Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K41/00—Medicinal preparations obtained by treating materials with wave energy or particle radiation ; Therapies using these preparations
  • A61K41/0057—Photodynamic therapy with a photosensitizer, i.e. agent able to produce reactive oxygen species upon exposure to light or radiation, e.g. UV or visible light; photocleavage of nucleic acids with an agent
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K47/00—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
  • A61K47/50—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
  • A61K47/51—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
  • A61K47/68—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment
  • A61K47/6835—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site
  • A61K47/6851—Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an antibody, an immunoglobulin or a fragment thereof, e.g. an Fc-fragment the modifying agent being an antibody or an immunoglobulin bearing at least one antigen-binding site the antibody targeting a determinant of a tumour cell
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/30—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants from tumour cells
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/28—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants
  • C07K16/30—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from animals or humans against receptors, cell surface antigens or cell surface determinants from tumour cells
  • C07K16/3015—Breast
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
• • 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
  • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
• • 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
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
  • A61K2039/55555—Liposomes; Vesicles, e.g. nanoparticles; Spheres, e.g. nanospheres; Polymers
• • 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
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
  • A61K2039/55566—Emulsions, e.g. Freund's adjuvant, MF59
• • 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
  • A61K2039/555—Medicinal preparations containing antigens or antibodies characterised by a specific combination antigen/adjuvant
  • A61K2039/55511—Organic adjuvants
  • A61K2039/55577—Saponins; Quil A; QS21; ISCOMS
• • 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

Definitions

• the invention relates to therapeutic compositions for the treatment of cancer. More particularly, the invention relates to the therapeutic treatment of cancers which express the MUC-1 antigen.
• the tumor-associated antigen MUC1 is a high- molecular weight glycoprotein that is expressed on many adenocarcinomas. Gendler, et al., J. Biol. Chem. 265: 15286, 1990, Gendler, et al, P.N.A.S. U.S.A., 84:6060, 1987, Siddiqui, et al, P.N.A.S. U.S.A. 85:2320, 1988, and Ligtenberg, et ah, J. Biol. Chem.
• Tumor MUC-1 are generally hypoglycosylated and the glycosylation sites often have aberrant sugar chain extensions.
• Magnani, et al, Cancer Res. 43:5489, 1983 teaches that this aberrant glycosylation results in the exposure of normally cryptic peptide epitopes and the creation of novel carbohydrate epitopes.
• cell membrane mucins exist as flexible rods and protrude at a relatively great distance from the cell surface. Mucins thus form an important component of the glycocalyx and are probably the first point of cellular contact with antibodies and cells of the immune system.
• Tumor mucins are thought to serve a critical function for tumor survival in the body. They may protect tumor cells from the low pH caused by high metabolic activity within the tumor. MUCl is thought to inhibit tumor cells from forming tight aggregates with the tumor tissue thereby increasing metastatic potential. Regimbald et al, Cancer Res. 56:4244, 1996, teaches that MUCl is involved in the homing of circulating tumor cells to distant sites by its molecular interaction with ICAM1 present on normal cells. Mucins may also protect tumor cells from recognition by the immune system.
• the invention provides therapeutic compositions comprising binding agents that specifically bind to tumor-associated MUC-1 and reduce, reverse or prevent their effects in cancer. More particularly, the invention provides therapeutic compositions that comprise a binding agent that can specifically bind to an epitope that comprises both peptide and carbohydrate on such tumor-associated MUC-1. The invention further provides methods for the use of such therapeutic compositions in the treatment of cancer. The present inventors have surprisingly discovered that the relative specificity for tumor associated MUC-1 is not necessarily sacrificed in the case of binding agents that recognize an epitope that includes carbohydrate. The compositions and methods according to the invention provide new promise for therapeutic treatment of tumors that produce tumor-associated MUC-1 antigens.
• the invention provides therapeutic compositions comprising binding agents that specifically bind to tumor -associated MUC-1 and that are effective in reducing tumor burden or prolonging survival in a mammal having a tumor that expresses a tumor-associated MUC-1.
• the MUC-1 is human MUC-1.
• Preferred binding agents bind specifically to MUC-1 epitopes that include carbohydrate.
• Particularly preferred binding agents include peptides or peptidomimetics, including antibodies and antibody derivatives.
• the invention provides methods for therapeutically treating a mammal bearing a tumor that comprises tumor-associated MUC- 1 antigen.
• the methods according to this aspect of the invention comprise administering to the mammal an effective amount of a binding agent according to the invention.
• the binding agent is administered intravenously or subcutaneously at low dosages.
• Figure 1 shows results of a survival study of mice administered binding agents according to the invention and control mice.
• Figure 2 shows results of studies of Ab2 production in mice administered binding agents according to the invention and control mice.
• Figure 3 shows results of studies showing that tumor cells can act as APCs to generate binding agent-specific T cell responses.
• Figure 4 shows results of tumor reduction studies of mice administered binding agents according to the invention and control mice.
• Figure 5 shows results of tumor reduction studies of hPBL-reconstituted SCID mice administered binding agents according to the invention.
• Figure 6 shows results of tumor reduction studies using a binding agent of the invention coupled with a photodynamic agent.
• the invention relates to therapeutic compositions for the treatment of cancer. More particularly, the invention relates to the therapeutic treatment of cancers which express the MUC- 1 antigen.
• the patents and publications recited herein reflect the knowledge in this field and are hereby incorporated by reference in their entirety. In case of conflict between the teachings of any of these references and the present specification, the latter shall prevail.
• the invention provides therapeutic compositions comprising binding agents that specifically bind to an epitope of tumor-associated MUC-1 and reduce, reverse or prevent their effects in cancer. More particularly, the invention provides therapeutic compositions that comprise a binding agent that can specifically bind to an epitope that comprises both peptide and carbohydrate on such tumor-associated MUC-1. The invention further provides methods for the use of such therapeutic compositions in the treatment of cancer. The compositions and methods according to the invention provide new promise for therapeutic treatment of tumors that produce tumor- associated MUC-1 antigens.
• the invention provides therapeutic compositions comprising binding agents that specifically bind to tumor -associated MUC-1 and that are effective in therapeutically treating a mammal having a tumor that expresses a tumor- associated MUC-1.
• the MUC-1 is human MUC-1.
• therapeutically treat' or “therapeutically treating” means causing statistically significant reduction in tumor volume, or causing statistically significant prolongation of survival in the mammal bearing the tumor.
• a "binding agent” is a molecule or macromolecule which binds under physiological conditions to MUC-1 and inhibits its biological activity.
• binds and "binds under physiological conditions” mean forming a covalent or non-covalent association with an affinity of at least 10 6 M “1 , most preferably at least 10 9 M “1 , either in the body, or under conditions which approximate physiological conditions with respect to ionic strength, e.g., 140 mM NaCl, 5 mM MgCl .
• the binding agent specifically binds an epitope that contains an immuno logical determinant that includes carbohydrate.
• Tumor MUC-1 are generally hypoglycosylated and the glycosylation sites are filled with aberrant sugar chain extensions, thus, distinguishing normal from tumor MUC-1.
• binding agents according to the invention can bind to these novel epitopes.
• An “epitope” is a portion of an antigen which is bound under physiological conditions by a binding agent according to the invention.
• An “immunological determinant” is a three-dimensional shape which contributes to the overall three-dimensional shape of an epitope.
• the binding agent binds an epitope that comprises immunological determinants from amino acid residues of a peptide having the amino acid sequence DTRPAP.
• An "amino acid residue” is an amino acid as it is in place in a particular peptide.
• “Inhibition of biological activity”, as used herein, means a statistically significant reduction in tumor burden, or a statistically significant prolongation of survival in an animal or patient bearing a tumor. Such statistically significant inhibition is illustrated in the examples hereof.
• Certain preferred embodiments of binding agents according to the invention are non-radiolabeled.
• Certain binding agents according to the invention bind to both circulating and tumor-bound tumor- associated MUC-1, wherein “tumor-associated” refers to the altered glycosylation of MUC- 1 made by tumor cells, rather than to its proximity to a tumor.
• a particularly preferred binding agent is AIM (ATTC Patent Deposit Designation PTA-975).
• Preferred tumors for treatment include, without limitation, breast carcinoma, colon carcinoma, esophageal squamous cell carcinoma, pancreatic carcinoma, prostate carcinoma and multiple myeloma.
• the binding agent according to the invention is a peptide or a peptidomimetic.
• a "peptide” is a molecule comprised of a linear array of amino acid residues connected to each other in the linear array by peptide bonds.
• Such peptides according to the invention may include from about three to about 500 amino acids, and may further include secondary, tertiary or quaternary structures, as well as intcrmolecular associations with other peptides or other non-peptide molecules.
• Such intermolecular associations may be through, without limitation, covalent bonding (e.g., through disulfidc linkages), or through chelation, electrostatic interactions, hydrophobic interactions, hydrogen bonding, ion- dipole interactions, dipole-dipole interactions, or any combination of the above.
• a binding agent comprises a complementarity determining region of an antibody which binds under physiological conditions to a MUC-1 epitope that includes carbohydrate, or a peptidomimetic of such a complementarity-determining region.
• a "complementarity determining region" (CDR) of an antibody is that portion of an antibody which binds under physiological conditions to an epitope, including any framework regions necessary for such binding, and which is preferably comprised of a subset of amino acid residues encoded by the human heavy chain V, D and J regions, the human light chain V and J regions, and/or combinations thereof.
• Certain preferred antibodies are xenogeneic antibodies, i.e. they are from a species that is different from the species being administered the antibody. Such antibodies will cause human anti- xenogeneic antibodies (HAXA) to be elicited.
• Preferred antibodies include murine antibodies, which elicit a human anti-mouse antibody (HAMA) response.
• compositions according to the invention may further include physiologically acceptable diluents, stabilizing agents, localizing agents or buffers.
• the binding agents according to the invention are activated, preferably by chemical or photodynamic approaches.
• Preferred chemical approaches include organic reducing agents, such as formamidine sulfonic acid, inorganic reducing agents, such as mercurous ion, stannous ion, cyanide ion, sodium cyanoborohydride and sodium borohydride, thiol exchange reagents, such as dithiothreitol, mercaptoethanol and mercaptoethanolamine, and protein reducing agents, such as thioredoxin.
• organic reducing agents such as formamidine sulfonic acid
• inorganic reducing agents such as mercurous ion, stannous ion, cyanide ion, sodium cyanoborohydride and sodium borohydride
• thiol exchange reagents such as dithiothreitol, mercaptoethanol and mercaptoethanolamine
• protein reducing agents such as thioredoxin.
• the presence of such groups can change the tertiary structure of the binding agent. Such structural change can modulate the immunoreactivity of the binding agent. Such modulation may lead to an improved anti-idiotypic response and/or cellular response in an individual to whom the binding agent is administered.
• activation utilizes a photodynamic approach. See, e.g., international application PCT/US93/06388.
• the binding agent is preferably irradiated with ultraviolet radiation, preferably in the spectrum range of from about 10 to about 820 nm. More preferably, at least 90% and most preferably at least 99% of the radiation is in the spectrum range of 250 to 320 nm.
• Such UV radiation is conveniently supplied from a source such as a hydrogen or deteurium discharge lamp, a xenon arc lamp, or a mercury vapor lamp.
• a source such as a hydrogen or deteurium discharge lamp, a xenon arc lamp, or a mercury vapor lamp.
• Conventional filters may be employed to obtain optimum spectrum wavelengths. (See e.g., Photochemistry, pp. 686-798 (John Wiley & Sons, N.Y., 1966).
• the binding agents according to the invention may optionally be coupled to photodynamic agents.
• such coupling is by covalent linkage or by liposomal association.
• Liposomal association is preferably achieved by mixing the photodynamic agent with a binding agent in the presence of a liposome-forming reagent.
• the binding agent according to the invention is covalently linked to the liposome-forming reagent.
• Preferred photodynamic agents include hypocrellins.
• the binding agents according to the invention specifically exclude the following monoclonal antibodies: HMPV, VU-3-C6, MF06, VU- 11-D1, MF30, BCP8, DF3, BC2, B27.29, VU-3-D1, 7540MR, MF11, Bc4E549, VU-1 1-E2, M38, E29, GP1.4, 214D4, BC4W154, HMFG- 1, HMFG-2, C595, Mc5 and A76-A/C7.
• HMPV HMPV
• VU-3-C6, MF06 VU- 11-D1, MF30, BCP8, DF3, BC2, B27.29, VU-3-D1, 7540MR, MF11, Bc4E549, VU-1 1-E2, M38, E29, GP1.4, 214D4, BC4W154, HMFG- 1, HMFG-2, C595, Mc5 and A76-A/C7.
• binding agents of the present invention act through a mechanism that generally includes an anti-idiotype network.
• the administration of binding agents according to the invention leads to the formation of complexes with MUC-1, which is postulated to elicit a more effective presentation of the antigen to the immune system.
• the complex formation between antigen and antibody can have several effects.
• Preferred binding agents according to the invention can bind both circulating and cellular MUC-1 tumor-associated antigen.
• the possible immune suppressive effect of the MUC-1 antigen can be inactivated by removal of the complex from circulation.
• the complex between antigen and antibody can be directed to antigen-presenting cells, carrying Fc receptors or membrane Ig receptors (macrophages, dendritic cells, B cells).
• the enhanced uptake of antigen by specific antigen-presenting cells will lead to increased presentation of antigen-derived peptides to T cells.
• the complex formation between antigen and antibody can also change the way the antigen is processed within the antigen-presenting cell, exposing novel immune dormant or cryptic epitopes, thus overcoming tolerance to the tumor- associated antigen.
• the binding agents according to the invention bind an epitope that is at least partially carbohydrate, they may also act to inhibit immune suppression by preventing interaction of the carbohydrate of lectin receptors on T cells.
• the embodiments of binding agents according to the invention that are coupled to photodynamic agents can also act through direct cytotoxicity to the tumor cells.
• the invention provides methods for therapeutically treating a mammal bearing a tumor that comprises tumor-associated MUC-1 antigen.
• the methods according to this aspect of the invention comprise administering to the mammal an effective amount of a binding agent according to the invention.
• the binding agent is a peptide, or a peptidomimetic, most preferably an antibody or antibody derivative, or a peptidomimetic thereof.
• the mammal is a human.
• the binding agent is preferably administered parenterally, more preferably intravenously or subcutaneously. In certain preferred embodiments, intravenous injection is carried out in the absence of any adjuvant.
• the binding agent is administered subcutaneously in the presence of an adjuvant, such as RIBI.
• the binding agent is covalently linked to an immunogenic carrier molecule, such as KLH or xenogeneic immunoglobulin.
• the method according to the invention utilizes binding agents that are non-radiolabeled.
• Certain preferred embodiments of the method according to the invention utilize binding agents that bind to both circulating and tumor-bound tumor- associated MUC-1, wherein "tumor- associated" refers to the altered glycosylation of MUC- 1 made by tumor cells, rather than to its proximity to a tumor.
• the binding agents are administered at a dosage of less than about 8 mg/30kg body weight, preferably less than about 3 mg/30 kg body weight, more preferably from about 0.5 to about 2 mg/ 30 kg body weight, still more preferably from about 0.5 to about 1.5 mg/30 kg body weight, and most preferably at about 1 mg/ 30 kg body weight.
• the dosage will be the maximum amount of binding agent that does not induce antibody-mediated toxicity.
• the dosage will be the maximum amount of binding agent that does not produce ADCC OR CDC.
• ADCC is assessed by incubating 51 Cr-labeled tumor cells with a binding agent according to the invention and adding fresh human PBMCs, followed by incubation for 4 hours and measurement of specific lysis.
• ADCC is deemed to be absent if specific lysis is less than 15%.
• Antibody- mediated toxicity means clinical toxicity, such as abnormal serum chemistries, impaired renal function, signs and symptoms of serum sickness or anaphylaxis. In certain embodiments a single such dosage will therapeutically treat the mammal. In other embodiments, treatment may be ongoing, e.g., four times per year for three or more years.
• an amount means an amount sufficient to therapeutically treat the mammal.
• therapeutically treat means an amount sufficient to therapeutically treat the mammal.
• therapeutically treating means an amount sufficient to therapeutically treat the mammal.
• binding agent means an agent used as described for the first aspect of the invention.
• a binding agent was prepared for use in the immunotherapy of patients with tumors expressing the tumor associated antigen (TAA) known as MUCl (Taylor- Papadimitriou. Int. J. Cancer 49: 1, 1990).
• TAA tumor associated antigen
• the binding agent is an activated murine monoclonal antibody (MAb), an IgG ⁇ k subclass immunoglobulin.
• MAb activated murine monoclonal antibody
• the binding agent binds with high affinity to MUCl, a high molecular weight glycoprotein that is expressed on many tumors (Ho, et al. Cancer Res. 53:641, 1993).
• the binding agent specifically recognizes the sequence DTRPAP within the MUCl tandem repeat peptide sequence. This binding agent is referred to as Alt- 1.
• the murine cell line or hybridoma that secretes the binding agent was generated by immunizing mice with MUC 1 and harvesting and immortalizing the antibody-secreting splenocytes.
• the steps involved in development of the hybridoma included (a) the immunization of BALB/cCrAltBM female mice with MUCl from several sources; (b) harvesting the splenocytes from the mice, (c) and immortalizing the splenocytes by fusing them with the myeloma cell line SP2/0-Agl4, (d) screening and selection of the desired clone by assaying the secreted antibodies for ability to bind MUCl, (e) expansion of the selected clone in the appropriate media, (f) isotype switching of the clone from an IgM to an IgG, and (g) continued 0.2 ⁇ m filtration and dilution using formulation buffer (10 mM sodium pyrophosphate-HCl, pH 8.0). Specific binding of the binding
• the binding agent was purified from the growth media by (a) clarification of the growth medium by microfiltration using a 0.22 ⁇ m filter, (b) anion exchange chromatography on Q Sepharose ® FF (Amersham Pharmacia Biotech) in 50 mM Tris, pH 8.0 with a NaCl gradient from 40 mM at equilibrium to 130 mM at elution, This was followed by 0.22 ⁇ m microfiltration, (c) affinity chromatography on Protein A Sepharose ® FF (Amersham Pharmacia Biotech) with elution occurring after change in buffer from 1.0 M glycine, 3.0 M NaCl, pH 8.8 for equilibration to elution buffer containing 200 mM glycine, 150 mM NaCl, pH 2.8, (d) incubation at pH 3.5 for 40 minutes, (e) nanometer filtration on Viresolve filter (Millipore Corporation), followed by 0.22 ⁇ m microfiltration,
• Purified binding agent was then activated in the following manner. Bulk fluid of purified binding agent (5 mg/ml in low molarity phosphate, pH 5-10) was exposed, compounded with excipient (stannous chloride) and reducing agent (sodium pyrophosphate) to 200-400 nm radiation, 90% at 300 nm +/- 20 nm from eight lamps at 3-9 watts per lamp to yield activated binding agent.
• the activated binding agent was supplied in vials containing 2 mg of the activated binding agent in frozen or lyophilized form together with the same reducing agent and buffer complex. Preparation of the final formulation was performed under aseptic conditions not more than 4 hours prior to the administration of the binding agent.
• the binding agent was prepared by the following procedure using aseptic methods.
• the tissue reactivity of a binding agent according to Example 2 was tested by immunohistochcmical procedures using the avidin-biotin amplified immunoperoxidase technique of staining frozen tissues.
• the binding agent was used to examine the expression and distribution of the MUCl antigen in a selected panel of normal human tissues and human tumors and to determine the optimal concentration of antibody or final product for specific staining of MUCl -expressing tissues. Specific staining was observed in tumor cells of breast, colon and lung as well as in epithelial cells of normal breast, kidney, large intestine and lung.
• the binding agent of Example 2 possesses variable regions specific for antigen (MUCl) recognition known as idiotypes. These variable regions are themselves immunogenic and can generate a series of anti-idiotypic antibodies known as Ab2. Some of these Ab2 can effectively mimic the three-dimensional structure or the peptide sequence of the original antigen (MUCl) and can be used to generate specific immune responses similar to those induced by the original antigen. Accordingly, administration of the binding agent is expected to generate antigen mimics or internal image antibodies in the form of Ab2, which can generate the specific anti-MUCl immune response.
• mice were immunized with binding agent conjugated to KLH (Keyhole Limpet Hemocyanin), in combination with RAS adjuvant (RIBI Adjuvant System). KLH and the adjuvant were included in these experiments to enhance the normally weak immune response in a mouse to a mouse antibody (as antigen).
• An isotype- matched antibody served as a control.
• sera were analyzed in a sandwich assay using F(ab') 2 fragments of binding agent on the solid phase. Bound murine antibodies were detected by goat anti-mouse IgG-(F c -specific)-HRP as a tracer.
• Anti-anti-idiotypic antibodies could be detected in the sera of mice immunized with binding agent versus the control sera. Similar to the Ab2 levels, the Ab3 levels reached their peak after six injections. In addition, a murine monoclonal Ab2 generated against binding agent was used in turn to generate anti-anti-idiotypic (Ab3) antibodies in rats. Two out of the three rats thus immunized demonstrated positive binding to the murine monoclonal Ab2. Generation of anti-MUCl antibodies in a different species was considered to be an important criterion for classification of an Ab2 ⁇ , in addition to the ability to inhibit the binding between Abl and Ab2 by the nominal antigen, i.e. MUCl .
• T cell proliferation studies showed a specific response to the injected binding agent according to Example 2 and MUCl, indicating the presence of idio type-specific T cells (T2) and anti-idiotype-speci ic T cells (T3).
• T2 idio type-specific T cells
• T3 anti-idiotype-speci ic T cells
• the murine monoclonal Ab2 was also evaluated for its ability to be recognized by MUCl -specific T cells.
• the proliferation of such T cells in response to Ab2 was monitored by ⁇ -Thymidine uptake and compared to MUC 1.
• the assay was performed as a 3 H-Thymidine uptake study. Spleens were removed from each group of immunized mice and the lymphocytes were separated from red blood cells on Histopaque 1077 (Sigma).
• Cells were seeded at a concentration of 2 x 10 " cells/well in 100 ⁇ L of AIM-V serum free medium (Gibco) into a 96-well U-bottomed plate (Becton Dickinson). The stimulants were added in triplicate and incubated with the cells for 3 days. The cells were pulsed with 1 ⁇ Ci [ 3 H-methyl] Thymidine per well for 24 hours. The cells were harvested in a cell harvester (Skatron) and the radioactivity assayed in a beta counter (Beckman). Stimulators included MUC-1, MUC-1 peptide, anti-MUC-1 antibodies, control antibodies and phytohemagglutinin (PHA). Ab2 and MUCl show similar reactivity providing further evidence of the cellular immune response.
• AIM-V serum free medium Gibco
• PHA phytohemagglutinin
• the dose response of binding agent according to Example 2 for the development of rat anti-murine antibodies (RtAMA) and rat anti-idiotypic antibodies (Ab2) was investigated in normal rats.
• Male Sprague-Dawley rats were immunized with binding agent at doses ranging from 26 ⁇ g to 213 ⁇ g by intravenous administration and one dose at 106 ⁇ g by subcutaneous administration. Immunizations were performed five times at intervals of 2 weeks. Baseline and test serum samples (one week following injection) were obtained from each rat.
• Two ELISA assays were developed to measure RtAMA and Ab2.
• the RtAMA ELISA measures the amount of antibody that binds to the constant region of a Mouse IgGl antibody.
• the Ab2 ELISA measures the amount of antibody reactive with the binding region of the binding agent.
• a dose of 53 ⁇ g (1.3 mg/m 2 ) appeared to be optimal in inducing RtAMA via intravenous injection. Injection of the antibody subcutaneously with adjuvant induced much stronger responses, three times higher than the same dose injected intravenously and two times higher than the most effective intravenous dose (1.3 mg/m 2 ).
• a dose of 1.3 mg/m 2 induced a persistent RtAMA response. Higher doses seem to induce anergy, since the response decreased with increasing number of injections at 2.6 mg/m 2 and no response was obtained with the highest dose tested (5.2 mg/m 2 ).
• Binding agent also induced an anti-idiotypic response, however, the response was not proportional to the dose injected. It was observed that the same dose effective for RtAMA was also the optimum dose for induction of anti-idiotypic antibodies. In the intravenous dosing schedule, a dose of 1.3 mg/m 2 was the only dose effective in inducing a strong Ab2 response. Using a subcutaneous injection of the antibody produced a better response, with a subcutaneous dose of 2.6 mg/m 3 inducing the strongest Ab2 response overall. Overall, correlation was observed between the RtAMA and Ab2 responses, showing optimum responses for the same intravenously administered doses. However, the absolute amounts of Ab2 and RtAMA cannot be directly compared.
• RtAMA could be detected as early as week 6 after the first immunization and Ab2 at week 4 (subcutaneous immunization) or week 10
• intravenous immunization The intravenous route required more immunizations to induce an immune response than the subcutaneous route. This weaker immune response may be due to the reduced immunogenicity of mouse proteins in this related species, rats. From these experiments, it appears that the suggested dose for therapeutic treatment is about 2 mg per patient, not taking into account any effect of circulating antigen on the immune response.
• Rabbits were used to more closely approximate the response seen in humans (recognition as foreign) to murine MAbs than either rats or mice. Rabbits were immunized with various amounts of the antibody and serum samples were analyzed for Ab2 and Rabbit- Anti Mouse Antibodies (RAMA).
• Female New Zealand White rabbits were immunized with binding agent according to Example 2 at three dose levels (125, 250 and 500 ⁇ g) by intravenous administration and one dose (125 ⁇ g) by subcutaneous administration. Baseline and test serum samples (obtained approximately every 2 weeks) were obtained from each rabbit. Two ELISA assays were developed to measure RAMA and Ab2.
• the RAMA ELISA measures the amount of antibody that binds to the constant region of a Mouse IgGl antibody.
• the Ab2 ELISA measures the amount of antibody reactive with the binding region of the binding agent.
• the RAMA response represents the humoral response of the host to the constant regions of the injected murine antibody.
• a dose of 0.575 mg/m " was injected subcutaneously as a positive control. Three different doses were injected intravenously: 0.575, 1.15 and 2.3 mg/m 2 .
• the RAMA response was strongest in rabbits injected intravenously with 250 ⁇ g/rabbit of MAb-ALT- 1, followed by the subcutaneous injection of 125 ⁇ g/rabbit, the intravenous injection of 500 ⁇ g/rabbit and the intravenous injection of 125 ⁇ g/rabbit.
• the binding agent induced an immune response in rabbits as both Ab2 and RAMA were found in samples from the first to last bleed.
• a dose of 250 ⁇ g/rabbit (1.15 mg/m 2 , equivalent to 2 mg / 60kg patient) induced the highest responses for both types of antibody, Ab2 and RAMA.
• the induced Ab2 could be inhibited by MUCl but not the MUCl peptide or CA19.9.
• the binding agent also induced an anti-idiotypic response in rabbits; however, the Ab2 response was not directly correlated with the dose injected. It was observed that a dose of 250 ⁇ g/rabbit gave the highest Ab2 response of the three intravenously administered doses. Subcutaneous injection of the antibody at 125 ⁇ g/rabbit induced the strongest Ab2 response overall. The induced Ab2 competed with MUCl but not the MUCl peptide at the concentrations examined. It is interesting to note that the route of administration affects the type of immune response. The Ab2 response was strongest in subcutaneously immunized rabbits, whereas the general RAMA response was best in rabbits injected intravenously.
• Example 8 Initial tumor treatment studies Tumor cells used in the animal model should have both host compatibility and MUCl expression. Only a MUCl gene transfected mouse tumor cell line qualifies as a model in mice. Two MUCl transfectoma cell lines, MT and 413BCR were evaluated.
• Both of these cell lines are derived from the mouse mammary carcinoma cell line 410.4 and were transfected with the full length MUCl gene containing more than 20 tandem repeat epitopes. Both cell lines are compatible with BALB/c and CBGF1 mice. These cell lines highly express the MUC 1 antigen as analyzed by binding of binding agent according to Example 2 to these cells by FACS analysis. MT cells were injected intravenously into CB6F1 mice and implanted in the lungs. Tumor foci appeared in the lungs 30-40 days after injection and the mice died at 50-60 days without treatment. Histopathological analysis also confirmed tumor in the lung and MUCl expression on the tumor tissue.
• This cell line does not form tumors subcutaneously, even when injected at a relatively high concentration of 2 x 10 7 cells per mouse.
• BALB/c mice were injected subcutaneously in the flank or mammary fat pad at various cell concentrations (2.5 - 5 x 10 6 cells per mouse). Tumors developed within 10-15 days and there was a lower rejection rate when the tumors were transplanted into the mammary fat pad.
• tumors were measured for tumor volume according to the formula: (a x b 2 )/2, where a represents the longest diameter and b represents the shortest diameter.
• the tumor tissue was removed from the lungs, cut into small pieces and digested with trypsin for 10 minutes. The tumor cells were then cultured for three days and FACS analysis was performed. The results indicated that more than 80% of the MT transfectoma cells were expressing the MUCl antigen after 1 month of growth in vivo.
• the binding ability of the antibody- KLH conjugate (KLH was used to increase the immunogenicity of the murine antibody in mice) to the MUCl antigen was measured by two methods, ELISA and RIA, and demonstrated the ability of the immunogens to recognize their targets in vivo. Two different types of adjuvants, RAS (RIBI Adjuvant System) and Quil A were employed in these studies.
• RAS is a stable oil-in-water emulsion containing highly purified bacterial components from Mycobacterium tuberculosis, the organism that is the major component in Freund's Complete Adjuvant (FCA).
• FCA Freund's Complete Adjuvant
• Quil A is a surface-active agent used as an alternative but can only be injected subcutaneously. Both adjuvants were used in separate experiments. Serum samples obtained throughout the experiments were analyzed by ELISA for Ab2 and / or Ab3 content.
• a lymphocyte proliferation assay was performed by determination of H- Thymidine uptake by a standard protocol using lymphocytes isolated from the spleens of immunized mice. Stimulants included MUCl, MUCl peptide, anti-MUCl antibodies, control antibodies and phytohemagglutinin (PHA).
• mice were sacrificed and the number of tumor foci in the lungs was analyzed by a direct counting technique. Additionally, in a select group of mice, 125 I-deoxy-Uridine was injected into the mice 4 hours prior to animal termination. The lungs were assayed for radioactivity in a gamma counter to enumerate tumor burden. The immune responses and efficacy of binding agent, binding agent- KLH, binding agent-hlgG and binding agent-MUCl complex were analyzed in both tumor-bearing BALB/c and tumor-bearing CB6F1 mice.
• the first series of experiments evaluated the effect of a conjugate of binding agent according to Example 2 (KLH) or a complex (binding agent-MUCl) on the induction of a humoral response (anti-mouse antibody, Ab2 and Ab3), a cellular response (T cell proliferation) as well as the effect of these compounds on tumor growth and/or size.
• Mice were implanted with 413BCR tumor cells 2 weeks after the start of the immunization series (either subcutaneous, intravenous or a combination of both routes). It was found that that a humoral response is induced in mice treated with both the conjugated and complexed binding agent.
• T2 T2 cellular response to the binding agent was induced in these mice, but the T3 population (responsive to MUCl or MUCl peptide) was not obvious (T2 are Abl idio type- specific T cells and T3 are Ab2 idiotype-specific T cells).
• T2 are Abl idio type- specific T cells and T3 are Ab2 idiotype-specific T cells.
• a trend for reduction in tumor mass and size in mice treated with conjugated or complexed binding agent was also demonstrated, although statistical significance was not demonstrated in these studies.
• Example 10 Microsphere-encapsulated binding agent Since liposomal formulations of antibodies can augment idiotypic responses, this study was performed to investigate the immune responses of microsphere- encapsulated binding agent administered to human breast tumor-bearing mice. Binding agent was incorporated into PLGA microspheres by a double-emulsion technique. Each BALB/c mouse received an inoculation of 5 x 10 6 413BCR tumor cells subcutaneously on Study Day 0. One week later, the mice, in groups of 4 animals, were divided into the following treatment groups,: PBS, IgG-KLH, binding agent-KLH, microspheres (MS), binding agent-Monophosphoryl Lipid A microspheres (MPLA-MS), and MUC-1.
• Microsphere encapsulated binding agent induced a superior idiotypic immune response to that of binding agent conjugated with KLH or in complex with MUC-1. Microsphere encapsulated binding agent showed some suppression of tumor growth, but statistical significance not was achieved. This may be due to the fact that mice were not pre- immunized with the antibody in this experiment.
• Example 11 Specificity for tumor-associated MUC-1
• the biological disposition of 99m Tc- labeled binding agent was also determined through its administration to immunodeficient (nude) mice implanted with cultured human breast cancer (ZR-75-1) cells. These cells have been previously tested and the expression of MUCl antigen has been confirmed.
• the 99m Tc-labeled binding agent was injected intravenously (20 ⁇ Ci of 99m Tc on 20 ⁇ g of binding agent) and the animals were sacrificed at 3, 6 and 24 hours post injection as per standard protocol. The organs and tissues of interest were removed and assayed for radioactivity in a gamma counter.
• a second non-MUCl reactive antibody of the same subclass (“"Tc- labeled MOPC-21) was similarly tested in another group of animals at 6 and 24 hours post injection.
• the overall pattern of biodistribution between the two antibodies was similar for most organs with the exception of higher liver and spleen uptake for ""Tc- labeled MOPC-21. This is most likely due to the higher amount of 99m Tc high molecular weight aggregates present in the preparation, and significantly higher uptake of 99m Tc-labeled binding agent in the tumor site.
• the difference in the mean tumor uptake of the two radiolabeled MAbs was analyzed using an unpaired two- tailed t-test and found to be statistically significant (p ⁇ 0.001) at both 6 and 24 hours post injection.
• the non-specific tissue localization of 99m Tc-labeled binding agent appears to be typical to that of other similarly prepared Igd murine monoclonal antibodies.
• This uptake is representative of normal tissue accumulation processes, such as those associated with tracer distribution and antibody metabolism, and is reflected in the high liver, blood and kidney values respectively.
• the tumor uptake values represent an almost 5 fold increase in target tissue accumulation for the ""Tc- labeled binding agent relative to the "Tc-labeled MOPC-21 preparation at 24 hours post injection. This highly significant difference is almost certainly indicative of preferential 99 ⁇ Tc-labeled binding agent retention due to specific antigen binding within MUCl expressing tumor xenograft tissue.
• Example 12 Preferential binding of glycosylated MUC-1 ZR-75-1 cells, which express MUC-1 glycoprotein on their surface were deglycosylated by treatment with 4mM Phenyl-N- ⁇ -D-Glucosamide at 37 °C for 48 hr. Binding of the binding agent according to Example 2 was compared for the untreated and deglycosylated MUC-1 by FACScan analysis using AIM or a control antibody (SM3) known to bind an all peptide epitope of MUC-1. As shown in Table 1, there was a slight preference in binding for the untreated MUC-1. These results demonstrate that the binding agent binds an epitope that includes at least some carbohydrate.
• tumor cells The ability of tumor cells to act as antigen-presenting cells to stimulate T-cells specific for Alt-1 was assessed as follows. 413BCR cells were incubated with PHA medium (positive control), Alt-1, hlgG, Alt-1 conjugated to hlgG, mouse anti-human antibodies (MAHA), or , AIM conjugated to hlgG and mouse anti-human antibodies (MAHA) at 37°C for 24 hours. Tumor cells were used as APC to stimulate purified T cells obtained from mice immunized with hlgG. T cell proliferation was measured using [ 3 H] -thymidine uptake. The results are shown in Figure 3. Only the Alt-1 conjugated to hlgG and mouse anti-human antibodies (MAHA)-treated cells.
• binding agents according to the invention can produce both an anti-idiotypic and a cellular response, and that this response is effective in the treatment of tumors.
• Example 14 Treatment of hPBL-reconstituted tumor-bearing SCID mice SCID/BG mice were injected with 10 7 hPBLs that had been stored at 80°C. Blood was collected from the mice on day 12 and tested for the presence of hlgG to determine if the mice were reconstituted. Five out of seven injected mice were reconstituted. Reconstituted mice were treated i.p. with PBS or lOO ⁇ g Alt-1 or a control IgGl on day 0, with repeated treatments on days 7 and 14. On day 17, the mice were implanted s.c. with 5x 10 6 tumor cells (NIH OVCAR-3) + 20% matrigel. The mice were bled on day 21, and treated i.v.
• Example 15 Preparation of a binding agent conjugated to hypocrellin
• the long circulating, sterically stabilized HBBA-R2 liposome (SL) and immunoliposome (SIL) formulations are composed of DPPC/maleimide-PEG2000- DSPE (94:6 molar ratio) and DSPC/Cholesterol/maleimide-PEG2000-DSPE (64:30:6 molar ratio) respectively.
• Control HBB A-R2 liposomes (CL) are composed of DPPC/DPPG (9:1 molar ratio).
• DSPC, DPPC, DPPG and Cholesterol were purchased from Avanti Polar Lipids (Alabaster, AL, USA) and maleimide-PEG2000-DSPE was purchased from Shearwater Polymers Inc. (Huntsville, AL, USA).
• hypocrellins utilizes art- recognized procedures (see e.g., international application no. PCT/US98/00235). Two methods were used to load hypocrellins into liposomes.
• HBBA-R2 was either loaded into pre-formed SL and SIL by a solvent injection method at a 15:1 lipid to drug molar ratio or loaded into CL (15:1 lipid:drug) by a solvent dilution method.
• the lipids and drug are first mixed together from stock solutions in organic solvent then dried. Methanol was added to give a final lipid concentration of 200mM. Liposomes were formed when the lipid/drug solution was slowly diluted to lOmM lipid at 65°C with the addition of 500 ⁇ l aliquots of heated buffer (20mM HEPES 140mM NaCl, pH 7.4). The resulting liposomes were purified by gel filtration using Sephadex G50 and eluting with the above buffer.
• (HBBA-R2)-SL liposomes are first prepared by hydrating a dried thin film to a final concentration of lOmM lipid 20mM MOPSO 140mM NaCl, pH 6.7.
• HBBA-R2 (lOmM in PEG300) is heated to 65°C and injected, drop wise, into a 65°C solution of liposomes, incubated for 15 minutes.
• the resulting hypocrellin-liposomes were extruded through 80nm polycarbonate membranes using a Lipex Biomcmbrancs (North Vancouver, BC) extrusion device to give an average vesicle size of lOOnm.
• Immunoliposomes were produced as follows: The antibody was first dissolved in 20mM pyrophosphate buffer (pH8.0) then incubated with 30 molar excess of 2- iminothiolane for 1 hour at 22°C. The thiolated antibody was purified and the pH lowered by gel chromatography using 20mM MOPSO 140mM NaCl, pH 6.7 buffer. The thiolated antibody was incubated at a concentration of 25-50 ⁇ gMAb/ ⁇ mole lipid overnight at 22°C with a portion of the maleimide-liposomes described above.
• Both sets of liposomes with and without bound antibody were purified by gel filtration, using Sepharose CL-4B and eluting with 20mM HEPES 140mM NaCl, pH 7.4 buffer. Approximately 90-95% of the antibody was bound to the liposomes.
• the hypocrellin-liposomes solutions were concentrated using Sartorious AG.
• the long circulating, sterically stabilized HBBA-R2 and HBEA-R1/2 liposome (SL) and immunoliposome (SIL) formulations are composed of DPPC/maleimide-PEG2000-DSPE (94:6 molar ratio) and DSPC/Cholesterol/maleimide-PEG2000-DSPE (64:30:6 molar ratio) respectively.
• Control HBBA-R2 liposomes (CL) are composed of DPPC/DPPG (9:1 molar ratio).
• DSPC, DPPC, DPPG and Cholesterol were purchased from Avanti Polar Lipids (Alabaster, AL, USA) and maleimide-PEG2000-DSPE was purchased from Shearwater Polymers Inc.
• HBBA-R2 was loaded into pre- formed SL and SIL by a solvent injection method at a 15:1 lipid to drug molar ratio.
• HBBA-R2 was loaded into CL (15: 1 lipid:drug) and HBEA-R1/2 was loaded into SL and SIL (2: 1 lipid:drug) by a solvent dilution method.
• liposomes are first prepared by hydrating a dried thin film, of various lipids, to a final concentration of lOmM lipid with either 20mM HEPES 140mM NaCl, pH 7.4 for SL preps or 20mM MOPSO 140mM NaCl, pH 6.7 for SIL preps.
• the drug dissolved in solvent (approx. 10-20mM in mcthanol or approx. 5-10mM in PEG300), is heated to 65°C and injected, drop wise, into a 65°C solution of liposomes.
• solvent dilution method the lipids and drug are first mixed together from stock solutions in organic solvent then dried. Either methanol or PEG300 was then added to give a final lipid concentration of 200mM or 50mM respectively.
• Liposomes were formed when the lipid and drug solution was slowly diluted to lOmM lipid at 65°C with the addition of small aliquots of heated buffer (20mM
• hypocrellin-liposomes are extruded through 80nm polycarbonate membranes using a Lipex Biomembranes (North Vancouver, BC) extrusion device to give an average vesicle size of lOOnm.
• the liposomes are then purified by gel filtration and assayed for lipid and drug concentrations. The final lipid to drug molar ratio of 20: 1 was typically obtained for all formulations.
• Immunoliposomes were produced as follows: The antibody was first dissolved in 20mM pyrophosphate buffer (pH8.0) then incubated with 15-30 molar excess of 2- iminothiolane for 1 hour at 22°C. The thiolated antibody was purified and the pH lowered by gel chromatography using 20mM MOPSO 140mM NaCl, pH 6.7 buffer.
• the thiolated antibody was incubated at a concentration of 25-50 ⁇ gMAb/ ⁇ mole lipid overnight at 22°C with maleimide-liposomes (described above). Unbound antibody was removed by gel filtration, eluting with 20mM HEPES 140mM NaCl, pH 7.4 buffer. Approximately 90-95% of the antibody was bound to the liposomes.
• hypocrellin-liposomes solutions were concentrated using
• Centrisart I centrifugal concentrators (100,000 or 300,000 MW cut-off respectively).
• mice were injected with 2 x 10 6 413BCR cells into the right flank s.c.
• mice were injected i.v. at 1 mg/kg. Two hours later, mice were irradiated with a slide projector at >590 nm (red cut-off filter), 40 J/cm 2 , 20 mW/cm 2 . Control mice were not irradiated. The results are shown in Figure 6. These results show that the conjugate according to the invention completely cures the tumor in the presence of light.
• mice were immunized three times before tumor implantation with Alt- 1 binding agent, with PBS, with mouse IgGl or with an unrelated mouse monoclonal antibody (50 ⁇ g in 0.2 ml PBS, i. v.).
• Mice were implanted with MT tumor cell line 410.4, a mouse breast cancer cell line transfected with full-length MUC l DNA.
• the tumor cells were injected i.v., 2 x 10 5 cells/mouse and developed metastases in the lungs.
• the mice were again immunized with Alt- 1 binding agent, with mouse IgGl or with an unrelated mouse monoclonal antibody (50 ⁇ g in 0.2 ml PBS).
• the mice were observed every other day for general condition changes, including weight, eyes and fur. The mice were euthanized if showing signs of being very sick or losing more than 25% of original weight.
• Example 18 Establishment of HAMA response in human patients Seventeen patients were treated with Alt- 1 antibody. Fourteen were female, of which eleven had breast cancer. Other cancers treated were thyroid (1), colon (2), endometrial (1), uterine (1) and salivary (1). AIM was administered by intravenous infusion over 20-30 minutes at week 1, 3, 5, 9, 13 and 17. Dosing was in three cohorts, 1, 2 and 4 mg per patient. For the 1 mg cohort, 2 of 5 patients showed some increase in HAMA, one showed an increase to > 200 ng/ml, and one showed an increase to over 2000 ng/ml.
• HAMA is taken as an indication of the extent of overall immune response generated against the antigen. Accordingly, these results suggest that as little as 1-2 mg of Alt- 1 can induce a powerful immune response.
• Example 18 Levels of Ab2 were taken at the end of the study. Two patients in the 2 mg dose group had Ab2 levels > 1240 U/ml and 1784 U/ml. respectively. One patient in the 4 mg dose group had Ab2 levels > 1102 U/ml. The normal range is 0-200 U/ml.
• Example 21 Formation of Anti-MUC- 1 antibodies Patients were treated as described in Example 18. Levels of anti-MUC-1 antibodies were taken at the end of the study. In the 2 mg dose group two patients exceeded the baseline value by >3x, at 667 U/ml and 2464 U/ml, respectively. Two patients from the 1 mg treatment group and one patient from the 4 mg dose group had anti-MUC-1 antibody levels 3x the baseline level. The normal level is 30-250 U/ml. Taken together, these data indicate that the 2 mg dose is probably optimal.

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