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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P13/00—Drugs for disorders of the urinary system
  • A61P13/08—Drugs for disorders of the urinary system of the prostate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/12—Materials from mammals; Compositions comprising non-specified tissues or cells; Compositions comprising non-embryonic stem cells; Genetically modified cells
  • A61K35/22—Urine; Urinary tract, e.g. kidney or bladder; Intraglomerular mesangial cells; Renal mesenchymal cells; Adrenal gland
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K39/0005—Vertebrate antigens
  • A61K39/0011—Cancer antigens
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
  • A61P37/04—Immunostimulants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/51—Medicinal preparations containing antigens or antibodies comprising whole cells, viruses or DNA/RNA
  • A61K2039/515—Animal cells
  • A61K2039/5152—Tumor cells
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/80—Vaccine for a specifically defined cancer
  • A61K2039/884—Vaccine for a specifically defined cancer prostate

Definitions

• This invention is concerned with agents for the treatment of primary, metastatic and residual cancer in mammals (including humans) by inducing the immune system of the mammal or human afflicted with cancer to mount an attack against the tumour lesion.
• the invention pertains to the use of whole-cells, derivatives and portions thereof with or without vaccine adjuvants and/or other accessory factors. More particularly, this disclosure describes the use of particular combinations of whole-cells and derivatives and portions thereof that form the basis of treatment strategy.
• cancerous cells contain numerous mutations, qualitative and quantitative, spatial and temporal, relative to their normal, non-cancerous counterparts and that at certain periods during tumour cells' growth and spread a proportion of these are capable of being recognised by the hosts' immune system as abnormal.
• immunotherapies that harness the power of the hosts' immune system and direct it to attack the cancerous cells, thereby eliminating such aberrant cells at least to a level that is not life-threatening (reviewed in Maraveyas, A. & Dalgleish, A.G. 1977 Active immunotherapy for solid tumours in vaccine design in The Role of Cytokine Networks, Ed.
• Antibodies may also be employed in active immunotherapy utilising anti-idiotype antibodies which appear to mimic (in an immunological sense) cancer antigens. Although elegant in concept, the utility of antibody-based approaches may ultimately prove limited by the phenomenon of 'immunological escape' where a subset of cancer cells in a mammalian or human subject mutates and loses the antigen recognised by the particular antibody and thereby can lead to the outgrowth of a population of cancer cells that are no longer treatable with that antibody.
• TSA tumour specific antigens
• TAA tumour associated antigens
• TAA or TSA proteins or peptides derived therefrom which fall into the category of TAA or TSA.
• differential display techniques whereby RNA expression is compared between tumour tissue and adjacent normal tissue to identify RNAs which are exclusively or preferentially expressed in the lesion. Sequencing of the RNA has identified several TAA and TSA which are expressed in that specific tissue at that specific time, but therein lies the potential deficiency of the approach in that identification of the TAA or TSA represents only a "snapshot" of the lesion at any given time which may not provide an adequate reflection of the antigenic profile in the lesion over time.
• cytotoxic T lymphocyte (CTL) cloning and expression-cloning of cDNA from tumour tissue has lead to identification of many TAA and TSA, particularly in melanoma.
• CTL cytotoxic T lymphocyte
• the approach suffers from the same inherent weakness as differential display techniques in that identification of only one TAA or TSA may not provide an appropriate representation of a clinically relevant antigenic profile.
• subunit vaccine approaches are in development for the treatment of a wide range of cancers, although none has yet received marketing authorisation for use as a human pharmaceutical product.
• subunit vaccines may also be limited by the phenomenon of immunological escape.
• Tumours have the remarkable ability to counteract the immune system in a variety of ways including: downregulation of the expression of potential target proteins; mutation of potential target proteins; downregulation of surface expression of receptors and other proteins; downregulation of MHC class I and II expression thereby disallowing direct presentation of TAA or TSA peptides; downregulation of co-stimulatory molecules leading to incomplete stimulation of T-cells leading to anergy; shedding of selective, non representative membrane portions to act as decoy to the immune system; shedding of selective membrane portions to anergise the immune system; secretion of inhibitory molecules; induction of T-cell death; and many other ways.
• cell-based vaccines include TSAs and TAAs that have yet to be identified as such; it is possible if not likely that currently unidentified antigens may be clinically more relevant than the relatively small number of TSAs/TAAs that are known.
• Cell-based vaccines fall into two categories. The first, based on autologous cells, involves the removal of a biopsy from a patient, cultivating tumour cells in vitro, modifying the cells through transfection and/or other means, irradiating the cells to render them replication-incompetent and then injecting the cells back into the same patient as a vaccine. Although this approach enjoyed considerable attention over the past decade, it has been increasingly apparent that this individually-tailored therapy is inherently impractical for several reasons. The approach is time consuming (often the lead time for producing clinical doses of vaccine exceeds the patients' life expectancy), expensive and, as a 'bespoke' product, it is not possible to specify a standardised product (only the procedure, not the product, can be standardised and hence optimised and quality controlled).
• tumour biopsy used to prepare the autologous vaccine will have certain growth characteristics, interactions and communication with surrounding tissue that makes it somewhat unique.
• the second type of cell-based vaccine and the subject of the current invention describes the use of allogeneic cells which are be genetically (and hence immunologically) mismatched to the patients. Allogeneic cells benefit from the same advantages of multivalency as autologous cells. In addition, as allogeneic cell vaccines can be based on immortalised cell lines which can be cultivated indefinitely in vitro, thus this approach does not suffer the lead-time and cost disadvantages of autologous approaches. Similarly the allogeneic approach offers the opportunity to use combinations of cells types which may match the disease profile of an individual in terms of stage of the disease, the location of the lesion and potential resistance to other therapies.
• Groups have used allogeneic cell lines that are HLA-matched or partially-matched to the patients' haplotype and also allogeneic cell lines that are mismatched to the patients' haplotype in the field of melanoma and also mismatched allogeneic prostate cell lines transfected with GM- CSF.
• the invention disclosed here relates to a product comprised of a cell line or lines intended for use as an allogeneic immunotherapy agent for the treatment of cancer in mammals and humans.
• tumour cells are utilised as the starting point on the premise that only tumour cells will contain TSAs or TAAs of relevance, and the tissue origins of the cells are matched to the tumour site in patients.
• a primary aspect of the invention is the use of immortalised normal, non-malignant cells as the basis of an allogeneic cell cancer vaccine.
• Normal cells do not posses TSAs or relevant concentrations of TAAs and hence it is surprising that normal cells as described herein are effective as anti-cancer vaccines.
• the approach is general and can be adapted to any mammalian tumour by the use of immortalised normal cells derived from the same particular tissue as the tumour intended to be treated.
• Immortalised normal cells can be prepared by those skilled in the art using published methodologies, or they can be sourced from cell banks such as ATCC or ECACC, or they are available from several research groups in the field.
• a vaccine may be based on one or a combination of different immortalised normal cell lines derived from the prostate which can be prepared using methods reviewed and cited in Rhim, J.S. and Kung, H-F., 1997 Critical Reviews in Oncogenesis 8(4):305-328 or selected from PNT1A (ECACC Ref No: 95012614), PNT2 (ECACC Ref No: 95012613) or PZ-HPV-7 (ATCC Number: CRL-2221).
• a further aspect of the invention is the addition of TSAs and/or TAAs by combining one or more immortalised normal cell line(s) with one, two or three different cell lines derived from primary or metastatic cancer biopsies.
• the cell lines are lethally irradiated utilising gamma irradiation at 50-300 Gy to ensure that they are replication incompetent prior to use in the mammal or human.
• cryoprotectant solutions may include but are not limited to, 10-30% v/v aqueous glycerol solution, 5-20% v/v dimethyl sulphoxide or 5-20% w/v human serum albumin may be used either as single cryoprotectants or in combination.
• a further embodiment of the invention is the use of the cell line combinations with non-specific immune stimulants such as BCG or M. Vaccae, Tetanus toxoid, Diphtheria toxoid, Bordetella Pertussis, interieukin 2, interieukin 12, interieukin 4, interieukin 7, Complete Freund's Adjuvant, Incomplete Freund's Adjuvant or other non-specific agents known in the art.
• non-specific immune stimulants such as BCG or M.
• FIG 1 shows T-cell proliferation data for patients 112, 307, and 406;
• Figure 2 shows Western Blot analysis of serum from patients 115, 304 and 402;
• Figure 3 shows antibody titres of serum from patients 112, 305 and 402;
• Figure 4 shows PSA data for patients 10, 303 and 404.
• Figure 5 shows survival curves for C57 mice immunised with normal melanocytes.
• An immortalised cell line derived from normal prostate tissue namely PNT2 was grown in roller bottle culture in RPMI 1640 medium supplemented with 2 mM L- glutamine and 5% foetal calf serum (FCS) following recovery from liquid nitrogen stocks. Following expansion in T175 static flasks the cells were seeded into roller bottles with a growth surface area of 850 cm 2 at 1-20 x10 7 cells per roller bottle
• An immortalised cell line derived from primary prostate tissue namely NIH1542- CP3TX was grown in roller bottle culture in KSFM media supplemented with 25 ⁇ g/ml bovine pituitary extract, 5 ng/ml of epidermal growth factor, 2 mM L-glutamine, 10 mM HEPES buffer and 5% foetal calf serum (FCS) (hereinafter called "modified KSFM”) following recovery from liquid nitrogen stocks. Following expansion in T175 static flasks the cells were seeded into roller bottles with a growth surface area of 1 ,700 cm 2 at 2-5 x10 7 cells per roller bottle
• LnCap was grown in large surface area static flasks in RPMI media supplemented with 10% FCS and 2 mM L-glutamine following seeding at 1-10x10 6 cells per vessel and then grown to near confluence.
• Du-145 was expanded from frozen stocks in static flasks and then seeded into 850 cm 2 roller bottles at 1-20x10 7 cells per bottle and grown to confluence in DMEM medium containing 10% FCS and 2 mM L-glutamine. All cell lines were harvested utilising trypsin at 1x normal concentration.
• the cells were re-suspended at a concentration of 5-40x10 6 cells/ml and irradiated at 50-300 Gy using a Co 60 source. Following irradiation the cells were formulated in cryopreservation solution composing of 10% DMSO, 8% human serum albumin in phosphate buffered saline, and frozen at a cell concentration of 5-150 x10 6 cells/ml, in liquid nitrogen until required for use.
• Prostate cancer patients were selected on the basis of being refractory to hormone therapy with a serum PSA level of at least 30 ng/ml. Ethical permission and MCA (UK Medicines Control Agency) authorization were sought and obtained to conduct this trial.
• Ethical permission and MCA UK Medicines Control Agency
• the cells were warmed gently in a water bath at 37 °C and admixed with mycobacterial adjuvant prior to injection into patients. Injections were made intra- dermally at four injection sites into draining lymph node basins. The minimum interval between doses was two weeks, and most of the doses were given at intervals of four weeks. Prior to the first dose, and prior to some subsequent doses, the patients were tested for delayed-type hypersensitivity (DTH) against the four cell lines listed in the vaccination schedule above (all tests involved 0.8 x 10 6 cells with no adjuvant).
• DTH delayed-type hypersensitivity
• Con ConA lectin (positive control)
• the results for the proliferation assays are shown in Figure 1 where a proliferation index for either CD4 or CD8 positive T-cells are plotted against the various cell lysates.
• the proliferation index being derived by dividing through the percentage of T-cells proliferating by the no-lysate control.
• Results are shown for patient numbers 112, 307 and 406.
• Results are given for four cell lysates namely, NIH1542, LnCap, DU-145 and PNT-2.
• 50% of patients treated mount a specific proliferative response to at least one of the cell lines.
• Standardised cell lysates were prepared for a number of prostate cell lines to enable similar quantities of protein to be loaded on a denaturing SDS PAGE gel for Western blot analysis. Each blot was loaded with molecular weight markers, and equal amounts of protein derived from cell lysates of NIH1542, LnCap, DU-145 and PNT-2. The blot was then probed with serum from patients derived from pre- vaccination and following 16 weeks vaccination (four to six doses).
• Antibody titres were determined by coating ELISA plates with standardised cell line lysates and performing dilution studies on serum from vaccinated patients.
• PSA levels for patients receiving the vaccine were recorded at entry into the trial and throughout the course of vaccination, using routinely used clinical kits.
• the PSA values for patients 110, 303 and 404 are shown in Figure 4 (vertical axis is serum PSA in ng/ml; horizontal axis is time, with the first time point representing the initiation of the vaccination programme) and portray a drop or partial stabilisation of the PSA values, which in this group of patients normally continues to rise, often exponentially.
• the result for patient 110 is somewhat confounded by the radiotherapy treatment to alleviate bone pain, although the PSA level had dropped prior to radiotherapy.
• Example 2 Use of a Normal Melanoeyte in a Murine Melanoma Protection Model Model
• a normal melanoeyte cell line was used in a vaccination protection model of murine melanoma utilising the B16.F10 as the challenge dose.
• the C57 mice received two vaccinations of either PBS, 5x10 6 irradiated K1735 allogeneic melanoma cells or 5x10 6 irradiated Melan P1 autologous normal melanoeyte cells on days -14 and -7.
• Challenge on day 0 was with 1 x 10 4 B16.F10 cells and tumour volume measured every three days from day 10 onwards. Animals were sacrificed when the tumour had grown to 1.5x1.5 cm measured across the maximum dimensions of the tumour.
• Figure 5 shows that vaccination with Melanl P cells offer some level of protection against this particularly aggressive murine tumour.

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