N-methylated bonds (—N(CH3)—CO—); ester bonds (—C(R)H—C—O—O—C(R)H—N); ketomethylene bonds (—CO—CH2—); ⁇ -aza bonds (—NH—N(R)—CO—), wherein R is any alkyl group, e.g., methyl; carba bonds (—CH2—NH—); hydroxyethylene bonds (—CH(OH)—CH2—); thioamide bonds (—CS—NH); olefinic double bonds (—CH ⁇ CH—); and peptide derivatives (—N(R)—CH2-CO—), wherein R is the “normal” side chain, naturally presented on the carbon atom. These modifications can occur at one or more of the bonds along the peptide chain and even at several (e.g., 2-3) at the same time.
  • the present invention also encompasses derivatives and analogs in which free amino groups have been derivatized to form amine hydrochlorides, p-toluene sulfonylamino groups, carbobenzoxyamino groups, t-butyloxycarbonylamino groups, chloroacetylamino groups or formylamino groups.
  • Free carboxyl groups may be derivatized to form, for example, salts, methyl and ethyl esters or other types of esters or hydrazides.
  • the imidazole nitrogen of histidine can be derivatized to form N-im-benzylhistidine.
  • the analogs can also contain non-natural amino acids.
  • non-natural amino acids include, but are not limited to, sarcosine (Sar), norleucine, ornithine, citrulline, diaminobutyric acid, homoserine, isopropyl Lys, 3-(2′-naphtyl)-Ala, nicotinyl Lys, amino isobutyric acid, and 3-(3′-pyridyl-Ala).
  • analogs can contain other derivatized amino acid residues including, but not limited to, methylated amino acids, N-benzylated amino acids, O-benzylated amino acids, N-acetylated amino acids, O-acetylated amino acids, carbobenzoxy-substituted amino acids and the like.
  • Specific examples include, but are not limited to, methyl-Ala (MeAla), MeTyr, MeArg, MeGlu, MeVal, MeHis, N-acetyl-Lys, O-acetyl-Lys, carbobenzoxy-Lys, Tyr-O-Benzyl, Glu-O-Benzyl, Benzyl-His, Arg-Tosyl, t-butylglycine, t-butylalanine, phenylglycine, cyclohexylalanine, and the like.
  • compositions of the invention can be formulated in the form of a pharmaceutically acceptable salt of the peptides of the present invention or their analogs or derivatives thereof.
  • Pharmaceutically acceptable salts include those salts formed with free amino groups such as salts derived from non-toxic inorganic or organic acids such as hydrochloric, phosphoric, acetic, oxalic, tartaric acids, and the like, and those salts formed with free carboxyl groups such as salts derived from non-toxic inorganic or organic bases such as sodium, potassium, ammonium, calcium, ferric hydroxides, isopropylamine, triethylamine, 2-ethylamino ethanol, histidine, procaine, and the like.
  • pharmaceutically acceptable means suitable for administration to a subject, e.g., a human.
  • pharmaceutically acceptable can mean approved by a regulatory agency of the Federal or a state government or listed in the U. S. Pharmacopeia or other generally recognized pharmacopeia for use in animals, and more particularly in humans.
  • carrier refers to a diluent, adjuvant, excipient, or vehicle with which the therapeutic compound is administered.
  • Such pharmaceutical carriers can be sterile liquids, such as water and oils, including those of petroleum, animal, vegetable or synthetic origin, such as peanut oil, soybean oil, mineral oil, sesame oil and the like, polyethylene glycols, glycerine, propylene glycol or other synthetic solvents. Water is a preferred carrier when the pharmaceutical composition is administered intravenously. Saline solutions and aqueous dextrose and glycerol solutions can also be employed as liquid carriers, particularly for injectable solutions.
  • Suitable pharmaceutical excipients include starch, glucose, lactose, sucrose, gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerol monostearate, talc, sodium chloride, dried skim milk, glycerol, propylene glycol, water, ethanol and the like.
  • the composition can also contain minor amounts of wetting or emulsifying agents, or pH buffering agents such as acetates, citrates or phosphates.
  • Antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfite; and agents for the adjustment of tonicity such as sodium chloride or dextrose are also envisioned.
  • compositions can take the form of solutions, suspensions, emulsions, tablets, pills, capsules, powders, gels, creams, ointments, foams, pastes, sustained-release formulations and the like.
  • the compositions can be formulated as a suppository, with traditional binders and carriers such as triglycerides, microcrystalline cellulose, gum tragacanth or gelatin.
  • Oral formulation can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharine, cellulose, magnesium carbonate, etc. Examples of suitable pharmaceutical carriers are described in: Remington's Pharmaceutical Sciences by E. W. Martin, the contents of which are hereby incorporated by reference herein.
  • the therapeutically effective amount of the components of the present invention e.g., AAT and anti-CD4/CD8 antibodies
  • AAT and anti-CD4/CD8 antibodies which will be effective in the prevention and treatment of graft rejection
  • in vitro assays may optionally be employed to help identify optimal dosage ranges.
  • the precise dose to be employed in the formulation will also depend on the route of administration, and the nature of the disease or disorder, and should be decided according to the judgment of the practitioner and each patient's circumstances. Effective doses can be extrapolated from dose-response curves derived from in-vitro or in-vivo animal model test bioassays or systems.
  • Toxicity and therapeutic efficacy of the compositions described herein can be determined by standard pharmaceutical procedures in cell cultures or experimental animals, e.g., by determining the IC50 (the concentration which provides 50% inhibition) and the LD50 (lethal dose causing death in 50% of the tested animals) for a subject compound.
  • the data obtained from these cell culture assays and animal studies can be used in formulating a range of dosage for use in human.
  • the dosage may vary depending upon the dosage form employed and the route of administration utilized. The exact formulation, route of administration and dosage can be chosen by the individual physician in view of the patient's condition. (See, for example, Fingl et al., 1975, in The Pharmacological Basis of Therapeutics, Ch. 1 p. 1, the contents of which are hereby incorporated by reference in their entirety).
  • dosing can also be a single administration of a slow release composition, with course of treatment lasting from several days to several weeks or until cure is effected or diminution of the disease state is achieved.
  • compositions of the present invention can be supplied in any manner suitable for the provision of the peptide to cells within the tissue of interest.
  • a composition of the present invention can be introduced, for example, into the systemic circulation, which will distribute the peptide to the tissue of interest.
  • a composition can be applied topically to the tissue of interest (e.g., injected, or pumped as a continuous infusion, or as a bolus within a tissue, applied to all or a portion of the surface of the skin, etc.).
  • Suitable routes of administration include, but are not limited to, parenteral injections, e.g., intradermal, intravenous, intramuscular, intralesional, subcutaneous, intrathecal, and any other mode of injection as known in the art.
  • parenteral injections e.g., intradermal, intravenous, intramuscular, intralesional, subcutaneous, intrathecal, and any other mode of injection as known in the art.
  • bioavailability of polypeptides administered by other routes can be lower than when administered via parenteral injection, by using appropriate formulations it is envisaged that it will be possible to administer the compositions of the invention via transdermal, oral, rectal, vaginal, topical, nasal, inhalation and ocular modes of treatment.
  • compositions of the invention may be introduced into the central nervous system by any suitable route, including intraventricular and intrathecal injection; intraventricular injection may be facilitated by an intraventricular catheter, for example, attached to a reservoir.
  • Pulmonary administration can also be employed, e.g., by use of an inhaler or nebulizer.
  • composition of the invention may be administered locally to the area in need of treatment; this can be achieved by, for example, and not by way of limitation, local infusion, topical application, by injection, by means of a catheter, by means of a suppository, or by means of an implant, said implant being of a porous, non-porous, or gelatinous material.
  • administration can be by direct injection e.g., via a syringe, at the site of a damaged tissue.
  • the pharmaceutical composition may be in the form of tablets or capsules, which can contain any of the following ingredients, or compounds of a similar nature: a binder such as microcrystalline cellulose, gum tragacanth or gelatin; an excipient such as starch or lactose; a disintegrating agent such as alginic acid, Primogel, or corn starch; a lubricant such as magnesium stearate; or a glidant such as colloidal silicon dioxide.
  • a binder such as microcrystalline cellulose, gum tragacanth or gelatin
  • an excipient such as starch or lactose
  • a disintegrating agent such as alginic acid, Primogel, or corn starch
  • a lubricant such as magnesium stearate
  • a glidant such as colloidal silicon dioxide.
  • dosage unit form is a capsule, it can contain, in addition to materials of the above type, a liquid carrier such as a fatty oil.
  • dosage unit forms can contain various other materials which modify
  • hAAT lung-specific transgenic mice (C57BL/6 background) were a kind gift from Prof. A. Churg (University of British Columbia, Vancouver, Canada). Six-to-eight-week old heterozygote siblings from breeding couples of WT C57BL/6 (Harlan laboratories Inc., Israel) ⁇ human AAT lung-specific transgenic mice were used as graft recipients, as described elsewhere (19). Nine-to-ten-week old Sprague Dawley female rats (Harlan laboratories) were used as pancreatic islet and skin donors. Experiments were approved by institutional Animal Care and Use Committee.
  • Pancreatic islet isolation Donor rats were anesthetized and then bled. The bile duct was ligated at the liver and at the intestinal ends, then cannulated with a 27G needle. The pancreas was inflated with 10 ml cold collagenase (1 mg/ml, type XI, Sigma, Israel), removed and incubated for 17 minutes at 37° C. while continuously stirred with a 3 mm sterile magnet. Digested pancreas was mechanically sheared by vortex and tissue was filtered through a 1,000 ⁇ m sieve. Islets were collected from a double-Ficoll gradient (1.0771 and 1.1191, Sigma).
  • HBSS Hanks balanced salt solution
  • BSA bovine serum albumin
  • FCS fetal calf serum
  • pancreatic islets were then hand-picked under a stereoscope into a culture flask and incubated overnight.
  • Islet xenotransplantation Islet transplantation in the renal subcapsular space was performed as described, with minor modifications (19). Rat islets (315-400/transplant) were implanted under the renal capsule of recipient mice that were rendered hyperglycemic by single-dose streptozotocin (225 mg/kg, Sigma). A relatively small number of xenogeneic islets (315-400) were implanted. Prospective recipients were screened for non-fasting circulating glucose levels of ⁇ 400 mg/dl. Blood glucose was followed three times a week, and graft failure was determined by glucose values exceeding 300 mg/dl after at least three days of normoglycemia.
  • Skin xenotransplantation Skin transplantation was performed as described (19) with minor modifications. Donor rats were anesthetized, abdominal midline was shaved and excised skin was placed in cold phosphate-buffered saline (PBS). Blood vessels and hypodermis were removed using sterile blade and the skin was cut into 1 mm 2 pieces under a stereoscope. Grafts were implanted subcutaneously in the inner-thigh region of recipients and incision sites were stitched closed.
  • PBS cold phosphate-buffered saline
  • hAAT AralastTM, Baxter, Westlake Village, Calif., USA
  • hAAT was introduced at 60 and 240 mg/kg, intraperitoneally (i.p.) and at either 1 or 10 days prior to transplantation. Therapy continued every 3 days throughout the experiments, as described (19). The maximal treatment duration was 80 days.
  • Temporary T cell depletion also termed debulking therapy
  • Subtherapeutic co-stimulation blockade included an equal mixture of anti-LFA-1 and anti-CD154 monoclonal antibodies (MR-1 and FD441.8, respectively, BioXCell, West Riverside, N.H., USA), each at 25 ⁇ l/injection at the concentration of 1.25 mg/ml, one day before transplantation and every three days thereafter. The maximal treatment duration was 40 days.
  • Insulin immunostaining was performed with guinea-pig-anti-swine-insulin, detected by Cy3-donkey-anti-guinea-pig (both 1:200, DakoCytomation, Glostrup, DK); B cell immunostaining was performed with rat-anti-mouse-B220 (1:100, eBioscience, San-Diego, Calif., USA), detected by DyLight488-goat-anti-rat (1:200,Jackson IR, Pa., USA); T cell immunostaining was performed with Armenian-hamster-anti-CD3 (BioLegend, San-Diego, Calif., USA), detected by fluorescence isothiocyanate (FITC)-rat-anti-Armenian-hamster (eBioscience), both at 1:50; Treg immunostaining was performed with mouse-anti-mouse-foxp3 (Biolegend), detected by Cy2-donkey-anti-mouse (Jackson IR), both at 1:100.
  • Nuclei were depicted by 4′,6-diamidino-2-phenylindole (DAPI) staining (1 g/ml, Sigma). Immunofluorescence was detected using Olympus BX60 (Olympus UK Ltd., London, UK).
  • Rat pancreatic islets (50/well in 48-well plates in triplicate) were cultured with medium alone or with recombinant IL-1 ⁇ _ 9 (10 ng/ml, R&D Systems), in the presence or absence of a 1 h pretreatment with hAAT (0.5 mg/ml). Nitrite concentration was determined after 72 h by Griess assay (Promega, Wis., USA).
  • FACS analysis Percent CD3+ cells out of circulating CD45+ leukocytes was determined in fresh heparinized whole blood obtained from mouse-tails. Red blood cells (RBC) were lysed using RBC lysis buffer followed by double-staining with FITC-anti-CD3 (BD Biosciences) and APC-anti-CD45 (eBioscience). Each sample contained at least 1 ⁇ 106 cells. Percent B cells in DNL were determined in single-cell suspensions of excised lymph nodes. Triple-staining was preformed using phycoerythrin (PE)-anti-CD40, FITC-anti-CD19 and APC-anti-B220 antibodies (all from eBioscience and diluted according to manufacture's recommendation). FACS analysis was carried out using FACS Calibuer (Becton Dickinson). Data was analyzed using CellQuest software.
  • PE phycoerythrin
  • hAAT monotherapy 60 mg/kg from 1 day prior to transplantation
  • both a higher dose was examined (240 mg/kg) and an extended 10-day pretreatment protocol was tested.
  • hAAT injections were repeated every 3 days in all experiments.
  • a total of n (number in group) 6 mice were grafted under these conditions, including two recipients per modified protocol.
  • n 6 mice were grafted with no added therapy, as control.
  • neither of the three modified hAAT monotherapy protocols delayed islet xenograft rejection day (CT 10,11,12,13,15, 22 and hAAT 11, 12, 13, 14, 15, 24).
  • the extended hAAT protocol is thereby used throughout the following studies.
  • mice LY94 a natural killer (NK) cell marker (not shown).
  • NK natural killer
  • FIG. 2B depicts relative changes in specific transcript numbers. While DLN CD40, IL-6 and IL-10 transcript levels did not increase after xenotransplantation at this time point, CD86 displayed a significant increase from non-grafted mice. In the presence of systemic hAAT, CD40 was reduced by 28.3% on average, CD86 by 21.5%, IL-6 by 40.6% and IL-10 by 32.87% ( FIG. 2B ).
  • Islet Xenotransplant Survival is Extended under hAAT and Temporary T Cell Depletion Combination
  • FIG. 3A-E and FIG. 4 Debulking therapy was examined alone and in combination with hAAT.
  • hAAT 5-7 per group.
  • mice injected with depleting antibodies exhibited a decrease in the relative number of circulating T cells and a spontaneous return to normal lymphocyte levels after a period of approximately two weeks.
  • mice treated by debulking therapy displayed a delay in xenograft rejection (days 28, 31, 31, 33, 33, 40, 52).
  • DB/AAT combined debulking therapy with hAAT
  • islet xenograft surviving until days 59, 61, >90, >90, >90.
  • Three out of 6 recipients displayed rejection days at the range of debulking therapy alone (22, 29, 32, 74, 83, >84).
  • mice a larger percentage of mice (from day 15 onwards) exhibited functional islet xenografts when treated with either a combination of AAT/anti-CD4 or AAT/anti-CD8 (compared to a monotherapy with each of the antibodies or AAT).
  • hAAT monotherapy resulted in a non-invasive population of mononuclear cells that was located in the region between the renal tissue, capsule and graft, containing Tregs.
  • histological images of islet grafts that lack an immune infiltrate was compared with histological samples collected from untreated xenogenic grafts, as well as xenogenic transplants treated by combination of debulking therapy and hAAT that were either accepted or rejected. As shown in FIG.
  • 35-day syngeneic islet graft sites are characterized by lack of an immune infiltrate and untreated xenotransplants displayed robust infiltration throughout the graft site (shown, 10 days after rejection). Histology obtained from treated mice was divided into two: shown, a graft that was rejected on day 59 and examined 11 days later, and a graft that was accepted (obtained 90 days post-transplantation). As shown, the rejected graft presented with a marginal mononuclear cell infiltrate that was not limited to the region between capsule, graft and kidney, but rather appeared to line the border with the host (black arrows). In contrast, accepted xenograft displayed a restricted infiltrate adjacent to the capsule and consistent with that found in long-term allogeneic hAAT-treated islet transplants.
  • hAAT and Temporary T Cell Depletion Combination Decreases T and B Lymphocyte Content in Xenografts and Promotes Local foxp3+ Tregs
  • Explanted grafts were analyzed for T and B cell markers, as well as for Tregs immunohistochemistry. As shown in FIG. 4B , representative images from grafts: debulking therapy 10 days after rejection, DB/AAT 11 days after rejection and DB/AAT that did not reject. Foxp3-positive Tregs were abundant in the accepted grafts. In addition, populations of CD3+ and B220+ cells were reduced in both debulking alone and combined debulking and hAAT, compared to untreated animals (not shown).
  • Islet Xenotransplants are Rejected under hAAT and Low-Dose Co-Stimulation Blockade Combination
  • hAAT with a combination of co-stimulation blockade was examined as another way for a possible xenograft survival.
  • Mouse monoclonal anti-CD154 and anti-LFA-1 antibodies promote xenograft survival (Arefanian et al., Cell Transplant 2007; 16(8):787-798; Arefanian et al., Diabetes 2010; 59(4):958-966).

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