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  • G01N2800/347—Renal failures; Glomerular diseases; Tubulointerstitial diseases, e.g. nephritic syndrome, glomerulonephritis; Renovascular diseases, e.g. renal artery occlusion, nephropathy

Definitions

• This invention relates generally to the treatment of proteinuric diseases by ⁇ v ⁇ 3 integrin inhibitors.
• Kidney podocytes and their foot processes are a key component of the ultrafiltration system in the glomerulus where they comprise the filtration barrier together with endothelial cells and the glomerular basement membrane (GBM).
• GBM glomerular basement membrane
• Podocytes are located within the glomerulus of the kidney where they are attached to the GBM via ⁇ 3 ⁇ l integrin 2> 3 , and ⁇ / ⁇ dystroglycan 4 .
• Podocyte FPs are interconnected by the slit diaphragm (SD), a modified adherens junction 5 .
• SD slit diaphragm
• Proteinuric kidney diseases are typically associated with various degrees of podocyte membrane remodeling (FP effacement and/or SD disruption) driven by a rearrangement of the podocyte microfilament system 6 .
• FP effacement and/or SD disruption Recent work has advanced our understanding of the molecular framework underlying podocyte structure largely through the analysis of hereditary proteinuria syndromes and genetic models 7 .
• a few studies suggest also mechanisms for the far more common acquired proteinuric diseases 8> 9 .
• An emerging concept for the regulation of podocyte structure and function is the regulation of the podocyte cytoskeleton by proteases such as cathepsin L 8> 10 .
• Cathepsin L induction in podocytes is accompanied by an increase in cell motility of cultured podocytes l0 .
• the increased motility of in vitro podocytes 10,11 is best translated into FP dynamics in vivo where podocytes remain locally attached to the GBM but may have altered FP dynamics resulting in FP fusion.
• podocytes In some forms of inflammatory glomerular diseases such as crescentic glomerulonephritis, podocytes have been reported to move out of their microenvironment into areas of crescentic glomerular damage 12 .
• a proteinuric disorder is a kidney proteinuric disorder.
• the kidney proteinuric disorder is selected from a list comprising of: Diabetic nephropathy,
• Nephrotic syndromes i.e. intrinsic renal failure
• Nephritic syndromes i.e. Toxic lesions of kidneys
• Glomerular diseases such as membranous glomerulonephritis, Focal segmental glomerulosclerosis (FSGS), IgA nephropathy (i.e., Berger's disease), IgM nephropathy, Membranoproliferative glomerulonephritis,
• kidney proteinuric disorder is diabetic nephropathy. In a certain other embodiment of the invention the kidney proteinuric disorder is selected from a list comprising of:
• Collagen vascular diseases e.g., systemic lupus erythematosus
• Dehydration
• Infections e.g., HTV, syphilis, hepatitis ⁇ ost-streptococcal infection
• the av ⁇ 3 integrin inhibitor is a ⁇ v ⁇ 3 monoclonal antibody or a peptide which contains a RGD binding sequence. In one aspect of the invention the av ⁇ 3 integrin inhibitor is a ⁇ v ⁇ 3 monoclonal antibody. In one embodiment of the invention the ⁇ v ⁇ 3 monoclonal antibody is anti-CD61.
• the av ⁇ 3 integrin inhibitor is a peptide which contains a RGD binding sequence.
• the peptide which contains a RGD binding sequence is cyclo-fArg-Gly-Asp-D-Phe-Val].
• the av ⁇ 3 integrin inhibitors is a compound of the formula:
• the av ⁇ 3 integrin inhibitors is selected from the compounds described herein.
• Figure 1 is a panel of immunostaining images and a bar graph showing uPAR is induced in podocytes in proteinuric patients and experimental proteinuric models.
• FSGS focal segmental glomerulosclerosis
• DN diabetic nephropathy
• uPAR expression in New Zealand black/white (NZB/W) Fl mice appears more segmental within the glomerulus
• uPAR expression is found in all cells of the glomerulus including podocytes.
• uPAR expression is significantly induced in foot processes of diabetic rats.
• MC mesangial cell
• P podocyte
• End endothelial cell
• GBM glomerular basement membrane
• US urinary space
• CL capillary lumen.
• Figure 2. is a panel of immunostaining images and bar graphs showing uPAR is required in podocytes for the development of foot process effacement and proteinuria.
• uPAR -/- mice were protected from urinary protein loss.
• uPAR ' ' ' mice reconstituted with uPAR-cDNA develop heavy proteinuria but like wild type mice only after LPS injection (0.11 ⁇ 0.11 (uPAR -/- uPAR-cDNA); (0.92 ⁇ 0.46 (uPAR -/- uPAR-cDNA LPS), *p ⁇ 0.002).
• Podocyte-uPAR expression in uPAR -/- mice is achieved by gene transfer of podocin-driven uPAR cDNA (Pod-uPAR) and monitored by synaptopodin staining. Note the merge of uPAR and synaptopodin labeling (merge).
• Endothelial-uPAR expression in uPAR -/- mice achieved by gene transfer of ICAM-2-driven uPAR cDNA (ICAM-2-uPAR) is monitored by staining with the endothelial marker CD31. Note the merge of uPAR and CD31 labeling (merge).
• Figure 3 is a panel of immunostai ⁇ ing images and bar graphs showing uPAR mediates podocyte migration.
• uPAR-siRNA showed decreased capability to migrate into the wound track within 24 hours (*p ⁇ 0.0024 for wild type vs uPAR- siRNA). Solid red lines indicate the initial margins of scrape wound. Data were based on six independent experiments. Original magnification, 4Ox.
• Figure 4. is a panel of a scheme, immunostaining image and a bar graph showing uPAR, ⁇ 3 integrin and vitronectin are important for LPS induced proteinuria.
• ⁇ 3 integrin ( ⁇ 3) and vitronection (Vn) is associated with normal renal permselective function and lack of proteinuria after LPS stimulation.
• mice deficient in urokinase (uPA) have no proteinuria under normal conditions, but readily develop urinary protein loss after LPS administration.
• uPA urokinase
• Figure 5. is a panel of immunostaining images and a bar graph showing uPAR activates ⁇ 3 integrin.
• Fluorescent intensity units EDTA: 3020.64 ⁇ 302.06; 0.1 mM Ca ++ : 3055.76 ⁇ 400; 0.4 mM Ca ++ : 1644.7 ⁇ 200; 1.0 mM Ca ++ : 534.52 ⁇ 121; 2.0 mM Ca 4+ : 312.5 ⁇ 53.45. (c) same as (a) but now with the antibody AP5 which recognizes active ⁇ 3 integrin.
• LPS treatment induces staining for AP5 in wild type but not in uPAR -/- mice
• Figure 6. is a panel of immunostaining images and bar graphs showing the active uPAR- ⁇ v ⁇ 3 integrin complex is lipid dependent and can be targeted pharmacologically to modify proteinuria.
• Both, uPAR and ⁇ 3 integrin are enriched within the lipid raft fraction after LPS treatment, (b) Localization of uPAR and active ⁇ 3 integrin (AP5-labeling) in podocytes before and after LPS treatment and in the presence of the cholesterol depleting agent Methyl- ⁇ -cyclodextrine (MBCD).
• MBCD Methyl- ⁇ -cyclodextrine
• RGDfV reduces proteinuria in a dose dependent manner (Con, 0.2064 ⁇ 0.038; cyclo-RGDfV, 0.28 ⁇ 0.0535; LPS, 0.924 ⁇ 0.1055; LPS + cyclo-RGDfV(lmg), 0.712 ⁇ 0.0817; LPS + cyclo-RGDfV(5mg), 0.5683 ⁇ 0.0729; LPS + cyclo- RGDfV(20mg), 0.4172 ⁇ 0.0423. *p ⁇ 0.013 for LPS vs LPS +cyclo-RGD).
• Figure 7 is a panel of a scheme, immunostaining images and a bar graph showing induction of uPAR in cultured podocyte in response to LPS and PAN.
• Figure 8. is a panel of immunostaining images showing Vitronectin is expressed in the human glomerulus and mainly in podocytes.
• Vitronectin green is expressed in the human glomerulus and mainly in podocytes, as displayed by double immunofluorescence with the podocyte marker synaptopodin (synpo, red) resulting in a partial yellow overlap.
• Podocytes are able to produce vitronectin as tested by RT-PCR.
• vitronectin primers are as follows: Forward: 5' AGT GGA GCA ACA GGA GGA GA 3' Reverse: 5' CAA GGC AAA GTG CTC AAA CA 3' (data not shown), (b) Induction of vitronectin in podocytes in rodent models of proteinuria revealed by immunocytochemistry. As shown by confocal microscopy, vitronectin expression (green) is low in control glomeruli (con) from rat or mouse and colocalized partially with the podocyte marker synaptopodin (synpo, red).
• vitronectin expression is significantly induced in podocytes, resulting in a yellow overlap with synaptopodin (merge).
• Original magnification 60Ox.
• vitronectin expression in New Zealand black/white (NZB/W) Fl mice appears more segmental within the glomerulus.
• Figure 9. is a panel of immunostaining images and graphs showing stable knockdown of uPAR mRNA using siRNA.
• uPA urokinase
• Figure 10. is a panel of immunostaining images showing uPAR interacts with ⁇ 3 integrin.
• Figure 11 is a bar graph showing the effect of cyclo-RGDFV on recovery of proteinuria.
• the present invention is directed to methods of treating proteinuric diseases by the administration of av ⁇ 3 integrin inhibitors.
• the invention is based at least in part on the discovery that induction of urokinase receptor signaling in podocytes leads to foot process effacement and urinary protein loss via a mechanism including lipid dependent activation of av ⁇ 3 integrin.
• the invention involves, at least in part, the study of molecules which are associated with cellular motility such as the urokinase plasminogen activator receptor (uPAR) 15> l6 .
• uPAR is a glycosylphosphatidylinositol (GPI)-anchored protein that has been recognized as a proteinase receptor but has also be involved in non-proteolytic pathways, mainly through its ability to form complexes with other membrane proteins such as integrins for signal transduction l5 .
• uPAR plays important roles during wound healing, inflammation, and stem cell mobilization, as well as in severe pathological conditions such as HIV-I infection, tumor invasion and metastasis l7 .
• uPAR Besides uPAR's well-established role in the regulation of pericellular proteolysis, it is also involved in cell adhesion, migration, and proliferation through interactions with proteins present in the extracellular matrix, including vitronectin (Vn) 18 . Most recently, the importance of uP AR-Vn interactions was demonstrated by the direct requirement of uPAR to bind Vn for the sufficient induction of downstream signaling aimed at cell motility and morphology 19 .
• the invention is based on the experimental observations discussed herein that present a mechanism that involves activation of av ⁇ 3 integrin within lipid rafts 24 .
• the inhibition of uPAR/av ⁇ 3 integrin function in podocytes ameliorated the course of proteinuria and opens novel avenues for pharmacological interventions.
• Blockade of av ⁇ 3 integrin reduces podocyte motility in vitro and proteinuria in mice. Mice deficient of uPAR are protected from proteinuria unless a constitutively active ⁇ 3 integrin is expressed.
• Gene transfer of uPAR into podocytes but not into endothelial cells conferred the ability to develop urinary protein loss.
• uPAR may be required to activate av ⁇ 3 integrin in podocytes which promotes cell motility and activation of small GTPases cdc42 and Racl .
• uPAR is required for podocyte migration and LPS-induced FP effacement and proteinuria in mice via a mechanism that includes lipid- dependent activation of ⁇ v ⁇ 3 integrin.
• uPAR expression is present in all glomerular cells, yet uPAR expression is not required for normal renal function in any of the cells as the uPAR -/- mice behave normal. Surprising is the requirement of uPAR during the development of podocyte FP effacement and proteinuria which suggests that inducible pathways are required for the remodeling of the filtration barrier. uPAR action for the development of proteinuria stems from its action in the podocyte, which was demonstrated using cell-specific promoter elements.
• methods for treating proteinuria are provided by inhibiting av ⁇ 3 integrin function by inhibiting uPAR function.
• uPAR is induced during proteinuria and that uPAR-/- mice are protected from the development of proteinurea.
• the uPAR inhibitors including small molecules, peptides and antibodies can be used to inhibit av ⁇ 3 integrin function.
• proteinuria refers to any amount of protein passing through a podocyte, such as a podocyte that has suffered podocyte damage.
• podocyte damage refers to FP effacement and/or cortical actin rearrangement or any other reversible structural or functional change in podocytes that results in proteinuria.
• proteinuria refers to the presence of excessive amounts of serum protein in the urine.
• the excessive amount of serum protein in the urine is greater than 50, 100, 150, or 200 mg of serum protein/day. In a preferred embodiment the amount of serum protein in the urine is greater than 150 mg/day.
• Proteinuria is a characteristic symptom of either renal (kidney), urinary, pancreatic distress, nephrotic syndromes (for example, proteinuria larger than 3.5 grams per day), eclampsia, toxic lesions of kidneys, and it is frequently a symptom of diabetes mellitus. With severe proteinuria general hypoproteinemia can develop and it results in diminished oncotic pressure (ascites, edema, hydrothorax).
• a proteinuric disorder refers to, but it is not limited to: Diabetic nephropathy, Nephrotic syndromes (i.e. intrinsic renal failure), Nephritic syndromes, Toxic lesions of kidneys, Glomerular diseases, such as membranous glomerulonephritis, Focal segmental glomerulosclerosis (FSGS), IgA nephropathy (i.e., Berger's disease), IgM nephropathy, Membranoproliferative glomerulonephritis, Membranous nephropathy, Minimal change disease, Hypertensive nephrosclerosis and Interstitial nephritis.
• FSGS Focal segmental glomerulosclerosis
• IgA nephropathy i.e., Berger's disease
• IgM nephropathy i.e., Berger's disease
• IgM nephropathy i.e., Berger's disease
• a proteinuric disorder refers to: Preeclampsia, Eclampsia, Collagen vascular diseases (e.g., systemic lupus erythematosus), Dehydration, Strenuous exercise, Stress, Benign Orthostatic (postural) proteinuria, Sarcoidosis, Alport's syndrome, Diabetes mellitus, Fabry's disease, Infections (e.g., HIV, syphilis, hepatitis.post-streptococcal infection), Aminoaciduria, Fanconi syndrome, Heavy metal ingestion, Sickle cell disease, Hemoglobinuria, Multiple myeloma,
• a proteinuric disorder refers to diabetes, hypertension, kidney disease, minimal change disease, membranous glomerulonephritis, focal segmental glomerulosclerosis, diabetic neuropathy, post-infectious glomerulonephritis, mesangioproliferative glomerulonephritis , HIV-associated nephropathy, IgA-nephropathy, and cardiovascular disease.
• Podocyte damage can be caused by many conditions and factors including LPS and purine aminonucleoside (PAN).
• the instant invention is based in part on the surprising discovery of the functional significance of ⁇ v ⁇ 3 integrin activation as a downstream effector for increased podocyte motility and FP effacement.
• Integrins belong to the family of heterodimeric class I transmembrane receptors, which play an important role in numerous cell-matrix and cell-cell adhesion processes (Tuckwell et al., 1996, Symp. Soc. Exp. Biol. 47). They can be divided roughly into three classes: the ⁇ l integrins, which are receptors for the extracellular matrix, the ⁇ 2 integrins, which can be activated on leucocytes and are triggered during inflammatory processes, and the ⁇ v integrins, which influence the cell response in wound-healing and other pathological processes (Marshall and Hart, 1996, Semin. Cancer Biol. 7, 191).
• the ⁇ v ⁇ 3 integrin also called that the vitronectin receptor, mediates adhesion to a multiplicity of ligand's- plasma proteins, extracellular matrix proteins, cell surface proteins, of which the majority contain the amino acid sequence Arg-Gly-Asp (RGD), such as, for example, fibronectin or vitronectin. Soluble RGD-containing peptides are capable of inhibiting the interaction of each of these integrins with the corresponding natural ligands. Integrin ⁇ v ⁇ 3 antagonistic action has been shown for a multiplicity of compounds, such as anti- ⁇ v ⁇ 3 monoclonal antibodies, peptides which contain the RGD binding sequence, natural, RGD-containing proteins (e.g.
• Advantageous ⁇ v ⁇ 3 integrin receptor ligands bind to the integrin ⁇ v ⁇ 3 receptor with an increased affinity by at least a factor of 10, preferably at least a factor of 100.
• a method for treating a proteinuric disorder comprising administering to a patient in need thereof an ⁇ v ⁇ 3 integrin inhibitors is provided.
• the ⁇ v ⁇ 3 integrin inhibitors are the compounds described in WO 97/08145 Al, WO 00/48996 A2, WO 06043930 Al, US2002072500, US 2005043344, US 2002045645, US 2002099209, US 2005020505, US 2002072518, US 2002077321, US 2004043994, US 2003069236, US 2003144311.
• the ⁇ v ⁇ 3 integrin inhibitors are peptidic sulfonamides having the formula (I): R'-Arg-X-Asp-Leu-Asp-Ser-Leu-Arg-R 2 , in which R 1 denotes H, acetyl or acyl and R 2 denotes -Oh, OR 3 NH 2 ,NHR 3 , N(R 3 ) 2 R 3 denotes alkyl, aralkyl, aryl, Het and X denotes an amino acid, in which A denotes (CH 2 ),, R 4 denotes H, alkyl, aralkyl or aryl, and n denotes 1, 2, 3, 4, 5 or 6, and the amino acid is bonded to the adjacent Arg via a peptide bond of the ⁇ -amino group and to the ⁇ -amino group of the adjacent Asp via a peptide bond of the ⁇ -carboxyl group as described in US
• the ⁇ v ⁇ 3 integrin inhibitors are peptido- mimetic compounds containing an RGD sequence as described in WO 2005/007654 Al and US Patent No. 6,451 ,972.
• the ⁇ v ⁇ 3 integrin inhibitors are antagonists of the ⁇ v ⁇ 3 integrin receptor based on a bicyclic structural element are described in WO 9906049, WO 9905107, WO 9814192, WO 9724124, WO 9724122 and WO 9626190.
• the ⁇ v ⁇ 3 integrin inhibitors are compounds described in US Publication No. 2004/0063934.
• the ⁇ v ⁇ 3 integrin inhibitors of the invention include isolated peptides and proteins.
• isolated means separated from its native environment and present in sufficient quantity to permit its identification or use. Isolated, when referring to a protein or polypeptide, means, for example: (i) selectively produced by expression cloning or (ii) purified as by chromatography or electrophoresis. Isolated proteins or polypeptides may be, but need not be, substantially pure. The term “substantially pure” means that the proteins or polypeptides are essentially free of other substances with which they may be found in nature or in vivo systems to an extent practical and appropriate for their intended use.
• Substantially pure polypeptides may be produced by techniques well known in the art. Because an isolated protein may be admixed with a pharmaceutically acceptable carrier in a pharmaceutical preparation, the protein may comprise only a small percentage by weight of the preparation. The protein is nonetheless isolated in that it has been separated from the substances with which it may be associated in living systems, i.e. isolated from other proteins.
• ⁇ v ⁇ 3 integrin inhibitors of the invention may be produced using any of the methods and techniques known to those skilled in the art.
• ⁇ v ⁇ 3 integrin inhibitors can be purified from a source which naturally expresses the protein, can be isolated from a recombinant host which has been altered to express the desired mutant or fragment thereof, or can be synthesized using protein synthesis techniques known in the art.
• the skilled artisan can readily adapt a variety of techniques in order to obtain ⁇ v ⁇ 3 integrin inhibitors that are peptides, proteins or fragments thereof.
• Other agents that are ⁇ v ⁇ 3 integrin inhibitors include but are not limited to small molecules, and other drugs, including known drugs, that prevent (i.e. reduce or inhibit further increase) integrin activation.
• ⁇ v ⁇ 3 integrin inhibitors of the present invention can be identified using the methods and assays described herein.
• the screening may be a random screen or it may be rationally designed.
• putative inhibitors are selected at random and assayed for their ability to produce the desired physiological effect.
• the putative modulators may be assayed for the ability to reduce selectively or specifically the amount or rate of ⁇ v ⁇ 3 integrin activation. Any suitable method or technique known to those skilled in the art may be employed to assay putative inhibitors.
• ⁇ v ⁇ 3 integrin inhibitors may be selected based, for example on the RGD binding domain. Any of the suitable methods and techniques known to those skilled in the art may be employed for rational selection or design. For example, one skilled in the art can readily adapt currently available procedures to generate pharmaceutical agents capable of binding to a specific peptide sequence of ⁇ v ⁇ 3 integrin or uPAR, precluding their interaction and signal transduction and thereby inhibiting ⁇ v ⁇ 3 integrin activity.
• ⁇ v ⁇ 3 integrin inhibitors include antibodies and antibody fragments which are capable of binding to ⁇ v ⁇ 3 integrin and consequently acting as a ⁇ v ⁇ 3 integrin inhibitors.
• the antibodies of the present invention include polyclonal and monoclonal antibodies, as well as antibody fragments and derivatives that contain the relevant antigen binding domain of the antibodies. Such antibodies or antibody fragments are preferably used in the diagnostic and therapeutic embodiments of the present invention. In a preferred embodiment the antibody is anti-CD61 antibody.
• "treating a proteinuric disorder” includes preventing the development of proteinurea, reducing or inhibiting proteinurea, slowing the progression, and/or any other desired effect on proteinurea.
• the ⁇ v ⁇ 3 integrin inhibitors can be administered prior to the onset of proteinurea, following the onset of proteinurea, or as part of any therapeutic regimen, for example, including cancer medicaments.
• the methods of the invention are intended to embrace the use of more than one other medicament along with the ⁇ v ⁇ 3 integrin inhibitor.
• the ⁇ v ⁇ 3 integrin inhibitor may be administered with both a chemotherapeutic agent, anti-diabetic agent or an immunotherapeutic agent.
• the invention also encompasses diagnostic assays for determining the presence of a disorder characterized by proteinuria in a subject. This aspect of the invention is based, at least in part, on the discovery that ⁇ v ⁇ 3 integrin activation is reduced in damaged or proteinuric podocytes. In the method an amount of ⁇ v ⁇ 3 integrin activity in a podocyte cell is determined. That amount is compared to a pre-determined threshold or to a control level.
• a disorder characterized by proteinuria is determined when the amount of ⁇ v ⁇ 3 integrin activity is below the pre-determined threshold.
• pre-determined threshold or a control level refers to ⁇ v ⁇ 3 integrin activity levels in normal, healthy podocytes, i.e. podocytes not affected by podocyte damage or proteinuria.
• the podocyte cells may be within a biological sample.
• the biological sample may be, for instance, a biopsy sample of proteinuric tissue.
• activity refers to expression and well as biochemical activity as described herein.
• ⁇ v ⁇ 3 integrin in podocyte cells can be readily carried out by standard immunostaining or immunocytometric methods, readily known by persons of ordinary skill in the art.
• immunostaining refers to a technique of applying coloured or fluorescent dyes to tissues in preparation for microscopic examination.
• the assay may be performed using immunogold electron microscopy.
• the diagnostic assays are performed on cells and/or tissue samples wherein morphological changes of the actin-cytoskeleton can not be readily detected by any other immunocytometric methods.
• one such disorder would be minimal change disease.
• minimal change disease comes from the notion that morphological podocyte changes are only visible by electron microscopy. Detection of proteinuria in patients with minimal change disease by immunocytometric methods would be advantageous because it provide ease and speed of detection.
• the immunocytometric methods may be performed using labeled antibodies.
• An antibody is said to be "detectably labeled” if the antibody, or fragment thereof, is attached to a molecule which is capable of identification, visualization, or localization using known methods.
• Suitable detectable labels include radioisotopic labels, enzyme labels, non-radioactive isotopic labels, fluorescent labels, affinity labels, chemiluminescent labels and nuclear magnetic resonance contrast agents.
• suitable enzyme labels include, but are not limited to, luciferase, malate dehydrogenase, staphylococcal nuclease, delta-5-steroid isomerase, yeast-alcohol dehydrogenase, alpha-glycerol phosphate dehydrogenase, triose phosphate isomerase, horseradish peroxidase, alkaline phosphatase, asparaginase, glucose oxidase, beta-galactosidase, ribonuclease, urease, catalase, glucose-6-phosphate dehydrogenase, glucoamylase, and acetylcholine esterase.
• suitable radioisotopic labels include, but are not limited to, 3 H, 111 In,
• 111 In coupled to monoclonal antibodies with 1- (p-isothiocyanatobenzyl)-DPTA has shown little uptake in non-tumorous tissues, particularly the liver, and therefore enhances specificity of tumor localization (Esteban et al., J. Nucl. Med. 28:861-870 (1987)).
• suitable non-radioactive isotopic labels include, but are not limited to, 157 Gd, 55 Mn, 162 Dy, 52 Tr, and 56 Fe.
• fluorescent labels include, but are not limited to, an 152 Eu label, a fluorescent protein (including green fluorescent protein (GFP), enhanced green fluorescent protein (EGFP), enhanced yellow fluorescent protein (YFP) and enhanced cyan fluorescent protein (ECFP),), a fluorescein label, an isothiocyanate label, a rhodamine label, a phycoerythrin label, a phycocyanin label, an allophycocyanin label, an o-phthaldehyde label, and a fluorescamine label
• chemiluminescent labels include a luminal label, an isoluminal label, an aromatic acridinium ester label, an imidazole label, an acridinium salt label, an oxalate ester label, a luciferin label, a luciferase label, and an aequorin label.
• nuclear magnetic resonance contrasting agents include paramagnetic heavy metal nuclei such as GFP, enhanced green fluorescent protein (EGFP), enhanced yellow fluorescent protein
• the coupling of one or more molecules to antibodies is envisioned to include many chemical mechanisms, for instance covalent binding, affinity binding, intercalation, coordinate binding, and complexation.
• the covalent binding can be achieved either by direct condensation of existing side chains or by the incorporation of external bridging molecules.
• Many bivalent or polyvalent agents are useful in coupling protein molecules to other proteins, peptides or amine functions, etc.
• the literature is replete with coupling agents such as carbodiimides, diisocyanates, glutaraldehyde, diazobenzenes, and hexamethylene diamines. This list is not intended to be exhaustive of the various coupling agents known in the art but, rather, is exemplary of the more common coupling agents.
• the ⁇ v ⁇ 3 integrin inhibitors are administered in pharmaceutically acceptable preparations.
• the pharmaceutical preparations of the invention are applied in pharmaceutically-acceptable amounts and in pharmaceutically-acceptable compositions.
• pharmaceutically acceptable means a non-toxic material that does not interfere with the effectiveness of the biological activity of the active ingredients.
• Such preparations may routinely contain salts, buffering agents, preservatives, compatible carriers, and optionally other therapeutic agents.
• the salts should be pharmaceutically acceptable, but non-pharmaceutically acceptable salts may conveniently be used to prepare pharmaceutically-acceptable salts thereof and are not excluded from the scope of the invention.
• pharmaceutically acceptable carrier or “physiologically acceptable carrier” includes any and all salts, solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like that are physiologically compatible.
• the carrier is suitable for intravenous, intramuscular, subcutaneous, parenteral, per os, spinal or epidermal administration (e.g., by injection or infusion).
• the active compound i.e., ⁇ v ⁇ 3 integrin inhibitor may be coated in a material to protect the compound from the action of acids and other natural conditions that may inactivate the compound.
• the carrier is sterile.
• a salt retains the desired biological activity of the parent compound and does not impart any undesired toxicological effects (see e.g., Berge, S.M., et al. (1977) J. Pharm. Sci. 66: 1-19).
• Examples of such salts include acid addition salts and base addition salts.
• Acid addition salts include those derived from nontoxic inorganic acids, such as hydrochloric, nitric, phosphoric, sulfuric, hydrobromic, hydroiodic, phosphorous and the like, as well as from nontoxic organic acids such as aliphatic mono- and dicarboxylic acids, phenyl substituted alkanoic acids, hydroxy alkanoic acids, aromatic acids, aliphatic and aromatic sulfonic acids and the like.
• Base addition salts include those derived from alkaline earth metals, such as sodium, potassium, magnesium, calcium and the like, as well as from nontoxic organic amines, such as N,N'-dibenzylethylenediamine, N- methylglucamine, chloroprocaine, choline, diethanolamine, ethylenediamine, procaine and the like.
• the pharmaceutical compositions may contain suitable buffering agents, including: acetic acid in a salt; citric acid in a salt; boric acid in a salt; and phosphoric acid in a salt.
• the pharmaceutical compositions also may contain, optionally, suitable preservatives, such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal.
• suitable preservatives such as: benzalkonium chloride; chlorobutanol; parabens and thimerosal.
• the pharmaceutical compositions may conveniently be presented in unit dosage form and may be prepared by any of the methods well-known in the art of pharmacy. All methods include the step of bringing the active agent into association with a carrier which constitutes one or more accessory ingredients. In general, the compositions are prepared by uniformly and intimately bringing the active compound into association with a liquid carrier, a finely divided solid carrier, or both, and then, if necessary, shaping the product.
• compositions suitable for parenteral administration conveniently comprise a sterile aqueous or non-aqueous preparation of the compounds, which is preferably isotonic with the blood of the recipient.
• This preparation may be formulated according to known methods using suitable dispersing or wetting agents and suspending agents.
• the sterile injectable preparation also may be a sterile injectable solution or suspension in a non-toxic parenterally-acceptable diluent or solvent, for example, as a solution in 1 ,3-butane diol.
• acceptable vehicles and solvents that may be employed are water, Ringer's solution, and isotonic sodium chloride solution.
• sterile, fixed oils are conventionally employed as a solvent or suspending medium.
• any bland fixed oil may be employed including synthetic mono-or di-glycerides.
• fatty acids such as oleic acid may be used in the preparation of injectables.
• Carrier formulations suitable for oral, subcutaneous, intravenous, intramuscular, etc. administration can be found in Remington 's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA.
• the active compounds can be prepared with carriers that will protect the compound against rapid release, such as a controlled release formulation, including implants, transdermal patches, and microencapsulated delivery systems.
• Biodegradable, biocompatible polymers can be used, such as ethylene vinyl acetate, polyanhydrides, polyglycolic acid, collagen, polyorthoesters, and polylactic acid.
• compositions comprising one or more ⁇ v ⁇ 3 integrin inhibitors.
• These pharmaceutical compositions may be administered orally, rectally, parenterally, intrathecally, intracisternally, intravaginally, intraperitoneally, topically (as by powders, ointments, drops or transdermal patch), bucally, or as an oral or nasal spray.
• parenteral refers to modes of administration which include intravenous, intramuscular, intrathecal, intraperitoneal, intrasternal, subcutaneous and intraarticular injection and infusion.
• compositions of the present invention for parenteral injection may comprise pharmaceutically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions as well as sterile powders for reconstitution into sterile injectable solutions or dispersions just prior to use.
• aqueous and nonaqueous carriers, diluents, solvents or vehicles include, but are not limited to, water, ethanol, polyols (such as glycerol, propylene glycol, polyethylene glycol, and the like), carboxymethylceuulose and suitable mixtures thereof, vegetable oils (such as olive oil), and injectable organic esters such as ethyl oleate.
• polyols such as glycerol, propylene glycol, polyethylene glycol, and the like
• carboxymethylceuulose and suitable mixtures thereof include vegetable oils (such as olive oil), and injectable organic esters such as ethyl oleate.
• Proper fluidity can be maintained, for example, by the use of coating materials such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
• compositions of the present invention may also contain preservatives, wetting agents, emulsifying agents, and dispersing agents. Prevention of the action of microorganisms may be ensured by the inclusion of various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol sorbic acid, and the like. It may also be desirable to include isotonic agents such as sugars, sodium chloride, and the like.
• Prolonged absorption of the injectable pharmaceutical form may be brought about by the inclusion of agents which delay absorption such as aluminum monostearate and gelatin.
• the absorption from subcutaneous or intramuscular injection In some cases, in order to prolong the effect of the therapeutic agent, it is desirable to slow the absorption from subcutaneous or intramuscular injection. This may be accomplished by the use of a liquid suspension of crystalline or amorphous material with poor water solubility. The rate of absorption of the drug then depends upon its rate of dissolution which, in turn, may depend upon crystal size and crystalline form. Alternatively, delayed absorption of a parenterally administered drug form is accomplished by dissolving or suspending the drug in an oil vehicle.
• Injectable depot forms are made by forming microencapsuled matrices of the drug in biodegradable polymers such as polylactide-polyglycolide. Depending upon the ratio of drug to polymer and the nature of the particular polymer employed, the rate of drug release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly(anhydrides). Depot injectable formulations are also prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissues. Solid dosage forms for oral administration include, but are not limited to, capsules, tablets, pills, powders, and granules.
• the active compounds are preferably mixed with at least one pharmaceutically acceptable excipient or carrier such as sodium citrate or dicalcium phosphate and/or a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and silicic acid, b) binders such as, for example, carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidone, sucrose, and acacia, c) humectants such as glycerol, d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate, e) solution retarding agents such as paraffin, f) absorption accelerators such as quaternary ammonium compounds, g) wetting agents such as, for example, cetyl alcohol and glycerol monostearate, h) absorbents such as kaolin and bentonite clay, and
• the dosage form may also comprise buffering agents as appropriate.
• Solid compositions of a similar type may also be employed as fillers in soft and hard filled gelatin capsules using such excipients as lactose or milk sugar as well as high molecular weight polyethylene glycols and the like.
• the solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They may optionally contain opacifying agents and can also be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract, optionally, in a delayed manner.
• opacifying agents such as enteric coatings and other coatings well known in the pharmaceutical formulating art.
• embedding compositions which can be used include polymeric substances and waxes.
• the active ⁇ v ⁇ 3 integrin inhibitors can also be in micro-encapsulated form, if appropriate, with one or more of the above-mentioned excipients.
• Liquid dosage forms for oral administration include, but are not limited to, pharmaceutically acceptable emulsions, solutions, suspensions, syrups and elixirs.
• the liquid dosage forms may contain inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and emulsifiers such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethyl formamide, oils (in particular, cottonseed, groundnut, corn, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
• inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and
• the oral compositions may also contain adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents.
• adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents.
• Suspensions in addition to the active compounds, may contain suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, and tragacanth, and mixtures thereof.
• suspending agents as, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, and tragacanth, and mixtures thereof.
• the ⁇ v ⁇ 3 integrin inhibitor is administered in the form of liposomes.
• liposomes are generally derived from phospholipids or other lipid substances. Liposomes are formed by mono- or multi-lamellar hydrated liquid crystals that are dispersed in an aqueous medium. Any non-toxic, physiologically acceptable and metabolizable lipid capable of forming liposomes can be used.
• the present compositions in liposome form can contain, in addition to the ⁇ v ⁇ 3 integrin inhibitor, stabilizers, preservatives, excipients, and the like.
• Preferred lipids are phospholipids and phosphatidyl cholines (lecithins), both natural and synthetic. Methods to form liposomes are known in the art. See, e.g., Prescott, ed., METHODS IN CELL BIOLOGY, Volume XIV, Academic Press, New York, N. Y. (1976), p. 33 et seq.
• therapeutic agents used in the methods of the invention can be determined empirically and may be employed in pure form or, where such forms exist, in pharmaceutically acceptable salt, ester or prodrug form.
• the therapeutic agents may be administered in compositions in combination with one or more pharmaceutically acceptable excipients. It will be understood that, when administered to a human patient, the total daily usage of the agents and compositions of the present invention will be decided by the attending physician within the scope of sound medical judgment.
• the specific therapeutically effective dose level for any particular patient will depend upon a variety of factors including the type and degree of the response to be achieved; the specific agent or composition employed; the age, body weight, general health, sex and diet of the patient; the time of administration, route of administration, and rate of excretion of the agent or composition; the duration of the treatment; drugs (such as a chemotherapeutic agent) used in combination or coincidental with the specific composition; and like factors well known in the medical arts. Techniques of dosage ⁇ determination are well known in the art.
• satisfactory results are obtained by oral administration of therapeutic dosages on the order of from 0.05 to 10 mg/kg/day, preferably 0.1 to 7.5 mg/kg/day, more preferably 0.1 to 2 mg/kg/day, administered once or, in divided doses, 2 to 4 times per day.
• dosages on the order of from 0.01 to 5 mg/kg/day, preferably 0.05 to 1.0 mg/kg/day and more preferably 0.1 to 1.0 mg/kg/day can be used.
• Suitable daily dosages for patients are thus on the order of from 2.5 to 500 mg p.o., preferably 5 to 250 mg per oral (p.o.), more preferably 5 to 100 mg p.o., or on the order of from 0.5 to 250 mg i.v., preferably 2.5 to 125 mg i.v. and more preferably 2.5 to 50 mg i.v.
• the administration of the agents of the present invention may be for either prophylactic or therapeutic purpose.
• the agent is provided in advance of any damage i.e., proteinuria or podocyte damage.
• the prophylactic administration of the agent serves to prevent or reduce the rate of onset of symptoms.
• the agent is provided at (or after) the onset of the appearance of symptoms of actual disease.
• the therapeutic administration of the agent serves to reduce the severity and duration of proteinuria.
• compositions of the invention are administered in effective amounts.
• An "effective amount” is that amount of any of the compositions provided herein that alone, or together with further doses, produces the desired response, e.g. reduces or eliminates proteinuria. This may involve only slowing the progression of the disease temporarily, although more preferably, it involves halting the progression of the disease permanently. This can be monitored by routine methods.
• the desired response to treatment of the disease or condition also can be delaying the onset or even preventing the onset of the disease or condition.
• An amount that is effective can be the amount of a ⁇ v ⁇ 3 integrin inhibitor alone which produces the desired therapeutic endpoint.
• An amount that is effective is also the amount of a ⁇ v ⁇ 3 integrin inhibitor in combination with another agent that produces the desired result.
• Such amounts will depend, of course, on the particular condition being treated, the severity of the condition, the individual patient parameters including age, physical condition, size and weight, the duration of the treatment, the nature of concurrent therapy (if any), the specific route of administration and like factors within the knowledge and expertise of the health practitioner. These factors are well known to those of ordinary skill in the art and can be addressed with no more than routine experimentation. It is generally preferred that a maximum dose of the individual components or combinations thereof be used, that is, the highest safe dose according to sound medical judgment. It will be understood by those of ordinary skill in the art, however, that a patient may insist upon a lower dose or tolerable dose for medical reasons, psychological reasons or for virtually any other reasons.
• the doses of ⁇ v ⁇ 3 integrin inhibitors administered to a subject can be chosen in accordance with different parameters, in particular in accordance with the mode of administration used and the state of the subject. Other factors include the desired period of treatment. In the event that a response in a subject is insufficient at the initial doses applied, higher doses (or effectively higher doses by a different, more localized delivery route) may be employed to the extent that patient tolerance permits.
• the dose can be delivered continuously, such as by continuous pump, or at periodic intervals. Desired time intervals of multiple doses of a particular composition can be determined without undue experimentation by one skilled in the art.
• Other protocols for the administration of the compositions provided will be known to one of ordinary skill in the art, in which the dose amount, schedule of administration, sites of administration, mode of administration and the like vary from the foregoing.
• Administration of ⁇ v ⁇ 3 integrin inhibitor compositions to mammals other than humans, e.g. for testing purposes or veterinary therapeutic purposes, is carried out under substantially the same conditions as described above.
• compositions of the present invention have in vitro and in vivo diagnostic and therapeutic utilities.
• these molecules can be administered to cells in culture, e.g. in vitro or ex vivo, or in a subject, e.g., in vivo, to treat, prevent or diagnose a variety of disorders.
• the term "subject” is used interchangeably with the term "patient” and is intended to include humans and non-human animals including but not limited to a dog, cat, horse, cow, pig, sheep, goat, or primate, e.g., monkey.
• Preferred patients include a human patient having a proteinuric disorder, including disorders characterized by proteinuria as described herein.
• a patient in need thereof refers to any patient that is affected with a disorder characterized by proteinuria.
• a patient in need thereof refers to any patient that may have, or is at risk of having a disorder characterized by proteinuria.
• a patient in need thereof is a patient that has, may have or is at risk at having cancer, precancer, refractory cancer or metastatic cancer.
• a patient in need thereof is a patient that has, may have, or is at risk of having a cognitive disorder, such as Alzheimer's disease or dementia.
• compositions provided of the present invention can be used in conjunction with other therapeutic treatment modalities.
• Such other treatments include surgery, radiation, cryosurgery, thermotherapy, hormone treatment, chemotherapy, vaccines, and immunotherapies.
• the invention also relates in some aspects to the identification and testing of candidate agents and molecules that may be ⁇ v ⁇ 3 integrin inhibitors. These molecules are referred to as putative ⁇ v ⁇ 3 integrin inhibitors.
• putative ⁇ v ⁇ 3 integrin inhibitors can be screened for activity using the same type of assays as described herein (e.g., the assays described in the Examples section). Using such assays, additional ⁇ v ⁇ 3 integrin inhibitors can be can be identified.
• the invention further provides efficient methods of identifying pharmacological agents or lead compounds as ⁇ v ⁇ 3 integrin inhibitors.
• the screening methods involve assaying for compounds which inhibit the level of ⁇ v ⁇ 3 integrin activity.
• the screening methods may measure the level of binding between the molecules directly, such as by using the methods employed in the Examples.
• screening methods may be utilized that measure a secondary effect of the ⁇ v ⁇ 3 integrin inhibitors, for example the level of proteinuria in a cell or tissue sample.
• assays for pharmacological agents can be used in accordance with this aspect of the invention, including, labeled in vitro protein-protein binding assays, electrophoretic mobility shift assays, immunoassays, cell-based assays such as two- or three-hybrid screens, expression assays, etc.
• the assay mixture comprises a candidate pharmacological agent.
• a plurality of assay mixtures are run in parallel with different agent concentrations to obtain a different response to the various concentrations.
• one of these concentrations serves as a negative control, i.e., at zero concentration of agent or at a concentration of agent below the limits of assay detection.
• Putative inhibitors useful in accordance with the invention encompass numerous chemical classes, although typically they are organic compounds.
• the putative modulators are small organic compounds, i.e., those having a molecular weight of more than 50 yet less than about 2500, preferably less than about 1000 and, more preferably, less than about 500.
• Putative ⁇ v ⁇ 3 integrin inhibitors comprise functional chemical groups necessary for structural interactions with proteins and/or nucleic acid molecules, and typically include at least an amine, carbonyl, hydroxyl or carboxyl group, preferably at least two of the functional chemical groups and more preferably at least three of the functional chemical groups.
• the putative modulators can comprise cyclic carbon or heterocyclic structure and/or aromatic or polyaromatic structures substituted with one or more of the above-identified functional groups.
• Putative modulators also can be biomolecules such as peptides, saccharides, fatty acids, sterols, isoprenoids, purines, pyrimidines, derivatives or structural analogs of the above, or combinations thereof and the like.
• the putative modulator is a nucleic acid molecule
• the agent typically is a DNA or RNA molecule, although modified nucleic acid molecules as defined herein are also contemplated.
• cell-based assays as described herein can be performed using cell samples and/or cultured cells. Biopsy cells and tissues as well as cell lines grown in culture are useful in the methods of the invention.
• Putative ⁇ v ⁇ 3 integrin inhibitors are obtained from a wide variety of sources including libraries of synthetic or natural compounds. For example, numerous means are available for random and directed synthesis of a wide variety of organic compounds and biomolecules, including expression of randomized oligonucleotides, synthetic organic combinatorial libraries, phage display libraries of random peptides, and the like.
• libraries of natural compounds in the form of bacterial, fungal, plant and animal extracts are available or readily produced.
• natural and synthetically produced libraries and compounds can be readily be modified through conventional chemical, physical, and biochemical means.
• known pharmacological agents may be subjected to directed or random chemical modifications such as acylation, alkylation, esterification, amidification, etc. to produce structural analogs of the agents.
• a variety of other reagents also can be included in the mixture. These include reagents such as salts, buffers, neutral proteins (e.g., albumin), detergents, etc. which may be used to facilitate optimal protein-protein and/or protein-nucleic acid binding. Such a reagent may also reduce non-specific or background interactions of the reaction components. Other reagents that improve the efficiency of the assay such as antimicrobial agents, and the like may also be used.
• the prerequisite for producing intact native polypeptides using E. coli is the use of a strong, regulatable promoter and an effective ribosome binding site.
• Promoters which may be used for this purpose include the temperature sensitive bacteriophage ⁇ p L - promoter, the tac-promoter inducible with IPTG or the T7-promoter.
• Numerous plasmids with suitable promoter structures and efficient ribosome binding sites have been described, such as for example pKC30 (Xp 1 ,; Shimatake and Rosenberg, Nature 292:128 (1981), pKK173-3 (tac, Amann and Brosius, Gene 40:183 (1985)) or pET-3 (T7-promoter (Studier and Moffat, J. MoI. Biol. 189:113 (1986)).
• E. coli strains which are specifically tailored to a particular expression vector are known to those skilled in the art (Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press (1989)).
• the experimental performance of the cloning experiments, the expression of the polypeptides in E. coli and the working up and purification of the polypeptides are known and are described, for example, in Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press (1989).
• eukaryotic microorganisms such as yeast may also be used.
• the plasmid YRp7 (Stinchcomb et al. Nature 282:39 (1979); Kingsman et al., Gene 7:141 (1979); Tschumper et al., Gene 10:157 (1980)) and the plasmid YEpl3 (Bwach et al., Gene 8:121-133 (1979)) are used, for example.
• the plasmid YRp7 contains the TRPl -gene which provides a selection marker for a yeast mutant (e.g., ATCC No. 44076) which is incapable of growing in tryptophan-free medium.
• TRPl defect as a characteristic of the yeast strain used then constitutes an effective aid to detecting transformation when cultivation is carried out without tryptophan.
• plasmid YEp 13 which contains the yeast gene LEU-2, which can be used to complete a LEU-2-minus mutant.
• yeast hybrid vectors also contain a replication start and a marker gene for a bacterial host, particularly E. coli, so that the construction and cloning of the hybrid vectors and their precursors can be carried out in a bacterial host.
• Other expression control sequences suitable for expression in yeast include, for example, those of PHO3- or PHO5-gene.
• yeast vectors contain the 5 '-flanking region of the genes of ADH I (Ammerer, Methods of Enzymology 101:192-210 (1983)), 3- phosphoglycerate kinase (Hitzeman et al., J Biol. Chem.
• glycolytic enzymes such as enolase, glycerinaldehyde-3-phosphate-dehydrogenase, hexokinase, pyruvate- decarboxylase, phosphofructokinase, glucose-6-phosphate isomerase, phosphoglucose- isomerase and glucokinase.
• the termination sequences associated with these genes may also be inserted in the expression vector at the 3 '-end of the sequence to be expressed, in order to enable polyadenylation and termination of the mRNA.
• any vector which contains a yeast-compatible promoter and origin replication and termination sequences is suitable.
• hybrid vectors which contain sequences homologous to the yeast 2 ⁇ plasmid DNA may also be used. Such hybrid vectors are incorporated by recombination within the cells of existing 2 ⁇ -plasmids or replicate autonomously.
• yeasts In addition to yeasts, other eukaryotic systems may, of course, be used to express the polypeptides according to the invention. Since post-translational modifications such as disulphide bridge formation, glycosylation, phosphorylation and/or oligomerization are frequently necessary for the expression of biologically active eukaryotic proteins by means of recombinant DNA, it may be desirable to express the DNA according to the invention not only in mammalian cell lines but also insect cell lines.
• Functional prerequisites of the corresponding vector systems comprise, in particular, suitable promoter, termination and polyadenylation signals as well as elements which make it possible to carry out replication and selection in mammalian cell lines.
• particularly suitable promoters are podocyte specific promoters.
• a podocyte specific promoter is one that is expressed exclusively in podocytes, such as the podocin promoter.
• Vectors which are replicable both in mammalian cells and also in prokaryotes such as E. coli.
• Vectors derived from viral systems such as SV40, Epstein- Barr- virus, etc., include, for example, pTK2, pSV2-dhfv, pRSV-neo, pKO-neo, pHyg, p205, pHEBo, etc. (Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Press, N. Y. (1989)). After transformation in suitable host cells, e.g.
• CHO cells corresponding transformed cells may be obtained with the aid of selectable markers (thymidine-kinase, dihydrofolate-reductase, green fluorescent protein, etc.) and the corresponding polypeptides are isolated after expression.
• selectable markers thymidine-kinase, dihydrofolate-reductase, green fluorescent protein, etc.
• the host cells suitable for the vectors are known, as are the techniques for transformation (micro-injection, electroporation, calcium phosphate method, etc.) as described, for example, in Sambrook et al.,
• the selected vector may be cut, for example, with a restriction endonuclease and, optionally after modification of the linearized vector thus formed, an expression control sequence equipped with corresponding restriction ends is inserted.
• the expression control sequence contains the recognition sequence of a restriction endonuclease, so that the vector already containing the expression control sequence is digested with the said restriction enzyme and the DNA molecule according to the invention, provided with ends which fit, can be inserted.
• the invention also relates to processes for preparing the vectors described herein, particularly expression vectors.
• These vectors are characterized in that a DNA provided with corresponding ends and coding for a functional derivative or a fragment of the protein is inserted into a vector DNA cut with restriction endonucleases and containing the expression control sequences described by way of example, in such a way that the expression control sequences regulate the expression of the DNA inserted.
• the peptides and antibody agents of the present invention which are obtained by the expression of recombinant DNA or from the native receptor molecule may, of course, also be derivatized by chemical or enzymatic processes.
• kits comprising the compositions of the invention and instructions for use.
• the kits can further contain at least one additional reagent, such as a chemotherapeutic agent.
• a kit may comprise a carrier being compartmentalized to receive in close confinement therein one or more container means or series of container means such as test tubes, vials, flasks, bottles, syringes, or the like.
• a first of said container means or series of container means may contain one or more ⁇ v ⁇ 3 integrin inhibitors or recombinant vectors for the expression thereof.
• a second container means or series of container means may contain a second therapeutic, such as, cytotoxic drug or ⁇ v ⁇ 3 integrin antibodies (or fragment thereof).
• Kits for use in the therapeutic methods of the invention containing the ⁇ v ⁇ 3 integrin inhibitors conjugated to other compounds or substances can be prepared.
• the components of the kits can be packaged either in aqueous medium or in lyophilized form.
• the ⁇ v ⁇ 3 integrin inhibitors or fragments thereof are used in the kits in the form of conjugates in which a label or a therapeutic moiety is attached, such as a radioactive metal ion or a therapeutic drug moiety
• the components of such conjugates can be supplied either in fully conjugated form, in the form of intermediates or as separate moieties to be conjugated by the user of the kit.
• Example 1 Modification of kidney barrier function by the urokinase receptor
• uPAR a treatment known to cause FP effacement and proteinuria 9 . It is shown that uPAR is dispensable for normal renal filtration but required in podocytes but not in endothelial cells for loss of renal permselectivity seen in human and rodent kidney diseases.
• LPS lipopolysaccharide
• the proteinuric signal originating from uPAR in podocytes is independent of urokinase and is required for podocyte FP effacement and LPS-induced proteinuria.
• uPAR protein is expressed in human glomeruli (Fig. Ia) and found expression in many glomerular cells including podocytes which are identified by synaptopodin labeling 25 .
• Fig. Ib human proteinuric renal diseases
• Fig. Ib We found a low level of glomerular uPAR mRNA expression in patients without glomerular disease (Fig. Ib). In contrast, patients with biopsy-proven FSGS had a significant increase in glomerular uPAR expression (FSGS 0.35 ⁇ 0.17 vs con 0.14 ⁇ 0.02, * *p ⁇ 0.05), (Fig. Ib). An even stronger induction of glomerular uPAR mRNA expression (0.69 ⁇ 0.21 vs con 0.14 ⁇ 0.02, *p ⁇ 0.012) was found in patients with diabetic nephropathy (Fig. Ib).
• uPAR was partially localized in podocytes as indicated by double immunofluorescent staining with synaptopodin 25 .
• expression of uPAR protein in all three proteinuria models was significantly increased in glomerular cells including podocytes as demonstrated by the increased yellow staining pattern resulting from overlap with synaptopodin (Fig. Ic).
• Fig. Ic synaptopodin
• uPAR localization in normal and diabetic animals (Fig. Id), since uPAR mRNA induction is strongest during diabetic nephropathy in humans (Fig. Ib).
• Fig. Id uPAR mRNA induction is strongest during diabetic nephropathy in humans
• Fig. Ib uPAR mRNA induction is strongest during diabetic nephropathy in humans
• uPAR in podocytes is required for foot process effacement and proteinuria
• FP morphology of wild type and uPAR -/- mice 30 before and after the administration of LPS Morphologically, there was no difference between the structure of podocyte FP in wild type or uPAR -/- mice (Fig. 2a, con).
• Fig. 2a con
• podocyte FP effacement in wild type but not in uPAR -A mice Fig. 2a, LPS
• uPAR protein was found in the liver, and at lower expression levels in glomerular extracts (Fig. 2c).
• the restoration of uPAR did change the morphology of podocyte FPs (Fig. 2d, con).
• concomitant administration of LPS and uPAR-cDNA into uPAR -/- mice resulted in FP effacement (Fig. 2d, LPS), similar to LPS-treated wild type animals (Fig. 2a, LPS).
• Fig. 2d, LPS LPS
• uPAR -/- mice reconstituted with uPAR-cDNA develop heavy proteinuria but like wild type mice only after LPS injection (Fig. 2e).
• the degree of proteinuria was comparable in LPS treated wild type and uPAR-cDNA reconstituted uPAR -/- mice.
• uPAR is required for the development of LPS-induced proteinuria in mice.
• uPAR orchestrates podocyte motility
• Podocyte FP effacement may represent a motile event resulting in spreading of podocyte FPs on the GBM.
• Fig. 9a semi-quantitative RT-PCR
• Fig. 9b Western blotting
• uPAR is a GPI-anchored protein without a cytoplasmic tail
• signal transduction from uPAR involves lateral interactions with membrane proteins such as integrins 16 .
• membrane proteins such as integrins 16 .
• Madsen et al. described that uPAR induced cell adhesion and migration required Vn binding which can occur independently of uPAR interactions with integrins l9 .
• Podocyte motility on Vn is enhanced in a uPAR-dependent fashion (Fig. 3) and Vn is induced in glomeruli during proteinuria (Fig. 8b).
• an uPAR-Vn complex or an uPAR- Vn-integrin complex facilitates podocyte motility and promotes FP effacement in response to LPS.
• Integrins can be in an inactive or active conformation 36 (Fig. 4a). The latter is stimulated by the association with interacting agonists such as domain 3 of uPAR which is important for a5bl integrin interaction 37> 38 .
• Degryse and colleagues recently identified an integrin-interacting sequence in domain 2 of uPAR, that acts as a new chemotactic epitope activating ⁇ v ⁇ 3 -dependent signaling pathways 39 .
• Vn receptor ⁇ v ⁇ 3 integrin 36 Given our findings of uPAR and Vn in the glomerulus, we were particulary interested in the Vn receptor ⁇ v ⁇ 3 integrin 36 . Indeed, the localization of ⁇ v ⁇ 3 integrin in podocyte FPs (Fig. 4b) 31 and the distribution of uPAR (Fig. 4b) was similar. In addition, uPAR interacts with ⁇ 3 integrin (Fig. 10a). Thus, we hypothesized that ⁇ v ⁇ 3 integrin may provide a functional link between uPAR, podocyte migration and proteinuria development. The genetic deletion of ⁇ 3 integrin or of the ⁇ v ⁇ 3 integrin ligand Vn resulted in protection from proteinuria when challenged with LPS (Fig. 4c).
• uPAR -/- , ⁇ 3 integrin -/- and Vn -/- mice have no overt renal phenotypes under normal conditions suggesting that uPAR signaling in podocytes is not required for normal glomerular filtration. On the other hand, all these molecules are required for the development of urinary protein loss. Based on this, we reasoned that changes in activation of ⁇ v ⁇ 3 integrin under disease conditions may be a cause for the increased podocyte motility and FP effacement after the administration of LPS. To explore this idea, we next studied the expression of total and active ⁇ 3 integrin in kidney sections from wild type and uPAR -/- mice.
• Total podocyte ⁇ 3 integrin expression was visualized by double labeling of ⁇ 3 integrin with the podocyte marker synaptopodin in wild type and uPAR -/- mice before and after injection of LPS (Fig. 5a).
• the expression of ⁇ 3 integrin in podocytes was unchanged in wild type and uPAR -/- mice before and after LPS administration (Fig. 5a).
• ⁇ v ⁇ 3 integrin has a low basal activity even in the absence of uPAR.
• LPS treatment of wild type mice was associated with a strong induction of podocyte AP5 labeling (Fig. 5c, WT + LPS). This induction was absent in LPS treated uPAR -/- mice (Fig. 5c, uPAR -/- + LPS).
• Fig. 5d colocalization of AP5 labeling at sites of uPAR overexpression in podocytes but not in podocytes in which uPAR was downregulated using siRNA (Fig. 5d).
• uPAR and ⁇ 3 integrin can associate with each other.
• Plasma membrane lipid rafts help to compartmentalize signal transduction events within different regions 24 and uPAR as a GPI-anchored protein is known to be found in lipid rich membrane compartments l6 .
• uPAR and ⁇ 3 integrin associate together within lipid rafts in podocytes. We therefore performed sucrose density gradient assays of whole cellular extracts of cultured podocytes before and after LPS administration (Fig. 6a).
• uPAR and ⁇ 3 integrin are mainly associated with the non-raft fractions in control podocytes.
• both uPAR and ⁇ 3 integrin were more enriched within the lipid raft fraction (Fig. 6a).
• the functional association of uPAR and ⁇ 3 integrin within lipid rafts was further confirmed by the observation that disruption of lipid rafts using Methyl- ⁇ -cyclodextrin (MBCD) 47 abrogated the activation of ⁇ 3 integrin in response to LPS in cultured podocytes as revealed by reduced AP5 staining (Fig. 6b).
• MCD Methyl- ⁇ -cyclodextrin
• ⁇ v ⁇ 3 integrin is an important downstream signal that mediates the uPAR-induced cellular events in podocytes leading to proteinuria
• expression of a constitutively active ⁇ 3 integrin should be sufficient to induce proteinuria even in the absence of uPAR. Therefore, we utilized a ⁇ 3 integrin cDNA which encodes a protein lacking aminoacids 616 to 690 of the carboxy-terminal regions of the ⁇ 3 ectodomain. This mutation confers constitutive activity to the ⁇ 3 protein and is expressed at the cell surface 4 .
• Antibodies The following antibodies were used in this study: anti-active ⁇ 3 integrin (AP5),
• GTI anti-WOW-1 fragment antigen binding
• Fab fragment antigen binding
• BD Pharmagen anti-CD31 (ER-MP 12) and anti-Vn (H-270), anti-uPAR (FL-290) (Santa Cruz Biotechnology, Inc); anti-uPAR-1 (R&D Systems); anti- ⁇ -tubulin (Calbiochem); anti- ⁇ 3 integrin (Chemicon International); anti-CD61 (Sigma); anti-caveolin (Sigma); anti-GAPDH (Sigma); anti-Flag (Sigma); anti-HA (Sigma); anti-transferrin receptor and anti caveolinl (Sigma); anti-synaptopodin mouse monoclonal antibody (Gl), anti-synaptopodin rabbit polyclonal (NT), (Peter Mundel, New York).
• BD Pharmagen anti-CD31 (ER-MP 12) and anti-Vn (H-270), anti-uPAR (FL-290) (Santa Cruz Biotechnology, Inc); anti-
• Rat PAN nephrosis model was set up by a single intraperitoneal injection of puromycin (15mg/100g of body weight, Sigma-Aldrich) into Sprague-Dawley rats as described before .
• NZB/W Fl mice were purchased from the Jackson Laboratory and analyzed after 20 weeks when proteinuria and Lupus glomerulonephritis were present.
• As diabetic nephropathy rat model we used Sprague Dawley rats treated with Streptozotocin. Hyperglycaemic state was induced by an intraperitoneal Streptozotocin injection (50- 70mg/kg body weight, in citrate buffer 10 mmol/L, pH 4.5).
• the hyperglycaemic state developed within 48 h and was maintained during the lifetime of the animals. No insulin administration was required. Glycosuria was evaluated with test strips of the Uriscan TM (YD Diagnostics, VWR, Montreal, QC, Canada) and glycaemia with the AccuSoft Monitoring System (Roche Diagnostics, Laval, QC, Canada). At the end of the study, glycaemia values were 4.3 ⁇ 0.53 and 8.5 ⁇ 0.7 mmol/L for 3 months-old and 12 months- old normoglycaemic animals, respectively, and 21.2 ⁇ 0.9 and 33.9 ⁇ 4.0 mmol/L for 3 months-old and 12 months-old diabetic animals, respectively.
• FSGS focal and segmental glomerulosclerosis
• DN diabetic nephropathy
• TaqMan real-time RT-PCR was done as previously reported 26 .
• commercially available predeveloped TaqMan assay reagents (Applied Biosystems) were used for uPAR mRNA analysis.
• the mRNA expression of uPAR was related to that of synaptopodin, which was used as a podocyte reference gene.
• the confounding factor of alterations in the proportion of podocyte cell number per total glomerular cells was counterbalanced, and only RNA from the podocyte compartment of the glomerulus was integrated in the analysis, as demonstrated recently 26 .
• mice were washed with PBS, and H 2 O and mounted for analysis with a confocal microscope (Bio-Rad Laboratories).
• a confocal microscope Bio-Rad Laboratories.
• uPAR -/- mice were injected with ⁇ 3a 6 i 6 - 690 or wild type ⁇ 3 integrin constructs. 14 h after injection, mice were sacrificed and kidney was snap-frozen. Cyro- sections were cut at 4 ⁇ m and fixed with cold acetone for 10 min before incubated with WOW-I Fab for 1 h. After washing with PBS, the sections were then incubated with the secondary antibody, anti-mouse Fab conjugated with 488 (Invitrogen) for 50 min and analyzed by confocal microscopy.
• 488 Invitrogen
• TEM and IEM were performed according to the standard protocols 8 .
• morphometry of uPAR labeling across the glomerular wall we used renal tissues from 3 and 12 months-old hyperglycaemic animals with the corresponding age-matched normoglycaemic animals (3-4 animals per group). Small pieces of renal cortex were sampled from the anaesthetized animal (urethane, Ig per kg body weight). The tissue samples were immediately fixed by immersion in periodate-lysine- paraformaldehyde solution, dehydrated in graded methanol and embedded in Lowicryl, following protocols described previously 52 .
• the grids carrying the ultra thin tissue sections were incubated on a drop of a saturated solution of sodium metaperiodate for 10 min, washed with distilled water, transferred on a drop of 0.15 M glycine for 10 min and washed with PBS. Grids were then incubated on a drop of ovalbumin 1% for 5 min and transferred to the diluted anti-uPAR antibody (1:10) overnight at 4°C. The grids were washed with PBS and incubated on a drop of protein A-gold complex for 30 min at room temperature. The grids were then washed with PBS (3x5 min) and distilled water (Ix5min), dried and contrasted with uranyl acetate.
• uPAR-cDNA plasmids were introduced into uPAR -/- mouse using the TransIT in vivo gene delivery system (Minis) as described previously 32 ' 8 .
• the following cDNAs and vector constructs were used for gene delivery: uPAR; mutated uPAR D262A (kind gift from Y Wei and HA Chapman, University of California, San Francisco); ⁇ 3 integrin and the constitutively active form of ⁇ 3 integrin, D616-690 ( ⁇ 3 ⁇ 6i6-69 ⁇ ) 48 J Podocin promoter vector p2.5 33 (a kind gift from Dr.
• siRNA Mouse uPAR siRNA (sense: CTTCCTGAAGTGTTGCAACTA) was constructed and inserted into a pRNA-H1.2/Neo vector (Genescript). Stable transfection was done with podocytes maintaining at 33 °C by Lipofectamine 2000 (Invitrogen). Positive clones were selected by G418 (Sigma-Aldrich) at 500 ⁇ g/ml. For further experiments with uPAR siRNA, cells were grown under non-permissive conditions for 10-14 days before proceeded with migration experiments. Flow cytometry:
• HEK 293 cells were seeded on a 100 mm culture dish and maintained at 37 °C in
• DMEM fetal bovine serum
• constructs encoding uPAR or ⁇ 3 integrin by Lipofectamine 2000 (Invitrogen). 24 h after transfection, cells were harvested for further experiments. Wild type podocytes were differentiated by culturing at 37 °C for at least 10 days (10 days for transfection and migration assay, 14 days for other experiments).
• HEK cells were co-transfected with constructs encoding uPAR, and ⁇ 3 integrin for 24 h. Then cells were lysed in RIPA buffer with a cocktail of protease inhibitors. The lysate was incubated with 25 ⁇ l of Flag or HA agarose beads (Sigma) at 4 °C overnight after a pre-cleaning. The beads were then washed 5 times with RIPA buffer and were eluted by heating at 70 °C for 10 min. After a brief centrifugation, the supernatants were ready for Western blotting.
• DAPI diamidino phenylindole
• podocytes were seeded on Vn or type I collagen coated cover-slips and cultured for 10 days at 37 °C before treated with LPS or PAN for 12-48 h.
• LPS or PAN for 12-48 h.
• cover-slips were washed twice with PBS and incubated in medium. After incubation, cells were fixed with 2% PFA and stained with DAPI for analysis. The cell migratory distance was calculated by averaging the distance from the wound edge to the maximally migrated cell in five distinct border zones.
• Podocyte lysate was overlaid with a sucrose step gradient and centrifuged for 20 h at 120,000 g at 4 °C in a swing-out rotor. 10 fractions (1 ml each) were collected starting from the top and analyzed by Western blotting with rafts, non-rafts markers, as well as uPAR and ⁇ 3 antibodies.
• CycloRGDfV also reduces already existing proteinuria (Fig. 11).
• B6 mice were injected LPS twice (0, 24h) with LPS to induce and maintain proteinuria.
• 48h, 66h urine was collected for Braford assay.
• the diagram shows the fold change of urinary protein at timepoint 66h, *p ⁇ 0.014.
• Example 3 Effect of S247 on recovery of proteinuria The following example shows that S247 also reduces already existing proteinuria.
• B6 mice are injected twice (0, 24h) with LPS to induce and maintain proteinuria.
• 48h, 66h urine was collected for Braford assay. Reduction of urinary protein at timepoint 66h by S247 is observed.
• uPAR Quantitative analysis of uPAR expression and localization in normal and diabetic glomeruli.
• uPAR is induced in podocyte foot processes of 3 and 12 months old diabetic rats.
• R 1 is selected from:
• R 2 is the group CH 2 ; CH 2 -CH 2 ;
• R 3 is selected from CHCH 2 COOH; C[CH n F m ]CH 2 -COOH;
• R 4 is selected from CH-CH 2 -Ph; C[CH n F n ]CH 2 -Ph; CH-CH 2 -(4-OH)Ph; CH-CH 2 -(4-0Me)Ph; CH- CH 2 - (4-F)Ph; CH-CH(OH)-Ph; C(CH 3 ) 2 ; CH- C(CH 3 ) 3 ; CH-CH 2 -COOH;
• R 5 is selected from CH-CH 2 -Ph; C[CH n F m ]CH 2 -Ph; CH-CH(CHg) 2 ;
• Xi-X ⁇ which may be the same or different, are H, (CH 2 ) n -CH 3 ; (CH 2 ) n -
• each NX-R-CO amino acid can have an absolute type R or type S configuration; their individual enantiomers, diastereoisomers, the related mixtures, the pharmaceutically acceptable salts are selective inhibitors of the ⁇ y ⁇ 3 and/or ⁇ y ⁇ 5 integrin receptors.
• objects of the present invention are compounds of formula (I), as described above, a process for their preparation, their use as medicaments and pharmaceutical compositions containing them.
• the invention relates to novel integrin inhibitors of the formula
• R 1 , R r and R 1" are H 1 A, Ar 1 H et ⁇ HaI 1 NO 2 .
• R 2 is A. Ar. (CH 2 ) m XA, (CHz) 1n OH, (CH 2 )b 1 NH 2 . (CH 2 X n NHA,
• A is alkyl having from 1 to 8 carbon atoms
• Ar is phenyl, naphthyl, anthra ⁇ yl or biphenyl, each of which is unsubstituted or monosubstituted or polysubstit ⁇ ted by Hal, A, OA, OH, CO-A. CN, COOA, COOH, CONH 2 , CONHA,
• Het 1 is an aromatic monocyclic or bicyclic heterocyclic radical having from 1 to 3 N, O and/or S atoms, which may be unsubstituted or monosubstituted or disubstituted by F, Cl, Br, A, OA, SA, OCF 3 , -CO-A, CN, COOA, CONH 2 , CONHA,
• Her 2 is a monocyclic or bicyclic heterocyclic radical having from
• N atoms which may be unsubstituted or monosubstituted or disubstituted by NH 2 or NHA
• m is 0, 1 , 2, 3, 4. 5, 6 or 8
• n is 1 , 2, 3, 4, 5 or 6,
• o is 0, 1, 2 or 3
• p is 2, 3, 4 or 5,
• WO 02/26227 provides lactone compounds useful as ⁇ v ⁇ s and/or ⁇ v ⁇ s inhibitors.
• the present invention comprises a class of biphenyl integrin antagonists.
• the present invention relates to a class of compounds represented by the Formula I:
• a and B are phenyl; n is an integer from 1 to 3; X 1 is selected from O, NR, S, SO, SO 2 , CHR and CH 2 , wherein:
• R is selected from the group consisting of hydrogen, aryl, and heterocyclyl
• X 2 is selected from the group consisting of alky I, alkylamino, aminoalkyl, alkylaminoalkyl, alklthio, thioalkyl, alkylthioalkyl, alkyls ⁇ lfonyl, sulfonylalkyl, alkylsulfonylalkyl, oxyalkyl, alkoxyalkyl, and alkoxy;
• X 3 is C 1 -C 6 alkyl
• R 1 is selected from the group consisting of pyridinyl and napthyridinyl, wherein: either is optionally substituted with a substituent selected from the group consisting of hydrogen, alkyl, halo, and amino; R 2 , R 3 .
• R 4 , R 5 , R 6 , R 7 , R 8 and R 9 are independently selected from the group consisting of hydrogen, alkyl, alkenyl, alkoxy, alkoxyalkyl, alkoxycarbonylalkyl, alkylamino, alkylcarbonyl, alkylheteroaryl, alkylsulfonylalkyl, alkylthio, alkynyl, aminocarbonylalkyl, cyano, dialkylamino, halo, haloalkoxy, haloalkyl, hydroxy and hydroxyalkyl; and
• the invention comprises pharmaceutical compositions comprising compounds of the Formula I.
• Such compounds and compositions are useful in selectively inhibiting or antagonizing the ⁇ v ⁇ 3 and/or c ⁇ v ⁇ s integrins and therefore in another embodiment the present invention relates to a method of selectively inhibiting or antagonizing the otv ⁇ 3 and/or ⁇ v ⁇ s integrin.
• the invention provides methods of treating or inhibiting pathological conditions associated therewith such as osteoporosis, humoral hypercalcemia of malignancy, Paget's disease, tumor metastasis, solid tumor growth (neoplasia), angiogenesis, including tumor angiogenesis, retinopathy including macular degeneration and diabetic retinopathy, arthritis including rheumatoid arthritis and osteoarthritis, periodontal disease, psoriasis, smooth muscle cell migration and restenosis in a mammal in need of such treatment.
• pathological conditions associated therewith such as osteoporosis, humoral hypercalcemia of malignancy, Paget's disease, tumor metastasis, solid tumor growth (neoplasia), angiogenesis, including tumor angiogenesis, retinopathy including macular degeneration and diabetic retinopathy, arthritis including rheumatoid arthritis and osteoarthritis, periodontal disease, psoriasis, smooth muscle cell migration and restenosis in a mammal in

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