Classifications

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  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/1703—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
  • A61K38/1709—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
• • A—HUMAN NECESSITIES
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  • A61K39/0008—Antigens related to auto-immune diseases; Preparations to induce self-tolerance
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  • A61K40/00—Cellular immunotherapy
  • A61K40/10—Cellular immunotherapy characterised by the cell type used
  • A61K40/11—T-cells, e.g. tumour infiltrating lymphocytes [TIL] or regulatory T [Treg] cells; Lymphokine-activated killer [LAK] cells
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  • A61K40/40—Cellular immunotherapy characterised by antigens that are targeted or presented by cells of the immune system
  • A61K40/41—Vertebrate antigens
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• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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  • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
  • A61P25/16—Anti-Parkinson drugs
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • A—HUMAN NECESSITIES
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/30—Drugs for disorders of the nervous system for treating abuse or dependence
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• • A—HUMAN NECESSITIES
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• • A—HUMAN NECESSITIES
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  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/02—Nutrients, e.g. vitamins, minerals
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
  • A61P7/06—Antianaemics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2239/00—Indexing codes associated with cellular immunotherapy of group A61K40/00
  • A61K2239/31—Indexing codes associated with cellular immunotherapy of group A61K40/00 characterized by the route of administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K2239/00—Indexing codes associated with cellular immunotherapy of group A61K40/00
  • A61K2239/38—Indexing codes associated with cellular immunotherapy of group A61K40/00 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
  • A61K2239/00—Indexing codes associated with cellular immunotherapy of group A61K40/00
  • A61K2239/46—Indexing codes associated with cellular immunotherapy of group A61K40/00 characterised by the cancer treated
  • A61K2239/47—Brain; Nervous system

Definitions

• the nervous system comprises the central and the peripheral nervous system.
• the central nervous system (CNS) is composed of the brain and spinal cord;
• the peripheral nervous system (PNS) consists of all of the other neural elements, namely the nerves and ganglia outside of the brain and spinal cord.
• anti-MBP T cell clones are present in the immune systems of healthy subjects (Burns, 1983; Pette, M. et al, 1990; Martin et al, 1990; Schluesener et al,
• central nervous system injury causes permanent impairment of motor and sensory functions.
• Spinal cord lesions regardless of the severity of the injury, initially result in a complete functional paralysis known as spinal shock.
• spinal shock Some spontaneous recovery from spinal shock may be observed, starting a few days after the injury and tapering off within three to four weeks. The less severe the insult, the better the functional outcome.
• the extent of recovery is a function of the amount of undamaged tissue minus the loss due to secondary degeneration. Recovery from injury would be improved by neuroprotective treatment that could reduce secondary degeneration. For example, alleviation of the effect of glutamate is a frequent target of neuroprotective drug development.
• NMDA N-methyl-D-aspartate
• AMPA alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid
• MK801 One of the most intensely studied NMDA- receptor antagonists.
• NMDA and AMPA receptor antagonists protect against acute brain damage and delayed behavioral deficits. Such compounds are undergoing testing in humans, but therapeutic efficacy has yet to be established.
• Other clinical conditions that may respond to drugs acting on glutamatergic transmission include epilepsy, amnesia, anxiety, hyperalgesia and psychosis (Meldrum, 2000) .
• peptides derived from NS- specific, self-antigens or derivatives of NS-specific antigens that activate T cells, but do not induce an autoimmune disease such as a peptide comprising amino acids 51-70 of myelin basic protein (MBP) .
• MBP myelin basic protein
• Copolymer 1 of average molecular weight 23,000, designated Copolymer 1 or Cop 1
• Copolymer 1 were shown to be highly effective in protecting and suppressing EAE in several animal species (Teitelbaum et al, 1971, 1974a, 1974b) .
• Copolymer 1 in the treatment of MS is in in the achievement of suppression or deactivation of autoimmune T cell reactivity to myelin antigens in multiple sclerosis patients.
• Copolymer 1 is administered without adjuvants by daily subcutaneous injection.
• Cop 1 can serve as an antagonist of the T-cell antigen receptor for the MBP immunodominant epitope (Aharoni, 1998) . It can also bind to various MHC class II molecules and prevent them from binding to T cells with specific antigen-recognition properties (Fridkis-Hareli et al, 1999a). In rodents, Cop 1 induces regulatory cells that probably act as bystander suppressors (Aharoni, 1998) of encephalitogenic T cells. Adoptive transfer of such T cells was found to prevent the development of EAE induced by MBP (Aharoni et al, 1993) , PLP (Aharoni, 1998), or whole spinal cord homogenate (Aharoni et al, 1997).
• Copolymer 1 Compounds related to Copolymer 1 have also been studied and found to have properties similar to Copolymer 1. For example, copolymers composed of three of the four amino acids found in Copolymer 1 bind to purified Class II MHC molecules (Fridkis-Hareli et al, 1999a, WO 005250) . In addition, binding motifs of Copolymer 1 to multiple sclerosis- and rheumatoid arthritis-associated HLA-DR molecules have recently been elucidated (Fridkis-Hareli et al, 1999b) . From these binding motifs, polypeptides of fixed sequence can readily be proposed and tested for binding to the peptide binding groove of the HLA-DR molecules. Such peptides would be expected to act in a way similar to Cop 1 itself. Examples of such synthetic peptides are disclosed in WO 005249.
• the Cop 1-specific activated T cells are used to promote nerve regeneration or to prevent or inhibit the secondary degenerative effects which may follow primary NS injury or the effects of neurodegenerative processes caused by a disease or condition as described in Section (3) hereinafter, but excluding multiple sclerosis.
• Non-limiting examples include glaucoma, stroke, ischemia, gunshot, and cerebral damage caused by dangerous sports.
• the Cop 1- specific activated T cells serve not only to provide neuroprotection against primary and secondary risk factors associated with myelin (white matter) but also against primary and secondary risk factors associated with the neuronal cell bodies themselves (gray matter) in view of the discovered protection against glutamate toxicity.
• Cop 1-specific activated T cells are expected to be useful for the purpose of the present invention and would not have been suggested by known immunotherapy techniques.
• oral administration of Cop 1 or a Cop 1-related peptide or polypeptide antigen is effective for neuroprotection after priming with Cop 1 administered in adjuvant.
• oral Cop 1 can be used to boost the activity of the T cells, subsequent to primary activation of such Cop 1, preferably in adjuvant, to build up a critical T cell response immediately after injury.
• cell banks can be established to store Cop 1 sensitized T cells for neuroprotective treatment of individuals at a later time, as needed.
• autologous T cells may be obtained from an individual.
• allogeneic or semi- allogeneic T cells may be stored such that a bank of T cells of each of the most common MHC-class II types are present.
• autologous stored T cells are used, but, if autologous T cells are not available, then cells should be used which share an MHC type II molecule with the patient, and these would be expected to be operable in that individual.
• the cells are preferably stored in an activated state after exposure to Cop 1 or a Cop 1-related peptide or polypeptide.
• the cells may also be stored in a resting state and activated once they are thawed and prepared for use.
• the cell lines of the bank are preferably cryopreserved.
• the cell lines are prepared in any way which is well known in the art.
• the cells Once the cells are thawed, they are preferably cultured prior to injection in order to eliminate non-viable cells.
• the cells can be activated or reactivated using the Cop 1 antigen or peptide as used in the original activation.
• activation may be achieved by culturing in the presence of a mitogen, such as phytohemagglutinin (PHA) or concanavalin A (preferably the former) . This will place the cells into an even higher state of activation.
• a mitogen such as phytohemagglutinin (PHA) or concanavalin A (preferably the former) . This will place the cells into an even higher state of activation.
• PHA phytohemagglutinin
• Figure 4 is a graph showing how immunization with Cop 1 protects optic nerve fibers from glutamate toxicity.
• Mice were immunized with Cop 1 emulsified in complete Freund' s adjuvant (CFA) and control mice were injected with CFA alone.
• CFA complete Freund' s adjuvant
• One eye of each mouse was then injected with saline alone and the other with saline containing 200 nmoles of glutamate. Seven days after glutamate administration, the retinas were excised and flat-mounted. Labeled (surviving) retinal ganglion cells (RGCs) were counted.
• CFA complete Freund' s adjuvant
• FIG. 8C RGCs survival following glutamate insult and immediate immunization with Cop-1 in adjuvant containing 0.5 mg/ ml of bacteria.
• Fig. 8D Survival of RGCs after immunization performed before, immediately after, or 48 h after glutamate insult. Bars show the pooled results obtained for all mice examined in each treatment, collected from repeated experiments. No effect was seen when immunization was performed 48 h after the insult
• FIG. 9 shows Cop-1 immunization fails to protect mice from NMDA toxicity.
• NMDA 75 nmole
• RGC survival in the Cop-1-immunized mice, expressed as a percentage of survival in a normal eye, was similar to that in the PBS-injected mice (p 0.55, Student's t test), indicating that no neuroprotection was obtained.
• COP 1 SPECIFIC ACTIVATED T CELLS Cop 1-specific activated T cells are T cells which have been activated in the presence of Cop 1 or a Cop 1-related peptide or polypeptide, as defined in Section (2) .
• Such ATCs can be used for treating, i.e., ameliorating or inhibiting, the effects of injury or disease of the CNS or PNS that result in NS degeneration or for promoting regeneration in the NS, in particular the CNS.
• the Cop 1-specific activated T cells are preferably autologous, most preferably of the CD4 and/or CD8 phenotypes, but they may also be allogeneic T cells from related donors, e.g., siblings, parents, children, or HLA-matched or partially matched, semi-allogeneic or fully allogeneic donors .
• HLA class II molecules are shared by most individuals in a population. For example, about 50% of the Jewish population express the HLA-DR5 gene. Thus, a bank of specific T cells reactive to Cop 1 epitopes that are restricted to HLA-DR5 would be useful in 50% of that population. The entire population can be covered essentially by a small number of additional T cell lines restricted to a few other prevalent HLA molecules, such as DR1, DR4 , DR2, etc. Thus, a functional bank of uniform T cell lines can be prepared and stored for immediate use in almost any individual in a given population. Such a bank of T cells would overcome any technical problems in obtaining a sufficient number of specific T cells from the subject in need of neuroprotection during the open window of treatment opportunity. The semi- allogeneic T cells will be safely rejected after accomplishing their role of neuroprotection. This aspect of the invention does not contradict, and is in addition to the use of autologous T cells as described herein.
• the Cop 1-specific activated T cells are preferably non-attenuated, although attenuated Cop 1-specific activated T cells may be used.
• T cells may be attenuated using methods well known in the art, including but not limited to, by gamma-irradiation, e.g., 1.5-10.0 Rads (Ben-Nun et al, 1981b; Ben-Nun et al, 1982); and/or by pressure treatment, for example as described in U.S. Patent No. 4,996,194 (Cohen et al) .
• the Cop 1-specific activated T cells are isolated as described below. T cells can be isolated and purified according to methods known in the art (Mor et al, 1995) . For an illustrative example, see Section ( 6) , Example 1.
• cryopreservation of viable cells or modifications thereof, are available and envisioned for use, e.g., cold metal-mirror techniques. See Livesey et al (1987); Linner et al (1986); see also U.S. Patent No. 4,199,022 by Senken et al, U.S. Patent No. 3,753,357 by Schwartz, and U.S. Patent No. 4,559,298 by Fahy .
• Frozen cells are preferably thawed quickly (e.g., in a water bath maintained at 37-47°C) and chilled immediately upon thawing. It may be desirable to treat the cells in order to prevent cellular clumping upon thawing. To prevent clumping, various procedures can be used, including but not limited to the addition before or after freezing of DNAse (Spitzer et al, 1980), low molecular weight dextran and citrate, citrate, hydroxyethyl starch (Stiff et al, 1983), or acid citrate dextrose (Zaroulis et al, 1980), etc.
• an appropriate activating agent can be added so as to activate the cells, if the frozen cells were resting T cells, or to help the cells achieve a higher rate of activation if they were activated prior to freezing.
• time is available to allow such a culturing step prior to administration as the T cells may be administered as long as a week after injury, and possibly longer, and still maintain their neuroregenerative and neuroprotective effect .
• compositions comprising Cop 1 or a Cop 1-related peptide or polypeptide antigen or derivative thereof can be used for preventing or inhibiting the effects of injury or disease that result in NS degeneration, for promoting nerve regeneration in the NS, particularly in the CNS, for protecting CNS cells from glutamate toxicity, or for treating injury or disease caused or exacerbated by glutamate toxicity. Additionally, Cop 1 or a Cop 1-related peptide or polypeptide antigen or derivative thereof may be used for in vivo or in vi tro activation of T cells.
• methods of promoting nerve regeneration or of preventing or inhibiting the effects of CNS or PNS injury or disease comprise administering Cop 1 or a Cop 1-related peptide or polypeptide antigen or derivative thereof to a mammal wherein the Cop 1 or Cop 1-related peptide or polypeptide antigen or derivative thereof activates T cells in vivo to produce a population of T cells that accumulates at a site of injury or disease of the CNS or PNS.
• Cop 1 or a Cop 1-related peptide or polypeptide antigen or derivative thereof is administered in methods for protecting CNS cells from glutamate toxicity or for treating injury or disease caused or exacerbated by glutamate toxicity.
• the composition may comprise random copolymers comprising a suitable quantity of an amino acid of positive electrical charge, such as lysine or arginine, in combination with an amino acid with a negative electrical charge (preferably in a lesser quantity) , such as glutamic acid or aspartic acid, optionally in combination with an electrically neutral amino acid such as alanine or glycine, serving as a filler, and optionally with an amino acid adapted to confer on the copolymer immunogenic properties, such as an aromatic amino acid like tyrosine or tryptophan.
• Such compositions may include any of those disclosed in WO 005250, the entire contents of which being hereby incorporated herein by reference.
• composition for use in the present invention comprises at least one copolymer selected from the group consisting of random copolymers comprising one amino acid selected from each of at least three of the following groups:
• the copolymer contains four different amino acids, each from a different one of the groups (a) to (d) .
• a preferred copolymer according to this embodiment of the present invention comprises in combination alanine, glutamic acid, lysine, and tyrosine, of net overall positive electrical charge and of a molecular weight of about 2,000 to about 40,000 daltons, preferably of about 2,000 to about 13,000 daltons.
• the most preferred example is Copolymer 1 (Cop 1) of average molecular weight about 4,700 to about 13,000 daltons. Preferred molecular weight ranges and processes for making a preferred form of Copolymer 1 are described in U.S. Patent No.
• the copolymer may be a polypeptide from about 15 to about 100, preferably from about 40 to about 80, amino acids in length.
• the terpolymers for use in the present invention contain tyrosine, alanine, and lysine, hereinafter designated YAK.
• the average molar fraction of the amino acids in these terpolymers can vary.
• tyrosine can be present in a mole fraction of about 0.005 to about 0.250;
• alanine can be present in a mole fraction of about 0.3 to about 0.6;
• lysine can be present in a mole fraction of about 0.1 to about 0.5.
• the average molecular weight is between 2,000 to about 40,000 daltons, and preferably between about 3,000 to about 35,000 daltons. In a more preferred embodiment, the average molecular weight is about 5,000 to about 25,000 daltons.
• the terpolymers for use in the present invention contain tyrosine, glutamic acid, and lysine, hereinafter designated YEK.
• the average molar fraction of the amino acids in these terpolymers can vary: glutamic acid can be present in a mole fraction of about 0.005 to about 0.300, tyrosine can be present in a mole fraction of about 0.005 to about 0.250, and lysine can be present in a mole fraction of about 0.3 to about 0.7.
• the average molecular weight is between 2,000 and about 40,000 daltons, and preferably between about 3,000 and about 35,000 daltons. In a more preferred embodiment, the average molecular weight is about 5,000 to about 25,000 daltons. It is possible to substitute aspartic acid for glutamic acid, arginine for lysine, and/or tryptophan for tyrosine. In another embodiment the terpolymers for use in the present invention contain lysine, glutamic acid, and alanine, hereinafter designated KEA. The average molar fraction of the amino acids in these polypeptides can also vary.
• glutamic acid can be present in a mole fraction of about 0.005 to about 0.300
• alanine can be present in a mole fraction of about 0.005 to about 0.600
• lysine can be present in a mole fraction of about 0.2 to about 0.7.
• the average molecular weight is between 2,000 and 40,000 daltons, and preferably between about 3,000 and 35,000 daltons. In a more preferred embodiment, the average molecular weight is about 5,000 to about 25,000 daltons. It is possible to substitute aspartic acid for glutamic acid, glycine for alanine, and/or arginine for lysine.
• the terpolymers for use in the present invention contain tyrosine, glutamic acid, and alanine, hereinafter designated YEA.
• the average molar fraction of the amino acids in these polypeptides can vary.
• tyrosine can be present in a mole fraction of about 0.005 to about 0.250
• glutamic acid can be present in a mole fraction of about 0.005 to about 0.300
• alanine can be present in a mole fraction of about 0.005 to about 0.800.
• the average molecular weight is between 2,000 and about 40,000 daltons, and preferably between about 3,000 and about 35,000 daltons.
• the average molecular weight is about 5,000 to about 25,000 daltons. It is possible to substitute tryptophan for tyrosine, aspartic acid for glutamic acid, and/or glycine for alanine.
• the mole fraction of amino acids of the terpolymers is about what is preferred for Copolymer 1.
• the mole fraction of amino acids in Copolymer 1 is glutamic acid about 0.14, alanine about 0.43, tyrosine about 0.10, and lysine about 0.34.
• the most preferred average molecular weight for Copolymer 1 is between about 5,000 and about 9,000 daltons.
• the activity of Copolymer 1 for the utilities disclosed herein is expected to remain if one or more of the following substitutions is made: aspartic acid for glutamic acid, glycine for alanine, arginine for lysine, and tryptophan for tyrosine.
• the molar ratios of the monomers of the more preferred terpolymer of glutamic acid, alanine, and tyrosine, or YEA is about 0.21 to about 0.65 to about 0.14.
• the molar ratios of the monomers of the more preferred terpolymer of glutamic acid, tyrosine, and lysine, or YEK is about 0.26 to about 0.16 to about 0.58.
• the terpolymers with a desired molecular weight may be prepared by a process which includes reacting a protected polypeptide with hydrobromic acid to form a trifluoroacetyl-polypeptide having the desired molecular weight profile.
• the reaction is performed for a time and at a temperature which is predetermined by one or more test reactions.
• the time and temperature are varied and the molecular weight range of a given batch of test polypeptides is determined.
• the test conditions which provide the optimal molecular weight range for that batch of polypeptides are used for the batch.
• a test sample of protected polypeptide from a given batch is reacted with hydrobromic acid for about 10-50 hours at a temperature of about 20-28°C.
• the best conditions for that batch are determined by running several test reactions.
• the protected polypeptide is reacted with hydrobromic acid for about 17 hours at a temperature of about 26°C.
• binding motifs of Cop 1 to MS-associated HLA-DR molecules are known (Fridkis-Hareli et al, 1999b), polypeptides of fixed sequence can readily be prepared and tested for binding to the peptide binding groove of the HLA- DR molecules as described in the Fridkis-Hareli et al (1999b) publication.
• Such peptides are those disclosed in WO 005249, the entire contents of which being hereby incorporated herein by reference. Thirty-two of the peptides specifically disclosed in said application are reproduced in Table 1, hereinbelow. Such peptides, and other similar peptides would be expected to have similar activity as Cop 1. However, this can readily be determined by testing for their ability to activate T cells in accordance with the present invention. All of this can be done without undue experimentation. Such peptides, and other similar peptides, are also considered to be within the definition of Cop 1- related peptides or polypeptides and their use is considered to be part of the present invention.
• Copolymer 1 has been approved in several countries for the treatment of multiple sclerosis (MS) under the trade name, COPAXONE®, Glatiramer acetate. COPAXONE® is a trademark of Teva Pharmaceuticals Ltd., Petah Tikva, Israel. Several clinical trials demonstrated that Copolymer 1 is well tolerated with only minor side reactions which were mostly mild reactions at the injection site (Johnson et al, 1995) . (3) THERAPEUTIC USES
• compositions described in Sections (1) through (2) may be used to promote nerve regeneration or to prevent or inhibit secondary degeneration which may otherwise follow primary NS injury, e.g., closed head injuries and blunt trauma, such as those caused by participation in dangerous sports, penetrating trauma, such as gunshot wounds, hemorrhagic stroke, ischemic stroke, glaucoma, cerebral ischemia, or damages caused by surgery such as tumor excision.
• primary NS injury e.g., closed head injuries and blunt trauma, such as those caused by participation in dangerous sports, penetrating trauma, such as gunshot wounds, hemorrhagic stroke, ischemic stroke, glaucoma, cerebral ischemia, or damages caused by surgery such as tumor excision.
• compositions may be used to ameliorate the effects of disease that result in a degenerative process, e.g., degeneration occurring in either gray or white matter (or both) as a result of various diseases or disorders, including, without limitation: diabetic neuropathy, senile dementias, Alzheimer's disease, Parkinson's Disease, facial nerve (Bell's) palsy, glaucoma, Huntington's chorea, amyotrophic lateral sclerosis (ALS), status epilepticus, non-arteritic optic neuropathy, intervertebral disc herniation, vitamin deficiency, prion diseases such as Creutzfeldt-Jakob disease, carpal tunnel syndrome, peripheral neuropathies associated with various diseases, including but not limited to, uremia, porphyria, hypoglycemia, Sjorgren Larsson syndrome, acute sensory neuropathy, chronic ataxic neuropathy, biliary cirrhosis, primary amyloidosis, obstructive lung diseases, acromega
• glutamate protective aspect of the present invention other clinical conditions that may be treated in accordance with the present invention include epilepsy, amnesia, anxiety, hyperalgesia, psychosis, seizures, abnormally elevated intraocular pressure, oxidative stress, and opiate tolerance and dependence.
• glutamate protective aspect of the present invention i.e., treating injury or disease caused or exacerbated by glutamate toxicity, can include post-operative treatments such as for tumor removal from the CNS and other forms of surgery on the CNS .
• Cop 1 immunization has been surprisingly found useful in protecting against glutamate toxicity
• Cop 1 treatment or Cop 1-related T cell treatment in accordance with the present invention will be effective in the treatment of the above listed conditions not only in a late phase when myelin is being affected, but also in the early stages in which the neurons are being attacked by factors which cause an elevation in glutamate levels to toxic levels.
• the present invention is useful for any indication, i.e., chronic or acute neurodegeneration, which is caused or exacerbated by an elevation in glutamate levels, including the early stages of ischemic stroke, Alzheimer's disease, etc.
• the activated T cells or immunization composition comprising Cop 1 or a Cop 1-related peptide or polypeptide of the present invention are used to treat diseases or disorders where promotion of nerve regeneration or prevention or inhibition of secondary neural degeneration is indicated, but excluding multiple sclerosis and neoplasias .
• the compositions of the present invention are administered to a human subject.
• Cop 1 has been used as an agent to achieve suppression or deactivation of autoimmune T cell reactivity to myelin antigens in multiple sclerosis patients.
• Cop 1 has been administered without adjuvants by daily subcutaneous injection.
• Cop 1 is administered to multiple sclerosis patients by the oral route, which is also aimed at inducing suppression of the autoimmune T cell response to myelin antigens.
• these uses of Cop 1 in the prior art of treatment for multiple sclerosis are fundamentally different from the use of Cop 1 for neuroprotection, which is the subject of the present invention.
• neuroprotection is mediated by the activation of autoimmune T cells specifically directed to myelin antigens.
• Cop 1 an agent designed to suppress T cell autoimmunity, should have an effect that requires activation of specific anti-myelin T cell autoimmunity.
• carrier refers to a diluent, adjuvant, excipient, or vehicle with which the therapeutic is administered.
• the carriers in the pharmaceutical composition may comprise a binder, such as microcrystalline cellulose, polyvinylpyrrolidone (polyvidone or povidone), gum tragacanth, gelatin, starch, lactose or lactose monochydrate; a disintegrating agent, such as alginic acid, maize starch and the like; a lubricant or surfactant, such as magnesium stearate, or sodium lauryl sulphate; a glidant, such as colloidal silicon dioxide; a sweetening agent, such as sucrose or saccharin; and/or a flavoring agent, such as peppermint, methyl salicylate, or orange flavoring.
• a binder such as microcrystalline cellulose, polyvinylpyrrolidone (polyvidone or povidone), gum tragacanth, gelatin, starch, lactose or lac
• Methods of administration include, but are not limited to, parenteral, e.g., intravenous, intraperitoneal, intramuscular, subcutaneous, mucosal (e.g., oral, intranasal, buccal, vaginal, rectal, intraocular), intrathecal, topical and intradermal routes.
• parenteral e.g., intravenous, intraperitoneal, intramuscular, subcutaneous, mucosal (e.g., oral, intranasal, buccal, vaginal, rectal, intraocular), intrathecal, topical and intradermal routes.
• Administration can be systemic or local .
• the pharmaceutical preparation may be in liquid form, for example, solutions, syrups or suspensions, or may be presented as a drug product for reconstitution with water or other suitable vehicle before use.
• the pharmaceutical compositions may take the form of, for example, tablets or capsules prepared by conventional means with pharmaceutically acceptable excipients such as binding agents (e.g., pregelatinized maize starch, polyvinyl pyrrolidone or hydroxypropyl methylcellulose) ; fillers (e.g., lactose, microcrystalline cellulose or calcium hydrogen phosphate); lubricants (e.g., magnesium stearate, talc or silica); disintegrants (e.g., potato starch or sodium starch glycolate) ; or wetting agents (e.g., sodium lauryl sulphate) .
• binding agents e.g., pregelatinized maize starch, polyvinyl pyrrolidone or hydroxypropyl methylcellulose
• fillers e.g., lactose, microcrystalline cellulose or calcium hydrogen phosphate
• lubricants e.g., magnesium stearate, talc or silica
• disintegrants
• Preparations for oral administration may be suitably formulated to give controlled release of the active compound.
• compositions may be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion.
• Formulations for injection may be presented in unit dosage form, e.g., in ampoules or in multidose containers, with an added preservative.
• the compositions may take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and may contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
• the active ingredient may be in powder form for constitution with a suitable vehicle, e.g., sterile pyrogen free water, before use.
• compositions may also be formulated in rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter or other glycerides .
• compositions for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas.
• a suitable propellant e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or
• Cop 1-activated T cells a Cop 1 or a Cop 1-related peptide or polypeptide are formulated in accordance with routine procedures as pharmaceutical compositions adapted for intravenous administration to human beings.
• compositions for intravenous administration are solutions in sterile isotonic aqueous buffer.
• the composition may also include a solubilizing agent and a local anesthetic such as lignocaine to ease pain at the site of the injection.
• the ingredients are supplied either separately or mixed together.
• the composition is to be administered by infusion, it can be dispensed with an infusion bottle containing sterile pharmaceutical grade water or saline.
• compositions comprising Cop 1 or Cop 1-related peptide or polypeptide may optionally be administered with an adjuvant in the usual manner for immunization.
• adjuvants include alum and incomplete Freund 's adjuvant.
• Other manners of improving the immunogenicity of the administered peptide or polypeptide include administration in the form of an aggregation or a complex with albumin or with other carriers, all as are well known to those of ordinary skill in the vaccine art.
• Metabolizable lipid emulsions such as
• Cop 1 When Cop 1 is introduced orally, it may be mixed with other food forms and consumed in solid, semi-solid, suspension, or emulsion form; and it may be mixed with pharmaceutically acceptable carriers, including water, suspending agents, emulsifying agents, flavor enhancers, and the like.
• the oral composition is enterically-coated.
• enteric coatings are well known in the art. For example, Lehman (1971) teaches enteric coatings such as Eudragit S and Eudragit L. The Handbook of Pharmaceutical Excipients, 2 nd Ed., also teaches Eudragit S and Eudragit L applications .
• One Eudragit which may be used in the present invention is L30D55.
• Cop 1 may also be administered nasally in certain of the above-mentioned forms by inhalation or nose drops. Furthermore, oral inhalation may be employed to deliver Cop 1 to the mucosal linings of the trachea and bronchial passages.
• the invention also provides a pharmaceutical pack or kit comprising one or more containers filled with one or more of the ingredients of the pharmaceutical compositions of the invention.
• the pharmaceutical compositions of the invention are administered to a mammal, preferably a human, shortly after injury or detection of a degenerative lesion in the NS .
• the therapeutic methods of the invention may comprise administration of Cop 1-activated T cells or Cop 1 or Cop 1-related peptide or polypeptide, or any combination thereof.
• Cop 1 may be administered before, concurrently or after administration of Cop 1-activated T cells.
• mononuclear phagocyte cells according to PCT Publication No. WO 97/09985 and U.S. patent application Serial No. 09/041,280, filed March 11, 1998, are injected into the site of injury or lesion within the CNS, either concurrently, prior to, or following parenteral administration of Cop 1-activated T cells, Cop 1 or a Cop 1- related peptide or polypeptide.
• administration of Cop- activated T cells, Cop 1 or a Cop 1-related peptide or polypeptide may be administered as a single dose or may be repeated, preferably at 2 week intervals and then at successively longer intervals once a month, once a quarter, once every six months, etc.
• the course of treatment may last several months, several years or occasionally also through the life-time of the individual, depending on the condition or disease which is being treated.
• the treatment may range between several days to months or even years, until the condition has stabilized and there is no or only a limited risk of development of secondary degeneration.
• the therapeutic treatment in accordance with the invention may be for life.
• the optimal dose of the therapeutic compositions comprising Cop 1-activated T cells of the invention is proportional to the number of nerve fibers affected by NS injury or disease at the site being treated.
• the dose ranges from about 5 x 10 6 to about 10 7 cells for treating a lesion affecting about 10 5 nerve fibers, such as a complete transection of a rat optic nerve, and ranges from about 10 7 to about 10 8 cells for treating a lesion affecting about 10 6 -10 7 nerve fibers, such as a complete transection of a human optic nerve.
• the dose of T cells can be scaled up or down in proportion to the number of nerve fibers thought to be affected at the lesion or site of injury being treated.
• patients can be treated by administering autologous or semi- allogeneic T lymphocytes sensitized to Cop 1 or a Cop 1- related peptide or polypeptide.
• therapy should be administered as soon as possible after the primary injury to maximize the chances of success, preferably within about one week.
• a bank can be established with personal vaults of autologous T lymphocytes prepared for future use for neuroprotective therapy against secondary degeneration in case of NS injury.
• T lymphocytes are isolated from the blood and then sensitized to Cop 1 or a Cop 1-related peptide or polypeptide. The cells are then frozen and suitably stored under the person's name, identity number, and blood group, in a cell bank until needed.
• autologous stem cells of the CNS can be processed and stored for potential use by an individual patient in the event of traumatic disorders of the NS such as ischemia or mechanical injury, as well as for treated neurodegenerative conditions such as Alzheimer's disease or Parkinson's disease.
• semi-allogeneic or allogeneic T cells can be stored frozen in banks for use by any individual who shares one MHC type II molecule with the source of the T cells.
• Myelin Basic Protein (MBP) from the spinal cords of guinea pigs and ovalbumin (OVA) were purchased from Sigma (St. Louis, MO) .
• the Cop 1 used in the present examples was the COPAXONE® product of Teva Pharmaceuticals (Israel), which product was obtained commercially.
• Mouse monoclonal anti rat T cell receptor was kindly provided by Dr. Boris Reizis. Cy-3 conjugated goat anti mouse IgG (with minimal cross-reaction to rat, human, bovine, and horse serum proteins), was purchased from Jackson ImmunoResearch (West Grove, PA) .
• T cell lines were generated from draining lymph node cells obtained from Lewis rats immunized with the above antigens (Ben-Nun et al, 1981a) .
• the antigen was dissolved in phosphate-buffered saline (PBS) (1 mg/ml) and emulsified with an equal volume of incomplete Freund 's adjuvant (IFA) (Difco Laboratories, Detroit, MI) supplemented with 4 mg/ml Mycoba cterium tuberculosis (Difco) .
• IFA incomplete Freund 's adjuvant
• the cells were washed and activated with the antigen (10 ⁇ g/ml) in stimulation medium containing Dulbecco's modified Eagle's medium (DMEM) supplemented with L-glutamine (2 mM) , 2-mercaptoethanol (5 x 10 ⁇ 5 M) , sodium pyruvate (1 mM) , penicillin (100 IU/ml), streptomycin (100 ⁇ g/ml), non- essential amino acids (1 ml/100 ml), and autologous serum 1% (volume/volume).
• DMEM Dulbecco's modified Eagle's medium
• 2-mercaptoethanol 5 x 10 ⁇ 5 M
• sodium pyruvate (1 mM
• penicillin 100 IU/ml
• streptomycin 100 ⁇ g/ml
• non- essential amino acids 1 ml/100 ml
• autologous serum 1% volume/volume
• the cells were transferred to propagation medium consisting of DMEM, L-glutamine, 2- mercaptoethanol, sodium pyruvate, non-essential amino acids, and antibiotics in the same concentrations as above, with the addition of 10% fetal calf serum (FCS) (volume/volume) and 10% T-cell growth factor derived from the supernatant of concanavalin A (ConA) -stimulated spleen cells (Gillis et al, 1978) .
• FCS fetal calf serum
• ConsA concanavalin A
• T cell lines were grown in propagation medium for 4-10 days before being restimulated with their antigen (10 ⁇ g/ml) in the presence of irradiated (2000 rad) thymus cells (10 7 cells/ml) in stimulation medium.
• the T cell lines were expanded by repeated stimulation and propagation (Ben-Nun et al, 1982) .
• the optic nerve was subjected to crush injury as previously described (Duvdevani et al, 1990). Briefly, rats were deeply anesthetized by intraperitoneal (i.p.) injection of Rompun (xylazine, 10 mg/kg; Vitamed, Israel) and Vetalar (ketamine, 50 mg/kg; Fort Dodge Laboratories, Fort Dodge, IA) . Using a binocular operating microscope, lateral canthotomy was performed in the right eye, and the conjunctiva was incised lateral to the cornea. After separation of the retractor bulbi muscles, the optic nerve was exposed intraorbitally by blunt dissection. Using calibrated cross-action forceps, the optic nerve was subjected to a crush injury 1-2 mm from the eye. Mild and severe crush injuries were inflicted for short-term trials
• Labeling and measurement were carried out as follows: the right optic nerve was exposed for the second time, again without damaging the retinal blood supply. Complete axotomy was performed 1-2 mm from the distal border of the injury site and solid crystals (0.2-0.4 mm diameter) of 4-Di-10-Asp were deposited at the site of the newly formed axotomy. Five days after dye application the rats were killed. The retina was detached from the eye, prepared as a flattened whole mount in 4% paraformaldehyde solution, and examined for labeled RGCs by fluorescence microscopy.
• Anti-MBP T cells were grown for a week in a propagation medium, then washed with PBS and resuspended in stimulation medium. The T cells (0.5 x 10 6 cells/ml) were incubated, in the presence of irradiated thymocytes (10 7 cells/ml), with ConA (1.25 ⁇ g/ml), or with MBP antigen (10 ⁇ g/ml), or with Cop 1 antigen (10 ⁇ g/ml), or with OVA antigen (10 ⁇ g/ml), or with no antigen, in stimulation medium at 37 °C, 98% relative humidity and 10% C0 2 .
• irradiated thymocytes (10 7 cells/ml) alone were incubated in stimulation medium. After 48 hours the cells were centrifuged and their supernatants were collected and sampled. Concentrations of neurotrophin (NT) -3, nerve growth factor (NGF) , and NT-4/5 in the samples were determined by the use of sandwich enzyme-linked immunosorbent assay (ELISA) kits (Promega, Madison, WI ) and comparison with a NT standard (absorbance measurement at 450 nm using an ELISA reader) . Concentrations of brain-derived neurotrophic factor (BDNF) in the samples were determined with a sensitive sandwich ELISA.
• ELISA sandwich enzyme-linked immunosorbent assay
• 96-well flat-bottomed plates were coated with a chicken anti-human BDNF antibody (Promega, Madison, WI) in 0.025 M NaHC0 3 and 0.025 M Na 2 C0 3 (pH 8.2).
• Recombinant human BDNF used as standard; Research
• Bound BDNF was detected by incubating the plates with a mouse anti-human BDNF antibody (Research Diagnostics) and then with peroxidase-conjugated goat anti- mouse IgG (Jackson ImmunoReasearch, West Grove, PA) in blocking solution.
• the plates were developed using a 3, 3' , 5, 5' -tetramethyl-benzidine liquid substrate system (Sigma, St. Louis, MO) .
• Immunohistochemis try Longitudinal cryosections (10 ⁇ m thick) of the nerves were picked up onto gelatin- coated glass slides and frozen until preparation for fluorescence staining. The sections were fixed in ethanol for 10 min at room temperature, washed twice with double- distilled water, and incubated for three minutes in PBS containing 0.05% Tween-20. Sections were then incubated for one hour at room temperature with mouse anti-rat monoclonal antibodies to TCR (Hunig, 1989) diluted in PBS containing 3% FCS and 2% BSA.
• the sections were then washed 3 times with PBS containing 0.05% Tween-20 and incubated with Cy3- conjugated goat anti-mouse IgG (with minimal cross-reaction to rat, human, bovine, and horse serum proteins; Jackson ImmunoResearch, West Grove, PA) for 1 h at room temperature.
• the sections were washed with PBS containing Tween-20 and treated with glycerol containing 1, 4-diazobicyclo- (2, 2 , 2 ) octane to inhibit quenching of fluorescence.
• the sections were viewed with a Zeiss Universal fluorescence microscope .
• the laboratory of the present inventors has previously shown that the passive transfer of anti-MBP T cells into crush-injured rats is followed by a massive accumulation of the injected T cells at the site of injury.
• the passive transfer of Cop 1-reactive T cells in the present study also caused a significant accumulation of the injected T cells at the site of injury relative to the accumulation of endogenous anti-MBP T cells in the PBS-treated injured rats.
• T cell accumulation in the Cop 1-treated rats was greatest on day 7 after the injection.
• T cell supernatants in the present study were subjected to ELISA to determine the neurotrophin (NT) profiles of T cells responsible for neuroprotection.
• the Cop 1-stimulated T cells secreted both NGF and NT-4/5, but in lower amounts than those secreted by the anti-MBP T cells. Relative to the production by anti-MBP T cells, the production of NT-3 by the Cop 1-stimulated T cells was insignificant; the production of BDNF, however, was massive (Fig. 2A) .
• Cop 1- stimulated T cells produced smaller amounts of all of the examined neurotrophic factors, with the notable exception of BDNF (Fig. 2A) .
• BDNF BDNF
• Four independent determinations of the amounts of NT-3 and BDNF secreted by the differentially stimulated T cells yielded similar results.
• Cop 1-stimulated T cells produced about 2.5-fold more BDNF than anti-MBP T cells, and only 10% of the amounts of NT-3 (Fig. 2B) .
• EXAMPLE 2 VACCINATION WITH COP 1
• EXAMPLE 3 PROTECTION FROM GLUTAMATE TOXICITY
• Experiment 1 Vaccination with Cop 1 Protects Optic Nerve Fibers from Glutamate Toxicity
• mice Ten days after immunization, the mice were anesthetized, and 1 ⁇ l of saline containing 200 nmoles of glutamate was injected into the vitreous of the right eye. The left eye was not injected and served as a control .
• Fluorochrome, Dever, CO was then applied (1 ⁇ l, at a rate of 0.5 ⁇ l/min) using a Hamilton syringe.
• MMOG MMOG
• MBP MBP
• Moalem et al . , 1999a; Moalem et al . , 1999b and Fisher et al . , 2000 is shown not to protect the neurons from the toxicity caused by glutamate. Protection from glutamate toxicity was achieved, however, by vaccination with Cop-1. Immunization with Cop-1 was further shown to provide highly effective protection from retinal ganglion cell death induced by ocular hypertension in the rat model of glaucoma, under conditions where the pressure remains high and is not affected by the immunization.
• mice of the C57BL/6J, and Balb/c strains, aged 8-13 weeks, and inbred adult Lewis rats aged 8-12 weeks were supplied by the Animal Breeding Center of the Weizmann Institute of Science and housed in light- and temperature- controlled rooms. The rats were matched for age and size in each experiment. Prior to their use in experiments, animals were anesthetized by intraperitoneal administration of ketamine 80 mg/kg and xylazine 16 mg/kg.
• GQFRVIGPGHPIRALVGDEAEL SEQ ID NO: 33
• mice or rats were immunized with 75 ⁇ g or 100 ⁇ g of Cop-1, respectively, or 300 ⁇ g pMOG emulsified with an equal volume of complete Freund' s adjuvant (CFA) containing 0.5 or 5 mg/ml Mycobacterium tuberculosis .
• CFA complete Freund' s adjuvant
• the emulsion (total volume 0.15 ml) was injected subcutaneously at 1 site in the flank.
• the mice immunized with pMOG were given an identical immunization in the other flank as a booster.
• Control mice were injected with phosphate-buffered saline (PBS) in CFA (Difco, Detroit, Michigan, USA) .
• PBS phosphate-buffered saline
• Crush inj ury of the optic nerve Mice or rats were anesthetized and subjected to severe crush injury in the intraorbital portion of the optic nerve, 1-2 mm from the eyeball. With the aid of a binocular operating microscope, the conjunctiva was incised and the optic nerve exposed. Using cross-action calibrated forceps and taking special care not to interfere with the blood supply, the nerve was crushed for 2 s (mice) or 30 s (rats) .
• mice Pre-inj ury appl ica tion of stereotactic dye in mice .
• the skull was exposed and kept dry and clean using 15% hydrogen peroxide.
• the bregma was identified and marked.
• a hole was drilled above the superior colliculus of each hemisphere (0.292 mm behind and 0.05 mm lateral to the midline) .
• the mice were injected with FluoroGold (5% in saline, Fluorochrome, Denver, CO; 1 ⁇ l) at 1 point in the superior colliculus of each hemisphere, at a depth of 0.16 mm or 0.175 mm (depending on the mouse strain) from the bony surface of the brain.
• the wound was sutured. Retrograde uptake of the dye provides a marker of the living cells.
• mice Assessmen t of retinal ganglion cell survival in mice .
• Mice were given a lethal dose of pentobarbitone (170 mg/kg) . Their eyes were enucleated and the retinas were detached and prepared as flattened whole mounts in paraformaldehyde (4% in PBS). Labeled cells from 4—6 selected fields of identical size (0.7 mm 2 ) were counted. The selected fields were located at approximately the same distance from the optic disk (0.3 mm) to overcome the variation in RGC density as a function of distance from the optic disk. Fields were counted under the fluorescence microscope (magnification x800) by observers blinded to the treatment received by the mouse. The average number of RGCs per field in each retina was calculated.
• the cells were washed and activated with the antigen (10 ⁇ g/ml) in stimulation medium containing RPMI supplemented with L- glutamine (2 mM) , 2-mercaptoethanol (5 x 10 ⁇ 5 M) , penicillin (100 units/ml), streptomycin (100 ⁇ g/ml), and autologous serum 0.5% (vol/vol).
• T-cell line was expanded by repeated stimulation and propagation. Basically the line has a similar phenotype to that previously described (Aharoni et al . , 1997) .
• T cell lines were generated from draining lymph node cells obtained from Lewis rats immunized with the above antigens.
• the antigen was dissolved in phosphate-buffered saline (PBS) (1 mg/ml) and emulsified with an equal volume of incomplete Freund' s adjuvant (IFA) (Difco Laboratories, Detroit, MI) supplemented with 4 mg/ml Mycobacterium tuberculosis (Difco) .
• IFA incomplete Freund' s adjuvant
• IOP was measured once a week using TONO-PEN (Mentor, Norwell, MA), after injecting the rats intramuscularly with the veterinary tranquilizer acepromazine 3.0 mg/kg and applying proparacaine 0.5% topically on the eyes to anesthetize the cornea .
• mice were immunized with pMOG prior to the intravitreal injection of glutamate (200 nmole) .
• glutamate 200 nmole
• the RGC survival rate was assessed 1 week after glutamate injection, no evidence of a beneficial effect of the immunization with pMOG could be detected (Fig. 5A) .
• no beneficial effect was detectable when the glutamate injection was immediately followed by passive transfer of anti-MBP T cells in rats (Fig. 5B) .
• vaccination with pMOG(l-22) was recently shown to induce a neuroprotective response in mice after crush injury of the optic nerve (Fisher et al . , 2000), no such neuroprotection was seen in the present study after the pMOG-vaccinated mice were subjected to glutamate insult .
• Cop-1 immunization protects against glutamate toxicity. While the search for a physiological antigen that might evoke a beneficial immune response to glutamate-induced toxicity is still a prime objective at this stage, the present inventors were interested in finding an antigen that might be used for purposes of exogenous immune system manipulation of the immune response to glutamate. First whether or not glutamate injection causes the RGCs to become accessible to lymphocytes was examined. It was found that large numbers of lymphocytes invade the glutamate-injected eye within 24 h of the glutamate injection (Figs. 6A and 6B) , suggesting that immune manipulation might influence the survival of RGCs following their local exposure to glutamate.
• Adoptive transfer of T cells reactive to Cop-1 protects against glutamate toxicity.
• 5xl0 6 Cop-1- reactive T cells 250 ⁇ l intraperitoneally were passively transferred into mice immediately after injection of glutamate (200 nmole) .
• Cop-1 immunization protects retinal ganglion cells from death induced by ocular hypertension in rats .
• Lewis rats were given 2 laser treatments, 1 week apart, to increase the IOP. Subsequent measurements at the indicated time points over a period of 3 weeks showed that by 2 weeks after the laser treatments the IOP had increased to 30 ⁇ 0.4 mm Hg (mean ⁇ SEM) , and remained at approximately that level thereafter (Fig. 11A) .
• Cop-1 was originally designed to mimic the activity of myelin basic protein (MBP) and to induce the inflammatory demyelinating disease EAE in rodents. It was found, however, to be non-encephalitogenic and even to suppress EAE induced by MBP (Teitelbaum et al . , 1971), proteolipid protein (PLP) (Teitelbaum et al . , 1996), or MOG (Ben-Nun et al . , 1996). Cop-1 prevents the development of EAE in rodents and ameliorates multiple sclerosis in humans. Studies have demonstrated partial cross-reactivity between antibody to Cop-1 and MBP or between T cells directed to these antigens (Webb et al .
• MBP myelin basic protein
• Cop-1 can serve as an antagonist of the T-cell antigen receptor for the immunodominant MBP epitope (Aharoni et al . , 1998). It can also bind to various major histocompatibility complex (MHC) class II molecules and prevent them from binding to T cells with specific antigen-recognition properties (Fridkis-Hareli et al . , 1998) . In rodents, Cop-1 induces the expression of regulatory cells that suppress the encephalitogenic T cells.
• MHC major histocompatibility complex
• Cop 1 is displaying here an effect that is opposite to its known effect; Cop 1 is known as an agent designed to suppress T-cell autoimmunity, whereas here it has an effect that requires activation of specific anti- myelin T-cell autoimmunity.
• T cell-dependent immune neuroprotection achieved by passive or active immunization with Cop-1, is also shown here in the results to be an effective therapy for glutamate- induced toxicity in mice and in a rat model of chronically high IOP.
• Example 3 the induced immune activity protected the cells against death caused by glutamate but not against death caused by NMDA; (v) Cop-1, acting as an immunogen, may induce neuroprotection by a mechanism that does not necessarily require cross-recognition of myelin proteins.
• T cells reactive to MBP were shown in the laboratory of the present inventors to be neuroprotective in rat models of partially crushed optic nerves (Moalem et al . , 1999 and Schwartz et al . , 1999) and spinal cord contusive injury (Hauben et al . , 2000a) .
• the previous findings in the laboratory of the present inventors demonstrated in vivo cross-recognition between Cop-1-reactive T cells and components of CNS myelin (Kipnis et al., 2000a) .
• Example 1 the laboratory of the present inventors examined T-cell immunity to Cop-1 after physical trauma to the white matter, where anti-Cop-1 T cells can cross-react with exposed myelin epitopes .
• the Cop-1-reactive T cells may interact directly with glutamate itself. Such interaction could convert the Cop-1- reactive T cells, or endogenous T cells, to a protective phenotype .
• Cop-1-reactive T cells might interact with the injected glutamate within the vitreous or with microglia-activated cells within the retina is supported by the large numbers of invading lymphocytes observed in the vitreous 24 h after glutamate injection. In mice injected with Cop-1, the invading lymphocytes are likely to include some that are specific to Cop-1. This observation, together with the finding that passive transfer of Cop-1-reactive T cells has a similar effect to that of active immunization with Cop-1, suggests that the effect of the vaccination is indeed mediated by T cells, rather than by humoral immunity or by Cop-1 itself. Because glutamate, being a mediator of secondary degeneration, appears at some distance in time from the primary insult (Yoles et al .
• NMDA neuroprotective
• T-cell-mediated neuroprotection demonstrated in the studies in Example 3 might be applicable to both chronic and acute injuries of CNS nerves in which neurons are vulnerable to degeneration and amenable to neuroprotection (Schwartz et al . , 2000a; Schwartz et al . , 2000b; Doble et al . , 1999; and Grunblatt et al . , 2000).
• a chronic condition, glaucoma is often associated with IOP, and is a leading cause of blindness.
• Fridkis-Hareli et al "Direct binding of myelin basic protein and synthetic copolymer 1 to class II major histocompatibility complex molecules on living antigen- presenting cells - specificity and promiscuity", Proc . Natl. Acad. Sci. USA 91 ( 11 ): 4872-76 (1994).

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