WO2005041991A1 - Leukocyte transplantation - Google Patents

Abstract

Described is the adjunctive prophylactic transplantation of autologous leukocytes, including the use of a leukocyte composition for the manufacture of a medicament for adjunctive prophylactic autotransplantation. The prophylactic autotransplantation may be adjunctive to the treatment or prophylaxis of infection (e.g. opportunistic or nosocomial infection), burn injury; acquired or congenital immunosuppression; asthma; multiple sclerosis, arthritis (e.g. rheumatoid or septic arthritis), chronic illness, joint disease and/or seasonal (e.g. winter or summer) disorders.

Description

LEUKOCYTE TRANSPLANTATION Field of the Invention

The invention relates to adjunctive prophylactic transplantation of autologous leukocytes.

Background to the Invention

A form of therapy has recently been described (see WO 00/29551 and WO 01/88099) in which various tissues (including leukocytes) are removed from a healthy donor and stored in a tissue or cell bank for later autologous transplantation in the event that a need for such autotransplantation arises at some future date. This form of therapy is herein referred to as contingent autologous transplantation (CAT) therapy.

Although it has been recognized that CAT therapy with autologous leukocytes can be used prophylactically (for example, post-operatively in elderly patients to lessen the likelihood of opportunistic infections), its potential as an adjunctive to other forms of treatment has remained unexplored.

The present inventors have now recognized that CAT therapy can be applied as a prophylactic adjunct in the treatment or prophylaxis of certain diseases and conditions. It has been found that transplanted autologous leukocytes can greatly potentiate (and may act in synergy with) the other treatment(s) to effect greatly enhanced prophylaxis.

Summary of the Invention

Accordingly, in a first aspect the invention provides the use of a leukocyte composition for the manufacture of a medicament for adjunctive prophylactic autotransplantation.

In prophylactic autotransplantation may be adjunctive to any other form of medical treatment(s), including for example one or more other drugs, interventions, regimens or physical treatments (such as surgery and/or irradiation). The adjunctive prophylaxis may comprise the concurrent, separate or sequential administration/application of the autologous leukocyte composition and the other medical treatment(s) (for example the other drugs, interventions, regimens or physical treatment(s)).

Thus, in one embodiment the prophylactic leukocyte autotransplantation is adjunctive to the treatment or prophylaxis of: (a) infection (e.g. opportunistic or nosocomial infection); and/or (b) burn injury; and/or (c) acquired or congenital immunosuppression; and/or (d) asthma; and/or (e) multiple sclerosis; and/or (f) arthritis (e.g. rheumatoid or septic arthritis); and/or (g) chronic illness; and/or (h) joint disease; and/or (i) seasonal (e.g. winter or summer) disorders.

The invention finds particular application when the prophylactic leukocyte autotransplantation is adjunctive to the treatment or prophylaxis of immunosuppression associated with AIDS or to the treatment or prophylaxis of an opportunistic infection (for example, adjunctive to prophylactic antibiotic therapy). ) Particularly preferred is prophylactic leukocyte autotransplantation adjunctive to the treatment of opportunistic infections associated vvith AIDS (for example, chronic cryptosporidial infection).

Also particularly preferred is the use of prophylactic leukocyte autotransplantation adjunctive to the treatment of asthma or arthritis (e.g. rheumatoid or septic arthritis) with steroidal compositions (e.g. with corticosteroidal compositions).

Typical seasonal disorders include winter disorders (for example bronchial infections, including influenza infection), and so the prophylactic leukocyte autotransplantation may be adjunctive to the treatment or prophylaxis of influenza infection (or other bronchial infections or disorders). Other seasonal disorders include summer disorders, including those caused or exacerbated by high pollen counts (for example, asthma). In these latter embodiments, the prophylactic leukocyte autotransplantation may be adjunctive to the treatment or prophylaxis of asthma.

In another embodiment, the prophylactic leukocyte autotransplantation is adjunctive to the administration of: (a) an immunostimulant; and/or (b) an immunosuppressant; and/or (c) a cytotoxic agent (e.g. cyclophosphamide, cortisone acetate, vinblastine, vincristine, adriamycin, 6-mercaptopurine, 5-fluorouracil, mitomycin C or chloramphenicol); and/or (d) an antimicrobial (e.g. antibacterial) agent; and/or (e) an antiviral agent (e.g. AZT); and/or (f) a vaccine; and/or (g) an anti-inflammatory agent.

The prophylactic leukocyte autotransplantation may be adjunctive to any antimicrobial agent, including an antiviral, anti-bacterial, anti-protozoal, anti-fungal or anti-parasitic. Particularly preferred is adjunctive use with a prophylactic dose of an antibiotic.

The prophylactic leukocyte autotransplantation may be adjunctive to any anti-inflammatory agent. Particularly preferred is adjunctive use with a steroid, particularly with corticosteroids (or with any steroid which induces immune suppression).

In another embodiment, the prophylactic leukocyte autotransplantation is adjunctive to: (a) chemotherapy; and/or (b) radiotherapy; and/or (c) bone marrow transplantation; and/or (d) haemoablative immunotherapy; and/or (e) surgery; and/or (f) hospitalisation (e.g. long-stay hospitalisation); and/or (g) perioperative intensive care; and/or (h) physical training. The invention finds application as an adjunct to any form of physical training, including sports training. It includes endurance training (for example as preparation for long-distance running), weight training (in preparation for any sport in which muscular strength is important), speed training and stretching. It finds particular application in circumstances where the donor individual is an athelete (for example, a runner, boxer, driver, skier, footballer, rugby player, tennis player, baseball player, hockey player or golf player) in preparation for scheduled competition, when the prophylactic leukocyte autotransplantation may form part of a programme of intense physical training designed to facilitate a scheduled peak in athletic performance whilst preventing (or substantially reducing the risks of) infections or other leukocyte deficiencies which might compromise performance (including for example respiratory, gastric and/or inflammatory disorders). In such cases, particularly preferred is the use of prophylactic leukocyte autotransplantation adjunctive to antibiotic administration (e.g. at a prophylactic dose)..

It is contemplated that the prophylactic leukocyte autotransplantation be used adjunctively with any form of surgery, but the invention finds particular application as an adjunct to surgery selected from: (a) prosthetic joint replacement; and/or (b) abdominal surgery; and/or (c) genitourinary surgery; and/or (d) gynaecological surgery.

In another aspect, the invention provides a pharmaceutical composition comprising a leukocyte composition suitable for autologous transplantation in combination with: (a) an immunostimulant; and/or (b) an immunosuppressant; and/or (c) a cytotoxic agent (e.g. cyclophosphamide, cortisone acetate, vinblastine, vincristine, adriamycin, 6- mercaptopurine, 5-fluorouracil, mitomycin C or chloramphenicol); and/or (d) an antimicrobial (e.g. antibacterial) agent; and/or (e) an antiviral agent (e.g. AZT); and/or (f) a vaccine; and/or (g) an anti-inflammatory agent.

In yet another aspect, the invention provides a method of adjunctive prophylactic autotransplantation comprising the step of administering to a patient in need thereof a composition comprising autologous leukocytes. Detailed Description of the Invention

Definitions

Where used herein and unless specifically indicated otherwise, the following terms are intended to have the following meanings in addition to any broader (or narrower) meanings the terms might enjoy in the art: The term leukapheresis is a term of art used herein to define a procedure involving the selective separation and removal of leukocytes from the withdrawn blood of a donor, the remainder of the blood then being retransfused into the donor.

A leukapheresis device is a term of art defining any device capable of performing leukapheresis, irrespective of the means employed in the device to separate and remove the leukocytes.

the term isolated leukapheresis is used herein to define a novel form of leukapheresis which is performed on an isolated blood sample.

The term isolated blood sample is used herein to define a blood sample which is not in fluid communication with the blood of the donor from which it originated. Thus, in the process of isolated leukapheresis which is applied to isolated blood samples, the leukapheresis device is not in fluid communication with the individual providing the blood sample and/or the remainder of the blood in the sample is not retransfused into the individual.

The term autotransplantation is used herein to define autologous transplantation (autogeneic or self-to-self transplantation), wherein the term autologous is used to indicate that the transplantation is to the same organism (i.e. the same individual) from which the cellular material (e.g. leukocytes) was removed. As used herein, transplantation defines any procedure involving the introduction of cellular material (e.g. leukocytes) into an organism, and so any form of transplantation or grafting known in the art is encompassed.

The term dormancy is used herein to define any state of suspended animation or stasis, and procedures for achieving this are well known in the art, as described below. Any of the known procedures may be used, including cryopreservation. Thus, the leukocytes may be held or maintained in a quiescent, inactive or non- proliferating state.

The term healthy is used herein in relation to an individual donor to indicate that the individual is not suffering from a leukocytic deficiency (as herein defined). Thus, the term healthy as used herein encompasses non- diseased individual donors in a state in which the individual donor is not suffering from any disease or disorder, or is not manifesting any symptoms of said disease or disorder (i.e. is asymptomatic or is in a pre-clinical condition). In particular, term healthy as used herein encompasses individual donors not suffering from, or demonstrating symptoms of, the disease or disorder which it is subsequently intended to treat by the autotransplantation procedure.

The term adjunctive (as applied to the prophylactic leukocyte autotransplantation of the invention) defines uses in which an autologous leukocyte composition is administered together with one or more other drugs, interventions, regimens or physical treatments (such as surgery and/or irradiation). Such adjunctive prophylaxis may comprise the concurrent, separate or sequential administration/application of the autologous leukocyte composition and the other drugs, interventions, regimens or physical treatment(s). Thus, in some embodiments, adjunctive use is reflected in the formulation of the pharmaceutical compositions of the invention. For example, adjunctive use may be reflected in a specific unit dosage of leukocyte cells, or in formulations in which the autologous leukocyte composition of the invention is present in admixture with the other drug(s) with which it is to be used adjunctively (or else physically associated with the other drug(s) within a single unit dose). In other embodiments, adjunctive use may be reflected in the content of the information and/or instructions co- packaged or co-presented with the autologous leukocyte composition and relating to formulation and/or posology.

The adjunctive prophylactic leukocyte autotransplantation of the invention may be used to alleviate, control or modify states in which the immune system is partially or completely suppressed or depressed. Such states may arise from congenital (inherited) conditions, be acquired (e.g. by infection or malignancy) or induced (e.g. deliberately as part of the management of transplants or cancers).

Adjunctive prophylactic leukocyte autotransplantation may be indicated following immunosuppressant therapies (such as cyclosporine A, azathioprine or immunosuppressant radiotherapies), chemotherapy (including treatment with both cycle-specific and non-specific chemotherapeutic agents), steroid administration or other forms of surgical or medical intervention (including radiotherapy). Thus the adjunctive prophylactic autotransplantation may be adjunctive to other treatments which tend to depress splenic and bone marrow cell populations. Particularly preferred adjunctive therapies according to the invention include the administration of an autologous leukocyte composition adjunctive to: (a) chemotherapy; and/or (b) radiotherapy; and/or (c) bone marrow transplantation; and/or (d) haemoablative immunotherapy.

Adjunctive prophylactic leukocyte autotransplantation may be indicated in the treatment and/or management of various diseases (including certain cancers) or medical interventions (including radiotherapy, immunosuppressant therapy (such as the administration of cyclosporine A, azathioprine or immunosuppressant radiotherapies), chemotherapy and cytotoxic drug administration (for example the administration of ricin, cyclophosphamide, cortisone acetate, vinblastine, vincristine, adriamycin, 6-mercaptopurine, 5-fluorouracil, mitomycin C, chloramphenicol and other steroid-based therapies). Adjunctive prophylactic leukocyte autotransplantation may therefore be used chemoprotectively in the management of various cancers and infections (including bacterial and viral infections, e.g. HIV infection) or to induce appropriate and complementary immunotherapeutic activity during conventional immunotherapy.

In particular, adjunctive prophylactic leukocyte autotransplantation may find application in the treatment or management of microbial infections which are associated with immune-suppressed states, including many viral infections (including HIV infection in AIDS) and in other situations where a patient has been immunocompromised (e.g. following infection with hepatitis C, or other viruses or infectious agents including bacteria, fungi, and parasites, in patients undergoing bone marrow transplants and in patients with chemical or tumour-induced immune suppression).

Other diseases or disorders which may give rise to an immunosupressed state treatable by the adjunctive prophylactic leukocyte autotransplantation according to the invention include: ataxia-telangiectasia; DiGeorge syndrome; Chediak-Higashi syndrome; Job syndrome; leukocyte adhesion defects; panhypogammaglobulinemia (e.g. associated with Bruton disease or congenital agammaglobulinemia); selective deficiency of IgA; combined immunodeficiency disease; Wiscott-Aldrich syndrome and complement deficiencies. It may be associated with organ and/or tissue (e.g. bone marrow) transplantation or grafting, in which applications the adjunctive prophylactic leukocyte autotransplantation is used as part of an overall treatment regimen including surgery and post-operative management of immune status. Obtention of Leukocytes

(a) Centrifugal leukocyte extraction from whole blood

It is known that whole blood can be readily separated into three discrete components by centrifugation.

Centrifugation (e.g. at about 3900 rpm) partitions the various components of the whole blood into three distinct layers: a blood plasma layer (of relatively low density), and red blood cell layer (of relatively high density) and a layer of intermediate density consisting predominantly of leukocytes and thrombocytes (platelets). This latter layer normally appears at the interface between an upper plasma and lower red blood cell layer after centrifugal separation, and is known as the buffy coat.

Such separation is presently carried out, for example on donated blood, in order that plasma, red cells and thrombocytes can be processed separately. This reflects the distinct storage regimens and potential therapeutic applications appropriate to each fraction. For example, the concentrated red blood cell fraction is usually stored chilled for up to 35 days, and can be used for treating anaemic patients, victims of trauma and patients undergoing surgery. The plasma is generally frozen below -30°C for up to one year, and can be used to reverse anticoagulant treatment and as a component in massive transfusions. The thrombocytes, stored at 20°C and continually agitated to prevent clotting, can be used to prevent bleeding in leukaemic patients or those undergoing chemotherapy or massive blood transfusions.

The leukocytes present in the buffy coat fraction are usually regarded as an unwanted contaminant, since they can induce profound and possibly dangerous immunological changes if transfused inappropriately. For this reason, steps are usually taken to limit the collection of these cells during blood sampling (e.g. by the use of inline filters during blood donation).

While the centrifugation of whole blood can be done in rigid vessels, it is most efficiently carried out on the flexible bags in which the blood is most conveniently collected. Such bags are usually fitted with flexible tubes opening into the upper and/or lower ends of the bags and are designed to fit into specially adapted centrifuge rotors, where they can withstand the forces necessary to effect separation of the blood in situ.

Such bags are known to those skilled in the art as blood (press) packs, and a wide range of different types are now commercially available (e.g. from Baxter Healthcare Ltd.).

Once separated in the blood pack, various types of apparatus have been devised for pressing the flexible walls of the blood pack in order to controllably express one or more of the separated blood fractions for further processing. Such apparatus, known to those skilled in the art as a blood (pack or bag) press, usually features one or more vertical press plates between which the bag can be introduced and which act to drive the different layers successively out of the pack when one plate is advanced towards the other. This usually results in the plasma layer being- expressed first, followed by the buffy-coat. The red blood cell fraction can then be expressed last, or retained as a residual fraction in the pack.

Alternatively, the bag press can be designed to express the plasma and red blood cell layers from opposite ends of the pack simultaneously, leaving the buffy-coat as a residual fraction. Examples of such bag presses are described in US 4350585, US 5874208 and US 4663032. A wide variety are commercially available, for example the Optipress® II from Baxter Healthcare Ltd.

(b) Leukapheresis

Leukapheresis has recently been proposed as a means for creating lymphocyte cell banks (see WO 00/29551 and WO 01/88099). Leukapheresis is a specific form of apheresis which involves the selective separation and removal of leucocytes from withdrawn blood, the remainder of the blood then being retransfused into the donor. During leukapheresis, the removed blood is passed through a cell separation device which separates nucleated white blood cells from red blood cells and plasma outside the body. The red blood cells and plasma are returned to the individual, as part of the separation process. The process is continuous with blood being removed and returned almost simultaneously after various extractions have been performed. Leukapheresis therefore makes it possible to remove and return the entire blood volume of the individual several times over and separate out and keep large numbers of white cells without detriment to the individual. The technique therefore relies on the establishment of a vein-to-vein extracorporeal blood circulation and extraction of leukocytes from the recirculating blood.

Leukaphereses are generally automated, and conducted using either continuous or interrupted flow centrifugation or filtration techniques, as described in "Leukapheresis and Granulocyte Transfusions", published by American Association of Blood Banks, Washington DC (1975).

Apparatus for carrying out centrifugation leukapheresis is described in US 3489145 and US 3655123, while that for carrying out filtration leukapheresis is described in US 3802432 and US 3892236. Gravity leukapheresis, in which the forces for both separating and collecting leukocytes are provided by gravity alone, is described in US 4111199. Many different types of automated leukapheresis apparatus are now commercially available including the Fenwal CS-3000 (Baxter Healthcare, Chicago, IL), the Cobe 2997 (Cobe BCT, Lakewood, CO), the Cobe Spectra, the Cobe 2991 , and the Haemonetics V50 (Haemonetics Corp., Braintree, MA). Any of these systems can be used in the processes of the invention, but preferred is the Cobe® system (Cobe BCT, Lakewood, CO, USA), which is capable of extracting between 40% and 50% of the total white cells in the whole blood that passes through the separator, and which can achieve a flow rate of 40-60 ml or more per minute.

(c) Isolated leukapheresis

Blood samples collected in the usual way from a donor can provide a convenient source of leukocytes for use according to the present invention if processed using commercially available leukapheresis devices: there is no need for the devices to be operated with the donor "in-line". Thus, isolated leukapheresis (as herein defined) may be employed to provide the leukocytes for use according to the invention.

(d) Leukapheresis devices

As explained above, standard leukapheresis or isolated leukapheresis may be used to obtain the leukocytes for use according to the invention. Many different types of leukapheresis devices are presently commercially available. Such devices usually comprise at least three separate elements: (1) a separation device (e.g. comprising a membrane or centrifuge rotor, which provides the forces for separating the leukocytes from the various other blood components; (2) one or more pumps for conveying the blood sample to the separation device, for removing the separated leukocytes and for maintaining the forces necessary for transfusion and retransfusion, and (3) a (normally disposable) tubing set which holds the blood and its various fractions in a particular geometry within the separation device, defines fixed channels through which the blood flows (normally in a circuit from the donor, through the leukapheresis device and back to the donor) as well as vessels (usually bags) for the collection of the separated leukocytes and/or other blood fractions or fluids.

Any of a wide variety of commercially available leukapheresis devices may be used according to the present invention. The particular way in which the leukapheresis device is operated will depend on a number of factors, including the nature of the separation device (e.g. centrifuge, filter etc.), the type of leukocyte sample required, the volume of the blood sample to be processed, the identity and status of the donor individual, the ultimate use to which the leukocyte composition is to be put and the nature of any treatments applied to the blood sample prior to processing according to the invention. Thus, those skilled in the art will readily be able to establish the appropriate operational parameters.

Preferably, however, the leukapheresis device is selected to minimize the need for operator intervention and/or training. Commercially available leukapheresis systems vary in the time and/or expertise required of an individual to prepare and operate it. For instance, reducing the time required by the operator to load and unload the tube set, as well as the complexity of these actions, can increase productivity and/or reduce the potential for operator error. Moreover, reducing the dependency of the system on the operator may lead to reductions in operator errors and/or to reductions in the credentials desired/required for the operators of these systems.

Performance-related factors are also relevant, and may be judged inter alia in terms of the "collection efficiency" of the leukapheresis system. The "collection efficiency" of a system may of course be gauged in a variety of ways, such as by the size of the fraction of leukocytes collected in relation to the total leukocytes present in the sample. Performance may also be evaluated based upon the effect which the leukapheresis procedure has on the various blood component types. For instance, it is desirable to minimize the adverse effects on at least the leukocytes of the apheresis procedure. It may also be desirable to reduce platelet activation, in order to avoid degeneration in sample quality during processing. Particularly preferred is the Cobe® system (Cobe BCT, Lakewood, CO, USA). Blood Collection Systems

As explained above, leukocytes for use according to the invention may be obtained from an isolated blood sample (for example by isolated leukapheresis). In such cases, the systems for collecting an isolated blood sample from an individual may comprise a sample vessel (for collecting and containing the blood sample) together with a leukapheresis tubing set. The term leukapheresis tubing set is used herein to define a tubing set as described in the preceding section. The tubing set may comprise a blood processing vessel within which the leukocytes are subjected to separation forces in the separation device.

In the case of tubing sets for use with leukapheresis devices which comprise a centrifuge-type separation device (as described in the preceding section), the blood processing vessel may comprise a centrifuge loop which defines a vessel within which the blood is subjected to centrifugal separation forces when loaded into the centrifuge rotor of the separation device.

The systems for use according to the invention may be closed, functionally closed, or open.

As used herein the term closed system, as applied to a leukapheresis tubing set, is used to define tubing sets which are sterile and isolated from the outside environment by aseptic barrier(s) and in which all components are fully integral, being attached and/or assembled at the manufacturing site.

As used herein the term functionally closed system, as applied to a leukapheresis tubing set, is used to define tubing sets which are assembled at the device manufacturing site and which use sterile barrier filters (e.g. 0.22 micron filters) for the attachment by the end user of solutions and sterile connecting devices for filters.

As used herein the term open system, as applied to a leukapheresis tubing set, is used to define tubing sets which are only partially assembled at the device manufacturing site and then customized by the end user.

Preferably, the system further comprises one or more (e.g. three) leukocyte collection vessel(s). Three or more collection vessels are preferred, so that there is a degree of redundancy in the samples and also to facilitate the creation of cell banks with duplicate/triplicate samples. This permits more flexible autotransplantation regimes.

The system also conveniently comprises a vessel for residual blood from which the leukocytes have been removed. This residual blood may prove to be of utility in other therapeutic paradigms, such as in an allogenous setting. A needle or cannula may also be incorporated for conducting a blood sample from the individual into the sample vessel.

The various vessels conveniently take the form of flexible, transparent bags. Some (or all) of the tubing is also conveniently formed of flexible, transparent material (e.g. plastics). Blood samples

The leukocytes for use according to the invention are obtained from blood provided by the donor. Where isolated leukapheresis is employed to obtain the leukocytes, then an isolated blood sample is used (as herein defined).

The blood sample may be subjected to various treatments ex vivo prior to use in the process of the invention. Typically, for example, the blood sample is chilled prior to use. Other treatments may include the addition of preservatives and/or anticoagulants. The blood sample may also be treated in vivo prior to collection by administering various agents to the donor individual before or during sample collection.

Examples of treatments (which may be applied ex vivo and/or in vivo) are discussed in more detail in the section entitled "Leukocyte treatments", below.

It is generally preferable to sample at least 450-500 ml of blood from the individual donor, which is the equivalent of a unit of blood as provided by a blood donor for the UK blood transfusion service. If possible a number of samples (e.g. several 450-500 ml samples) are taken over a period of time (e.g. over 2-3 weeks, preferably 2-3 months or over 6 months or a year, 2 or 3 years or more). One or more of these can then be divided or combined into a number of leukocyte cell bank deposits. The removal of a unit of blood is commonplace with over three million units of blood being taken, for allografting, from individuals annually in the UK alone.

The blood removed is soon replaced and, therefore, multiple samplings of a unit of blood from an individual can be provided over a year, say 2-12 unit samplings if necessary, without detriment to the individual being sampled. Selection of donor individuals

General considerations

Adjunctive prophylactic autotransplantation of leukocytes is a form of prophylaxis that might ultimately be indicated for any individual. Consequently, it is preferred that comprehensive leukocyte cell banks covering as large a number of different individuals as possible be generated for use according to the invention in order that adjunctive prophylactic leukocyte autotransplantation can be carried out in any of the represented individuals should the need arise.

However, since the quality of the individual deposits will depend (at least to some extent) on the health status of the individual donor at the time of blood sample donation, it is preferred that the blood sample for use in the processes of the invention be taken from healthy individual donors.

Other factors also affect donor selection: for example, the blood sample for use in the processes of the invention may advantageously be obtained from individual donors when they are young, preferably in adolescence or early adulthood. In the case of humans, blood sampling (preferably multiple sampling) at the ages of about 12 to 30, preferably 15 to 25 is preferred. Especially preferably, sampling is from the age of 16 or 17 upwards, for example in the age range 16 to 30, 17 to 30, or 18 to 30, or perhaps 18 to 35 or 40. It is thus preferred that the cells be obtained when the host organism is mature, or reaching maturity, but before the processes of ageing or senescence have significantly set in. In particular, it is preferred and advantageous that the immune system of the host organism is mature or fully developed. However, in some applications where the donor individual is an adult donor individual, then the donor's age may be at least 30, 40, 50, 60 or 70 years, preferably at least 40 years, more preferably between 40 and 50 years. However, the obtention of cells outside these ranges is encompassed, and cells may be obtained at any postnatal life stage e.g. from juvenile host organisms e.g. in mid-to late childhood, or even infants, or from older individuals.

Sampling from post-natal or older hosts allows multiple samples to be collected, thereby increasing the opportunity of storing sufficient number of cells. In addition sampling from juvenile or older hosts overcomes the ethical requirements such as providing informed consent.

Sampling from adolescent or adult host organisms is preferred since the sampled cells, from blood in particular, will contain a greater proportion of valuable mature T-cells capable of recognising aberrant cell populations, such as cancer cells or virally infected cells. Thus, when blood samples are used, it is advantageous that they are taken from an individual with a mature immune system (i.e. not foetal or neonatal).

Thus, the invention contemplates the use of blood samples collected from donor individuals at a stage when there is no direct prediction, suggestion, or suspicion that a particular disorder or disease may develop, for use against a future possible or unpredicted event, or an event which may occur simply by chance, rather than an anticipated or suspected or predicted illness or condition. Thus, in certain embodiments of the invention, the donor individual is not predisposed to, or at risk from, any particular disease or disorder e.g. not exhibiting any symptoms or manifestations predictive of a subsequent disease or disorder. Likewise, the host organism is preferably not suffering from any injuries or damage which may give rise to an anticipated or expected condition.

Indeed, it is preferred that the blood sample for use in the invention be obtained from the donor individual before any disease or disorder develops or manifests itself, and more preferably when the host organism is in general good health, and preferably not immunocompromised in any way. In such embodiments it is particularly advantageous to sample the blood from donor individuals at a time when the organism has not previously exhibited symptoms of or presented with or been diagnosed as suffering from the disease or disorder which is subsequently to be treated, i.e. when the host organism is healthy and not "in remission" e.g. not in a state of partial or full recovery from the leukocyte deficiency to be treated.

Predisposed donor individuals

Advances in therapy continue to be made, and our greater understanding of disease processes helps us to modify and refocus our therapeutic approaches to alleviate disease and suffering. Such understanding has been greatly advanced by technological improvements in the field of molecular biology. We are now in a position to follow the pathogenesis of diseases at a molecular level, and recognize the importance of an individual's genetic make-up in predisposing them to certain diseases. For example, we are aware that some individuals, because of their genetic composition, are prone to certain diseases.

Many of the diseases to which certain individuals can be predisposed are leukocyte deficiencies, which term is used herein to indicate a condition in which the administration of autologous leukocytes is indicated. Such conditions therefore include those in which an individual has acquired a disease, infection or condition involving leukocyte dysfunction or a disease, infection or condition in which the augmentation or stimulation of endogenous leukocyte activity is indicated. Detailed examples of particular leukocyte deficiencies are set out in the section entitled "Exemplary indications", below. Through genetic testing, therefore, it is now possible to identify those individuals predisposed to a leukocyte deficiency (e.g. any of various forms of cancer, immune disorder or infection).

Furthermore, our knowledge of the body's immune system, and in particular the way in which it recognises and kills virally infected and tumour cells, continues to advance. We now know that in order to elicit cell-mediated immunity, an offending cell (e. g. a virally infected or tumour cell) must co-present an HLA class I restricted tumour or viral epitope with danger signals such as GM-CSF and/or TNF-alpha, so that the antigen presenting cells (APC) of the immune system will express co-stimulatory signals such as B7 and 1L-12 in conjunction with antigen to the interacting cytotoxic T-lymphocyte (CTL) population. The co-presentation leads to the production of clones of both activated and memory cells (for review see Nature Medicine Vaccine Supplement 4 (1998) 525). In the absence of these additional signals, HLA-I antigen-restricted T-cells which recognise offending cells are processed for destruction or desensitization (a bodily process presumably put into place to avoid the development of e.g. autoimmune disease). The induction of such tolerance is because of either ignorance, anergy or physical deletion (Cold Spring Harbour Symp Quant Biol 2 (1989) 807; Nature 342 (1989) 564; Cell 65 (1991) 305; Nature Med 4 (1998) 525).

It is now clear that tumour cells do not automatically co-present danger and/or co-stimulatory signals. Hence, the spawning of a tumour may lead to eradication of the very T cell clones that provide cell-mediated immunity against the tumour. A patient presenting with a cancer, leukaemia/lymphoma or sarcoma etc, therefore, may have already removed their innate ability to destroy the tumour, by default.

However, if the required T lymphocytes, or a sample thereof, were removed from the patient prior to the onset of proliferative disease, the relevant T-cell population could now be returned to the patient, after the necessary co-stimulation of the T-cells, so as to alleviate disease. Co-stimulation may be provided at the same time as the cells are returned to the patient, or after they are returned through further treatment (s) of the patient, or without stimulation other than that naturally produced by the patient. Activation/stimulation of the cells may also initially be induced in vitro prior to reinfusion.

The present invention therefore finds particular application in the case of individuals predisposed to the development of a leukocyte deficiency. It therefore represents a means for removing leukocytes from a healthy donor individual for subsequent transplantation to that same individual in a subsequent autologous (autogeneic) transplantation procedure, when the need or desire to do so arises. Although the predisposed individual may never receive the cells because no disease to be treated by this method ever occurs, the invention nevertheless may be used to provide some form of insurance against the heightened risk of a leukocyte deficiency arising in the individual.

Similarly, individuals with no diagnosed predisposition may choose to provide samples for incorporation into the leukocyte cell bank of the invention for prospective use by themselves prior to travelling abroad. Such use might include for the treatment of infections contracted whilst abroad.

In addition, it is well recognized that the ageing process makes individuals more susceptible to disease. The basis for the susceptibility appears to be in the loss of immune function resulting from a significant decrease in T and B cell numbers/activity during ageing (Mech Ageing & Dev 91 (1996) 219; Science 273 (1996) 70; Mech Ageing & Dev 96 (1997) 1). Disease susceptibility is particularly pertinent when elderly patients are subjected to e.g. surgery in a hospital environment, where they are prone to opportunistic infections with serious or even fatal consequences. Blood samples taken from such individuals much earlier in life and processed according to the invention for inclusion in a leukocyte cell bank could provide the opportunity for restorative autotransplantation in such circumstances.

Such an approach could be used more broadly to provide for a method of augmenting the patient's immune system after surgery in order to lessen the likelihood of post-operative complications caused by opportunistic infections. The invention, therefore, could be used as a prophylactic therapy, e.g. for elderly patients when they are more susceptible to disease.

Leukocytes for use according to the invention

It will be appreciated that the separation and/or removal of leukocytes from the blood (e.g. by leukapheresis) need not be absolute. Rather, the removal and/or separation of a fraction of the total leukocytes present in the sample is sufficient in most circumstances. Those skilled in the art will readily be able to determine the appropriate size of the fraction to be removed, which will vary inter alia according to the use to which the isolated leukocytes are to be put, the size of the sample, the status of the donor, the nature of the leukocytes and the particular leukocyte extraction techniques and/or device(s) employed.

The leukocytes collected in the processes of the invention are to some degree isolated from the original blood sample. The term isolated is used here to indicate that the isolated leukocytes exist in a physical milieu distinct from that in which they occur in vivo and does not imply any particular degree of purity. Indeed, the absolute level of purity is not critical, and those skilled in the art can readily determine appropriate levels of purity according to the use to which the leukocytes are to be put.

The separation and collection of the leukocytes in the processes of the invention also does not necessarily imply that any particular class or type of leukocyte is preferentially separated and collected. Rather, the leukocytes of the invention include any white blood cell, including granulocytes, lymphocytes and monocytes.

Granulocytes include myelocytes, basophils, eosinophils and neutrophils. Lymphocytes include B, T lymphocytes and natural killer cells. Monocytes include mononuclear phagocytes and other macrophages.

However, in some embodiments the leukocytes which are separated and collected preferably comprise one or more specific leukocyte cell types. A preferred cell type is the lymphocyte, especially a T-lymphocyte (T-cell). Mature T-lymphocytes are particularly preferred.

Since the total mature T-cell number per litre of blood ranges between 1-2.5 x I0⁹ for humans, a 100 ml sample of blood typically contains 1-2.5 x 10⁸ mature T-cells and this is generally sufficient to provide an adequate representation of the entire mature human T-cell population for the beneficial effect. However, depending on the fraction of total leukocytes separated and collected by the leukapheresis device and the efficiency of any revitalizing technique employed, preferably at least 100 ml, 115 ml, 200 ml or 300 ml and even more preferably in excess of 400 or 500 ml of blood sample is used in order to obtain the appropriate number of mature T-cellsto support a beneficial therapeutic effect for return to the individual if and when they become ill.

Standard techniques are known in the art which permit selection of particular subpopulations of lymphocytes from a sample comprising a mixed population of lymphocytes. Examples of such subpopulations are CD3⁺, CD8⁺, CD4⁺ and CD16/56⁺ (natural killer) T cells and CD19⁺ B cells. For example, any one or any mixture or combination of such subpopulations of T cells can be used in the methods, uses and compositions of the invention, and they are readily obtained by means of well known methods such as FACS (Fluorescence Activated Cell Sorting) and haemocytometry systems.

Leukocyte treatments

The leukocytes for use according to the invention may be subjected to various treatments. Such treatments may, for example, result in expansion of some or all of the representative cell subsets, improve the long-term viability of the leukocytes during the dormancy period, improve their therapeutic potency and/or render their subsequent use in adjunctive prophylactic autotransplantation safer.

The treatments can be carried out before or after the leukocytes are rendered dormant (and before or after autotransplantation is carried out). Moreover, the treatments may be applied after the blood sample is taken

(i.e. be carried out ex vivo) either prior to rendering the cells dormant or after revitalization. For example, treatment of the leukocytes may be effected by co administration of a separate composition, sequentially or simultaneously with the leukocyte composition, during autotransplantation. Treatment of the leukocytes can be effected immediately prior to autotransplantation.

Alternatively (or in addition) the treatments may be applied to the leukocytes while still in vivo prior to blood sampling by the administration of e.g. growth factors or cytokines (see below).

Exemplary pre-transplantation treatments may include various genetic modifications, such as the incorporation of a negative selection marker (as described, for example, in W096/14401 , the content of which is incorporated herein by reference). Such treatment permits ablation of the leukocytes after transplantation or titration of dose versus response. Other genetic interventions may include regulating or modifying the expression of one or more genes (e. g. increasing or decreasing gene expression), inactivating one or more genes, gene replacement and/or the expression of one or more heterologous genes). Other genetic modifications include the targeting of particular T-cells (as described in W096/15238, the content of which is incorporated herein by reference), and the modification of the T-cell receptor repertoire/expression with antibodies to make T-cell chimaeras.

Other treatments contemplated by the invention include the exposure of the leukocytes with one or more stimulatory molecules, for example antigens (e.g. cancer or viral antigens), antibodies, T cell recognition epitopes, peptides, blood factors, hormones, growth factors or cytokines or combinations thereof. For example, the leukocytes may be treated in vitro (or in vivo prior to blood sampling) with antigens (for example cancer (e.g. prostate-specific antigen 1 or prostate-specific antigen 2, her-2/new, MAGE-1 , p53, Haras and c-myc) or viral antigens), antibodies, T cell recognition epitopes, peptides, blood factors, hormones, growth factors or cytokines or combinations thereof. The stimulatory molecules may be synthetic, recombinant or may be purified or isolated from the human or animal body. Particularly useful in this respect are stimulatory molecules selected from IFN-alpha, IFN-beta, IFN-gamma, 11-1 a, ll-lb, II-2, II-3, H-4, II-5, II-6, II-7, II-8, II-9, 11-10, 11-11 , 11-12, 11-13, 11-14, 11-15, GM-CSF, M-CSF, G-CSF, LT and combinations of two or more of the foregoing. Such treatments may modify the growth and/or activity and/or state of differentiation of the leukocytes, and/or may serve to separate or selectively isolate or enrich desired leukocyte cell types or to purge unwanted cells.

Recent advances have been made in the way cells may be obtained for subsequent autotransplantation. For example, investigations into the agents which regulate haematopoiesis have led to the isolation of a series of factors that influence the proliferation and differentiation of lymphocytes. These agents include the cytokines (such as the interleukin series IL-1 to IL-18 and the leukotrienes) and growth factors such as the TNF's, the TGF's, FGF's, EGF's, GM-CSF, G-CSF and others. A number of these factors are now available commercially for clinical use, and some have been shown to increase substantially the number of lymphocytic cells and, in particular, immature T-lymphocytes in the peripheral blood. Their administration to the donor individual prior to blood sampling permits the quantity and/or quality (in terms of the number and nature of leukocyte subtypes present) to be controlled and makes it possible to recover large quantities of the cells of interest, e.g. immature T-lymphocytes, directly from the donor individuals peripheral blood sample without the need to sample the marrow.

Other pre-transplantation treatments include culture of the leukocytes (or a sub-population thereof). For example, the leukocytes may be cultured to increase cell numbers. For example, the cells may be passaged, according to methods well known in the art. Such culturing may be carried out before or after the leukocytes are rendered dormant, or both before and after dormancy is induced.

Thus, in the case where the leukocytes include T-cells, the T-cells may be co-stimulated prior to transplantation and/or exposed to tumour antigens (optionally together with co-stimulatory factors) prior to autotransplantation.

Leukocyte banking

Since the need for adjunctive prophylactic leukocyte autotransplantation is likely to arise in only a fraction of the healthy population, the effectiveness of this form of prophylaxis is improved by the availability of comprehensive leukocyte cell banks in which deposits from a large percentage of the population are included.

Thus, it is contemplated that the leukocyte compositions for use according to the invention are banked prior to use, thereby creating a leukocyte bank.

Any suitable leukocyte cell banking system may be employed, provided that the deposits are retrievable for autotransplantation. This implies the use of some form of labelling, but this need not be in the form of a physical appendage to the individual deposits. Thus, the leukocyte cell bank of the invention may comprise a plurality of cell storage units for storage of leukocyte compositions. The cell banks of the invention may further include a digital information unit for digitally storing information relating to the identity, location and medical history of the donor individual and/or the conditions associated with the particular deposit (for example relating to the date at which the blood sample was collected from the donor individual, the processing conditions and details of any treatments applied to the leucocytes contained in the deposit). The digital information unit preferably comprises at least one digital computer having sufficient digital storage capacity for storage of the potentially large amounts of information relating to each deposit.

The leukocyte cell bank of the invention preferably further comprises an arrangement for digital data retrieval interfaced with the digital information unit for retrieving selected information stored in the digital information unit. The data retrieval arrangement may be integrated with the digital computer. Remote access of the digital information via the telephone or the internet may also be provided and may permit rapid and convenient access of the information on a global basis.

When the leukocytes are banked prior to use according to the invention, the leukocytes are rendered dormant prior to banking. Any suitable means may be employed for rendering the. leukocytes dormant, including cryogenic preservation.

According to a preferred cryopreservation procedure, the cells are frozen preferably to a temperature below - 160°C. A particularly preferred means of achieving dormancy is to freeze the cells to the boiling point of helium (He), i.e. to about -269°C or below.

As described in Freshney's (Freshney's Tissue Culture of Animal Cells (Culture of Animal Cells: A Manual of Basic Technique, Wiley Liss, 1994)), the cells may be suspended in a suitable medium (e. g. containing up to 10% DMSO) and cooled at a controlled rate (e. g. 1°C per minute to -70°C, then into liquid/gas N₂). Such conventional procedures may be adapted to cool the cells into He/N₂ mixtures or He. Alternative methods of achieving and/or maintaining cell dormancy include cooling to 4°C.

Any of a wide range of suitable cryopreservation media may be used according to the invention, but preferred are media comprising a suitable penetrating cryoprotectant. Particularly suitable for use as a penetrating cryoprotectant is DMSO, which may be used for example at a concentration of up to 10%. The cryopreservation medium may further comprise an anticoagulant (such as acid citrate dextrose, EDTA, heparin or mixtures thereof), a nuclease (for example a Dnase and/or Rnase as well as a physiologically acceptable medium (for example, phosphate buffered saline). The cryopreservation medium may also further comprise a proteinaceous composition, such as blood serum or a blood serum component and/or a sugar and/or a polysaccharide (which may be particularly preferred in embodiments where plunge freezing is employed).

Particularly preferred proteinaceous compositions for use in the cryogenic preservation media of the invention comprise blood albumin (e.g. bovine serum albumin or human serum albumin). Particularly convenient is the use of human blood serum isolated from the blood sample of the donor individual. This can be isolated as a co- product together with the leukocytes. It is necessary to revitalize leukocytes that have been rendered dormant prior to use according to the invention. This may be achieved in any convenient manner known in the art, and any method of revitalising or reviving the cells may be used.

Conveniently, this may, for example, be achieved by thawing and/or diluting the cells. Techniques for revitalisation are well known in the art. Cells may be thawed by gentle agitation of the container holding the cells in water at 37°C, followed by dilution of DMSO to 1% or below, e. g. with medium or serum.

Cells may be implanted immediately or after recovery/expansion in culture.

Exemplary indications

The adjunctive prophylactic uses of the invention encompass a very broad spectrum of diseases, syndromes, disorders, conditions and infections. Some examples are described in detail below.

Infections

The invention may find application as an adjunctive in the prophylaxis of various infections.

In this case, the endogenous leukocyte activity may be normal (or responding normally) but its alteration, augmentation or stimulation is nevertheless desirable. In others (such as HIV infection) the endogenous leukocyte activity is dysfunctional as a direct consequence of infection.

Infections which may be prevented according to the invention include bacterial, fungal or viral infections, or infections by any other organism e.g. a protozoan, nematode, insect or other parasite.

Cancers, leukaemias and sarcomas

The invention may find application as an adjunctive in the prophylaxis of various malignancies: in general, any malignant or pre-malignant condition, proliferative or hyper-proliferative condition or any disease arising or deriving from or associated with a functional or other disturbance or abnormality in the cells or tissues of the body may be prevented by the adjunctive prophylactic leukocyte autotransplantation of the invention.

Prophylaxis of various forms of cancer represents a preferred embodiment of the invention, and the prophylaxis of any cancerous cells or tissues of the body is contemplated.

Thus, the invention is not limited to any one type of proliferative disease (e. g. leukaemias, lymphomas, carcinomas or sarcomas), nor is it restricted to specific oncogenes or tumour-suppressor gene epitopes such as prostate-specific antigen 1 or prostate-specific antigen 2, her-2/new, ras, myc, myb, fos, fas, retinoblasto a, p53 etc. or other tumour cell marker epitopes that are presented in an HLA class I antigen restricted fashion or other such way so as to be identifiable by a leukocyte. All cancers such as leukaemia, lymphoma, breast, stomach, colon, rectal, lung, liver, uterine, testicular, ovarian, prostate and brain tumours such as gliomas, astrocytomas and neuroblastomas, sarcomas such as rhabdomyosarcomas and fibrosarcomas are included for prophylaxis by the present invention.

Thus, the present invention finds application in the prophylaxis of breast cancer, colon cancer, lung cancer and prostate cancer. It also finds application in the prophylaxis of cancers of the blood and lymphatic systems (including Hodgkin's Disease, leukemias, lymphomas, multiple myeloma, and Waldenstrόm's disease), skin cancers (including malignant melanoma), cancers of the digestive tract (including head and neck cancers, oesophageal cancer, stomach cancer, cancer of the pancreas, liver cancer, colon and rectal cancer, anal cancer), cancers of the genital and urinary systems (including kidney cancer, bladder cancer, testis cancer, prostate cancer), cancers in women (including breast cancer, ovarian cancer, gynecological cancers and choriocarcinoma) as well as in brain, bone carcinoid, nasopharyngeal, retroperitoneal, thyroid and soft tissue tumours. It also finds application in the prophylaxis of cancers of unknown primary site.

Posology

Those skilled in the art will be readily able to determine the amount of leukocyte composition to be autotransplanted in the prophylactic applications according to the invention. It should be noted that as few as 0.01 x 10⁸ (e.g. 1-10 x 10⁸) mature lymphocytes (which can be derived from a single sample of approximately 100 ml of normal human blood) are sufficient to boost the immune system of a subject and hence may have a beneficial effect according to the autologous transplantation method of the invention. It should be noted that the removal of a unit of blood is commonplace with over three million units of blood being taken, for allografting, from individuals annually in the UK alone.

The leukocyte composition administered may be derived from a single blood sample, or may constitute a pool of leukocyte compositions derived from a plurality of different blood samples taken from a donor individual at different times. The leukocyte composition administered may constitute all or a fraction of the deposited material, but preferably constitutes only a fraction thereof in order that multiple dosing can be achieved, optionally following cellular expansion of the residue (for example, T cell numbers may be increased by in vitro expansion using standard methods).

In applications based on T-cell activity, the number of mature T-cells administered is at least 0.01 x 10⁸, more preferably at least 0.1 x 10⁸, more preferably at least 1 x 10⁸ (e.g. at least 1-10 x 10⁸). The preferred ranges are 0.01 x 10^s to 10¹⁰ mature T lymphocytes, such as 0.1 x 10⁸ to 10¹⁰, 1 x 10⁸ to 10¹⁰ or 1 x 10⁹ to 10¹⁰ mature T lymphocytes. Thus, the mature T-cell sample acquired for autotransplantation is at least 0.01 x 10⁸, generally in the range of 10⁸ - 10¹⁰ CD3⁺ mature T-cells, preferably 2 x 10⁸ - 10¹⁰, more preferably 3 x 10⁸ - 10¹⁰ CD3⁺ and even more preferably 4-5 x 10⁸ - 10¹⁰ CD3⁺ mature T-cells.

Conveniently, each sample prepared for autotransplantation contains 3 x 10⁸ CD3⁺ mature T-cells, more preferably 5 x 10^s and even more preferably 1x10⁹ CD3⁺ mature T-cells. If sufficient resources of blood are available from an individual, even more preferably still 4-5 x 10⁹ CD3⁺ mature T-cells or 10¹⁰ CD3⁺ mature T- cells may be used.

Preferably, the mature T-cell subpopulation sample acquired for autotransplantation which is CD3⁺ and CD8⁺ is at least 0.01 x 10⁸, generally in the range of 0.25 x 10⁸- 0.25 x 10¹⁰, and more preferably 0.5 x 10⁸ - 0.25 x 10¹⁰, and even more preferably 0.75 x 10^s - 0.25 x 10¹⁰, and even more preferably still 0.75 x 10⁸ - 0.25 x 10¹⁰ or 1.00 - 1.25 x 10⁸ - 0.25 x 10¹⁰. Specific CD3⁺ and CD8⁺ cell numbers in each sample prepared for grafting is conveniently of the order of 0.2 x 10⁸, preferably 0. 4 x 10⁸, or more preferably 1 x 10⁸, or still more preferably 2 x 10⁸, or more preferably 3 x 10⁸, or more preferably 5 x 10⁸. If sufficient resources from an individual are available, 1 x 10⁹, preferably 2 x 10⁹, 4 x 10⁹, or more preferably 1 x 10¹⁰ CD3⁺ and CD8⁺ cells may be used.

Preferably, the mature T-cell subpopulation sample acquired for autologous transplantation which is CD3⁺ and CD4⁺ is at least O.01 x 10⁸, generally in the range of 0. 1 x 10⁸ - 0.5 x 10¹⁰, and more preferably 0.65 x 10⁸ - 0. 5 x 10¹⁰, and even more preferably 0.85 x 10⁸ - 0.5 x 10¹⁰, and even more preferably still 1 x 10⁸ - 0.5 x 10¹⁰ or 1.8 - 3.6 x 10⁸ - 0.5 x 10¹⁰. Specific CD3⁺ and CD4⁺ cell numbers in each sample prepared for grafting is conveniently of the order of 0.2 x 10¹⁰, preferably 0.3 x 10⁸, or more preferably 0.4 x 10⁸, 0.5x10⁸, 1 x 10⁸, 2 x 10⁸, 3 x 10⁸, 4 x 10⁸, or more preferably 5 x 10⁸. If sufficient resources from an individual are available, I x 10⁹, or more preferably 2 x 10⁹, or more preferably 1 x 10¹⁰ CD3⁺ and CD4⁺ cells may be used.

Preferably, the mature T-cell natural killer subpopulation sample acquired for autotransplantation which is CD3⁺ and CD16/56⁺ is at least 0.01 x 10⁸, generally in the range of 0.01 x 10⁸ - 0.5 x 10¹⁰, preferably 0.02 x 10⁸ - 0.5 x 10¹⁰, more preferably 0.03 x 10⁸ - 0.5 x 10¹⁰, and even more preferably still 0.5 x 10⁸ -0.5 x 10¹⁰ or 0.5-2 x 10⁸ to 0.5 x 10¹⁰. Specific CD3⁺ and CD16/56⁺ cell numbers in each sample prepared for grafting is conveniently of the order of 0.01 x 10⁸, 0.2 x 10⁸, 0. 3 x 10⁸, 0.5 x 10⁸, 1 x 10⁸, 2 x 10⁸, 3 x 10⁸, 5 x 10^β, or more preferably, if sufficient resources are available, I x 10⁹, or more preferably 2 x 10⁹, or more preferably 1 x 10¹⁰ CD3⁺ and CD16/56⁺ cells may be used.

In addition, the mature lymphocyte cell sample may preferably include B cells, such as CD19⁺ B lymphocytes. The mature B-cell sample included in the T-cell sample may be at least 10⁷, 10⁸ or 10⁹, generally in the range of 10⁷ -10¹⁰ mature B-cells and preferably 2 x 10⁷- 10¹⁰ mature B-cells, more preferably 3 x 10⁷ - 10¹⁰ mature B- cells, and even more preferably 4-5 x 10⁷ - 10¹⁰ mature B-cells. Specific numbers of B-cells in autograft is conveniently of the order of 3 x 10⁷, preferably 5 x 10⁸, more preferably 1 x 10⁸ mature B-cells, and even more preferably still 4-5 x 10⁹ or 10¹⁰ mature B-cells.

In addition, the lymphocyte cell sample may preferably include dendritic cells. The dendritic cell sample may be at least 10⁷, 10⁸ or 10⁹ in number, and generally in the range of 10⁷ - 10¹⁰ dendritic cells and preferably 2 x 10⁷ - 10¹⁰ cells, more preferably 3 x 10⁷ - 10¹⁰ cells, and even more preferably 4-5 x 10⁷ - 10¹⁰ cells. Specific numbers of dendritic cells in an autograft is conveniently of the order of 3 x 10⁷, preferably 5 x 10⁸, more preferably 1 x 10⁸, and even more preferably still 4-5 x 10⁹ or 10¹⁰ mature B-cells.

Eguivalents

The foregoing description details presently preferred embodiments of the present invention which are therefore to be considered in all respects as illustrative and not restrictive. Those skilled in the art will recognize, or be able to ascertain, using no more than routine experimentation, many equivalents, modifications and variations to the specific embodiments of the invention described specifically herein. Such equivalents, modifications and variations are intended to be (or are) encompassed in the scope of the following claims.

Claims

C AIMS:

1. Use of a leukocyte composition for the manufacture of a medicament for adjunctive prophylactic autotransplantation.

2. Use of claim 1 wherein the prophylactic autotransplantation is adjunctive to the treatment or prophylaxis of: (a) infection (e.g. opportunistic or nosocomial infection); and/or (b) burn injury; and/or (c) acquired or congenital immunosuppression; and/or (d) asthma; and/or (e) multiple sclerosis; and/or (f) arthritis (e.g. rheumatoid or septic arthritis); and/or (g) chronic illness; and/or (h) joint disease; and/or (i) seasonal (e.g. winter or summer) disorders.

3. Use of claim 2 (c) wherein the immunosuppression: (a) is associated with AIDS; and/or (b) is associated with an opportunistic infection (e.g. a cryptosporidial infection).

4. Use of claim 2 (i) wherein the seasonal disorder is bronchial infection (e.g. influenza infection).

5. Use of any one of the preceding claims wherein the prophylactic autotransplantation is adjunctive to the administration of: (a) an immunostimulant; and/or (b) an immunosuppressant; and/or (c) a cytotoxic agent (e.g. cyclophosphamide, cortisone acetate, vinblastine, vincristine, adriamycin, 6-mercaptopurine, 5-fluorouracil, mitomycin C or chloramphenicol); and/or (d) an antimicrobial (e.g. antibacterial) agent; and/or (e) an antiviral agent (e.g. AZT); and/or (f) a vaccine; and/or (g) an anti-inflammatory agent.

6. Use of claim 5 (d) wherein the antimicrobial agent is a prophylactic dose of an antibiotic.

7. Use of claim 5 (g) wherein the anti-inflammatory agent is a steroid (e.g. a corticosteroid).

8. Use of any one of the preceding claims wherein the the prophylactic autotransplantation is adjunctive to: (a) chemotherapy; and/or (b) radiotherapy; and/or (c) bone marrow transplantation; and/or (d) haemoablative immunotherapy; and/or (e) surgery; and/or (f) hospitalisation (e.g. long-stay hospitalisation); and/or (g) perioperative intensive care; and/or (h) physical training.

9. Use of claim 8 (e) wherein the surgery is selected from: (a) prosthetic joint replacement; and/or (b) abdominal surgery; and/or (c) genitourinary surgery; and/or (d) gynaecological surgery.

10. A pharmaceutical composition comprising a leukocyte composition suitable for autologous transplantation in combination with: (a) an immunostimulant; and/or (b) an immunosuppressant; and/or (c) a cytotoxic agent (e.g. cyclophosphamide, cortisone acetate, vinblastine, vincristine, adriamycin, 6-mercaptopurine, 5-fluorouracil, mitomycin C or chloramphenicol); and/or (d) an antimicrobial (e.g. antibacterial) agent; and/or (e) an antiviral agent (e.g. AZT); and/or (f) a vaccine; and/or (g) an anti-inflammatory agent.

11. A method of adjunctive prophylactic autotransplantation comprising the step of administering to a patient in need thereof a composition comprising autologous leukocytes.

12. The method of claim 11 wherein the adjunctive prophylactic autotransplantation is as defined in any one of claims 1 to 9.