WO2005053618A2 - Synthetic hla binding peptide analogues and uses thereof - Google Patents
Synthetic hla binding peptide analogues and uses thereof Download PDFInfo
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- WO2005053618A2 WO2005053618A2 PCT/US2004/040347 US2004040347W WO2005053618A2 WO 2005053618 A2 WO2005053618 A2 WO 2005053618A2 US 2004040347 W US2004040347 W US 2004040347W WO 2005053618 A2 WO2005053618 A2 WO 2005053618A2
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- C07K14/82—Translation products from oncogenes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
- A61P35/02—Antineoplastic agents specific for leukemia
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
- C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
- C07K14/4701—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals not used
- C07K14/4702—Regulators; Modulating activity
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- C—CHEMISTRY; METALLURGY
- C07—ORGANIC CHEMISTRY
- C07K—PEPTIDES
- C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
- C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
- C07K14/46—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
- C07K14/47—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
- C07K14/4701—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals not used
- C07K14/4748—Tumour specific antigens; Tumour rejection antigen precursors [TRAP], e.g. MAGE
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K38/00—Medicinal preparations containing peptides
Definitions
- This invention relates to the fields of immunology and leukemia therapy. More specifically, this invention relates to the use of synthetic analogue peptides to induce heteroclitic human T cell responses against native peptides of the synthetic analogues.
- Chronic myelogenous leukemia is a pluripotent stem cell disorder characterized by the presence of the Philadelphia chromosome (Ph).
- the Philadelphia chromosome represents a translocation in which the c-abl oncogene has moved from chromosome 9 into the breakpoint cluster region (bcr) within the bcr gene on chromosome 22, resulting in a chimeric bcr-abl gene.
- the fused genes encode an 8.5 kb chimeric mRNA which is usually translated into a 210-kDa or 190-kDa protein.
- This bcr-abl protein is a tyrosine-kinase which is uniquely present in the leukemia cells of chronic myelogenous leukemia patients and is necessary and sufficient for transformation.
- the breakpoint in the bcr gene occurs either between bcr exon 2 (b2) and 3 (b3) or between bcr exon 3(b3) and 4(b4).
- bcr-abl fusion genes and bcr-abl mRNA splicing can occur, the majority of patients with chronic myelogenous leukemia therefore express p210-b3a2 or p210-b2a2; often both p210 and pi 90 proteins are expressed together with low levels of pl90-ela2 bcr-abl proteins.
- Phi positive acute lymphocytic leukemia (ALL) the predominant breakpoint is at the ela2 site.
- the chimeric fusion proteins are potential antigens.
- the proteins are uniquely expressed in chronic myelogenous leukemia cells in which the junctional regions contain a sequence of amino acids that is not expressed on any normal protein.
- a tumor specific, bcr-abl derived multivalent vaccine may be safely administered to patients with chronic phase chronic myelogenous leukemia.
- the vaccine reliably elicits a bcr-abl peptide-specific CD4 immune response as measured by DTH in vivo, by CD4+ T cell proliferation ex vivo and by gamma interferon secretion in an ELISPOT assay.
- a sensitive gamma interferon ELISPOT assay Wilms tumor protein 1 ( T1) is a zinc finger transcription factor expressed during normal ontogenesis such as in fetal kidney, testis and ovary.
- WT1 expression is limited to low levels on hematopoietic stem cells, myoepithelial progenitor cells, renal podocytes and some cells in testis and ovary.
- Recent demonstration that WT1 is overexpressed in several types of leukemia suggested that WT1 would be an attractive target for immunotherapy.
- Three peptide nonamers from WT1 have been identified to generate a WT1 specific cytotoxic response in the context of HLA 0201 and HLA 2402.
- breaking tolerance is a potential concern.
- CD 8 responses For stimulation of responses the strength of CD 8 responses depends upon the binding affinity of the target peptide to class I MHC molecules, the peptide- HLA complex stability, and the avidity of the T cell receptor binding for the peptide complex. Killing of native CML cells also requires adequate processing and presentation of the natural antigen. Therefore the lack of reproducible CD8 responses in these clinical trials could be the result of the biochemistry of these class I peptide- HLA interactions, which results in their weak immunogenicity to cytotoxic CD8 cells. None of the native CML peptides reported to bind to human MHC bound the HLA pocket with high affinity.
- peptide analogues are used to circumvent a poor immunogenic response.
- a high correlation has been found between overall analogue peptide affinities for MHC class I molecules and in vivo peptide immunogenicity in HLA-A2Kb transgenic mice.
- a better correlation with a peptide's ability to form stable HLA-A0201 complexes and immunogenicity has been reported.
- CTL responses to variant peptides can be sustained for a longer period without causing annihilation of the clones due to insufficient signals for cell division or survival. Since a substantial fraction of such CTLs cross-react with non- mutated self-peptides expressed in tumor cells in much smaller amounts, immunization with variant peptides may be a more efficient method to induce CTLs against tumors.
- the scoring system for MHC class I-binding peptides should provide a convenient method for design of cross-reactive self-mimicking peptides for immunization.
- MHC anchor- modified ligands The improved immunogenicity in vivo and relevance of MHC anchor- modified ligands was first shown formally in human neoplastic disease in a controlled study of patients with malignant melanoma using a melanoma-associated A0201 restricted peptide derived from gplOO. It has been shown recently with HLA- tetramer based detection methods that the parental Melan-A antigenic peptides are weak agonists which activate antigen-specific T cells suboptimally (3). In contrast, melan A peptide analogues were identified that behaved as full agonists and induced full T cell activation leading to strong tumor antigen-specific CTL responses (4).
- Simple motifs and the statistical binding matrices can be used to perform a crude search for MHC-binding peptides. Unfortunately, the presence of a simple sequence motif does not correlate well with binding. Therefore these simple motifs are not always necessary or sufficient for binding. Only 30% of the peptides that carry such simple motifs bind well when examined in a biochemical binding assay. Predictions of binding can be improved considerably when extended motifs are used, rather than the simple motifs. About 70% of the peptides carrying an extended motif bind well.
- the weak immunogenicity of native bcr-abl fusion peptides has prevented use of these native peptides as an effective vaccine against CML.
- the prior art is deficient in the lack of synthetic analogue peptides that could generate an immune response that not only recognizes the immunizing epitopes, but that also cross reacts with the original native peptides.
- the prior art is deficient in synthetic peptide analogs with both improved HLA binding and improved ability to elicit a greater immunogenic response against cancer cells.
- the present invention fulfills this longstanding need and desire in the art.
- the present invention is directed to a synthetic peptide comprising a sequence of amino acids containing at least a segment that is an analogue of a native peptide that specifically binds to HLA A0201 or HLA A0301 molecules on a cell characteristic of a pathophysiologic state in a mammal.
- the synthetic peptide may be derived from native peptides comprising a breakpoint region of the bcr-abl fusion protein or of the WT1 protein.
- the present invention also is directed to a related synthetic peptide with an amino acid sequence selected from YLKALQRPN (SEQ ID ⁇ O: 2), KQSSKALQN (SEQ ID ⁇ O: 4), KLSSKALQV (SEQ ID ⁇ O: 5), KLLQRPNAN (SEQ ID ⁇ O: 7), TLFKQSSKN (SEQ ID ⁇ O: 9), YLFKQSSKV (SEQ ID ⁇ O: 10), LLI ⁇ KEEAL (SEQ ID ⁇ O: 12), LTI ⁇ KNEAL (SEQ ID ⁇ O: 13), YLL ⁇ KEEAL (SEQ ID ⁇ O: 14), YLL ⁇ KEEAN (SEQ ID ⁇ O: 15), or YLI ⁇ KVEAL (SEQ ID ⁇ O: 16), ⁇ MYQR ⁇ MTK (SEQ ID ⁇ O: 36), ⁇ MHQRNMTK (SEQ ID ⁇ O: 37), ⁇ MYQRNMTK (SEQ ID
- the present invention also is directed to pharmaceutical composition comprising a therapeutically effective amount of the synthetic peptides described herein or a DNA encoding the synthetic peptide and a suitable carrier.
- the present invention is directed further to an immunogenic composition comprising an immunogenically effective amount of the synthetic peptide described herein and a pharmaceutically acceptable carrier, adjuvant or diluent or a combination thereof.
- the present invention is directed further still to a method of treating a cancer in a human.
- the pharmaceutical compositions described herein are administered to the human.
- a heteroclitic response is induced by cytotoxic T-cells that recognize at least the analogue segment of the synthetic peptides described herein against cancer cells presenting a native peptide from which the analogue segment is derived.
- the cytotoxic T-cells recognize or kill the cancer cells thereby treating the cancer.
- the present invention is directed to a method of treating leukemia in a human using the pharmaceutical compositions comprising the synthetic peptide containing at least the analogue segment derived from a native peptide of a WT1 protein or a DNA encoding the synthetic peptide.
- the present invention is directed further still to a method of inducing formation and proliferation of human cytotoxic T cells that produce a heteroclitic immune response against cancer cells. Human immune cells are contacted with a synthetic peptide containing at least the analogue segment described herein.
- the present invention also is directed further to a related method of inducing formation and proliferation of human cytotoxic T cells that produce a heteroclitic immune response against leukemic cells in a human as described in the method for inducing formation and proliferation of cytotoxic T cells against a cancer cell.
- the present invention is directed to a related method of inducing a heteroclitic response in a human.
- the immunogenic compositions described herein are administered to a human to activate human immune cells.
- the formation and proliferation of cytotoxic T cells against the activated cells presenting the analogue segment of the synthetic peptide described herein that comprises the immunogenic composition is induced thereby.
- the cytotoxic T cells will cross-react with a cancer cell presenting a native peptide from which the analogue segment is derived to induce the heteroclitic response.
- the present invention is directed further to a related method of inducing a heteroclitic response in a human against leukemic cells as described in the method for inducing such heteroclitic response against a cancer cell.
- FIG. 3A-3B show the results of a CD3+ gamma interferon ELISPOT from a healthy HLA A0201 donor using the b2a2 A3-A5 peptides ( Figure 3 A) and from a chronic myelogenous leukemia patient in chronic phase HLA A0201 ( Figure 3B) using the b2a2 A3 peptide.
- Figures 4A-4B show the results of cytotoxicity assays with T cells from a healthy HLA A0201 donor using p2 IOC, p21 OF and pl90B peptides (Figure 4 A) and the b2a2 A3 peptide ( Figures 4B).
- Figures 5A-5E show binding of native and synthetic WT-1 peptides to HLA A0201 cells ( Figure 5A) and to HLA A0301 cells ( Figures 5B-5E).
- Figures 6A-6B show the results of a CD3+ gamma interferon ELISPOT (Figure 6A) and cytotoxicity (Figure 6B) from a healthy HLA A0201 donor against native and synthetic peptide pulsed T2 cells.
- Figures 7A-7D show the results of a CD8+ ( Figure 7A) and CD3+ ( Figures 7B-7D) gamma interferon ELISPOT from healthy HLA AO201 donors using native and synthetic WT-1 peptides.
- Figures 8A-8B show the results of cytotoxicity assays using CD 8+ T cells stimulated with synthetic WT-1 Al peptides from a HLA A0201 donor against HLA matched CML blasts presenting native peptide sequences.
- a synthetic peptide comprising a sequence of amino acids containing at least a segment that is analogue of a native peptide that specifically binds HLA A0201 or HLA A0301 molecules on a cell characteristic of a pathophysiologic state in a mammal.
- the analogue segment may have a number of amino acids that is about 70% to about 130% of the number of amino acids in the native peptide.
- the number of amino acids may be about 8 to about 12.
- the pathophysiologic state may be a cancer.
- the cancer may be a leukemia such as a chronic myelogenous leukemic.
- the cancer may breast cancer, lymphoma, mesothelioma, lung cancer, testicular cancer, or ovarian cancer.
- the mammal may be a human.
- the synthetic peptide may comprise an immunogenic carrier linked thereto.
- carriers are a protein, a peptide or an antigen-presenting cell.
- Representative examples of a protein or peptide are keyhole limpet hemocyanin, an albumin or a polyamino acid.
- a representative example of an antigen-presenting cell is a dendritic cell.
- the amino acids comprise a precursor to the analogue segment which is a degradation product thereof.
- the presursor may be a bcr-abl fusion protein where the analogue segment spans the breakpoint region of the fusion protein.
- the precursor may be " WT1 where the analogue segment replaces a native peptide of WT1.
- the analogue segment is derived from a native peptide comprising a breakpoint region of a bcr-abl fusion protein.
- the native peptide may be a native pl90-31a2 peptide.
- the native peptide may be a native p210-b3a2 peptide and the amino acid sequence of the analogue segment may be YLKALQRPN (SEQ ID ⁇ O: 2), KQSSKALQN (SEQ ID ⁇ O: 4), KLSS ALQN (SEQ ID ⁇ O: 5), KLLQRPNAN (SEQ ID ⁇ O: 7), TLFKQSSKN (SEQ ID ⁇ O: 9), or YLFKQSSKV (SEQ ID ⁇ O: 10).
- YLKALQRPN SEQ ID ⁇ O: 2
- KQSSKALQN SEQ ID ⁇ O: 4
- KLSS ALQN SEQ ID ⁇ O: 5
- KLLQRPNAN SEQ ID ⁇ O: 7
- TLFKQSSKN SEQ ID ⁇ O: 9
- YLFKQSSKV SEQ ID ⁇ O: 10
- the amino acid sequence is YLKALQRPV (SEQ ID ⁇ O: 2), KLLQRPVAV (SEQ ID ⁇ O: 7) or YLFKQSSKV (SEQ ID ⁇ O: 10)
- the native peptide may be a native p210-b2a2 peptide and the amino acid sequence of the analogue segment may be LLL ⁇ KEEAL (SEQ ID ⁇ O: 12), LTI ⁇ KVEAL (SEQ ID ⁇ O: 13), YLI ⁇ KEEAL (SEQ ID ⁇ O: 14), YLI ⁇ KEEAV (SEQ ID ⁇ O: 15), and YLL ⁇ KVEAL (SEQ ID ⁇ O: 16).
- the amino acid sequence is YLI ⁇ KEEAL (SEQ ID ⁇ O: 14).
- the analogue segment is derived from a native peptide comprising a WT1 protein.
- the amino acid sequence of the WT1 derived analogue segment may be YMFP ⁇ APYL (SEQ ID ⁇ O: 18), YLGEQQYSN (SEQ ID ⁇ O: 20), YLLPAVPSL (SEQ ID ⁇ O: 22), YLGATLKGV (SEQ ID ⁇ O: 24), YL ⁇ ALLPAV (SEQ ID ⁇ O: 26), GLRRGIQDV (SEQ ID ⁇ O: 28), KLYFKLSHL (SEQ ID ⁇ O: 30), ALLLRTPYV (SEQ ID ⁇ O: 32), YMTW ⁇ QM ⁇ L (SEQ ID ⁇ O: 34), ⁇ MYQR ⁇ MTK (SEQ ID ⁇ O: 36), ⁇ MHQRVMTK (SEQ ID ⁇ O
- a synthetic peptide with an amino acid sequence that may be one or more of YLKALQRPV (SEQ ID ⁇ O: 2), KQSSKALQV (SEQ ID ⁇ O: 4), KLSSKALQV (SEQ ID ⁇ O: 5), KLLQRPVAV (SEQ ID NO: 7), TLFKQSSKV (SEQ ID NO: 9), YLFKQSSKV (SEQ ID NO: 10), LLLNKEEAL (SEQ ID NO: 12), LTLNKVEAL (SEQ ID NO: 13), YLINKEEAL (SEQ ID NO: 14), YLLNKEEAV (SEQ ID NO: 15), or YLLNKVEAL (SEQ ID NO: 16).
- a synthetic peptide is provided with an amino acid sequence that may be one or more of NMYQRNMTK (SEQ ID NO: 36), NMHQRVMTK (SEQ ID NO: 37), NMYQRNMTK (SEQ ID ⁇ O: 38), QMYLGATLK (SEQ ID ⁇ O: 40), QMNLGNTLK (SEQ ID ⁇ O: 41), QMYLGNTLK (SEQ ID ⁇ O: 42), FMYAYPGC ⁇ K (SEQ ID ⁇ O: 44), FMCAYPFC ⁇ K (SEQ ID ⁇ O: 45), FMYAYPFC ⁇ K (SEQ ID ⁇ O: 46), KLYHLQMHSR (SEQ ID ⁇ O: 48), KLSHLQMHSK (SEQ ID ⁇ O: 49), or KLYHLQMHSK (SEQ ID ⁇ O: 50).
- NMYQRNMTK SEQ ID NO: 36
- NMHQRVMTK SEQ ID NO: 37
- NMYQRNMTK SEQ
- a pharmaceutical composition comprising a therapeutically effective amount of the synthetic peptide of claim 1 or a D ⁇ A encoding the synthetic peptide; and a pharmaceutically acceptable carrier.
- the pharmaceutical composition comprises a D ⁇ A encoding the synthetic peptide
- the D ⁇ A may be inserted into a vector or into an antigen-presenting cell.
- An example of an antigen presenting cell is a dendritic cell.
- an analogue segment comprising the synthetic peptide is derived from a native p210-b3a2 peptide, a native p210-b2a2 peptide or a native pl90-ela2 peptide.
- an analogue segment comprising the synthetic peptide is derived from a native peptide comprising the WT-1 protein.
- These amino acid sequences for these WTl -derived analogue segments are as identified supra for WT-1 derived analogues.
- an immunogenic composition comprising an immunogenically effective amount of the synthetic peptides described supra and a pharmaceutically acceptable carrier, adjuvant or diluent or a combination thereof.
- the carrier may be a protem, a peptide or an antigen-presenting cell linked to the synthetic peptide.
- a protein or peptide carrier are keyhole limpet hemocyanin, an albumin or a polyamino acid.
- An example of an antigen-presenting cell is a dendritic cell.
- the synthetic peptides and analogue segments comprising the synthetic peptides are as described supra. In aspects of this embodiment, the analogue segments may be derived from those native peptides and the amino acid sequences may be those sequences described supra for a pharmaceutical composition.
- a method of inducing formation and proliferation of human cytotoxic T cells that produce a heteroclitic immune response against cancer cells comprising contacting human immune cells with the synthetic peptides described supra to activate the immune cells; and inducing formation and proliferation of human cytotoxic T cells reactive against the activated cells presenting at least the analogue segment of the synthetic peptide, where the proliferating T cells will cross react with the cancer cells presenting a native peptide from which said analogue segment is derived such that the human cytotoxic T cells are capable of producing a heteroclitic immune response against the cancer cells.
- the method further comprises providing a DNA encoding the synthetic peptide and expressing the DNA.
- the DNA may be inserted into a suitable vector.
- the DNA may be inserted into an antigen-presenting cell.
- An example of an antigen-presenting cell is a dendritic cell.
- the human immune cells are contacted in vivo in an individual having a cancer.
- the human immune cells are contacted in vivo in a donor and the method further comprises obtaining the cytotoxic T cells from the donor and infusing the cytotoxic T cells into a recipient having a cancer.
- the cells are contacted ex vivo and the method further comprises obtaining the human immune cells from a donor prior to the contacting the human immune cells with the pha ⁇ naceutical composition and infusing the activated immune cells into an individual having a cancer prior to the inducing formation and proliferation of cytotoxic T cells.
- the cells are contacted ex vivo and the method further comprises obtaining human immune cells from a donor prior to contacting the human immune cells. In this aspect, both contacting the human immune cells and formation and proliferation of the cytotoxic T-cells occurs ex vivo, infusing the cytotoxic T-cells into an individual having a cancer.
- representative human immune cells may be peripheral blood mononuclear cells, bone marrow cells, dendritic cells, or macrophages.
- the synthetic peptides and analogue segments comprising the synthetic peptides are as described supra.
- the analogue segments comprising the synthetic peptide may be derived from a native p210-b3a2 peptide, a native p210-b2a2 peptide, a native pl90-ela2 peptide or from a native WT-1 peptide as described supra.
- the amino acid sequences of these synthetic peptides or the analogue segments comprising the synthetic peptides may have an amino acid sequence as identified supra for p210-b3a2-, p210-b2a2- or WT-1 -derived analogues.
- WT-1 analogue segments and p210-b3a2 and p210- b2a2 derived analogue segments may induce a heteroclitic response against leukemic cells.
- Representative leukemic cells are chronic myelogenous leukemic cells.
- WT-1 analogue segments may induce a heteroclitic response against from breast cancer, lymphoma, mesothelioma, lung cancer, testicular cancer, or ovarian cancer.
- a method of treating a cancer in a human comprising administering the pharmaceutical compositions described herein to the human; and inducing a heteroclitic response by cytotoxic T-cells that recognize at least the analogue segment of said synthetic peptide against cancer cells presenting a native peptide from which said analogue segment is derived, said cytotoxic T-cells recognizing or killing said cancer cells thereby treating the cancer.
- the synthetic peptides or DNAs encoding the synthetic peptides are as described supra.
- the analogue segment comprising the synthetic peptides may be derived from a native pl90 ela2 peptide, a native p210-b3a2 peptide, a native p210-b2a2 peptide, or from a native WT-1 peptide as described supra. Furthermore, the amino acid sequences of these synthetic peptide or the analogue segments comprising the synthetic peptides are as identified supra for p210-b3a2-, p210-b2a2- or WT-1 -derived analogue segments.
- WT-1 at least the analogue segments comprising the synthetic peptides and p210-b3a2 and p210-b2a2 derived synthetic peptides may treat a leukemia.
- a representative leukemia is chronic myelogenous leukemic.
- WT-1 at least the analogue segments comprising the synthetic peptides may treat breast cancer, lymphoma, mesothelioma, lung cancer, testicular cancer, or ovarian cancer.
- a method of inducing a heteroclitic immune response in a human comprising administering to the human an effective amount of the immunogenic compositions described supra; activating human immune cells with the immunogenic composition; and inducing formation and proliferation of human cytotoxic T cells against the activated cells presenting at least the analogue segment of the synthetic peptide comprising the immunogenic composition.
- the human cytotoxic T cells will cross-react with a cell comprising a cancer presenting a native peptide from which said analogue segment is derived, thereby inducing the heteroclitic immune response.
- the human may have an active cancer, may be in remission from cancer or may be at risk of developing a cancer.
- human donates the cytotoxic T-cells to an individual having an active cancer, is in remission from cancer or is at risk of developing a cancer.
- the immunogenic compositions, the human immune cells and the synthetic peptides and the analogue segments comprising the synthetic peptides are as described supra.
- at least WT-1 analogue segments and p210-b3a2 and p210-b2a2 derived analogue segment comprising synthetic peptides may induce a heteroclitic response in the human against leukemia.
- a representative leukemia is chronic myelogenous leukemic.
- At least WT-1 analogue segments may induce a heteroclitic response in the human against breast cancer, lymphoma, mesothelioma, lung cancer, testicular cancer, or ovarian cancer.
- synthetic immunogenic peptides with an amino acid sequence containing at least an analogue segment of a native peptide that demonstrates improved binding over the native peptides to HLA A0201 or to HLA A0301 complexes. These synthetic peptides or analogue segments can stimulate T- cells to cross-react with the native peptides thus eliciting a heteroclitic immune response that will recognize or kill cells presenting the native peptides.
- Such cells are characteristic of a pathophysiological state, for example, but not limited to, a cancer.
- At least the analogue segments comprising the synthetic peptides will bind with more affinity to the HLA class I and class II molecules that are instrumental in presenting the analogue segments to the T-cells than the native peptide itself.
- the synthetic peptide analogue segments are designed by making one or two amino acid substitutions in anchor or auxiliary residues.
- the native peptides particularly described herein are nonamers encompassing the anchor or auxiliary residues
- analogues may be designed having about 70% to about 130% of the amino acids in the native peptide.
- the synthetic peptide analogues may have about 8-12 amino acids.
- Such substitutions are determined by a bioinformatic model system (BIMAS) which uses a matrix approach to predict binding and ranks the peptides based on predicted binding to the HLA molecule.
- BIMAS bioinformatic model system
- the amino acid sequences and predicted score for binding to HLA A0201 and HLA A0301 are generated by online software BIMAS available at http://bimas.dcrt.nih.gov/cgi- bin/molbio/ken parker comboform and SYFPEITHI available at http://syfpeithi.bmi- heidelberg.com/.
- the synthetic peptide may be a precursor to the analogue segment which may be a degradation product of the synthetic peptide.
- Such precursor may be a bcr-able fusion protein such that the synthetic analogue spans the breakpoint region of the fusion protein.
- the precursor may be a WTl protein such that the analogue segments replaces a native peptide sequence within WTl .
- the synthetic peptide is or comprises analogue segments that may be analogues of the breakpoint region of the bcr-abl fusion protein, which is the oncogenic protein required for neoplasia in chronic myelogenous leukemia.
- the synthetic peptides are or comprise analogue segments derived from the junctional sequences of p210-b3a2, p210-b2a2 and pl90-ela2.
- the synthetic peptides or the analogue segments are derived from p210-b3a2 and p210-b2a2 in which single or double amino acid substitutions were introduced into the peptides at key HLA A0201 binding positions.
- These high affinity peptide analogues were able to generate specific CD8+ T cells far more efficiently than the native peptides and are capable of stimulating human CD8+ CTL heteroclitic responses that cross-react with the native sequences presented on leukemic cells.
- Preferred synthetic peptides or analogue segments are the p210-b3a2 analogues p210C, p210D, p210E, and p210F, more preferably p210C, and the p210- b2a2 analogues b2a2 A3, b2a2 A4 and b2a2 A5, more preferably b2a2 A3.
- Table 1 shows the amino acid sequences and binding predictions of native and synthetic analogues.
- the underlined K in the b3a2 and underlined blue E in b2a2 are the amino acids in the breakpoint. Highlighted residues represent modifications from the native sequence.
- the synthetic immunogenic peptides may be analogue segments or comprise analogue segments derived from WTl protein.
- Computer prediction analysis as described herein, predicted synthetic peptides analogues derived from nonamer sequences of the WTl protein in which single amino-acid substitutions were introduced at HLA A0201 binding and single or double amino acid substitutions were introduced at A0301 binding positions.
- These synthetic peptide analogues or analogue segments were able to generate specific CD8+ or CD3+ T cells far more efficiently than the native peptides and are capable of stimulating human CD8+ or CD3+ CTL heteroclitic responses that cross-react with the native sequences presented on leukemic cells or on other cells that present these native WT-1 peptides.
- Tables 2 and 3 show the amino acid sequences and binding predictions of native WT-1 and synthetic WT-1 peptide analogues. Highlighted residues represent modifications from the native sequence. TABLE 2 HLA 0201 native e tides from WT-1 and s nthetic analogues
- the present invention also provides a pharmaceutical composition of a therapeutic amount of the synthetic peptides or analogue segments or a genetic sequence or DNA encoding the same and a pharmaceutical carrier, as is known in the art.
- the pharmaceutical composition may be formulated with the pharmaceutical carrier for administration by any of the many techniques known to those of skill in the art.
- the pharmaceutical composition may be administered parenterally, intravenously, subcutaneously, intradermally, intramucosally, topically, orally, or by inhalation. Therefore, it is contemplated that the synthetic peptides or analogue segments or pharmaceutical compositions thereof may be used in the preparation of an immunogenic composition suitable to effect immunization of a subject.
- the immunogenic composition may comprise a carrier or a suitable adjuvant to boost immune response or a combination thereof, as are known in the art.
- the immunogenic composition further may comprise a diluent standard in the art as described herein.
- the immunogenic composition may comprise a vaccine.
- a carrier may comprise one or more proteins or peptides. Examples of carriers are well known and may be, although not limited to keyhole limpet hemocyanin, an albumin, such as human serum albumin or a polyamino acid.
- a carrier may comprise a live antigen-presenting cell, such as a dendritic cell, which presents the synthetic peptides described herein.
- a suitable adjuvant may be Freund's adjuvant, aluminum phosphate, aluminum hydroxide, alum, QS21, BCG. These compositions further may comprise a physiologically acceptable diluent, e.g., water, phosphate buffered saline or saline. Additionally, a genetic sequence encoding a synthetic peptide or an analogue segment thereof may be delivered as naked DNA to an individual via appropriate methods known in the art. Alternatively, the genetic sequence may be introduced or inserted into a suitable vector, such as for example, but not limited to, attenuated viral or bacterial vectors, as are standard in the art.
- the naked DNA or vectors comprising the genetic sequence or DNA may be transduced into an antigen-presenting cell, e.g., a dendritic cell.
- the genetic sequence, DNA, vector or transduced antigen-presenting cell may be introduced into an individual in need of the treatment or into a healthy donor whereupon the DNA encoding the genetic sequence expresses the synthetic peptide to elicit a cytotoxic T-cell response.
- Donor T-cells may then be infused into a patient in need thereof.
- the pharmaceutical or immunogenic compositions may be used to treat a disease or a condition such as cancer.
- the synthetic peptides or synthetic analogue segments thereof or genetic sequences encoding the same or the pharmaceutical or the immunogenic compositions thereof can induce human cytotoxic T cells to produce a heteroclitic immune response against cancerous cells, for example, leukemic cells.
- cytotoxic T cells can induce human cytotoxic T cells to produce a heteroclitic immune response against cancerous cells, for example, leukemic cells.
- Contacting human immune cells with at least the analogue segment that is or comprises the synthetic peptides activates the immune cells to induce formation and proliferation of human cytotoxic T cells that will recognize or react against a cell presenting the synthetic peptide.
- Such cytotoxic T cells cross react with human cells presenting the native peptides from which the analogue segment is derived thereby producing a heteroclitic response.
- the word "contacting" in terms of activating target immune cells to elicit a subsequent immune response as referring to any suitable delivery method of bringing an immunogenic agent into contact with the target cells. In vitro or ex vivo this is achieved by exposing the target cells to the agent in a suitable medium. For in vivo applications, any known method of administration is suitable as described herein.
- the synthetic peptides or analogue segments thereof described herein may be used to activate T-cells ex vivo or in vivo.
- the synthetic peptides or analogue segments thereof or DNA encoding the same may be administered to a patient or to a healthy donor to induce cytotoxic T-cells.
- these cytotoxic T-cells are obtained from the donor and infused into an individual in need of them, such as an individual with an active cancer, in remission from a cancer or at risk for developing a cancer.
- the T cells are obtained from a patient or from a healthy donor and are incubated in the presence of antigen presenting cells and a synthetic peptide or at least an analogue segment thereof to activate the T-cells.
- the activated T-cells subsequently are infused back into the patient where they will recognize and/or destroy cells presenting the native peptide.
- human immune cells may be incubated with the synthetic peptide or at least an analogue segment thereof whereupon the activated immune cells are infused back into the patient to induce T- cell production against both the activated cells and cell presenting the native peptide.
- immune cells may be peripheral blood mononuclear monocytic cells, bone marrow cells, dendritic cells, or macrophages. It is contemplated further that administration of the synthetic peptide or at least an analogue segment thereof or pharmaceutical compositions thereof induces an immune response in a subject, preferably, although not limited to, a CD8/HLA A or CD3/HLA A class I immune response.
- the synthetic peptides or at least an analogue segment thereof may be used in a method of immunizing a subject against a pathophysiologic condition or disease presenting HLA molecules, e.g., a leukemia, such as chronic myelogenous leukemia.
- WT- 1 synthetic peptides or at least analogue segments thereof may be used to induce an immune response in a subject with other leukemias or cancers such as, although not limited to, breast, lymphoma, mesothelioma, lung, testicular, or ovarian cancers.
- immunizing or immunization of a subject encompasses full and partial immunization whereby the subject becomes fully immune to the condition or partially immune to the condition.
- the subject may be a mammal, preferably a human.
- the subject may have a condition or disease which may be active or in remission, prior to immunization. Alternatively, if at risk for developing the disease or condition, the subject may be immunized prior to such development.
- risk factors such as environmental risk factors or personal risk factors, such as family history, genetic makeup or behavior, to make a determination of risk in the subject.
- the pharmaceutical compositions and immunogenic compositions may be administered one or more times to achieve a therapeutic or an immunogenic effect.
- Synthetic Peptides Each of the peptides utilized in this study was purchased and was synthesized by Genemed Synthesis Inc, CA using fluorenylmethoxycarbonyl chemistry, solid phase synthesis and purified by high pressure liquid chromatography. The quality of the peptides was assessed by high-performance liquid chromatography analysis and the expected molecular weight was observed using matrix-assisted laser desorption mass spectrometry. Peptides were sterile and > 90% pure. The peptides were dissolved in DMSO and diluted in phosphate-buffered saline (PBS) at pH 7.4 or saline to give a concentration of 5 mg/ml and were stored at - 80°C. For in vitro experiments an irrelevant control peptide, HLA A24 consensus, was used.
- PBS phosphate-buffered saline
- EXAMPLE 2 Cell lines Cell lines were cultured in RPMI 1640 medium supplemented with 5% FCS, penicillin, streptomycin, 2mM glutamine and 2-mercaptoethanol at 37 °C in humidifier air containing 5% CO2.
- SKLY-16 is a human B cell lymphoma expressing HLA A0201and T2 is a human cell line lacking TAP1 and TAP2 and therefore unable to present peptides derived from cytosolic proteins.
- T2 assay for peptide binding and stabilization of HLA A0201 molecules T2 cells (TAP -, HLA-A0201 +) were incubated overnight at 27 °C at 1 x 10E6 cells/ml in FCS-free RPMI medium supplemented with 5 ⁇ g/ml human B2m
- T2 cells were labeled for 30 min at 4 °C with a saturating concentration of anti-HLA-A2.1 (BB7.2) mAb, then washed twice.
- BB7.2 anti-HLA-A2.1
- the cells then were incubated for 30 min at 4 °C with a saturating concentration of FITC-conjugated goat IgG F(ab')2 anti-mouse Ig (Caltag, South San Francisco, CA), washed twice, fixed in PBS/1 % paraformaldehyde and analyzed using a FACS Calibur cytofluorometer (Becton Dickinson, Immunocytometry systems, San Jose, CA). The mean intensity of fluorescence (MIF) observed for each peptide concentration, after subtraction of the MIF observed without peptide, was used as an estimate of peptide binding. Stabilization assays were performed similarly.
- MIF mean intensity of fluorescence
- Binding of 125 I-labeled peptide with or without competitive unlabeled peptide was done for 30 min at 20°C. Total bound 125 I was determined after two washes using PBS/2% BSA and one wash with PBS. Relative affinities were determined by comparison of escalating concentrations of the test peptide versus a known binding peptide. Peptides of affinities ⁇ 500 nM were chosen for use. A specificity analysis of the binding of peptide to HLA on the live cell surface (SKLY-16) was conducted to confirm that the binding was to the appropriate HLA molecule and to characterize its restriction.
- PBMC peripheral blood mononuclear cells
- leukemia cell lines and EBV-transformed T-cell lines of specific HLA types.
- the relative avidity of the peptides found to bind MHC molecules on the specific cells were assayed by competition assays as described above against 125 I- labeled peptides of known high affinity for the relevant HLA molecule, e.g., tyrosinase or HBV peptide sequence.
- Peripheral blood dendritic cells were generated as follows: Monocyte-enriched peripheral blood mononuclear cell fractions were isolated, using a plastic adherence technique, from total peripheral blood mononuclear cells. The plastic-adherent cells were cultured further in RPMI 1640 medium supplemented with 1-5% autologous plasma, 1000 U/mL recombinant human interleukin (IL)-4 (Shering-Plough, NJ), and 1000 U/mL recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) (Immunex, Seattle).
- IL human interleukin
- GM-CSF granulocyte-macrophage colony-stimulating factor
- T lymphocytes were isolated from the same donors by use of negative selection by depletion with an anti-CD l ib, anti-CD56 and CD 19 monoclonal antibody (Miltenyi, CA).
- a total of lxlOE6 of pure T lymphocytes were cultured with lxlOE5 autologous dendritic cells in RPMI 1640 medium supplemented with 5% heat-inactivated human autologous plasma with bcr-abl synthetic peptides at a concentration of 10 ⁇ g/mL and b2 microglobulin at 2 ⁇ g/ml in a 24 well plates in the presence of 5-10 ng/mL recombinant human IL-7 (Genzyme) and 0.1 ng/ml of IL-12.
- IL-2 After culture for 3 days 20 U/ml of IL-2 was added. After 10 days, lxlOE6 cells were stimulated again by adding 2xl0e5 autologous magnetically isolated CD 14+ monocytes together with 10 ng/ml of IL-7 and 20U/ml of IL-2 and peptide at a concentration of 10 ⁇ g/mL. In some cases, after culture for another 7 days, the cells were stimulated a third time in the same manner. After the second or third stimulation, CD 8 T cells were isolated magnetically and cytotoxicity and gamma-LFN secretion of these cells were examined. EXAMPLE 6
- Gamma interferon ELISPOT HA-Multiscreen plates (Millipore, Burlington, MA) were coated with 100 ⁇ l of mouse-anti-human IFN-gamma antibody (10 ⁇ g/ml; clone 1-D1K, Mabtech, Sweden) in PBS, incubated overnight at 4°C, washed with PBS to remove unbound antibody and blocked with RPMI/ autologous plasma for 1 h at 37 °C.
- Purified CD8+ T cells more than 95% pure, were plated at a concentration of lxl0 5 /well. T cells were stimulated with lxl 0E4 T2 cells per well, pulsed with 10 ⁇ g/ml of B2- microglobulin (Sigma, St.
- Control wells contained T2 cells with or without CD8+ cells. Additional controls included medium or CD8+ alone plus PBS/5% DMSO diluted according to the concentrations of peptides used for pulsing T2 cells. After incubation for 20 hours at 37 °C, plates were washed extensively with PBS/0.05% Tween and 100 ⁇ l/well biotinylated detection antibody against human IFN-g at 2 ⁇ g/ml (clone 7-B6-1, Mabtech, Sweden) were added. Plates were incubated for an additional 2 hours at 37 °C and spot development was performed. Spot numbers were automatically determined with the use of a computer-assisted video image analyzer with KS ELISPOT 4.0 software (Carl Zeiss Vision, Germany).
- EXAMPLE 7 Cytotoxicity assay The presence of specific CTLs was measured in a standard 4 h- chromium release assay. 4x10E6 targets were labeled with 300 ⁇ Ci of Na 2 51 CrO 4 (NEN Life Science Products, Inc. Boston, MA) for 1 hour at 37 °C. After washing, cells at 2xlOE6/ml were incubated with or without synthetic peptides at a concentration of lO ⁇ g/ml for 2 hours at 20 °C in presence of ⁇ 2 microglobulin at 3 ⁇ g/ml.
- target cells were resuspended in complete media at 5x10E4 cells per ml and plated in a 96 well U-bottom plate (Becton Dickinson ® , NY) at 5x10E3 cells per well with effector cells at effector to target ratios (E/T) ranging from 100:1 to 10:1. Plates were incubated for 5 hours at 37C in 5% CO 2 . Supernatant fluids were harvested and radioactivity was measured in a gamma counter. Percent specific lysis was determined from the following formula: lOOx [(experimental release minus spontaneous release)/(maximum release minus spontaneous release)]. Maximum release was determined by lysis of targets in 2.5% Triton X-100.
- HLA-A0201 Amino acid sequences of the human b3a2 and b2a2 fusion proteins were scanned for peptides with potential binding capacity for HLA A0201, a subtype encompassing 95% of the HLA-A02 allele. HLA-A0201 is expressed in about 40% of the Caucasian population. No peptides with high or intermediate affinity were identified in the native b3a2 or b2a2 fusion proteins with > than 1 minute of predicted half life. One peptide that does not exhibit the consensus HLA 0201 binding motifs has been described but it has weak avidity to MHC.
- Binding of HLA-A0201 by synthetic peptides analogues of b2a2 and b3a2 native peptides requires the capacity to bind and stabilize MHC class I molecules on the live cell surface. Moreover the computer prediction models above have only 60-80% predictive accuracy. Direct measurement of the strength of the interaction between the peptides and the HLA-A0201 molecule was made using a conventional binding and stabilization assay that uses the antigen-transporting deficient (TAP2-) HLA-A0201 human T2 cells. T2 cells lack TAP function and consequently are defective in properly loading class I molecules with antigenic peptides generated in the cytosol.
- TAP2- antigen-transporting deficient
- p210F is a peptide derived from the sequence previously described by Yotonda et al. CMLA2, shown to be a weak binder in the T2 assay.
- the two serines in position one and two were substituted by a tyrosine and a leucine.
- the BIMAS prediction showed a 700 fold improvement and the binding to T2 cell revealed an excellent avidity for HLA A0201 molecules (Figure 1A).
- Figure 1A Of the peptides derived from b2a2, all were generated from a peptide that not predict a good binding to HLA A0201.
- Three peptides, b2a2 A3-A5 (Table 1) bound well to HLA A0201 molecules ( Figure IB).
- These three peptides have a tyrosine-leucine sequence substitution at position 1 and 2 and also a valine substitution in position 6 or 9.
- EXAMPLE 10 Assessment of the dissociation time of b2a2 and b3a2 synthetic peptides analogues The immunogenicity of peptide antigens depends on a low dissociation rate of MHC/peptide complexes. The stability of complexes formed between HLA- A0201 and the b3a2 analogue peptides was assayed on T2 cells over time. Overnight incubation of T2 cells with saturating amounts of HLA-A0201 binding peptides and human ⁇ 2 microglobulin resulted in increased surface expression of HLA-A0201 molecules.
- HLA-A0201 complexes formed with peptides p210A and p210B were unstable, reaching background levels in less than 1 h of incubation at 37°C.
- peptides p210C, p210D, p210E and p210F formed complexes that were relatively stable over 6-8 hours.
- EXAMPLE 11 Induction of CD8 immune response against b2a2 and b3a2 synthetic peptide analogues While affinity for MHC molecules is necessary for peptide immunogenicity, there is also a requirement for presence of reactive precursor T cells with appropriate T cell receptors.
- T cell-expansion system with monocyte derived DC, CD 14+ cells as APC, and purified T cells, the ability of the synthetic b3a2 and b2a2 analogues to stimulate peptide-specific CTLs is examined.
- p210D and p210E produced an immune response in some of the donors tested although p210C and p210F generated a more consistent and higher immune-responses (Figure 2A).
- Responses were observed after the second or third round of peptide stimulation after CD8+ isolation or in unpurified CD3+ T cells.
- the spot numbers were consistently higher with peptides that bound with higher affinity to HLA 0201 molecules as determined by T2 assay. More importantly, T cells generated in the presence of the new synthetic analogues were able to recognize the native sequences.
- p210C and p210F were able to stimulate T cells to recognize their respective native sequences ( Figure 2A).
- CML A2 the native sequence from p210F is a natural weak binder and there is indirect evidence that it can be naturally expressed in the surface of chronic myelogenous leukemia blasts. No immune response could be generated against the p210A and p210B, despite attempts using different donors. This result is consistent with their reduced affinity for MHC.
- a chronic myelogenous leukemia patient in chronic phase HLA A0201 responded to p210C stimulation of T cells and demonstrated T-cell cross-reactivity with native p210cn peptide. Response was observed after the second round of T-cell stimulation in vitro ( Figure 2B).
- the peptides derived from b2a2 also generated a significant immune response as measured by gamma interferon secretion CD3+ T cells.
- Peptides b2a2A3, A4 and A5 generated an immune response in two healthy donors (Figure 3A).
- the response against b2a2 A3 was more consistent between donors.
- T cells generated in the presence of b2a2 A3 were able to identify the original native sequence. This is of special relevance because the native sequence is a weak/intermediate binder to HLA.
- a CML patient in chronic phase HLA A0201 responded to b2a2 A3 stimulation of T cells and demonstrated T-cell cross- reactivity with native b2a2 A peptide (Figure 3B).
- Gamma interferon ELISPOT is not always associated with functional killing.
- T cell lines obtained after several stimulations with the analogue peptide were tested in a classic chromium-51 assay using peptide pulsed target cell lines.
- T cells generated in vitro in the presence of p210C ( Figure 4A) and b2a2 A3 ( Figure 4B) were able to kill T2 cell line pulsed with specific peptides but not without peptide or with control peptide.
- This experiment was also performed using HLA matched chronic myelogenous leukemia cell lines or CML blasts expressing the respective translocation b3a2 or b2a2.
- Significant cytotoxicity was generated raising the possibility that the native peptides were not naturally processed and/or sufficiently expressed in the surface of the leukemic cells.
- WT1-D1 demonstrated a significantly higher level of binding to HLA-A0201 over WT1-D which was similar to control.
- a comparison of HLA A0301 binding of A3WT1-A, -B, -C, and -D with each of their respective three analogues demonstrated relatively similar binding ( Figures 5B-5E).
- CD8 or CD3 immune response against synthetic peptide analogues derived from the WTl oncoprotein Cells were primarily stimulated with autologous monocyte-derived, peptide-pulsed dendritic cells generated in the presence of GM-CSF, IL-4, TNF alpha, PGE2 and CD40L and re-stimulated with peptide-pulsed CD 14+ monocytes in the presence of IL-2 and IL-7.
- the CD8+ CTL lines were assessed by either IFN alpha ELISPOT or a chromium release assay using pulsed, HLA-matched leukemic cell lines ( Figures 6A-6B).
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EP3769782A1 (en) | 2013-01-15 | 2021-01-27 | Memorial Sloan Kettering Cancer Center | Immunogenic wt-1 peptides and methods of use thereof |
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WO2017087857A1 (en) | 2015-11-20 | 2017-05-26 | Memorial Sloan Kettering Cancer Center | Methods and compositions for treating cancer |
WO2018101309A1 (en) | 2016-11-30 | 2018-06-07 | 大日本住友製薬株式会社 | Wt1 helper peptide, and combination of said peptide and cancer antigen peptide conjugate |
WO2018181648A1 (en) | 2017-03-30 | 2018-10-04 | 大日本住友製薬株式会社 | Wt1 cancer antigen peptide and peptide conjugate body containing same |
WO2020067453A1 (en) | 2018-09-28 | 2020-04-02 | 大日本住友製薬株式会社 | Injectable composition |
WO2021230247A1 (en) | 2020-05-12 | 2021-11-18 | 大日本住友製薬株式会社 | Pharmaceutical composition for treating cancer |
WO2023017836A1 (en) | 2021-08-12 | 2023-02-16 | 株式会社癌免疫研究所 | Pharmaceutical composition and method for treatment or prevention of cancer |
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US20050119185A1 (en) | 2005-06-02 |
CA2548135A1 (en) | 2005-06-16 |
EP1708732A2 (en) | 2006-10-11 |
US7598221B2 (en) | 2009-10-06 |
WO2005053618A3 (en) | 2006-02-23 |
ES2402184T3 (en) | 2013-04-29 |
JP2007516966A (en) | 2007-06-28 |
AU2004294345A1 (en) | 2005-06-16 |
US7488718B2 (en) | 2009-02-10 |
EP2478913A1 (en) | 2012-07-25 |
EP1708732B1 (en) | 2013-01-02 |
US20060084609A1 (en) | 2006-04-20 |
CA2548135C (en) | 2014-04-22 |
ES2402184T5 (en) | 2016-10-25 |
US20100239547A1 (en) | 2010-09-23 |
AU2004294345B2 (en) | 2012-02-23 |
EP1708732A4 (en) | 2009-09-02 |
EP1708732B2 (en) | 2016-05-18 |
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