CYTOKINE AND CYTOKINE RECEPTOR, AGONIST, ANTAGONIST AND/OR ANTIBODY COMBINATION FOR THERAPEUTIC USE
BACKGROUND OF THE INVENTION
The Human Immunodeficiency Virus Type 1 (HIV-1) is the etiological agent of Acquired Immune Deficiency Syndrome (AIDS). AIDS is characterised as a profound breakdown in host's cellular and humoral immunity and increased susceptibility to a wide range of opportunistic infections. One of the consequences of this immune dysfunction is a marked depletion in absolute CD4+ cells in HIV-infected individuals, and from our finding a large component of this immune dysfunction is the inability of the cytokine CD8 cells to clear HIV infected cells because the Interleukin 4 receptor signal mechanism has been disturbed. Herein are described methods of administration of combination of a Th2 cytokine, e.g., lnterleukin- , (i.e., IL-4) and an agonist, antagonist or receptor or antibody to a soluble receptor to a Th2 cytokine, e.g., lnterleukin-4. In a preferred embodiment, a receptor to IL-4 (i.e., IL-4R) is administered in combination with IL-4. Additionally, these combinations of Th2 cytokines and agonist, antagonist, receptor and/or antibody, such as IL-4 and receptor to IL-4, may be administered in combination with one or more protease inhibitors and/or one or more reverse transcriptase inhibitors or other non-specific anti-virals and/or antibiotics.
The present invention stems from the novel discovery that peptide/glycopeptide sequences exhibited as components of immature non-infectious virions coat proteins or glycoproteins act in a deleterious manner to human and animal biological functions by binding specifically to the receptor molecules of certain Th2 cytokines, e.g., receptors to Interleukin 4. The presence of these peptides, polypeptides/glycopeptide sequences which facilitate binding to receptor for Th2 cytokines is the essential factor, which allows these classes of virons to inhibit improved immune response. This discovery opens new avenues to treatment and/or prevention by inoculation or therapy of immunosuppressive disorders
caused by viral, bacterial and/or mycoplasma infections.
This invention relates to a combination therapy, one component of which is an agonist or an antagonist to a Th2 cytokine, e.g., IL-4, for administration to mammals to alleviate indications of immunosuppression of CT8 cells caused by infectious agents. hlL-4 (i.e., human IL-4) is produced by T cells and acts as a growth factor for pre-activated B cells and T cells. It acts on enriched B cell populations to produce IgE and on purified B cells to secrete IgG and IgM. It enhances the generation of cytotoxic T cells but inhibits the IL-2 dependent generation of lymphocyte- activated killer cells. hlL-4 shows numerous growth and differentiation promoting effects on other hemopoietic lineages. IL-4 elicits its biological activities by binding to specific receptors on the cell surface of IL-4 responsive cells. Binding of IL-4 to its receptor causes rapid receptor internalisation followed by up-regulation of IL-4 receptor expression in the case of a human B lymphoma, human tonsillar B cells, and mouse T and
B cells.
This invention relates to methods of treatment of persons and animals with indications of immuno-deficiency, specifically as relates to cytokine CD8 cell activity, wherein the said indication is resultant from viral and/or bacterial infection and/or infectious protein units.
Discussion of Prior Art
Patent WO 94/04180 provides compositions and methods for the use of IL-4 and/or IL-10 (Interleukin 10), for treatment of a number of diseases. In one embodiment, IL-10 is used to treat inflammatory bowel disease. In still another embodiment, IL-10 is used to treat inflammatory bowel disease. In still another embodiment, antibodies against IL-4 and IL- 10 mediate inhibition of cytokine production by T cells. In still another embodiment IL-10, alone or in combination with IL-4, is used to inhibit delayed type hypersensitivity reactions. WO 94/04180 further provides pharmaceutical compositions comprising a physiologically acceptable carrier and a combination of IL-4 and IL-10, or a combination of antibodies
against IL-4 and IL-10.
This disclosure of WO 94/04180 presents the administration of :-
A. 11-10 to:-
1. inhibit IL-2 production by neoplastic lymphocytes; 2. inhibit IL-2 dependent neoplastic cell proliferatin;
3. treat inflammatory bowel disease;
4. inhibit delayed type hypersensitivity reactions;
B. Antibodies to IL-4 plus antibodies to IL-10 to:- 1. increase levels of IFN-γ; C. IL-10 plus IL-4 to:-
1. potentiate IL-10 mediated inhibition of cytokine production by T cells;
2. inhibit delayed type hypersensitivity reactions.
U.S. Patents 5,132,109 and 5,246,701 Dugas et al discloses a method for inhibiting production of IgE, and a method for enhancing production of IgG is disclosed. The methods are linked to the role of Interleukin 9 in antibody production. Specifically, production of IgG is potentiated by administering either to a subject or a cell culture a combination of Interleukin 4 and Interleukin 9. Production of IgE is inhibited by administering an amount of an Interleukin 9 inhibitor to a subject.
Patent WO 93/18783 De Waal Malefyt discloses a method for treating inflammatory conditions which comprises administering to a patient an effective amount of lnterleukin-10. The invention relates generally to a method for inducing the production of lnterleukin-1 receptor antagonist (IL- 1 ra) by administering an effective amount of lnterleukin-10.
WO 93/17698 Shering Corporation, Roncarolo, Maria-Grazia discloses a method to provide for suppressing graft-vs.-host disease or tissue rejection which comprises administering to an individual an effective amount of lnterleukin-10. The invention relates generally to a method for treating and inhibiting graft-vs.-host disease or tissue rejection by administering to an afflicted individual an effective amount of Interleukin-
10.
U.S. Patent 5,597,900 discloses a process for crystallizing recombinant human Interleukin 4 (rhulL-4) from a solution containing a sulfate or citrate salt. The crystalline form is suitable for x-ray diffraction and has wide applications in several pharmaceutical processes including purification, formulation and manufacturing.
U.S. Patents 5,656,266, 5,017,691 , Lee et al, disclose that mammalian proteins and muteins thereof, designated lnterleukin-4s (IL- 4s), muteins thereof, and nucleic acids, are effectively homologous to disclosed cDNAs, and/or are capable of coding for mammalian IL-4s.
U.S. patent 5,599,905 Mosley et al discloses mammalian lnterleukin-4 receptor proteins, DNAs and expression vectors encoding mammalian IL-4 receptors, and processes for producing mammalian IL-4 receptors as products of cell culture. This patent discloses a method for suppressing an IL-4-dependent immune or inflammatory respones in a mammal, including a human, by administering an effective amount of soluble IL-4 receptor (slL-4R) and a suitable diluent or carrier.
U.S. patent 5,601,815, Powrie et al, discloses in vivo methods for potentiating IL-10. U.S. patents RE35.450, 5,180,812, 5,488,032 and 5,492,888, Dower et al, disclose soluble human lnterleukin-1 receptor proteins (shulL-1Rs) to suppress immune or inflammatory responses in a mammal and methods for using shulL-1Rs to suppress IL-1 mediated immune response and inflammation in a mammal.
U.S. patent 5,597,710 Dalie et al provide humanized monoclonal antibodies which are specific for human IL-4 and allegedly have properties unexpectedly superior to other, previously available humanized antibodies. Also provided are nucleic acids which encode the heavy and light chain variable regions of such monoclonal antibodies or antigenic fragments thereof; anti-idiotypic antibodies; and methods for detecting, measuring and immunopurifying human IL-4, and for blocking or mimicking the biological activity of human IL-4.
U.S. patent 5,223,605 Fanslow et al discloses isolated and purified lnterleukin-4 Binding Protein-γ (IL-4bpγ) and methods for obtaining isolated and purified IL-4bpγ.
U.S. patent 5,382,427, Plunkett et al, provides a method of using IL-4. The use of IL-4 for the manufacture of a medicament and pharmaceutical compositions containing IL-4, for treating solid tumor growth by systemically injecting IL-4, such as hlL-4 or recombinant E. coli- derived IL-4, into mammals afflicted with solid tumors is disclosed.
U.S. patent no. 5,206,345 provides a method of screening a cell line for the production of a binding partner that binds with a cell surface molecule, by contacting the binding partner with IL-4-activated and nonactivated human bone marrow stromal cells, and selecting binding partners that bind to the IL-4-activated human bone marrow stromal cells but not to the nonactivated cells. The selected binding partners may thereafter be tested for the ability to block CD34+ bone marrow cell binding to IL-4-activated human bone marrow stromal cells. SUMMARY OF THE INVENTION
Our studies have established the functional binding and immunosuppressive similarities between certain HIV envelope glycoproteins and specific human Th2 cytokines.
The acquired immunodeficiency syndrome (AIDS) is characterised by a profound immune dysfunction and opportunistic infections. The immunologic abnormalities include not only the T-helper/inducer lymphocyte subset but also most if not all the major cellular components of the immune system including B lymphocytes, monocytes/macrophages, natural killer cells (NK), and others. Therefore, it is reasonable to expect that in addition to a selective depression of CD4 helper lymphocytes, there exist additional immunoregulatory mechanisms involved in the observed immunodepression of HIV. Abnormalities in NK (Natural Killer) cell activity have been reported in AIDS patients in spite of an apparently normal number of circulating NK
cells. The activity of cell-mediated defence systems is stimulated by consecutive formation of Interleukin 1β (IL-1β), lnterleukin-2 (IL-2) and Interferon Y (IFN Y).
HIV envelope glycoprotein is synthesised as a polyprotein precursor of 160 kDa (gp160) and is subsequently cleaved into an amino terminus subunit, gp120, and a carboxy terminus transmembrane subunit, gρ41. Lymphocytes from AIDS patients have been reported to secrete a protein with immunosuppressive properties. Mitogen- and antigen-driven blastogenic responses have been shown to be inhibited by purified HIV preparations.
The immunosuppressive properties include the inhibition of normal human NK cell activity of the FeLV transmembrane glycoprotein P15E and the suppression of mitogen- and alloantigen-induced lymphocyte blastogenesis by HIV synthetic peptides 735-752 and 846-860 corresponding to sequences within the HIV transmembrane gp41. Both these transmembrane HIV peptides were found to have a significant inhibitory effect on NK cell activity, even at doses as low as 0.1 μg/ml.
One of the mechanisms by which the immune system normally regulates itself includes the production of proteins called cytokines. For example, lymphokines are cytokines produced by T-cells and some B-cells, and monokines are cytokines produced by monocytes. Cytokines, which may be glycosylated, mediate numerous immune responses.
The present invention relates to methods of treating patients (human or animal) to regulate immunosuppression in such patients, and/or to methods of treating patients (human or animal) suffering from immunodeficiency, as well as to compositions, formulations and kits for use in such methods. Such methods of treatment according to the present invention comprise administering to the patient at least one Th2 cytokine, and administering to the patient (simultaneously, previously, or subsequently) at least one receptor, agonist, antagonist and/or antibody to a Th2 cytokine. The at least one Th2 cytokine is preferably selected from
IL-3, IL-4, IL-5, IL-6, IL-9, IL-10, IL-13 and cytokine GM-CSF. In accordance with a preferred aspect of the present invention, there is provided a method of treatment comprising administering at least one Th2 cytokine and administering (simultaneously, previously, or subsequently) at least one receptor, agonist, antagonist and/or antibody to that (or those)
Th2 cytokine. The present invention also includes methods of treatment comprising administering at least one Th2 cytokine and at least one receptor, agonist, antagonist and/or antibody to a different Th2 cytokine. The present invention also includes any of the above methods, further comprising administering additional materials, e.g., anti-viral or antibiotic materials. The present invention also includes compositions including the two or more materials administered in any of the methods described above, as well as kits including unit dosages of the two or more materials administered in any such methods. The present invention also relates to use of the materials identified herein in the manufacture of a medicament for treatment of a patient in need of immune regulation and/or for treatment of a patient suffering from immunodeficiency.
As mentioned above, some embodiments of the present invention employ one or more receptor of Th2 cytokine. In general, such receptors may be any receptors, as are known in the art, including, by way of example, soluble receptors, cell bound receptors, high affinity receptors, and low affinity receptors. As described below, some preferred embodiments disclosed herein include soluble receptors. The expression "receptor" as used herein, should be interpreted as encompassing Th2 cytokine receptors, as well as "substantially similar" (as defined below) receptors (or sequences) and "substantially equivalent" (as defined below) soluble receptors, including proteins having amino acid sequences which are "bioequivalent" (as defined below) to a Th2 cytokine receptor or which are "substantially similar" to a native mammalian Th2 cytokine receptor amino acid sequence, and which are sufficiently similar to such receptor
that they are "biologically active" (as defined below).
The following description contains, in particular, detailed discussion of embodiments of the present invention in which the method includes the administration of IL-4 and receptor, agonist, antagonist and/or antibody of IL-4 (and compositions and kits for use in such methods), which are among the preferred embodiments of the invention. In like manner, the present invention also includes other compositions and methods in which there are administered one or more Th2 cytokine (i.e., IL-4 or any other Th2 cytokine, such as IL-3, IL-5, IL-6, IL-9, IL-10 IL-13 or cytokine GM-CSF) and one or more receptor, agonist, antagonist and/or antibody to any such Th2 cytokine(s). By way of example, Callard et al., The Cytokine Facts Book. Academic Press, 1994 describes some Interleukins and receptors of interleukins, e.g., IL-3 and receptor thereof (pp. 46-52), IL-4 and receptor thereof (pp. 53-58), IL-5 and receptor thereof (pp. 59-63), IL-6 and receptor thereof (pp. 64-69), IL-9 and receptor thereof (pp. 79-82), IL-10 and receptor thereof (pp. 83-86), IL-13 and receptor thereof (pp. 92-94), and cytokine GM-CSF and receptor thereof (pp. 139-143).
In addition, as would be appreciated by those skilled in the art, the descriptions relating to IL-4 and receptors, agonists, antagonists and antibodies thereof apply analogously to the extent appropriate, as would readily be recognized by those skilled in the art). For example (where appropriate in view of contemporary knowledge), the present invention encompasses use of analogs, subunits, fragments, derivatives, mutants and other modified forms (analogous to analogs, subunits, fragments, derivatives, mutants and other modified forms of IL-4 and receptor, agonist, antagonist and/or antibody to IL-4, as dscussed below) of Th2 cytokines other than IL-4, and of receptor, agonist, antagonist and/or antibody to such Th2 cytokine.
IL-4 is a cytokine capable of stimulating production of antibody producing B-cells and which also promotes growth of killer T-cells or cytotoxic T-cells. Additionally, it can inhibit the activity of T-helper cells
type 1 (Th1). This in turn may inhibit production of more B-cells or antibody production by more B-cells. Thus, IL-4 is part of an internal regulatory mechanism. A selection of amino acid sequences prepared according to our sequences have demonstrated in a dose dependent manner the ability to down regulate the expression of la molecules on human macrophages similar to lnterleukin-4. In-vitro experiments suggest that direct T cell antigen interactions without the mediation of la bearing macrophages may result in the generation of antigen specific suppressor T cells. All experimental evidence indicates that the development of antigen-reactive clones of helper T cells requires the presence of la bearing cells in the tissue. This inhibition of expression on the membrane surface of these class II molecules (la) as produced with immunosuppressive cytokines signals the immune system to accept the appearance of new antigens as self to the immune system. The following are hereby incorporated by reference:
-Th2s as per Rideout et al U.S. Patent 5,086,044;
-IL-4 Muteins as per Lee et al U.S. Patent 5,017,691 ;
-lnterleukin-4 binding protein-a as per Fanslow et al. U.S. Patent 5,223,605; -Humanized Monoclonal Antibodies Against Human lnterleukin-4 as per Dalie et al U.S. Patent 5,597,710;
-Antibodies both polyclonal and monoclonal in human IL-13, and purified IL-13 proteins and fragments thereof as per Culpepper et al, U.S. Patent 5,596,072; -Th2s as per Prendergast, U.S. Patent 4,956, 355;
-Compounds of the invention include muteins human and murine IL- 4s, and nucleic acids which are effectively homologous to disclosed cDNAs, and/or which are capable of coding for mammalian plL-4s muteins as per Lee et al, U.S. Patent 5,656,266; -Monoclonal antibodies specific to IL-4, IL-5, IL-6, and IL-10 as per
Mosmann et al, The Journal of Immunology. Vol. 145. 2036-2945. No. 9,
November 1, 1990;
-IL-4 Receptor Proteins as per Mosley et al U.S. Patent 5,599,905; -Cytokines receptor as per Puri et al U.S. Patent 5,614,191 ; -Th2s as per Prendergast U.S. Patent 5,681,831; and -IL-4 antibodies and IL-10 antibodies as disclosed in WO 94/04180.
According to the invention, there are provided agonist or antagonist to lnterleukin-4, as part of a combination therapy for use in the prophylaxis and therapy of a viral infection, or a complication or consequence thereof. The viral agent may be a retrovirus; in particular, the retrovirus may be the Human Immunodeficiency Virus.
Protease inhibitors are drugs that resemble pieces of the protein chain that protease normally cuts. By "gumming up" the protease
"scissors," HIV protease inhibitors prevent protease from cutting long chains of proteins and enzymes into the shorter pieces that HIV needs to make new copies of itself.
New copies of HIV are still made and still push through the wall of the infected cell even if the long chains are not cut up into the correct smaller pieces. But these new copies of HIV are "defective", in that they cannot go on to infect other cells. Protease inhibitors can greatly reduce the number of new, infectious copies of HIV made inside cells. If protease inhibitors succeed in making most new HIV viruses defective, HIV infection would not spread inside the body as quickly as it does now. The European name for protease inhibitor is proteinase inhibitor. A protease inhibitor alone will not get rid of HIV in an infected person's body. Even though these drugs can reduce the amount of virus, more virus can remain elsewhere in the body. Because some infected cells are "dormant" or "latently infected" - meaning they are already infected but still waiting to make new virus - researchers doubt that any one drug can remove all the virus in an infected person. Some virus will stay in the body in latently infected cells. Herein is described, as can be
observed from blood work obtained according to this invention, the use of a Th2 Cytokine in combination with an agonist to a Th2 cytokine, preferably the use of a Th2 cytokine and an agonist to that Th2 cytokine, most preferably the use of IL-4 and an agonist to IL-4. See test data for patients TL50, MA49, DY58 and GH45 (Tables 1A, 1B, 1C, 1D, 2A, 2B, 2C, 2D, 3A,
3B, 3C, 3D, 4A, 4B, 4C, and 4B) wherein due to viral replication, fewer latent virus are present.
The main ways protease inhibitors differ from the other anti-HIV drugs used now are in their target and in their strength. These other drugs are called reverse transcriptase inhibitors because they disturb the job of an HIV enzyme called reverse transcriptase. Reverse transcriptase is the enzyme HIV uses to change its chemical (or genetic) message into a form that can easily be inserted inside the nucleus of the infected cell.
This step in the HIV replication process happens soon after HIV infects a cell - much earlier than the step in which protease inhibitors are involved. Because protease inhibitors and reverse transcriptase inhibitors work at two separate steps in the HIV replication process, some studies are testing the use of drugs from both groups at the same time to treat HIV infection. Protease inhibitors also differ from reverse transcriptase inhibitors in their strength. Results from laboratory tests and tests in people show that certain protease inhibitors are many times more powerful than reverse transcriptase inhibitors in slowing the replication of HIV and in increasing the number of CD4 cells in the body. Most AIDS experts agree that it will make sense to combine protease inhibitors with drugs that attack HIV at different stages of its replication process. In fact, if protease inhibitors appear to be safe and effective when given alone in early, small trials in people with HIV infection, they are combined with other types of drugs in larger trials.
Protease Inhibitors Drug name s) Maker Invirase Hoffmann-La Roche (saquinavir, RO-31-8959) Norvir Abbott
(ritonavir, ABT-538) Crixivan Merck
(indinavir, MK-639) Viracept Agouron
(nelfinavir, AG-1343) VX-478, 141W94 Glaxo-Wellcome/Vertex KNI-272 Nikko Kyoto (kynostatin) Pharmaceutical and National
Cancer Institute
U-103373 Upjohn CGP-53437 Ciba-Geigy/Novartis Hoe/Bay-793 Hoechst-Bayer SR-41476 Sanofi
HIV can become resistant to two or more drugs at the same time. When it does, HIV is said to be cross-resistant to those drugs. Researchers studying the protease inhibitor indinavir found that HIV in some people first became resistant to the drug and then became resistant to several other protease inhibitors when they were tested later.
In the United States, physicians may prescribe five reverse transcriptase inhibitors. The common names of these drugs are:
AZT (Retrovir, zidovudine) ddl (Videx, didanosine) ddC (Hivid, zalcitabine) d4T (Zerit, stavudine)
3TC (Epivir, Lamivudine)
In preferred embodiments of the present invention, there are provided composition which include one or more lnterleukin-4 receptor. Additionally, preferred embodiments of the present invention relate to a combination therapy for the treatment of viral infection containing (a) an lnterleukin-4 receptor in combination with (b) lnterleukin-4, "in combination" referring to either co-administration or sequential administration (with or without delay between the two or more materials). lnterleukin-4 (IL-4, also known as B cell stimulating factor, or BSF-1) was originally characterised by its ability to stimulate the proliferation of B cells in response to low concentrations of antibodies directed to surface immunoglobulin. More recently, IL-4 has been shown to possess a far broader spectrum of biological activities, including growth co-stimulation of T cells, mast cells, granulocytes, megakaryocytes, and erythrocytes. In addition, IL-4 stimulates the proliferation of several IL-2 and IL-3 dependent cell lines, induces the expression of class II major histocompatibility complex molecules on resting B cells, and enhances the secretion of IgE and lgG1 isotypes by stimulated B cells. Both murine and human IL-4 have been definitively characterised by recombinant DNA technology and by purification to homogeneity of the natural murine protein (Yokota et al., Proc. Natl. Acad. Sci. USA 83:5894, 1986; Norma et al.,
Nature 319:640, 1986; and Grabstein et al., J. Exp. Med. 163:1405, 1986).
The biological activities of IL-4 are mediated by specific cell surface receptors for IL-4 which are expressed on primary cells and in vitro cell lines of mammalian origin. IL-4 binds to the receptor, which then transduces a biological signal to various immune effector cells. Purified IL-
4 receptor (IL-4R) compositions will therefore be useful in diagnostic assays for IL-4 or IL-4 receptor, and in raising antibodies to IL-4 receptor for use in diagnosis or therapy. In addition, purified IL-4 receptor compositions may be used directly in therapy to bind or scavenge IL-4, providing a means for regulating the biological activities of this cytokine.
As used herein, the terms "IL-4 receptor" or IL-4R" refer to proteins
which bind lnterleukin-4 (IL-4) molecules and, in their native configuration as intact human plasma membrane proteins, play a role in transducing the biological signal provided by IL-4 to a cell. Intact receptor proteins generally include an extracellular region which binds to a ligand, a hydrophobic transmembrane region which causes the protein to be immobilised within the plasma membrane lipid bilayer, and a cytoplasmic or intracellular region which interacts with cytoplasmic proteins and/or chemicals to deliver a biological signal to effector cells via a cascade of chemical reactions within the cytoplasm of the cell. The hydrophobic transmembrane region and a highly charged sequence of amino acids in the cytoplasmic region immediately following the transmembrane region co-operatively function to halt transport of the IL-4 receptor across the plasma membrane.
"IL-4 receptors" are proteins having amino acid sequences which are substantially similar to the native mammalian lnterleukin-4 receptor amino acid sequences disclosed in FIGS. 1 (A.B&C) and 2 (A,B,C & D) or fragments thereof, and which are biologically active as defined below, in that they are capable of binding lnterleukin-4 (IL-4) molecules or transducing a biological signal initiated by an IL-4 molecule binding to a cell, or cross-reacting with anti-IL-4R antibodies raised against IL-4R from natural(i.e., nonrecombinant) sources. The native human IL-4 receptor molecule has an apparent molecular weight by SDS-PAGE of about 140 kilodaltons (kDa). The native murine IL-4 receptor molecule has an apparent molecular weight by SDS-PAGE of about 140 kilodaltons (kDa). The terms "IL-4 receptor" or "IL-4R" include, but are not limited to, soluble
IL-4 receptors, as defined below. Specific IL-4 receptor polypeptides are designated herein by parenthetically indicating the amino acid sequence numbers, followed by any additional amino acid sequences. As used throughout the specification, the term "mature" means a protein expressed in a form lacking a leader sequence as may be present in full-length transcripts of a native gene. Various bioequivalent protein and amino acid
analogs are described in the detailed description of the invention.
"Substantially similar" IL-4 receptors include those whose amino acid or nucleic acid sequences vary from the native sequences by one or more substitutions, deletions, or additions, the net effect of which is to retain biological activity of the IL-4R protein. For example, nucleic acid subunits and analogs are "substantially similar" to the specific DNA sequences disclosed herein if: (a) the DNA sequence is derived from the coding region of a native mammalian IL-4R gene; (b) the DNA sequence is capable of hydrodisation to DNA sequences of (a) under moderately stringent conditions and which encode biologically active IL-4R molecules; or DNA sequences which are degenerate as a result of the genetic code to the DNA sequences defined in (a) or (b) and which encode biologically active IL-4R molecules. Substantially similar analog proteins will generally be greater than about 30 percent similar to the corresponding sequence of the native IL-4R. Sequences having lesser degrees of similarity but comparable biological activity are considered to be equivalents. More preferably, the analog protein will be greater than about 70 percent similar to the corresponding sequence of the native IL-4R, in which case they are defined as being "substantially identical". In defining nucleic acid sequences, all subject nucleic acid sequences capable of encoding substantially similar amino acid sequences are considered substantially similar to a reference nucleic acid sequence. Percent similarity may be determined, for example, by comparing sequence information using the GAP computer program, version 6.0, available from the University of Wisconsin Genetics Computer Group (UWGCG). The GAP program utilises the alignment method of Needleman and Wunsch (J. Mol. Biol. 48: 443, 1970), as revised by Smith and Waterman (Adv. Appl Math.2:482, 1981). Briefly, the GAP program defines similarity as the number of aligned symbols (i.e., nucleotides or amino acids) which are similar, divided by the total number of symbols in the shorter of the two sequences. The preferred default parameters for the GAP program include: (1) a unary
comparison matrix (containing a value of 1 for identities and 0 for non- identies) for nucleotides) for nucleotides, and the weighted comparison matrix of Gribskov and Burgess, Nucl. Acids Res. 14:6745, 1986, as described by Schwartz and Dayhoff, ed., Atlas of Protein Sequence and Structure, National Biomedical Research Foundation, pp. 353-358, 1979;
(2) a penalty of 3.0 for each gap and an additional 0.10 penalty for each symbol in each gap; and (3) no penalty for end gaps.
"Soluble IL-4 receptor" or "slL4-R" as used in the context of the present invention refers to a protein, or a substantially equivalent analog, having an amino acid sequence corresponding to the extracellular region of native IL-4 receptors, for example, polypeptides having the amino acid sequences substantially equivalent to the sequences of amino acids 1-208 of FIG. 1 , amino acids 1-207 of FIG. 2. Equivalent slL-4Rs include polypeptides which vary from the sequences shown in FIGS. 1 or 2 by one or more substitutions, deletions, or additions, and which retain the ability to bind IL-4 and inhibit the ability of IL-4 to transduce a signal via cell surface bound IL-4 receptor proteins. Because slL-4R proteins are devoid of a transmembrane region, they are secreted from the host cell in which they are produced. When administered in therapeutic formulations, slL-4R proteins circulate in the body and bind to circulating IL-4 molecules, preventing interaction of IL-4 with natural IL-4 receptors and inhibiting transduction of IL-4 mediated biological signals, such as immune or inflammatory responses. The ability of a polypeptide to inhibit IL-4 signal transduction can be determined by transfecting cells with recombinant IL-4 receptor DNAs to obtain recombinant receptor expression. The cells are then contacted with IL-4 and the resulting metabolic effects examined. If an effect results which is attributable to the action of the ligand, then the recombinant receptor has signal transducing activity. Exemplary procedures for determining whether a polypeptide has signal transducing activity are disclosed by Idzerda et al., J. Exp. Med., March 1990 in press,
Curtis et al., Proc. Natl. Acad. Sci. USA 86: 3045 (1989), Prywes et al.,
EMBO J. 5:2179 (1986) and Chou et al., J. Biol. Chem. 262:1842 (1987). Alternatively primary cells of cell lines which express an endogenous IL-4 receptor and have a detectable biological response to IL-4 could also be utilised. Such is the case with the CTLL-2 cell line which responds by short term proliferation in response to either IL-2 or IL-4; the IL-4 induced proliferation can be blocked specifically by the addition of exogenous soluble IL-4R (Mosley et al., Cell 59:335 (1989). The cloning, sequencing and expression of full-length and soluble forms of the receptor for murine IL-4 have recently been described by, Mosley et al., Cell 59:335, 1989. "Recombinant," as used herein, means that a protein is derived from recombinant (e.g., microbial or mammalian) expression systems. "Microbial" refers to recombinant proteins made in bacterial or fungal (e.g., yeast) expression systems. As a product, "recombinant microbial" defines a protein produced in a microbial expression system which is essentially free of native endogenous substances. Protein expressed in most bacterial cultures, e.g., E. coli, will be free of glycan. Protein expressed in yeast may have a glycosylation pattern different from that expressed in mammalian cells.
"Biologically active," as used throughout the specification, e.g., as a characteristic of IL-4 receptors, means that a particular molecule shares sufficient amino acid sequence similarity with the embodiments of the present invention disclosed herein to be capable of binding detectable quantities of IL-4, transducing an IL-4 signal to a cell, for example, as a component of a hybrid receptor construct, or cross-reacting with anti-IL-4R antibodies raised against IL-4R from natural (i.e., nonrecombinant) sources. Preferably, biologically active IL-4 receptors within the scope of the present invention are capable of binding greater than 0.1 nmoles IL-4 per nmole receptor, and most preferably, greater than 0.5 nmole IL-4 per nmole receptor in standard binding assays (see below). "DNA sequence" refers to a DNA molecule, in the form of a separate fragment or as a component of a larger DNA construct, which has been
derived from DNA isolated at least once in substantially pure form, i.e., free of contaminating endogenous materials and in a quantity or concentration enabling identification, manipulation, and recovery of the sequence and its component nucleotide sequences by standard biochemical methods, for example, using a cloning vector. Such sequences are preferably provided in the form of an open reading frame uninterrupted by internal nontranslated sequences, or introns, which are typically present in eukaryotic genes. Genomic DNA containing the relevant sequences could also be used. Sequences of non-translated DNA may be present 5' or 3' from the open reading frame, where the same do not interfere with manipulation or expression of the coding regions.
"Nucleotide sequence" refers to a heteropolymer of deoxydbonucleotides. DNA sequences encoding the proteins provided by this invention can be assembled from cDNA fragments and short oligonucleotide linkers, or from a series of oligonucleotides, to provide a synthetic gene which is capable of being expressed in a recombinant transcriptional unit.
"Recombinant expression vector" refers to a replicable DNA construct used either to amplify or to express DNA which encodes IL-4R and which includes a transcriptional unit comprising an assembly of (1) a genetic element or elements having a regulatory role in gene expression, for example, promoters or enhancers, (2) a structural or coding sequence which is transcribed into mRNA and translated into protein, and (3) appropriate transcription and translation initiation and termination sequences. Structural elements intended for use in yeast expression systems preferably include a leader sequence enabling extracellular secretion of translated protein by a host cell. Alternatively, where recombinant protein is expressed without a leader or transport sequence, it may include an N-terminal methionine residue. This residue may optionally be subsequently cleaved from the expressed recombinant protein to provide a final product.
"Recombinant microbial expression system" means a substantially homogenous monoculture of suitable host micro-organisms, for example, bacteria such as E. coli or yeast such as S. cerevisiae, which have stably integrated a recombinant transcriptional unit into chromosomal DNA or carry the recombinant transcriptional unit as a component of a resident plasmid. Generally, cells constituting the system are the progeny of a single ancestral transformant. Recombinant expression systems as defined herein will express heterologous protein upon induction of the regulatory elements linked to the DNA sequence or synthetic gene to be expressed.
The present invention provides substantially homogeneous recombinant mammalian IL-4R polypeptides substantially free of contaminating endogenous materials and, optionally, without associated native-pattern glycosylation. The native murine and human IL-4 receptor molecules are recovered from cell lysates as glycoproteins having an apparent molecular weight by SDS-PAGE about 130-145 kilodaltons (kDa). Mammalian IL-4R of the present invention include, by way of example, primate, human, murine, canine, feline, bovine, ovine, equine and porcine IL-4R. Derivatives of IL-4R within the scope of the invention also include various structural forms of the primary protein which retain biological activity. Due to the presence of ionisable amino and carboxyl groups, for example, an IL-4R protein may be in the form of acidic or basic salts, or in neutral form. Individual amino acid residues may also be modified by oxidation or reduction. The primary amino acid structure may be modified by forming covalent or aggregative conjugates with other chemical moieties, such as glycosyl groups, lipids, phosphate,, acetyl groups and the like, or by creating amino acid sequence mutants. Covalent derivatives are prepared by linking particular functional groups to IL-4R amino acid side chains or at the N- or C-termini. Other derivatives of IL-4R within the scope of this invention include covalent or aggregative conjugates of IL-4R or its
fragments with other proteins or polypeptides, such as by synthesis in recombinant culture as N-terminal or C-terminal fusions. For example, the conjugated peptide may be a signal (or leader) polypeptide sequence at the N-terminal region of the protein which co-translationally or post- translationally directs transfer of the protein from its site of synthesis to its site of function inside or outside of the cell membrane or wall (e.g., the G- f actor leader). IL-4R protein fusions can comprise peptides added to facilitate purification or identification of IL-4R (e.g., poly-His). Specific examples of a poly-HIS fusion construct that is biologically active are soluble human IL-4R (1-207) His His and soluble human II-4R (1-207) His
His His His His His. The amino acid sequence of II— 4 receptor can also be linked to the peptide Asp-Tyr-Lys-Asp-Asp-Asp-Asp-Lys (DYKDDDDK) (Hopp et al., Bio/Technology 6:1204, 1988) The latter sequence is highly antigenic and provides an epitope reversibly bound by a specific monoclonal antibody, enabling rapid assay and facile purification of expressed recombinant protein. This sequence is also specifically cleaved by bovine mucosal enterokinase at the residue immediately following the Asp-Lys pairing. Fusion proteins capped with this peptide may also be resistant to intracellular degradation in E. coli. A specific example of such a peptide is soluble human IL-4R (1-207) Asp Tyr Lys Asp Asp Asp Asp
Lys.
IL-4R derivatives may also be used as immunogens, reagents in receptor-based immunoassay, or as binding agents for affinity purification procedures of IL-4 or other binding ligands. IL-4R derivatives may also be obtained by cross-linking agents, such as M-maleimidobenzoyl succinimide ester and N-hydroxysuccinimide, at cysteine and lysine residues. IL-4R proteins may also be covalently bound through reactive side groups to various insoluble substrates, such as cyanogen bromide-activated, bisoxirane-activated, carbonyldiimidazole-activated or tosyl-activated agarose structures, or by adsorbing to polyolefin surfaces (with or without glutaraldehyde cross-linking). Once bound to a substrate, IL-4R may be
used to selectively bind (for purposes of assay or purification) anti-IL-4R antibodies or IL-4.
The present invention also includes IL-4R with or without associated native-pattern glycosylation. IL-4R expressed in yeast or mammalian expression systems, e.g., COS-7 cells, may be similar or significantly different in molecular weight and glycosylation pattern than the native molecules, depending upon the expression system. Expression of IL-4R DNAs in bacteda such as E. coli provides non-glycosylated molecules. Functional mutant analogs of mammalian IL-4R having inactivated N- glycosylation sites can be produced by obligonucleotide synthesis and ligation or by site-specific mutagenesis techniques. These analog proteins can be produced in a homogenous, reduced-carbohydrate form in good yield using yeast expression systems. N-glycosylation sites in eukaryotic proteins are characterised by the amino acid triplet Asn-A1-Z, where A1 is any amino acid except Pro, and Z is Ser or Thr. In this sequence, asparagine profices a side chain amino group for covalent attachment of carbohydrate. Such a site can be eliminated by substituting another amino acid for Asn or for residue Z, deleting Asn or Z, or inserting a non-Z amino acid between A1 and Z, or an amino acid other than Asn between Asn and A1.
IL-4R derivatives may also be obtained by mutations of IL-4R or its subunits. An IL-4R mutant, as referred to herein, is a polypeptide homologous to IL-4R but which has an amino acid sequence different from native IL-4R because of a deletion, insertion or substitution. Like most mammalian genes, mammalian IL-4 receptors are presumably encoded by multi-exon genes. Alternative mRNA constructs which can be attributed to different nRNA splicing events following transcription, and which share large regions of identity or similarity with the cDNAs claimed herein, are considered to be within the scope of the present invention. Bioequivalent analogs of IL-4R proteins may be constructed by, for example, making various substitutions of residues or sequences or deleting
terminal or internal residues or sequences not needed for biological activity. For example, cysteine residues can be deleted or replaced with other amino acids to prevent formation of incorrect intramolecular disulfide bridges upon renaturation. Other approaches to mutagenesis involve modification of adjacent diabasic amino acid residues to enhance expression in yeast systems in which KEX2 protease activity is present. Generally, substitutions should be made conservatively; i.e., the most preferred substitute amino acids are those having physiochemical characteristics resembling those of the residue to be replaced. Similarly, when a deletion or insertion strategy is adopted, the potential effect of the deletion or insertion on biological activity should be considered.
Subunits of IL-4R may be constructed by deleting terminal or internal residues or sequences. Particularly preferred subunits include those in which the transmembrane region and intracellular domain of IL-4R are deleted or substituted with hydrophilic residues to facilitate secretion of the receptor into the cell culture medium. The resulting protein is a soluble IL-4R molecule which may retain its ability to bind IL-4. Particular examples of soluble IL-4R include polypeptides having substantial identity to soluble murine IL-4R (1-208), soluble human IL-4R (1-207) and soluble human IL-4R (1-198), all of which retain the biological activity of soluble human IL-4R (1-207). Chimeric polypeptides comprising fragments of human and murine IL-4R may also be constructed, for example, IL-4R (1- 197) Pro Ser Asn Glu Asn Leu, which is comprised of the sequence of amino acids 1-197 of human IL-4R followed by the N-terminal six amino acids of soluble murine IL-4R clone 18. This polypeptide has been found to retain the biological activity of soluble IL-4R (1-207). To prepare pharmaceutical compositions including the peptide IL-4R the peptide is admixed with a pharmaceutically acceptable carrier or excipient which is preferably inert. Preparation of such pharmaceutical compositions are known in the art: see, for example, Remington's Pharmaceutical Sciences and U.S. Pharmacepeia: National Formulary, Mack Publishing Company,
Easton, Pa. (1984).
The peptide may be administered in aqueous vehicles such as water, saline or buffered vehicles with or without various additives and/or diluting agents. One embodiment disclosed herein describes the novel administration of Cytokine & Receptor to same as a sublingual formlation wherein cyclodextrin is used as a carrier, see patient TL50, administration period days 0-41 and patient GH45, administration period days 0-13 and 21-34. Another embodiment disclosed herein describes the administration of a Cytokine and receptor to same as a subcutaneous formulation wherein the cyclodextrin is used as a carrier. See patient TL50, administration period days 42-56 and 86-94; patient MA49, administration period days 0- 13; patient D58, administration period days 7-20; and patient GH45, administration period days 35-48. A suspension, such as a zinc suspension, can be prepared to include the peptide. Such a suspension can be useful for subcutaneous (SQ) or intramuscular (IM) injection. By adjusting the proportion of zinc and the acidity, the absorption rate of the peptide can be manipulated.
The proportion of peptide and additive can be varied over a broad range so long as both are present in effective amounts. On a per-dose basis, the amount of the peptide can range from about 10 μg to about 1500 μg of each protein per kilogram body weight of the patients. A preferable range is from about 300 μg to about 800 μg.
Compositions may be ingested orally or injected into the body. Injections are usually intramuscular, subcutaneous, intradermal or intravenous. Alternatively, intra-articular injection or other routes could be used in appropriate circumstances. Additionally, compositions including the peptide IL-4R may be implanted into a patient or injected using a drug delivery system. See, for example, Urquhart, et al., Ann. Rev. Pharmacol. Toxicol. 24: 199-236 (1984), incorporated herein by reference; Lewis, ed. "Controlled Release of Pesticides and Pharmaceuticals" (Plenum Press,
New York, 1981), incorporated herein by reference; U.S. Pat. No.
3,773,919, incorporated herein by reference; and U.S. Pat. No. 3,270,960, incorporated herein by reference.
Preferably, the peptide is administered parenterally and preferably in a unit dosage injectable form. Examples of an injectable form include solutions, suspensions and emulsions. Typically, the peptide is injected in association with a pharmaceutical carrier such as normal saline, Ringer's solution, dextrose solution and other aqueous carriers known in the art. Appropriate non-aqueous carriers may also be used and examples include fixed oils and ethyl oleate. A preferred carrier is 5% dextrose in saline. Frequently, it is desirable to include additives in the carrier such as buffers and preservatives or other substances to enhance isotonicity and chemical stability.
Preferably, the peptide, IL-4R is formulated in purified form substantially free of aggregates and other proteins at a concentration of about 1 to 30 mg/ml. The concentration of the peptide in a unit dose is from about 60 micrograms to 200 milligrams varying with the application and the potency of the peptide. Although IL-4R may be administered by any of a number of routes, and intravenous infusion or bolus is preferred. Most preferably, an intravenous injection delivers about 1 mg to about 100 mg of the peptide per day. The dose range is about 15 μg to 1500 μg per kilogram of body weight of the recipient per day per peptide. Dosages should be varied according to side effects and blood cell counts which should be monitored frequently, preferably daily.
The combination of Cytokine and agonist or antagonists to said cytokines are preferably administered intravenously. A preferred antagonist is an antibody specific for binding to IL-4. The antibodies can be chimeric, recombinant, polyclonal or monoclonal. Autologous antibodies, human or humanized antibodies are preferred for safety when human patients are being treated. The preferred single dosage of antibodies is 1-10mg/kg body weight per antibody. Alternatively the amount of the antibody administered in a single dose is about 10 to about
100μg per milliliter of patient sera.
An effective amount for a particular patient may vary depending on factors such as the condition being treated, the overall health of the patient, the method route and dose of administration and the severity of side effects. Determination of the appropriate dose is made by the clinician using parameters known in the art. Generally, the dose begins with an amount somewhat less than the optimum dose and it is increased by small increments thereafter until the desired or optimum effect is achieved. The total daily dose of the peptide can be given as bolus injection, such as an intravenous injection, or it can be given as a continuous infusion. Alternatively, the daily dosage may be divided into several smaller doses for multiple bolus intravenous administration. Other routes of administration such as intramuscular injection, can be employed. The preferred method comprises co-administering to the mammal an effective amount of each of IL-4 and IL-4 Receptor. The mammal is preferably a human. The co-administering can be simultaneous or sequential. Generally, "co-administering" means that the cytokine is present in the recipient during a specified time interval. This combination of Th2 Cytokine and Cytokine Receptor may be administered with a Th2.
Typically, the Th2 is administered within the half life of the cytokine. Preferably, the co-administration is parenteral, and most preferably it is intravenous. The effective amount is selected from a range from about 15 μg to about 1500 μg per kilogram of body weight of the mammal. Herein it is shown that the Th2 Cytokine and Cytokine Receptor can be administered sub-lingual. Specifically, cyclodextrin may be used as the carrier of both active agents for sub-lingual administration. The present invention further includes compositions which comprise one or more cyclodextrin and one or more Th2 Cytokine along with one or more Th2 Cytokine binding partner, one or more agonist to a Th2 Cytokine, one or more antagonist to a Th2 Cytokine and/or one or more protein, in particular
for sub-lingual administration.
Mutations in nucleotide sequences constructed for expression of analog IL-4Rs must, of course, preserve the reading frame phase of the coding sequences and preferably will not create complementary regions that could hybridise to produce secondary mRNA structures, such as loops or hairpins, which would adversely affect translation of the receptor mRNA. Although a mutation site may be predetermined, it is not necessary that the nature of the mutation per se be predetermined. For example, in order to select for optimum characteristics of mutants at a given site, random mutagenesis may be conducted at the target codon and the expressed IL-
4R mutants screened for the desired activity.
This invention includes treatments against viral, bacterial, and mycoplasma infections by any suitable route including enteric, parenteral, topical, oral, rectal, nasal or vaginal routes. Parenteral routes include subcutaneous, intramuscular, intravenous and sublingual administration.
The preferred route of administration would be an intravenous one but this may not be feasible with a large patient base and oral administration of compounds may be the most preferred route. The Antagonists are preferably administered intravenously. The bacterial infections which can be treated according to the present invention generally include any bacterial infection against which treatment according to the present invention is effective, e.g., Mycobacterium, Salmonella, Pseudomonas, Enterococcus, Vibrio, Plasmodium, Leishmania, Pheumocystis, Cryptococcus, etc. The following are enumerated embodiments:
1. A method of enhancing immune response in a patient, said method comprising a combination therapy containing (i) one or more Th2 cytokine and (ii) one or more agonist and/or antagonist to a Th2 cytokine.
2. A method of treating a viral infection in a mammal, human or animal, said method comprising a combination therapy containing one or more Th2 cytokine and one or more agonist and/or Antagonist to a Th2
cytokine.
3. A method of treating a condition in a mammal, human or animal, said method comprising a combination therapy containing one or more Th2 cytokine and one or more agonist and/or Antagonist to a Th2 cytokine. 4. A pharmaceutical formulation containing one or more Th2 cytokine and one or more agonist and/or Antagonist to a Th2 cytokine. 5. A method of administration to a patient a pharmaceutical formulation containing one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine. 6. A method of providing an immunosuppressive or immunoregulatory effect in a mammal, human or animal, comprising a combination therapy containing one or more Th2 cytokine and Agonist and/or Antagonist to a Th2 cytokine.
7. A combination therapy comprising the administration to a patient one or more Th2 cytokine and one or more agonist and/or antagonist to a
Th2 cytokine.
8. A method of enhancing immune response in a patient, said method comprising a combination therapy containing a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
9. A method of treating a viral infection in a mammal, human or animal, said method comprising a combination therapy containing a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine. 10. A method of treating a condition in a mammal, human or animal, said method comprising a combination therapy containing a protease inhibitor and one or more Th2 cytokine and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
11. A pharmaceutical formulation containing a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
12. A method of administration to a patient a pharmaceutical formulation containing a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
13. A method of providing an immunosuppressive or immunoregulatory effect in a mammal, human or animal, comprising a combination therapy containing a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
14. A combination therapy comprising the administration to a patient a protease inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
15. A method of enhancing immune response in a patient, said method comprising a combination therapy containing a reverse transcriptase inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine. 16. A method of treating a viral infection in a mammal, human or animal, said method comprising a combination therapy containing a reverse transcriptase inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
17. A method of treating a condition in a mammal, human or animal, said method comprising a combination therapy containing a reverse transcriptase inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
18. A pharmaceutical formulation containing a reverse transcriptase inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
19. A method of administration to a patient a pharmaceutical formulation containing a reverse transcriptase inhibitor and one or more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
20. A method of providing an immunosuppressive or immunoregulatory effect in a mammal, human or animal, comprising a combination therapy containing reverse transcriptase inhibitor and one or
more Th2 cytokine and one or more agonist and/or antagonist to a Th2 cytokine.
21. A combination therapy comprising the administration to a patient an interleukin and a receptor to said interleukin. 22. A method of enhancing immune response in a patient, said method comprising administering an amount of a receptor to interleukin-4 in combination with interleukin-4.
23. A method of treating a viral infection in a mammal, human or animal, said method comprising administering an amount of receptor to interleukin-4 in combination with interleukin-4.
24. A method of treating a condition in a mammal, human or animal, said method comprising administrating an amount of receptor to lnterleukin-4 in combination with interleukin-4.
25. A pharmaceutical formulation containing a receptor to interleukin-4 in combination with interleukin-4.
26. A method of administration to a patient a pharmaceutical formulation containing a receptor to interleukin-4 in combination with interleukin-4.
27. A method of providing an immunosuppressive or immunoregulatory effect in a mammal, human or animal, comprising administering to said mammal a receptor to interleukin-4 in combination with one or more protease inhibitors.
28. A combination therapy according to any one of embodiments 7, 14, and 21, wherein each component of the combination is administered jointly or at different stages of a treatment regime.
29. A method according to any one of embodiments 1 , 2, 3, 6, 8, 9, 10, 13, 15,-17 and 22, wherein each component of the combination is administered jointly or at different stages of a treatment regime.
30. A formulation according to any one of embodiments 4, 11 and 18, wherein the cytokine is one or more of the following: lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10,
Interleukin 13 and cytokine GM-CSF.
31. A therapy according to any one of embodiments 7, 14 and 21 , wherein the cytokine is one or more of the following: lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
32. A method according to any one of embodiments 1-3, 5, 6, 8-10, 12, 13, 15-17, 19 and 20, wherein the cytokine is one or more of the following: lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF. 33. A method according to any one of embodiments 1 , 3, 5, 10, 12,
15, 16, 19, 20, 24 and 27, wherein the mammal or patient has a neoplastic condition.
34. A therapy according to embodiment 21 , wherein the mammal or patient has a neoplastic condition. 35. A formulation according to either of embodiments 11 and 25, for use in the treatment of a mammal or patient having a neoplastic condition.
36. A method according to any one of embodiments 8, 9, 10, 12 and 13, wherein the Protease Inhibitor is one or more of the following: -Invirase (saquinavir, RO-31-8959), Hoffmann-La Roche;
-Norvir (ritonavir, ABT-538), Abbott;
-Crixivan (indinavir, MK-639), Merck;
-Viracept (nelfinavir, AG-1343), Agouron;
-VX-478 (141w94), Glaxo-Wellcome/Vertex; -KNI-272 (kynostatin), Nikko Kyoto, Pharmaceutical and National
Cancer Institute;
-U-103373, Upjohn;
-CGP-53437, Ciba-Geigy/Novartis;
-Hoe/Bay-793, Hoechst-Bayer; and -SR-41476, Sanofi.
37. A therapy according to embodiment 14, wherein the Protese
Inhibitor is one or more of the following:
-Invirase (saquinavir, RO-31-8959), Hoffmann-La Roche;
-Norvir (ritonavir, ABT-538), Abbott;
-Crixivan (indinavir, MK-639), Merck; -Viracept (nelfinavir, AG-1343), Agouron;
-VX-478 (141w94), Glaxo-Wellcome Vertex;
-KNI-272 (kynostatin), Nikko Kyoto, Pharmaceutical and National Cancer Institute;
-U-103373, Upjohn; -CGP-53437, Ciba-Geigy/Novartis;
-Hoe/Bay-793, Hoechst-Bayer; and
-SR-41476, Sanofi.
38. A formulaiton according to embodiment 11 , wherein the Protese Inhibitor is one or more of the following: -Invirase (saquinavir, RO-31-8959), Hoffmann-La Roche;
-Norvir (ritonavir, ABT-538), Abbott;
-Crixivan (indinavir, MK-639), Merck;
-Viracept (nelfinavir, AG-1343), Agouron;
-VX-478 (141w94), Glaxo-Wellcome/Vertex; -KNI-272 (kynostatin), Nikko Kyoto, Pharmaceutical and National
Cancer Institute;
-U-103373, Upjohn;
-CGP-53437, Ciba-Geigy/Novartis;
-Hoe/Bay-793, Hoechst-Bayer; and -SR-41476, Sanofi.
39. A method according to any one of embodiments 15-17, 19 and 20, wherein the inhibitor is one or more of the following AZT (Retrovir, zidovudine), ddl (Videx, didanosine), ddC (Hivid, zalcitabine), d4T (Zerit, stavudine), 3TC (Epivir, Lamivudine). 40. A formulation according to embodiment 18, wherein the inhibitor is one or more of the following AZT (Retrovir, zidovudine), ddl (Videx,
didanosine), ddC (Hivid, zalcitabine), d4T (Zerit, stavudine), 3TC (Epivir, Lamivudine).
41. A method according to any one of embodiments 1-3, 5, 6, 8-10, 12, 13, 15-17, 19 and 20, wherein the agonist/antagonist is an antibody specific to a Th2 cytokine.
42. A formulation according to any one of embodiments 4, 11 and 18, wherein the agonist/antagonist is an antibody specific to a Th2 cytokine.
43. A therapy according to any one of embodiments 7, 14 and 21 , wherein the agonist/antagonist is an antibody specific to a Th2 cytokine. 44. A method according to embodiment 41 , wherein the antibodies are chimeric, recombinant, polyclonal, monoclonal or antibodies of plant origin.
45. A formulation according to embodiment 42, wherein the antibodies are chimeric, recombinant, polyclonal, monoclonal or antibodies of plant origin.
46. A therapy according to embodiment 43, wherein the antibodies are chimeric, recombinant, polyclonal, monoclonal or antibodies of plant origin.
47. A method according to any one of embodiments 1-3, 5, 6, 8-10, 12, 13, 15-17, 19 and 20, wherein the agonist/antagonist is a receptor or mutein receptor to specific Th2 cytokines.
48. A formulation according to any one of embodiments 4, 11 and 18, wherein the agonist/antagonist is a receptor or mutein receptor to specific Th2 cytokines. 49. A therapy according to any one of embodiments 7, 14 and 21 , wherein the agonist/antagonist is a receptor or mutein receptor to specific Th2 cytokines.
50. A method according to any one of embodiments 22-24, 26 and 27, wherein the receptor to the cytokines is administered by IV, enema or transdermal patch.
51. A method according to embodiment 50, wherein the receptor
to the cytokines is administered In dose amounts of between 10 and 1000 μg per day.
52. A formulation according to embodiment 25, wherein the receptor to the cytokines is administered by IV, enema or transdermal patch.
53. A formulation according to embodiment 52, wherein the receptor to the cytokines is administered In dose amounts of between 10 and 1000 μg per day.
54. A Combination Therapy according to embodiment 21 wherein the Interleukin is one of the following: lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
55. A method according to any one of embodiments 22-24, 26 and 27, wherein the receptor to the cytokines is administered as a soluble receptor.
56. A formulation according to embodiment 25, wherein the receptor to the cytokines is administered as a soluble receptor.
57. A method according to any one of embodiments 1 , 2, 3, 6, 8, 9, 10, 13, 15, 16, 17 and 20, wherein the administrations are sequentially co-administered.
58. A combination therapy according to any one of embodiments 14, 21 and 28, wherein the combination therapy is sequentially co- administered.
59. A method according to any one of embodiments 1 , 2, 3, 6, 8, 9, 10, 13, 15, 16, 17 and 20, wherein the administrations are parenterally co-administered.
60. A combination therapy according to any one of embodiments 14, 21 and 28, wherein the combination therapy is parenterally co- administered. 61. A method according to any one of embodiments 1 , 2, 3, 6, 8,
9, 10, 13, 15, 16, 17 and 20, wherein at least one of the administered
materials is administered with a cyclodextrin.
62. A combination therapy according to any one of embodiments 14, 21 and 28, wherein the combination is administered with a cyclodextrin.
63. A method of reducing TCID in a patient, said method comprising a combination therapy containing one or more Th2 cytokine and one or more agonist and/or Antagonist to a Th2 cytokine.
64. A method of reducing TCID in a patient, said method comprising administering an amount of a receptor to lnterleukin-4 in combination with lnterleukin-4. 65. A method as recited in either of embodiments 63 and 64, wherein the cytokine is one or more of the following: lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
66. A method of treating a patient suffering from immunodeficiency, comprising administering to said patient an immunoregulatory effective amount of a combination therapy comprising: -at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of a Th2 cytokine. 67. A method as recited in embodiment 66, wherein said patient is a human or animal.
68. A method as recited in embodiment 66, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
69. A method as recited in embodiment 66, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
70. A method as recited in embodiment 66, wherein said at least
one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
71. A method as recited in embodiment 66, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
72. A method as recited in embodiment 66, wherein said at least one Th2 cytokine is IL-4.
73. A method as recited in embodiment 66, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
74. A method as recited in embodiment 72, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 75. A method as recited in embodiment 66, wherein said at least one Th2 cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF.
76. A method as recited in embodiment 66, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
77. A method as recited in embodiment 75, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
78. A method of treating a patient suffering from immunodeficiency, comprising administering to said patient an immunoregulatory effective amount of a combination therapy consisting essentially of:
-at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine.
79. A method as recited in embodiment 78, wherein said patient is a human or animal.
80. A method as recited in embodiment 78, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF. 81. A method as recited in embodiment 78, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF. 82. A method as recited in embodiment 78, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
83. A method as recited in embodiment 78, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
84. A method as recited in embodiment 78, wherein said at least one Th2 cytokine is IL-4.
85. A method as recited in embodiment 78, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
86. A method as recited in embodiment 84, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 87. A method of providing immunoregulation to a patient, comprising administering to said patient an immunoregulatory effective
amount of a combination therapy comprising:
-at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine. 88. A method as recited in embodiment 87, wherein said patient is a human or animal.
89. A method as recited in embodiment 87, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
90. A method as recited in embodiment 87, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
91. A method as recited in embodiment 87, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine. 92. A method as recited in embodiment 87, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
93. A method as recited in embodiment 87, wherein said at least one Th2 cytokine is IL-4. 94. A method as recited in embodiment 87, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
95. A method as recited in embodiment 93, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
96. A method as recited in embodiment 87, wherein said at least
one Th2 cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF.
97. A method as recited in embodiment 87, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
98. A method as recited in embodiment 96, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
99. A method of providing immunoregulation to a patient, comprising administering to said patient an immunoregulatory effective amount of a combination therapy consisting essentially of:
-at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine. 100. A method as recited in embodiment 99, wherein said patient is a human or animal.
101. A method as recited in embodiment 99, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
102. A method as recited in embodiment 99, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
103. A method as recited in embodiment 99, wherein said at least
one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
104. A method as recited in embodiment 99, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
105. A method as recited in embodiment 99, wherein said at least one Th2 cytokine is IL-4.
106. A method as recited in embodiment 99, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
107. A method as recited in embodiment 105, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 108. A method of producing a reduction of TCID in a patient, comprising administering to said patient an immunoregulatory effective amount of a combination therapy comprising: -at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine.
109. A method as recited in embodiment 108, wherein said patient is a human or animal.
110. A method as recited in embodiment 108, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10,
Interleukin 13 and cytokine GM-CSF.
111. A method as recited in embodiment 108, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6,
Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
112. A method as recited in embodiment 108, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine. 113. A method as recited in embodiment 108, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
114. A method as recited in embodiment 108, wherein said at least one Th2 cytokine is IL-4. 115. A method as recited in embodiment 108, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
116. A method as recited in embodiment 114, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
117. A method as recited in embodiment 108, wherein said at least one Th2 cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF. 118. A method as recited in embodiment 108, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF. 119. A method as recited in embodiment 117, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a repeptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF. 120. A method of providing a reduction of TCID in a patient, comprising administering to said patient an immunoregulatory effective
amount of a combination therapy consisting essentially of:
-at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine. 121. A method as recited in embodiment 120, wherein said patient is a human or animal.
122. A method as recited in embodiment 120, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
123. A method as recited in embodiment 120, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
124. A method as recited in embodiment 120, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine. 125. A method as recited in embodiment 120, wherein said immunodeficiency is resultant from viral infection, acterial infection and/or infectious protein units.
126. A method as recited in embodiment 120, wherein said at least one Th2 cytokine is IL-4. 127. A method as recited in embodiment 120, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
128. A method as recited in embodiment 126, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
129. A composition comprising:
-at least one Th2 cytokine; and
-at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine.
130. A composition as recited in embodiment 129, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
131. A composition as recited in embodiment 129, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
132. A composition as recited in embodiment 129, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
133. A composition as recited in embodiment 129, wherein said at least one Th2 cytokine is IL-4.
134. A composition as recited in embodiment 129, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
135. A composition as recited in embodiment 133, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 136. A composition as recited in embodiment 129, wherein said at least one Th2 cytokine is selected fro the group consisting of Interleukin- 3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF.
137. A composition as recited in embodiment 129, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected
from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
138. A composition as recited in embodiment 136, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
139. A composition consisting essentially of: -at least one Th2 cytokine; and -at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine.
140. A composition as recited in embodiment 139, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
141. A composition as recited in embodiment 139, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
142. A composition as recited in embodiment 139, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine. 143. A composition as recited in embodiment 139, wherein said at least one Th2 cytokine is IL-4.
144. A composition as recited in embodiment 139, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 145. A composition as recited in embodiment 143, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is
a receptor, agonist, antagonist and/or antibody of IL-4.
146. A kit comprising:
-unit dosages of at least one Th2 cytokine; and -unit dosages of at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine, and
- optionally a label insert that specifies an intermittent dosing protocol for treatment of an infection, an immunosuppression condition or a neoplastic condition.
147. A kit as recited in embodiment 146, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, Interleukin-
4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
148. A kit as recited in embodiment 146, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF.
149. A kit as recited in embodiment 146, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
150. A kit as recited in embodiment 146, wherein said at least one Th2 cytokine is IL-4.
151. A kit as recited in embodiment 146, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
152. A kit as recited in embodiment 150, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4. 153. A kit as recited in embodiment 146, wherein said at least one
Th2 cytokine is selected from the group consisting of lnterleukin-3,
lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF.
154. A kit as recited in embodiment 146, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
155. A kit as recited in embodiment 153, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF.
156. Use of at least one Th2 cytokine and at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine in the manufacture of a medicament for providing immuoregulation.
157. A use as recited in embodiment 156, wherein said at least one cytokine is selected from the group consisting of lnterleukin-3, Interleukin- 4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF. 158. A use as recited in embodiment 156, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of lnterleukin-3, lnterleukin-4, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 10, Interleukin 13 and cytokine GM-CSF. 159. A use as recited in embodiment 156, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is selected from the group consisting of receptor, agonist, antagonist and/or antibody of a cytokine which is the same as said at least one Th2 cytokine.
160. A use as recited in embodiment 156, wherein said at least one Th2 cytokine is IL-4.
161. A use as recited in embodiment 156, wherein said at least one
receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
162. A use as recited in embodiment 160, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of IL-4.
163. A use as recited in embodiment 156, wherein said at least one Th2 cytokine is selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM- CSF. 164. A use as recited in embodiment 156, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF. 165. A use as recited in embodiment 163, wherein said at least one receptor, agonist, antagonist and/or antibody of Th2 cytokine is a receptor, agonist, antagonist and/or antibody of a Th2 cytokine selected from the group consisting of lnterleukin-3, lnterleukin-5, Interleukin 6, Interleukin 9, Interleukin 13 and cytokine GM-CSF. 166. A method to modulate an immune response in a patient comprising administering to the patient a complex that comprises a Th2 cytokine and a binding partner (i.e., an agonist, antagonist, antibody, receptor or a mutein or biologically active fragment or derivative of any of these molecule types) for the Th2 cytokine, whereby the complex exposes to the patient's immune system (i) a cytokine neoantigen or (ii) a cytokine- cytokine binding partner neoantigen, that is not exposed to the patient's immune system in the absence of the complex and optionally wherein the patient's immune system responds to the presence of the cytokine neoantigen or the cytokine-cytokine binding partner neoantigen. 167. The method of embodiment 166, wherein the patient suffers from an infection, immunosuppression and/or a neoplastic condition and
the modulation of the patient's immune response is (i) an enhanced Tf^ response, (ii) a decreased Tl-^ response, (iii) an enhanced Th2 response, (iv) a decreased Th2 response, (v) a shift from a predominantly Th, response in the patient that results from the infection, immunosuppression and/or neoplastic condition to a predominantly Th2 response or (vi) a shift from a predominantly Th2 response in the patient that results from the infection, immunosuppression and/or neoplastic condition to a predominantly Th, response.
168. Any of the methods or compositions of embodiments 1-167 wherein (i) the method utilizes a composition that is made under GMP conditions, (ii) the composition is made under GMP conditions, (iii) the method utilizes an intermittent dosing protocol, such as one described in embodiment 170, and/or (iv) the methods or compositions further contain at least one pharmaceutically acceptable carrier and/or excipient, such as an aqueous carrier, e.g. cyclodextrin, such as α-cyclodextrin, β- cyclodextrin, normal saline, Ringer's solution, dextrose solution, e.g., 5% dextrose in saline, and other aqueous carriers known in the art, a non- aqueous carrier such as fixed oils and ethyl oleate, optionally together with one or more additive, such as buffer, and/or optionally at least one biocompatible polymer, e.g., any suitable polymeric biomaterial or combination thereof known and used in the art for biological applications such as polyurethanes, silicone elastomers, hydrogels (e.g., poly(hydroxyethyl methacrylate), polyesters, polyethers, polyvinyl alcohol, and the like. 169. Any method of embodiment 168 wherein the method involves an intermittent dosing protocol to the patient of the composition the method recites.
170. The method of embodiment 169 wherein the intermittent dosing protocol comprises (a) about 4-120 daily doses, preferably about 7-45 daily doses, followed by (b) about 5-120 days of no doses, preferably about 20-60 days of no doses, and (c) repeating 1 , 2, 3, 4 or more times,
a dosing protocol that is within the protocol described in steps (a) and (b) or that is the same as the protocol that was used in steps (a) and (b).
171. The method of embodiment 170 wherein the patient is a human or a primate. 172. Any of the methods or compositions of embodiments 1-171 wherein the methods or compositions comprise, consist essentially of, or consist of the recited components.
All references cited herein are incorporated herein by reference in their entirety. All such references are incorporated herein with specificity. In one aspect of the present invention, the agonist and/or antagonist to a Th2 cytokine is a "Th2 cytokine binding partner", as defined below.
As used herein, the expressions "pharmaceutical formulation", "formulation" and "medicament" refer to pharmaceutically acceptable compositions, preferably compositions that are made under good laboratory practice ("GLP") or, preferably, good manufacturing practice
("GMP") conditions. Such compositions are preferably prepared using purified cytokine and/or cytokine binding partner molecules, e.g., at least about 85-90% w/w pure protein, such as at least about 91-95% pure (e.g., about 95% or about 96% or about 97% pure), which are usually suitable for human therapeutic or prophylactic uses under health regulatory guidelines or requirements, e.g., under U.S. FDA regulations and under U.S. state and federal law.
In an aspect of the present invention, the terms "cytokine binding partner", "Th2 cytokine binding partner" and "agonist and/or antagonist to a Th2 cytokine" can refer to a molecule that binds to any Th2 cytokine (e.g., a cognate Th2 cytokine) and can form a stable or detectable complex in vivo, e.g., an antibody that binds to IL-4 or an IL-4 receptor that binds to IL- 4. Such stable or detectable complexes can be characterized by a binding affinity between the partners that comprise the complex of at least about 10 °-107 M \ and preferably at least about 10'8 M"\ e.g., about
10"9-10"10 M"1. Cytokine binding partners can include (but are not limited to)
monoclonal or polyclonal antibodies from any suitable source, e.g., human, animal or hybridoma (see e.g., Pharm. Res. 15:1652-1656 1998). They can also include cytokine receptors and cytokine binding proteins (see, e.g., Immunol. Today 16:216-220 1995, J. Pharmacol. Exp. Therapeutics 279:340-350 1996). Cytokine binding partners can also include fragments and muteins of any of these molecules, provided that the fragment or mutein have the capability of forming a stable or detectable complex.. The cytokine binding partner may be bifunctional or multifunctional, i.e., it can comprise (i) a binding site for the cytokine and a binding site for another molecule such as a cell surface antigen or marker and/or (ii) a tag or moiety that one can use to modulate the half-life of the complex in vivo. Cytokine binding partners can be agonists or antagonists of the cytokine's biological activity. The cytokines and cytokine binding partner can be from any patient, e.g., human, rodent or primate. Members that comprise the cytokine and the cytokine binding partner can comprise molecules from different species, but usually they will be from the same species.
A "patient" can be any organism, e.g., a human or animal. The animal may be a vertebrate such as a primate, rodent, domestic animal or game animal. Primates include chimpanzees, cynomologous monkeys, spider monkeys, and macaques, e.g., Rhesus. Rodents include mice, rats, woodchucks, ferrets, rabbits and hamsters. Domestic and game animals include cows, horses, pigs, deer, bison, buffalo, felines, e.g., domestic cat, canine, e.g., dog, avian, e.g., chicken, emu, ostrich, and fish, e.g., trout, catfish, salmon or sturgeon. The expression "subject" can include any subset of the foregoing, e.g., all of the above, but excluding one or more groups or species such as humans, primates or rodents. EXAMPLES
The tests described below demonstrate utility of the present invention by virtue of pharmacological activity of compositions of the present invention. These tests are presented as illustrations of the use of the present invention, and should not be interpreted as in any way limiting
the scope of the present invention, as defined in the claims.
Four patients, TL50, MA49, DY58 and GH45 were treated according to the treatment regimens set forth below (in which the Formulations, A, B, C and D, and unit dosages were as also defined below: Patient TL50
This patient received no other therapy during this trial.
Days (inclusive) Formulation (unit dose)
0-41 A(1)
42-56 C(1) 57-85 No Therapy
86-94 C(2)
Patient MA49
This patient received no other therapy during this trial.
Days (inclusive) Formulation (unit dose) 0-6 C(2)
7-13 C(1)
14-54 No Therapy
Patient DY58
This patient received no other therapy during this trial. Days (inclusive) Formulation (unit dose)
0-6 No Therapy
7-13 C(2)
14-20 C(1)
21-64 No Therapy Patient GH45
This patient is on/off a cocktail of other anti-viral agents. What is identified herein relates to therapies relating to the protocols according to the present invention.
Days (inclusive) Formulation (unit dose) 0-13 A(1)
14-20 B(1)
21-34 A(1)
35-48 C(1)
49-78 No Therapy
79-91 D(1) Formulation A
-a unit dose is 5 ml;
-5 ml each day of gPP28X1 (Lot No. p37090LT) which contained: -400 μg rh IL-4 -400 μg rh IL-4 SR -this was taken orally formulated in cyclodextrin (CD) and held under the tongue for 3-4 minutes;
-the CD is a 45 % w/v aqueous solution of hydroxypropyl beta cyclodextrin.
Formulation B -a unit dose is 5 ml;
-5 ml each day of gPP28X2 (Lot No. KG520LT) which contained: -0.5 mg rabbit anti IL-4 -0.5 mg rabbit anti IL-10 -0.5 ml rhlL-4 SR -this was taken orally formulated in cyclodextrin (CD) and held under the tongue for 3-4 minutes. Formulation C -a unit dose is 1 ml;
-1 ml subcutaneous dose per day, each dose containing: -60 μg rh IL-4
-60 μg rh IL-4 SR -this was formulated in CD. Formulation D -a unit dose is 1 ml; -1 ml subcutaneous does per day, each dose containing:
-60 μg rh IL-4
-60 μg rh IL-4 SR -this was formulated in saline.
Test results for these patients (samples taken on the day indicated in the tables) is set forth in Tables 1A, 1B, 1C, 1D (for patient TL50), 2A, 2B, 2C, 2D (for patient MA49), 3A, 3B, 3C, 3D (for patient DY58), 4A, 4B,
4C, and 4D (for patient GH45), in which the "No. of Days" reflects the number of days elapsed from the taking of the first sample (Day 0) until the day on which the sample reported in that column was taken.
In the following tables, the following abbreviations are employed: Abbreviation Meaning clr clear do cloudy dy dark yellow det. detected haz. hazy
K thousand
M million mod. moderate neg. negative ns none seen occ. occasional pos. positive tur. turbid una. unable to determine y yellow
Results of HIV-1 culture results for these tests is plotted in terms of
TCID in Figs. 3A, 3B, 3C and 3D. TCID is an abbreviation for tissue culture infectious dose. This is a calculated number that indicates the number of infectious HIV viral particles present in the assay. Serially diluted patient PBMCs are incubated with HIV negative PHA-stimulated
donor PBMC (1 million per well) in a microtiter plate at 37 °C. On day 7, one half of medium is removed and fresh stimulated donor cells are supplemented. Supernatant fractions from day 14 are removed and tested for HIV-1 p24 antigen. A microculture will be scored positive if ≥ 30 pg/mL of HIV-1 p24 antigen is present. The number of infectious units per million (IUPM) PBMC is then determined. A TCID presented b SLI can be converted as the following:
SLI Results TCID
1 HIV-1 infectious unit per 1 HIV-1 infectious unit per
1 million PBMC 1 milion PBMC 1 HIV-1 infectious unit per 5 HIV-1 infectious unit per
200,000 PBMC 1 milion PBMC 1 HIV-1 infectious unit per 25 HIV-1 infectious unit
40,000 PBMC per 1 milion PBMC 1 HIV-1 infectious unit per 125 HIV-1 infectious unit
8,000 PBMC per 1 milion PBMC 1 HIV-1 infectious unit per 625 HIV-1 infectious unit
1,600 PBMC per 1 milion PBMC 1 HIV-1 infectious unit per 3,125 HIV-1 infectious
320 PBMC unit per 1 milion PBMC 1 HIV-1 infectious unit per 15,625 HIV-1 infectious
64 PBMC unit per 1 milion PBMC
Table 1 A-Patient TL50 (part A)
Table IB, Patient TL50 (part B)
Table IC-Patient TL50 (part C)
Table 1D--Patient TL50 (part D)
Table 2A-Patient DY58 (part A)
cπ oo
Table 2B-Patient DY58 (part B)
cπ so
Table 2C-Patient DY58 (part C)
Table 2D~Patient DY58 (part D)
Table 3A-Patient MA49 (part A)
CD ro
Table 3B~Patient MA49 (part B)
c
Table 3C-Patient MA49 (part C)
en
4"=»
Table 3D-Patient MA49 (part D)
cn cπ
Table 4A-Patient GH45 (part A)
n
Table 4B-Patient GH45 (part B)
cn
Table 4C-Patient GH45 (part C)
n o
Table 4D-Patient GH45 (part D)
σ*ι so