WO2006109286A1

WO2006109286A1 - Filamentous hemagglutinin for the prevention of the development of neutralising antibodies to a biologic agent

Info

Publication number: WO2006109286A1
Application number: PCT/IE2006/000033
Authority: WO
Inventors: Kingston Mills; Brian Keogh; Peter Mcguirk
Original assignee: The Provost, Fellows And Scholars Of The College Of The Holy And Undivided Trinity Of Queen Elizabeth Near Dublin
Priority date: 2005-04-14
Filing date: 2006-04-18
Publication date: 2006-10-19
Also published as: GB0507548D0

Abstract

Described is a novel method for preventing the induction of an immune response directed against a biologic which is administered to an individual in need of treatment with the biologic, wherein the method comprises administering filamentous haemagglutinin (FHA) along with the biologic. The administration of FHA suppresses a ThI type T cell response which in turn prevents B cell stimulation and maturation and hence the production of antibodies which have specificity for the administered biologic. The suppression of such a neutralising antibody response will confer significant therapeutic advantages relating to therapy using the biologic.

Description

FILAMENTOUS HEMAGGLUTININ FOR THE PREVENTION OF THE DEVELOPMENT OF NEUTRALISING ANTIBODIES TO A BIOLOGIC AGENT

Field of the Invention

The present invention relates to a novel method for the prevention of the formation of neutralising antibodies against a therapeutic compound such as a biologic. More specifically there is provided a method for preventing the generation of antibodies with binding specificity directed against such a biologic through the administration of filamentous haemagglutinin (FHA) . The use of FHA in a composition for preventing the generation of a neutralising antibody response against a biologic is further provided.

Background to the Invention

The clinical efficacy of a drug treatment regime directed against a particular disease or indication can be severely impeded by the development of antibodies specific for that particular drug or biologic .

Recombinant Interferon Alpha Therapy Various type I interferons administered by intramuscular or subcutaneous injection are indicated for the treatment of chronic hepatitis B and chronic hepatitis C. Interferon alpha is a naturally occurring glycoprotein that is secreted by cells in response to viral infections. It exerts its effects by binding to a membrane receptor. Receptor binding initiates a series of intracellular signaling events that ultimately leads to enhanced expression of certain genes. This leads to the enhancement and induction of certain cellular activities including augmentation of target cell killing by lymphocytes and inhibition of virus replication in infected cells .

Various recombinant forms of interferon alpha

(interferon alpha-2a and interferon alpha-2b) and a recombinant non-naturally occurring type I interferon (interferon alfacon-1) are approved to treat viral hepatitis.

Interferon alpha-2a (Roferon-A; Hoffmann-La Roche) , inteferon alpha-2b (Intron-A; Schering-Plough) and interferon alfacon-1 (Infergen; Amgen) are all approved in the United States for the treatment of adults with chronic hepatitis C. Recombinant interferon alpha has also been used to treat various forms of malignancy and lymphoma.

The incidence of antibody formation to such recombinant forms of interferon alpha has been reported to be as common as occurring in approximately 10% of patients receiving therapy, however this figure may be as high as 38% in patients with renal cell cancer.

In one review of patients receiving alpha 2a (Jones GJ, Itri LM. Safety and tolerance of recombinant interferon alpha-2a (Roferon®-A) in cancer patients. Cancer 1986; 57 : 1709-15) , 27.4% of patients developed neutralising antibodies. Antibody formation was especially high among patients with renal cell carcinoma (45%) .

In another study among patients receiving alpha 2b (Spiegel RJ, Spicehandler JR, Jacobs SL, et al . Low incidence of serum neutralizing factors in patients receiving recombinant alpha-2b interferon (Intron A). American Journal Medicine 1986; 80: 223-8), only 2.4% developed neutralising antibodies.

Antonelli and colleagues (Antonelli G, Currenti M, Turriziani O, et al . Neutralizing antibodies to interferon: Relative frequency in patients treated with different interferon preparations. J Infect Dis 1991; 163 : 882-5) reported on antibody levels using a single assay method in hepatitis patients. The seroconversion rates were 20.2% with alpha 2a-, --6.-9%-- with alpha 2b, and 1.2% with alfacon-1. Furthermore, sera obtained from patients treated with alpha 2a or alpha 2b neutralised both types of interferon but failed to neutralise interferon alfacon-1.

The issue of neutralising antibodies may further have clinical relevance in patients with various neoplasms, since loss of response to therapy after the formation of antibodies has been reported.

Interferon beta therapy

Neutralising antibodies in the three interferon-beta treatments currently approved in the United States were the subject of an article in the Journal of

Neurology, Neurosurgery and Psychiatry 2002:73:148- 153, Bertolotto, et al .

The article stated that "Because of the cross reactivity of the antibodies, a switch from one preparation to the other will not benefit patients while they are NAB (neutralising antibody) positive. If a person with relapsing-remitting MS develops neutralizing antibodies to one interferon-beta drug, then that person is likely to have neutralizing antibodies to all of the interferon-beta medications" .

The article concluded that, "Neutralizing antibodies can appear early during the course of MS treatment, persist for several years before disappearing, decrease interferon-beta bioavailability, - and reduce or abolish the clinical efficacy of interferon- beta. "

Infliximab Infliximab is a chimeric monoclonal IgGl antibody against the cytokine, tumour necrosis factor alpha (TNF-alpha) . Inflammatory Bowel Disease (IBD) includes two major pathologies, ulcerative colitis and Crohn's disease. Both are characterised by an exaggerated response of the mucosal immune system to stimuli originated from the intestinal flora. Infliximab is also known by the brand name Remicade.

In both ulcerative colitis and Crohn's disease, tumour necrosis factor alpha (TNF-alpha) has been invoked as one of the major factors in the chronicity of the inflammation. The availability of Infliximab, as a chimeric monoclonal antibody against TNF-alpha has represented a therapeutic advance in the treatment of Crohn's disease patients .

A study by Baert et al . (Baert, F, et al, New England Journal of Medicine, 2003, Feb 13;348 (7) :601-8) considered the formation of neutralising antibodies to the drug Infliximab.

The Baert study found that antibodies against Infliximab were identified in 61% of 125 patients with Crohn's disease who were receiving infusions of

Infliximab. The development of antibodies to Infliximab was found to be associated with an increased risk of infusion reaction and a reduced duration of treatment response.

Infliximab also has utility in the treatment of rheumatic disease such as rheumatoid arthritis . Again, when used to treat this indication, the occurrence of neutralising antibodies can result in failure of therapy or a significant reduction in the treatment provided.

Other biologies

As well as the above mentioned treatments and therapies, neutralising antibodies are known to be produced in response to therapy with a wide range of other biologies such as Factor VIII which is administered to patients with haemophilia in order to facilitate blood clotting.

A method of preventing the formation of neutralising antibodies with specificity to biologies used in therapy would therefore be highly advantageous in improving a wide range of therapies as a result of the direct improvement of the clinical efficacy of the biologic.

Summary of the Invention

The inventors of the present invention have made the surprising discovery that the co-administration of FHA (filamentous haemagglutinin) along with a biologic has the effect of preventing the production of neutralising antibodies to that biologic. In particular, the -inventors-have surprisingly found — that the administration of FHA serves to suppress and inhibit the ThI type T-cell response which can result in B cell activation and maturation and as a result antibody production. The inhibition of this response prevents the generation of cytokines by ThI T-cells which result in the production of immunoglobulins by B cells, and in particular the production of antibodies of the complement fixing and opsonising IgG, which are the IgG2a subclass in the mouse. These antibodies have been shown to mediate downstream effector functions such as complement activation and opsonisation which can result in the neutralisation of the biologic.

According to a first aspect of the present invention there is provided a method of suppressing an immune response against a biologic used in therapy, the immune response being characterised in that it suppresses the production of neutralising antibodies which have specificity for the administered biologic, the method comprising the step of administering to an individual in need of such treatment, the biologic along with an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof .

In one embodiment of this aspect of the invention, the production of antibodies which have specificity for the biologic and which therefore bind to and inhibit the action of the biologic, are prevented from being produced—due- to -the -suppression- of the — immune response, this suppression being primarily caused by the immunomodulatory action of the FHA which causes the immune response to be prevented from being skewed down the ThI pathway.

It has been identified that the antibodies which are primarily involved in mediating neturalisation of an administered biologic are antibodies of the IgG subclass. Accordingly, the suppression of the production of such antibodies is in particular achieved through the administration of FHA. In a further embodiment, the antibodies, production of which are suppressed are antibodies of the murine IgG2 subtype, or the human equivalent, such as IgG2a.

It is therefore desirable that the administration of FHA prevents an immune response which produces antibodies of the IgG subtype.

The specific biologic and the FHA may be administered separately, sequentially or simultaneously. In preferred embodiments of the invention, the FHA is administered prior to the biologic.

In another embodiment the FHA is formulated to be administered contemporaneously with the biologic. In such an embodiment, the FHA will preferably be administered by the same route and as part of the same dose as the biologic. However, administration of FHA is not restricted to being administered simultaneously with the biologic. In an alternative embodiment, the FHA can be administered independently (separately or sequentially) of the biologic. Furthermore, in such an embodiment, the FHA can either be administered by the same route as the biologic, or alternatively by a different route, however it is preferred that both the biologic and FHA are administered by the same route.

Where the FHA is administered independently of the biologic, it can be administered using a dosing schedule which is different to that used for the biologic. For example, the FHA could be administered as a one dose regimen, as a two dose regimen or further as a three dose regimen.

In a further embodiment, a single dosage regimen of FHA can be used to prevent the mounting of an immune response which causes the production of antibodies with binding specificity to a plurality of biologies administered to an individual by way of, for example, a combination therapy. Combinational therapies which involve the administration to a patient of two or more different biologies, drugs or pharmaceuticals are frequently adopted as a mode of therapy in order to treat a condition in the optimum way. The combination of drugs provided can, in some cases, be directed to the condition which is to be treated, while in other such cases, further drugs or biologies are provided in order to prevent- side effects which are caused by other drugs administered as part of said therapy.

In a further embodiment, the biologic is any biologic against which neutralising antibodies may be raised.

As herein defined a 'biologic' is a drug prepared from a cell, an animal tissue or other living source, this may include, but is not limited to a virus, serum, toxin, antitoxin, vaccine, blood, blood component or derivative, allergenic product, or other similar product used to prevent, treat or cure disease or injury. The biologic may be any biologic against which neutralising antibodies may be raised or naturally produced biologically active agent etc .

The biologic may be in particular an antibody, in particular a monoclonal antibody, a chimeric antibody, or a humanised antibody, or a binding member with specificity for a target ligand, a protein, a peptide or a fragment thereof.

In specific embodiments the biologic may be a monoclonal antibody such as a chimeric mouse-human monoclonal antibody or a humanised antibody, or a fully human antibody produced in a mouse which has been transgenicalIy modified to express humun immunoglobulin genes. In further examples, the biologic may be selected from the group consiting of Infliximab -(Remicade--Gentocor/Schering-Plough)-, - - - OthoClone OKT3 (muromonab-CD3 - Johnson and Johnson) , Panorex (edrecolomab - Centocor (J&J) / Glaxo SmithKline) , ReoPro (abciximab) Centocor / Eli Lilly) , Zenapax (daclizumab - Protein Design Laboratories/Roche) , Rituxan (rituximab -

Biogen/Genentech/Roche) , Herceptin (tratuzumab - Genentech/Roche) , Synganis (palivizumafo- Medliranune/Abbott) , Simulect (basiliximab-Novartis) , Mylotarg (gemtuzumab-Celltech Group) , Campath (alemtuzumab-Millennium/Schering AG) , Zevalin

(ibritumomab tiuxetan-Biogen/Schering AG) , Humira (adalimumab - Abbott/Cambrige Antibody Technology) , Bexxar (tositmomab - GlaxoSmithKline) , Xolair (omalizumab - Genentech/Novartis/Tanox) , Raptiva (efalizumab - Genentech /Xoma) , Erbitux (cetuximab - Imclone/Merck) , Avastatin (bevacizumab - Genentech/Roche) , Tysabri (natalizumab - Elan / Biogen) .

In yet further aspects of the present invention, the biologic may be a recombinant type I interferon product such as interferon alpha-2a, recombinant interferon alpha-2b, interferon beta, or a biological compound such as Factor VIII or the like, EPO (erythropoietin) or insulin.

A second aspect of the present invention provides the use of FHA in the preparation of a medicament for the prevention of the generation of an immune response which results in the production of antibodies with specificity for a biologic administered to an individual in need of treatment or therapy with that biologic.

In one embodiment generation of the IgG subclass antibodies is prevented.

In a third aspect of the present invention, there is provided the use of (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof in the preparation of a medicament for the treatment of an immune-mediated condition.

In a fourth aspect of the present invention, there is provided a product comprising (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof as a combined preparation for the simultaneous, separate or sequential use in the treatment of an immune-mediated disease.

According to a fifth aspect of the present invention, there is provided a pharmaceutical composition for the treatment of an immune-mediated disease, wherein the composition comprises (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof and (c) a pharmaceutically acceptable excipient, diluent or carrier. In preventing the formation of neutralising antibodies against a biologic administered to an individual for therapy, the administration of FHA effectively induces a state of tolerance against the biologic. Such a state of tolerance ensures that an immune response is not mediated against the biologic by the individual to whom the biologic is being administered, and in particular that antibodies with specificity to that biologic, and in particular antibodies of the subclass IgG2 are not generated against the biologic. In particular, the inventors have found, surprisingly, that this state of tolerance is induced through the suppression of the ThI T-cell response (due to the associated modulation of the cytokines which skew the immune response down the ThI pathway) . Further, the inventors have shown that this effect is also mediated by an associated enhancement in T cells which exhibit a regulatory phenotype. Accordingly, the administration of FHA is shown to result in a cytokine profile being expressed which skews the immune response away from the ThI pathway, accordingly B cell stimulation and maturation and the associated production of antibodies which may have specificity for the biologic administered to an individual as part of a therapeutic regime, and in particular the production of antibodies of the IgG subclass, such as antibodies equivalent to the murine subclass IgG2a, are suppressed.

According to a sixth aspect of the present invention, there is -provided a method of inducing a state of tolerance against a biologic which is administered to an individual in need of therapy, said method comprising the step of administering the biologic along with an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof. The FHA may be administered simultaneously, sequentially or separately from the biologic.

In one embodiment, the administration of FHA serves to modify the cytokine production of cells of the innate and adaptive arms of the immune system, such that there is a change in cytokine expression profiles which drive the down stream immune responses. For example, the expression of IFN-gamma can be downregulated as well as the expression of IIJ-23₇ and hence in turn IL-17. IL-IO production is also upregulated, and production of IL-12 is suppressed. A decrease in T-cell proliferation can also be associated with the FHA treatment. The modification of the above cytokine profiles block or suppress the development of a ThI response. Accordingly, antibodies, such as those of the subclass IgG will not be generated and cannot be raised against the biologic. In turn, the downstream effector functions mediated by an IgG antibody specific for the biologic such as complement fixation and opsonisation will be avoided.

In one embodiment the filamentous haemagglutinin (FHA) is the wild-type -FHA--molecule, for example as derived from Bordetella pertussis or Bordetella bronchisepetica or Bordetella parapertussis . However the term FHA also encompasses related molecules from other bacteria. Related molecules may include 5 proteins from other bacteria with sequences homologous to those in FHA. "FHA" also encompasses, fragments, analogues and derivatives of FHA, including synthetic (e.g., recombinant) forms of FHA. Such synthetic molecules may be altered, 10 removed or purified from its naturally occurring state through human intervention.

Where the form of the FHA molecule provided is not the naturally occurring, full length form, then

15 preferably the amino acid sequence has at least about 30%, or 40%, or 50%, or 60%, or 70%, or 75%, or 80%, or 85%, or 90%, 95%, 98% or 99% homology to amino acid sequence of the full length naturally occurring ^λwild type' form.

20

A derivative of FHA as disclosed herein may be, in certain embodiments, the same length or shorter than the wild type FHA peptide. In other embodiments, the peptide sequence or a variant thereof may

25 comprise a larger peptide.

As is well understood, homology at the amino acid level is generally in terms of amino acid similarity or identity. Similarity allows for 'conservative

30 variation' , such as substitution of one hydrophobic residue such as isoleucine, valine, leucine or

- ^• methionine for another-,- ox—the substitution-of.-one -- polar residue for another, such as lysine or glutamic acid for aspartic acid, or glutamine for asparagine .

5 Analogues of, and for use in, the invention as defined herein means a peptide modified by varying the amino acid sequence e.g. by manipulation of the nucleic acid encoding the protein or by altering the protein itself.

10

Such analogues of the amino acid sequence may involve insertion, addition, deletion and/or substitution of one or more amino acids, while providing a peptide capable of inducing an

15 alteration in the cytokine profile of a neural cell, and in particular a cell of the hippocampus .

Analogues also include derivatives of FHA, including FHA being linked to a coupling partner, e.g. a 20 label, a drug, a toxin and/or a carrier or transport molecule.

Non-peptide mimetics of FHA, or a fragment of FHA are further provided within the scope of the 25 invention. Such mimetics of FHA may be prepared, either wholly or partly, by chemical synthesis.

Generation of the peptides in this way can be performed by methods which are well known to the person skilled in the art. 30

A seventh aspect of the present invention provides - -- the use of- FHA -in- the preparati-on -of-a -medi-cament for inducing a state of tolerance in the individual to whom the medicament is provided against a biologic which has or is to be administered to the patient .

In one embodiment the FHA serves to prevent the development of a ThI T cell immune response and further can upregulate the generation of regulatory T cells.

In addition to the advantageous effects of FHA in preventing the generation of antibodies, and in particular antibodies of the IgG subclass to a biologic administered to an individual, the administration of FHA along with a biologic, could, in some instances enhance, either additively or synergistically the effects of the biologic being administered.

For example, where the biologic is a therapeutic monoclonal antibody such as Infliximab, the coadministration of FHA would serve not only to prevent the formation of neutralising antibodies, such as IgG antibodies, against the biologic, but could also enhance the clinical efficacy of the biologic through the enhancement of the antiinflammatory effect mediated by the therapeutic monoclonal antibody.

A yet further aspect of the present invention provides a method for the treatment of a chronic inflammatory disease-,—the -method comprising- the step of administering a therapeutically effective amount of (a) FHA and (b) a suitable biologic to a mammal in need thereof .

In one embodiment of this aspect of the invention, the FHA and the suitable biologic may be administered separately, sequentially or simultaneously. In preferred embodiments of the invention, the FHA is administered prior to the suitable biologic.

In one embodiment the biologic is a therapeutic antibody, such as a chimeric mouse-human antibody, a humanized antibody or an antibody produced in a transgenic mouse. In a specific embodiment the monoclonal antibody is infliximab.

Without wishing to be bound by theory, the inventors predict that the administration of the FHA results in an upregulation of the cytokine IL-10 and/or a down regulation in the cytokines IL-17 and/or interferon-gamma .

In a further aspect, there is provided the use of (a) FHA and (b) a suitable biologic in the preparation of a medicament for the treatment of an immune-mediated condition.

In one embodiment the immune-mediated condition is an autoimmune condition, such as rheumatoid arthritis, multiple sclerosis, Crohn's disease or psoriasis. - - - - - -- In a yet further aspect, there is provided a medicinal product comprising (a) FHA and (b) a suitable biologic as a combined medicament for the simultaneous, separate or sequential use in the treatment of an immune-mediated condition.

According to a yet further aspect of the present invention, there is provided a pharmaceutical composition for the treatment of an immune-mediated condition, wherein the composition comprises (a) FHA and (b) a suitable biologic and (c) a pharmaceutically acceptable excipient, diluent or carrier.

In a still further aspect, there is provided a kit for the treatment of an immune-mediated condition, said kit comprising a) FHA and (b) a suitable biologic and (c) instructions for the administration of (a) and (b) separately, sequentially or simultaneousIy.

In a yet further aspect of the present invention there is provided a pharmaceutical composition for preventing an immune response against a biologic, said composition comprising dendritic cells activated in the presence of FHA and a biologic along with a pharmaceutically acceptable carrier or diluent.

In a yet further aspect of the present invention there is provided the-use of dendritic cells which have been pulsed with a biologic and an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof in the preparation of a medicament for modulating the immune response in an individual who has been administered the biologic.

In one embodiment the dendritic cells are derived from naϊve dendritic cells which have been pulsed with the biologic and FHA.

In one embodiment the medicament further comprises a Toll-like receptor agonist.

In a yet further aspect of the present invention there is provided a method for suppressing an immune response against a biologic administered to a subject, the method comprising the steps of:

- exposing isolated dendritic cells to the biologic and an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof ex-vivo for a sufficient time and under condition suitable in order to modulate the function of the dendritic cells,

- administering the dendritic cells to the subject whereby the immune response generated in the subject is sufficient to prevent the onset or progression of the immune-mediated disease. Treatment / Therapy

The term 'treatment' is used herein to refer to any regime that can benefit a human or non-human animal . The treatment may be in respect of an existing condition or may be prophylactic (preventative treatment) . Treatment may include curative, alleviation or prophylactic effects. The term "therapy" is used interchangeably with "treatment".

Administration

FHA, or a variant, analogue or fragment thereof for use in the present invention may be administered alone but will preferably be administered as a pharmaceutical composition, which will generally comprise a suitable pharmaceutical excipient, diluent or carrier selected depending on the intended route of administration. Most preferably the FHA will be incorporated into the pharmaceutical formulation of the biologic with which it is being co-administered in order to prevent the generation of neutralising antibodies .

FHA, or a variant, analogue or fragment thereof for use in the present invention may be administered to a patient in need of treatment via any suitable route. The precise dose will depend upon a number of factors, including the precise nature of the form of FHA to be administered. Preferably the route of administration will be the same as that of the biologic . Where the FHA is administered separately to the biologic, the preferred route of administration is parenterally (including subcutaneous, intramuscular, intravenous) . Further suitable routes of administration include (but are not limited to) oral, rectal, nasal, topical (including buccal and sublingual) , vaginal, intradermal, intrathecal and epidural) administration or administration via oral or nasal inhalation, by means of, for example a nebuliser or inhaler.

For intravenous injection, the active ingredient will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability. Those of relevant skill in the art are well able to prepare suitable solutions using, for example, isotonic vehicles such as sodium chloride injection, Ringer's injection, Lactated Ringer's injection. Preservatives, stabilisers, buffers, antioxidants and/or other additives may be included, as required.

Pharmaceutical compositions for oral administration may be in tablet, capsule, powder or liquid form. A tablet may comprise a solid carrier such as gelatin or an adjuvant. Liquid pharmaceutical compositions generally comprise a liquid carrier such as water, petroleum, animal or vegetable oils, mineral oil or synthetic oil. Physiological saline solution, dextrose or other saccharide solution or glycols such as ethylene glycol, propylene glycol or polyethylene glycol may be included.- The composition may also be administered via microspheres, liposomes, other microparticulate delivery systems or sustained release formulations placed in certain tissues including blood. Suitable examples of sustained release carriers include semipermeable polymer matrices in the form of shared articles, e.g. suppositories or microcapsules. Implantable or microcapsular sustained release matrices include polylactides (US Patent No. 3,773,919 or European Patent Application No

0,058,481) copolymers of L-glutamic acid and gamma ethyl-L-glutamate (Sidman et al, Biopolymers 22(1): 547-556, 1985), poly (2-hydroxyethyl-methacrylate) or ethylene vinyl acetate (Langer et al, J. Biomed. Mater. Res. 15: 167-277, 1981, and Langer, Chem. Tech. 12:98-105, 1982) .

Examples of the techniques and protocols mentioned above and other techniques and protocols which may be used in accordance with the invention can be found in Remington's Pharmaceutical Sciences, 18th edition, Gennaro, A. R., Lippincott Williams & Wilkins; 20th edition (December 15, 2000) ISBN 0- 912734-04-3 and Pharmaceutical Dosage Forms and Drug Delivery Systems; Ansel, H. C. et al . 7^th Edition ISBN 0-683305-72-7 the entire disclosures of which are herein incorporated by reference.

Pharmaceutical Compositions As described above, the present invention extends to a pharmaceutical composition for the induction of tolerance against- a -biologic—such as those -listed - hereinbefore, wherein the composition comprises at least FHA, or a derivative, fragment, variant, mutant or recombinant version thereof along with said biologic.

Pharmaceutical compositions according to the present invention, and for use in accordance with the present invention may comprise, in addition to active ingredients (i.e. FHA) and the biologic, a pharmaceutically acceptable excipient, carrier, buffer stabiliser or other materials well known to those skilled in the art.

Such materials should be non-toxic and should not interfere with the efficacy of the active ingredient. The precise nature of the carrier or other material will depend on the route of administration, which may be, for example, oral, intravenous, intranasal or via oral or nasal inhalation.

The formulation may be a liquid, for example, a physiologic salt solution containing non-phosphate buffer at pH 6.8-7.6, or a lyophilised or freeze dried powder.

Dose

The composition is preferably administered to an individual in a "therapeutically effective amount", this being sufficient to show benefit to the individual . The actual amount administered, and rate and time- course of administration, will depend on the nature of the biologic along with which the FHA is being administered and also on the severity of the 5 condition for which the biologic is being administered to treat.

Prescription of treatment, e.g. decisions on dosage etc, is ultimately within the responsibility and at

10 the discretion of general practitioners, physicians or other medical doctors, and typically takes account of the disorder to be treated, the condition of the individual patient, the site of delivery, the method of administration and other factors known to

15 practitioners.

The optimal dose can be determined by physicians based on a number of parameters including, for example, age, sex, weight, severity of the condition

20 being treated, the active ingredient being administered and the route of administration. Further, due consideration must be taken as to the dose and route of administration of the biologic along with which the FHA is being co-administered. 25 It is preferable that the dose of FHA is formulated such that it can be provided to the individual in need of treatment using the same dosage intervals and route of administration as the biologic.

30 For example the dosage regimen for treatment of moderate to severe Crohn's disease is suggested as - - 5mg/kg administered as a single dose-.—The initial^{" "} dose is followed by further doses of 5 mg/kg two and six weeks after the first dose. Hence, with regard to the above, the dose of FHA would be formulated so as to be sufficient and appropriate to be administered along with Infliximab in such a treatment .

Similarly, treatment of rheumatoid arthritis with Infliximab requires a single dose of 3 mg/kg, with this additional dose being followed by an additional 3 mg/kg at time points two and six weeks after the first dose. Thereafter, the maintenance dose is 3 mg/kg every eight weeks. Again, the dose of FHA to be co-administered would be formulated so a to be sufficient to be effectively administered along with such an Infliximab regimen.

With regard to the clinical administration of recombinant interferon, dosing is based upon the disease being treated and the interferon being used.

Therefore, wide variation in dosing exists, and doses are individualised. The interferons may be given intramuscularly, intravenously, or subcutaneousIy on a daily, weekly or three times a week basis. Hence, again the co-administration with FHA will be adjusted to be integrated into such a treatment schedule.

For example, in one embodiment, a suitable dose may result in FHA or a derivative, fragment, variant, mutant or recombinant version thereof being administered at a dose range of between 0. Olμg/patient up to 50mg/patient .

Definitions Unless otherwise defined, all technical and scientific terms used herein have the meaning commonly understood by a person who is skilled in the art in the field of the present invention.

The term "tolerising immune response" refers to a suppression of T cell activation by deletion of self-reactive thymocytes, by induction of T cell anergy, or by a combination thereof.

Throughout the specification, unless the context demands otherwise, the terms 'comprise' or 'include', or variations such as 'comprises' or 'comprising', 'includes' or 'including' will be understood to imply the inclusion of a stated integer or group of integers, but not the exclusion of any other integer or group of integers .

Preferred features and embodiments of each aspect of the invention are as for each of the other aspects mutatis mutandis unless the context demands otherwise.

The present invention will now be described with reference to the following examples which are provided for the purpose of illustration and are not intended to be construed as being limiting on the present invention, and further, with reference to the figures .

Brief description of the drawings

Figure 1 shows that FHA suppresses collagen- specific IgG2a antibody response in mice immunised with collagen and complete Freund's adjuvant , and

Figure 2 shows 6 bar charts , A to F showing that FHA inhibits spleen and lymph node cell proliferation, IL-17 and IFN-γ response to MOG.

Filamentous haemagglutinin (FHA)

Bordetella pertussis causes a protracted and severe disease, which is often complicated by secondary infection and pneumonia, and can have a lethal outcome in young children. Recovery from infection is associated with the development of B. pertussis- specific ThI cells and these cells play a critical role in clearance of the bacteria from the respiratory tract. However, antigen-specific ThI responses in the lung and local lymph nodes, are severely suppressed during the acute phase of infection. B. pertussis has evolved a number of strategies to circumvent protective immune responses .

The virulence factor, filamentous haemagglutinin

(FHA) from B. pertussis, is capable of inhibiting LPS-driven IL-12 _^production by macrophages ,__XL-12 and IFN-γ production in a murine model of septic shock and ThI responses to an unrelated pathogen, influenza virus, when administered simultaneously to the respiratory tract. FHA is considered to function primarily as an adhesin, mediating binding of JS. pertussis to the β2-integrins (CR3, CDllb/CDl8, 0CMβ2) via binding to leukocyte response integrin (αvβ3, CD61) and the integrin-associated protein (CD47) complex (5) . FHA may also contribute to suppressed ThI responses during acute infection with B. pertussis by the induction of T cells with regulatory activity, as a result of its interaction with cells of the innate immune system.

FHA interacts directly with dendritic cells (DCs) to induce IL-IO and inhibit LPS-induced IL-12 and inflammatory chemokine production. The dendritic cells generated following interaction with FHA selectively stimulate the induction of TrI cells from naϊve T cells.

EXAMPLES

Example 1 - Effect of FHA on lgG2a antibody response in mice immunised with collagen and complete Freund's adjuvant.

Groups of male DBA/1 mice were immunised on days 0 and 21 with collagen (50 μg) , KLH (50 μg) and FHA (5 μg) , collagen and FHA or were left un-immunized. On day 28 mice were immunised_ intradermalIy _in..the bas.e. of the tail with 200μg of bovine type II collagen emulsified in complete Freund's adjuvant (CFA).

Twenty one days later, mice were immunised intraperitoneally with 200μg of bovine type II collagen in PBS. Forty days later, mice were sacrificed. Collagen-specific IgGl (Figure 1, upper graph) and IgG2a (Figure 1, lower graph) antibody responses were measured in the sera by ELISA.

The data, as illustrated in Figure 1, shows that pre-immunisation / pre-treatment with collagen in the presence of FHA suppresses the development of antibody responses induced with collagen in the presence of CFA. This is particularly pronounced with the IgG2a antibody response as shown in the lower graph of Figure 1.

Example 2 - FHA inhibits spleen and lymph node cell proliferation/ IL-17 and IFN-γ response to MOG

Materials and methods :

Groups of female C57BL/6 mice were injected with (i) MOG35-55 (50μg) , or (ii) MOG35-55 and FHA (5μg) at days 0 and 21.

All mice were boosted with 50μg MOG₃₅-_S5 emulsified in CFA at day 28. Mice injected with PBS without a MOG and CFA boost were used as background controls.

Thirty five days after the initial immunisation, _ mice were sacrificed--and spleens -and ^"ixrgunial^" lymph^"'" nodes were harvested. Cells (2xlO^δ/ml) were incubated for 72 hours with MOG₃₅-₅₅ at 25μg/ml and lOOμg/ml, or with medium. The supernatants were removed after 72 hours and assayed for IL-17 and IFN-Y concentrations by ELISA.

³H-thymidine incorporation was used as a measure of proliferation by incubating the cells for 18 hours in medium supplemented with ³H-thymidine.

Results :

The results, as depicted by charts A to F of Figure 2, show that immunisation with MOG twice followed by MOG and CFA (column A) induces T cells that proliferate and secrete IFN-γ and IL-17 in response to MOG re-stimulation in vitro. However, coadministration with FHA (i.e. MOG and FHA instead of MOG alone for the first 2 doses) (see column B) completely suppresses lymph node and spleen IL-17 and IFN-γ production to background concentrations and reduces MOG-induced proliferation to almost background levels . Hence it is shown that FHA inhibits a ThI response and enhances a regulatory T cell response, through the downregulation of interferon gamma and IL-17.

Example 3 - Effect of FHA on antibody and T cell response to KLH with CpG

Further experiments directed to assessing the effect of FHA at inhibiting an antibody response will be conducted in due course using the protocol outlined below.

Materials and Methods :

5 Groups of female C57BL/6 mice will be immunised at days 0 and 7 with either PBS, KLH (5 μg) , KLH (5 μg) and FHA (5 μg) , KLH (5 μg) and CpG (10 μg) or KLH (5 μg) , CpG (10 μg) and FHA (5 μg) subcutaneousIy in PBS. 10

Two weeks later the mice will be sacrificed. KLH- specific antibody responses will be measured in the sera using a specific ELISA.

15 KLH-specific proliferation and cytokine production will be assayed using spleen and inguinal lymph nodes from immunised mice.

All documents referred to in this specification are

20 herein incorporated by reference. Various modifications and variations to the described embodiments of the inventions will be apparent to those skilled in the art without departing from the scope of the invention. Although the invention has 25 been described in connection with specific preferred embodiments, it should be understood that the invention as claimed should not be unduly limited to such specific embodiments. Indeed, various modifications of the described modes of carrying out

30 the invention which are obvious to those skilled in the art are intended to be covered by the present

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Claims

1. A method of suppressing an immune response against a biologic used in therapy, the immune response being characterised in that it suppresses the production of neutralising antibodies which have specificity for the administered biologic, the method comprising the step of administering to an individual in need of such treatment, the biologic along with an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof .

2. The method of claim 1 wherein the administration of FHA prevents ThI T cell mediated B cell activation and maturation.

3. The method of claim 1 wherein the FHA is formulated to be administered separately, sequentially or simultaneously with the biologic.

4. The method of claim 3 wherein the FHA is administered by the same route and as part of the same dose as the biologic.

5. The method of claim 3 wherein the FHA is administered independently of the biologic.

6. The method of claim 5 wherein the FHA is administered by the same route as the biologic.

7. The method of claim 5 wherein the FHA is administered by a different route than the biologic.

8. The method of claim 5 wherein the FHA is administered using a dosage schedule which is independent to that used for the biologic.

9. The method of any preceding claim wherein the biologic is any biologic against which neutralising antibodies may be raised.

10. The method according to any preceding claim wherein two or more biologies are administered to the patient, and wherein FHA prevents the generation of neutralising antibodies to said two or more biologies .

11. The method of any of claims 1 to 9 wherein the biologic is an antibody.

12. The method as claimed in claim 11 wherein the antibody is a monoclonal antibody.

13. The method as claimed in any one of claims 1 to 9 wherein the biologic is a type I interferon.

14. The method as claimed in any one of claims 1 to 9 wherein the biologic is Factor VIII .

15. The use of FHA in the preparation of a medicament for the prevention of an immune response, said immune response being characterised-i-n- that- is causes the generation of an antibody response to a biologic administered to an individual in need of treatment or therapy with that biologic.

16. A method of inducing a state of tolerance in an individual against a biologic which is administered to the individual in need of therapy, said method comprising the step of:

- administering the biologic along with an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof.

17. The method of claim 16 wherein the biologic is an antibody.

18. The method of claim 17 wherein the antibody is a monoclonal antibody.

19. The method as claimed in claim 16 wherein the biologic is a type I interferon.

20. The method as claimed in claim 16 wherein the biologic is Factor VIII.

21. The method of claim 16 wherein the filamentous haemagglutinin (FHA) is derived from Bordetella pertussis or Bordetella bronchisepetica or Bordetella parapertussis or related molecules from other bacteria.

22. The use of FHA in preparation of a medicament for the generation of a toleregenic response to a biologic administered to an individual in need of treatment with said biologic.

23. Use as claimed in claim 22 wherein the biologic is an antibody.

24. Use as claimed in claim 22 wherein the antibody is a monoclonal antibody.

25. Use as claimed in claim 22 wherein the biologic is a type I interferon.

26. Use as claimed in claim 22 wherein the biologic is Factor VIII.

27. The use of FHA in the preparation of a medicament for preventing the generation of an antibody response directed to a biologic administered to an individual in need of treatment or therapy with that biologic.

28. The use of (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof in the preparation of a medicament for an immune-mediated condition.

29. A product comprising (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or -fragment- or--variant- or ^■-- - peptide thereof as a combined preparation for the simultaneous, separate or sequential use in the treatment of an immune-mediated disease.

30. A pharmaceutical composition for the treatment of an immune-mediated disease, wherein the composition comprises (a) a biologic and (b) an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof and (c) a pharmaceutically acceptable excipient, diluent or carrier.

31. A pharmaceutical composition for preventing an immune response against a biologic, said composition comprising dendritic cells activated in the presence of FHA and a biologic along with a pharmaceutically acceptable carrier or diluent.

32. Use of dendritic cells which have been pulsed with a biologic and an agent comprising filamentous haemagglutinin (FHA) or a derivative or mutant or fragment or variant or peptide thereof in the preparation of a medicament for modulating the immune response in an individual who has been administered the biologic.

33. Use as claimed in claim 32 wherein the dendritic cells are derived from naϊve dendritic cells which have been pulsed with the biologic and FHA.

34. Use as claimed in claim 32 wherein the medicament further comprises a Toll-like receptor agonist .

35. A method for suppressing an immune response against a biologic administered to a subject, the method comprising the steps of:

- administering the dendritic cells to the subject whereby the immune response generated in the subject is sufficient to prevent the onset or progression of the immune-mediated disease.