Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7088—Compounds having three or more nucleosides or nucleotides
  • A61K31/7105—Natural ribonucleic acids, i.e. containing only riboses attached to adenine, guanine, cytosine or uracil and having 3'-5' phosphodiester links
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
  • A61P33/02—Antiprotozoals, e.g. for leishmaniasis, trichomoniasis, toxoplasmosis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
  • A61P33/02—Antiprotozoals, e.g. for leishmaniasis, trichomoniasis, toxoplasmosis
  • A61P33/04—Amoebicides
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P33/00—Antiparasitic agents
  • A61P33/02—Antiprotozoals, e.g. for leishmaniasis, trichomoniasis, toxoplasmosis
  • A61P33/06—Antimalarials
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
  • A61P35/04—Antineoplastic agents specific for metastasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• This invention relates to providing an agonist for Toll-like receptor 3 (TLR3) for use as an anti-infectious agent (e.g., to treat or prevent an infection caused by at least one or more bacteria, protozoa, or viruses), an antiproliferative agent (e.g., to treat at least cancer, including virally-induced cancers), and/ or an immunostimulant (e.g., to treat at least infectious disease or cancer by stimulating immunity, with or without vaccination).
• an anti-infectious agent e.g., to treat or prevent an infection caused by at least one or more bacteria, protozoa, or viruses
• an antiproliferative agent e.g., to treat at least cancer, including virally-induced cancers
• an immunostimulant e.g., to treat at least infectious disease or cancer by stimulating immunity, with or without vaccination.
• Methods of medical treatment and processes for manufacturing medicaments are provided. Double-stranded RNA like poly(l:C) has been used as a TLR3 agonist.
• a desirable medicament would have an increased therapeutic index (e.g., the ratio of the dose that produces a toxic effect divided by the dose that produces a therapeutic effect such as LD 5 O divided by ED 5 o) for treating an incipient or established infection, treating a precancerous or cancerous condition, without inducing an excessive pro-inflammatory response as mediated by TLR3.
• an increased therapeutic index e.g., the ratio of the dose that produces a toxic effect divided by the dose that produces a therapeutic effect such as LD 5 O divided by ED 5 o
• Double-stranded ribonucleic acid triggers innate immunity (e.g., the production of host defenses) through dsRNA-dependent intracellular antiviral defense mechanisms including the 2',5'-oligoadenylate synthetase/ RNase L and p68 protein kinase pathways.
• poly(l:C) also activates TLR3 and thereby induces secretion of proinflammatory chemokines and cytokines. See WO 2006/060513 at pages 3-4. This may initiate or enhance harmful inflammatory processes instead of selectively activating TLR3 to mediate the development of beneficial immunity.
• PoIy(LC) is believed to cause necrosis associated with inflammation, systemic inflammatory response syndrome, infection-associated acute cytokine storm, and chronic autoimmune diseases such as rheumatoid arthritis and inflammatory bowl disease.
• WO 2006/060513 taught that it would be beneficial to use a TLR3 antagonist as a medicament for various indi- cations. Therefore, it was surprising that a selective agonist of TLR3 found use as a medicament in the present invention.
• AMPLIGEN® poly(l:C 12 U) from HEMISPHERx® Biopharma is a specifically-configured dsRNA with antiviral and immunostimulatory properties, but which exhibits reduced toxicity.
• AMPLIGEN® poly(l:Ci 2 U) inhibits viral and cancer cell growth through pleiotropic activities: it regulates 2',5'-oligoadenylate synthetase/RNase L and p68 protein kinase pathways as do other dsRNA molecules.
• poly(l:Cn-i 4 U) has broad application as an antimicrobial chemotherapeutic agent effective in treatment of bacteria, viruses, and protozoa by acting directly on the immune system.
• Administration of PoIy(IiC- I - I-I4 U) avoids the side effects observed with poly(l:C) such as initia- tion or enhancement of harmful inflammatory processes.
• Our specifically-configured dsRNA is a more selective agonist of TLR3 as compared to poly(l:C) even though the two double-stranded RNA are structu- rally analogous. A long-felt need for a selective TLR3 agonist is addressed thereby.
• the invention may be used to treat a subject (e.g., human or animal) with an incipient or established microbial infection, a pathological condition marked by abnormal cell proliferation (e.g., neoplasm or tumor), or as an immu- nostimulant to treat the subject for a disease or condition caused by at least infection, abnormal cell proliferation, or cell damage from autoimmunity or neurodegeneration.
• a subject e.g., human or animal
• a pathological condition marked by abnormal cell proliferation e.g., neoplasm or tumor
• immu- nostimulant e.g., a pathological condition marked by abnormal cell proliferation
• the amount of mismatched double- stranded ribonucleic acid (dsRNA) used is sufficient to bind Toll-Like Receptor 3 (TLR3) on immune cells of the subject. Innate or adaptive immunity may be triggered thereby.
• TLR3 Toll-Like Receptor 3
• a specifically-configured dsRNA may be used to activate TLR3 without activating other Toll-like receptors like TLR4 or an RNA helicase like RIG-I or mda-5, or without inducing an excessive pro-inflammatory response as seen with poly (I:C), which is a nonselective TLR3 agonist.
• a subject may be infected with at least one or more bacteria, protozoa, or viruses.
• a pharmaceutical composition which is comprised of specifically- configured dsRNA in an amount sufficient to bind to TLR3 is administered to the subject. Infection of the subject is reduced or eliminated thereby as assayed by decreased recovery time, increased immunity (e.g., increase in antibody titer, lymphocyte proliferation, killing of infected cells, or natural killer (NK) cell activity), decreased division or growth of the microbe, or any combination thereof as compared to the subject not treated with specifically-configured dsRNA.
• the immunity induced by treatment is preferably specific for the microbe.
• a subject may be afflicted by abnormal cell proliferation (e.g., neoplasm or tumor, other transformed cells).
• abnormal cell proliferation e.g., neoplasm or tumor, other transformed cells.
• a pharmaceutical composition which is comprised of specifically-configured dsRNA in an amount sufficient to bind to TLR3 is administered to the subject.
• Disease in the subject is reduced or eliminated thereby as assayed by improved morbidity or mortality, increased immunity (e.g., increase in antibody titer, lymphocyte proliferation, killing proliferating or transformed cells, or NK cell activity), decreased division or growth of proliferating or transformed cells, or any combination thereof as compared to the condition of a subject not treated with specifically-configured dsRNA.
• Dendritic cell maturation may be induced in the subject.
• Immature dendritic cells which are capable of antigen uptake, may be induced to differentiate into more mature dendritic cells, which are capable of antigen presen- tation and priming an adaptive immune response (e.g., antigen-specific T cells).
• an adaptive immune response e.g., antigen-specific T cells.
• they may at least change their cell-surface expression of major histocompatibility complex (MHC) molecules, costimulatory molecules, adhesion molecules, or chemokine receptors; decrease antigen uptake; increase secretion of chemokines, cytokines, or proteases; grow dendritic processes; reorganize their cytoskeleton; or any combination thereof.
• MHC major histocompatibility complex
• a subject may be vaccinated against at least infection or cancer. Sometimes, e.g., virus-induced cancers, both infection and cancer may be treated.
• a pharmaceutical composition which is comprised of specifically-configured dsRNA in an amount sufficient to bind to TLR3 is admi- nistered to the subject. The immune response to a vaccine or dendritic cell preparation is stimulated thereby.
• the vaccine or dendritic cell preparation may be comprised of killed, fixed, or attenuated whole microbes or cells (e.g., proliferating or transformed); a lysate or purified fraction of microbes or cells (e.g., proliferating or transformed); one or more isolated microbial antigens (e.g., native, chemically synthesized, or recombinantly produced); or one or more isolated tumor antigens (e.g., native, chemically synthesized, or recombinantly produced).
• In situ vaccination may be accomplished by the subject's production of antigen at a site or circulation thereto (e.g., produced in a natural infection or cell growth, or shed antigen), and specifically-configured dsRNA acting as an adjuvant thereon.
• Antigen presenting cells e.g., B lymphocyte, dendritic cell, macrophage
• mucosal tissues e.g., gastric or respiratory epithelium
• the microbial or tumor antigen(s) may be presented, and the antigen(s) should be susceptible to the sole action of the specifically-configured dsRNA acting exclusively as a TLR3 agonist.
• Microbes, cancer cells, or other transformed cells may be susceptible to specific cytokine response patterns activated by specifically- configured dsRNA acting exclusively as a TLR3 agonist.
• the specifically- configured dsRNA is preferably administered by intravenous infusion; intradermal, subcutaneous, or intramuscular injection; intranasal or intratracheal inhalation; or oropharyngeal or subungual application.
• intravenous infusion intradermal, subcutaneous, or intramuscular injection
• intranasal or intratracheal inhalation or oropharyngeal or subungual application.
• processes for using and making medicaments are also provided. It should be noted, however, that a claim directed to the product is not necessarily limited to these processes unless the particular steps of the process are recited in the product claim.
• FIG. 1 shows that prime-boost immunization with 5 ⁇ g ⁇ -DEC-gag and 50 ⁇ g poly (I:C) provides protective immunity to airway challenge with vaccinia gag virus.
• A Average weight loss and
• Another group was immunized with ⁇ -DEC-p24 and poly (I:C) at the time of the boost only.
• mice Six to eight weeks after boost, mice were challenged intranasally with 5 x 10 4 PFU vaccinia-gag.
• C Average weight loss and (D) vaccinia plaque-forming titers in lung as mean ⁇ SD post challenge from one of two similar experiments: five each for C57BL/6, DEC-205-/-, and TLR3-/- mice were immunized with ⁇ -DEC- p41.
• mice were challenged intranasally with 5 x 10 4 PFU vaccinia-gag.
• FIG. 2 shows that poly(l:Ci 2 U) acts as an adjuvant for CD4+ T cell immunity to 5 ⁇ g ⁇ -DEC-p24 vaccine in a TLR3-dependent manner.
• CxB6 F1 mice were injected intraperitoneally with ⁇ -DEC-p24 plus either graded doses of poly(l:C) or poly(l:Ci 2 U) or PBS, then boosted with the same conditions six weeks later. The percentage of IFN- ⁇ -producing and proliferating CD3+CD4+ T cells in response to HIV gag p17 or p24 mix one week after D
• C57BL/6 mice were injected subcutaneously with 5 ⁇ g of ⁇ -DEC-p24 and either 2, 10, or 50 ⁇ g poly(l:C 12 U) or phosphate buffered saline (PBS), then boosted with the same conditions six weeks later.
• An additional group was immunized with 5 ⁇ g of ⁇ -DEC-p24 and 50 ⁇ g poly IC at the time of the boost only.
• the frequency of IFN- ⁇ +, TNF- ⁇ +, IL-2+, CD4+ T cells in gated CD3+ splenic T cells was analyzed in response to HIV gag p24 peptide mix.
• A Total frequency of IFN- ⁇ -, TNF- ⁇ -, or IL-2-producing CD4+ T cells for each vaccine group.
• B The percentage of CD4+ T cells from the total cytokine response expressing all three cytokines (red), any two cytokines (blue), or any one cytokine (green), for each vaccine group is represented pictorially by pie charts. The total frequency of cytokine-producing CD4+ T cells is shown.
• An infection by a microbe may be treated. They may infect a human or animal subject. The infection may be incipient or established.
• the microbe may be a bacterium, protozoan, or virus; especially those that cause disease (i.e., pathogenic microbes).
• the terms "microbe” and "microorganism” are used interchangeably.
• the bacterium may be a species of the genus Bacillus (e.g., B. anthra- cis, B. cereus), Bartonella (B. henselae), Bordetella (e.g., B. pertussis), Borrelia (e.g., B.
• pylori Klebsiella (K pneumoniae), Legionella (e.g., L. pneumophila), Listeria (e.g., L. monocytogenes), Mycobacterium (e.g., M. avium, M. bows, M. branderi, M. leprae, M. tuberculosis), Mycoplasma (e.g., M. genita- lium, M. pneumoniae), Neisseria (e.g., N. gonorrheae, N. meningitidis), Pneumocystis (e.g., P. carinii), Pseudomonas (P.
• P. pylori Klebsiella (K pneumoniae), Legionella (e.g., L. pneumophila), Listeria (e.g., L. monocytogenes), Mycobacterium (e.g., M. avium, M. bows, M. branderi, M.
• aeruginosa Rickettsia, (e.g., R. rickettsia, R. typhi), Salmonella (e.g., S. enterica), Shigella (e.g., S. dysente- riae), Staphylococcus (e.g., S. aureus, S. epidermidis), Streptococcus (e.g., S. pneumoniae, S. pyogenes), Treponema (e.g., T. pallidum), Vibrio (e.g., V. cholerae, V. vulnificus), or Yersinia (e.g., V. pestis).
• Salmonella e.g., S. enterica
• Shigella e.g., S. dysente- riae
• Staphylococcus e.g., S. aureus, S. epidermidis
• Streptococcus e.g.,
• the protozoan may be a species of the genus Cryptosporidium (e.g., C. hominis, C. parvum), Entamoeba (e.g., E. histolytica), Giardia (e.g., G. intesti- nalis, G. lamblia), Leishmania (e.g., L. amazonensis, L. braziliensi, L. donovani, L. mexicana, L. tropica), Plasmodium (e.g., P. falciparum, P.
• Cryptosporidium e.g., C. hominis, C. parvum
• Entamoeba e.g., E. histolytica
• Giardia e.g., G. intesti- nalis, G. lamblia
• Leishmania e.g., L. amazonensis, L. braziliensi, L. donovani, L. mexi
• the virus may be a DNA or RNA virus that infects humans and animals.
• DNA viruses include those belonging to the Adenoviridae, Iridoviridae, Papillo- maviridae, Polyomavirididae, and Poxviridae families (Group I double-stranded DNA viruses); the Parvoviridae family (Group Il single-stranded DNA viruses).
• RNA viruses include those belonging to the Birnaviridae and Reoviridae fami- lies (Group III double-stranded RNA viruses); the Arteriviridae, Astroviridae, Caliciviridae, Hepeviridae, and Roniviridae families (Group IV positive single- stranded RNA viruses); and the Arenaviridae, Bornaviridae, Bunyaviridae, Filoviridae, Paramyxoviridae, and Rhabdoviridae families (Group V negative single-stranded RNA viruses).
• dsRNA double-stranded ribo- nucleic acid
• Cells of a subject undergoing abnormal proliferation may be a neoplasm or tumor (e.g., carcinoma, sarcoma, leukemia, lymphoma), especially a cell transformed by a tumor virus (e.g., DNA or RNA virus carrying a transforming O
• Epstein-Barr virus is associated with nasopharyngeal cancer, Hodgkin's lymphoma, Burkitt's lymphoma, and other B-cell lymphomas; human hepatitis B and C viruses (HBV and HCV) are associated with liver cancer; human herpesvirus 8 (HHV8) is associated with Kaposi's sarcoma; human papillomaviruses (e.g., HPV6, HPV11 , HPV16, HPV18, or combination thereof) are associated with cervical cancer, anal cancer, and genital warts; and human T-lymphotrophic virus (HTLV) is associated with T-cell leukemia or lymphoma.
• EBV Epstein-Barr virus
• HCV human hepatitis B and C viruses
• HHV8 is associated with Kaposi's sarcoma
• human papillomaviruses e.g., HPV6, HPV11 , HPV16, HPV18
• Cancers include those originating from the gastrointestinal (e.g., esophagus, colon, intestine, ileum, rectum, anus, liver, pancreas, stomach), genitourinary (e.g., bladder, kidney, prostate), musculoskeletal, nervous, pulmonary (e.g., lung), or reproductive (e.g., cervix, ovary, testicle) organ systems.
• gastrointestinal e.g., esophagus, colon, intestine, ileum, rectum, anus, liver, pancreas, stomach
• genitourinary e.g., bladder, kidney, prostate
• musculoskeletal, nervous pulmonary
• pulmonary e.g., lung
• reproductive e.g., cervix, ovary, testicle
• Poly(riboinosinic) is partially hybridized to poly(ribocytosinici 2 uracilic) and can be represented as Tl n T(C 12 U) n .
• Other specifically-configured dsRNA that may be used are based on copolynucleotides selected from poly(C n U) and POIy(C n G) in which n is an integer from 4 to 29 or are mismatched analogs of complexes of polyriboinosinic and polyribocytidilic acids, formed by modifying rl n rC n to incorporate unpaired bases (uracil or guanine) along the polyribo- cytidylate (rC ⁇ ) strand.
• mismatched dsRNA may be derived from r(l) r(C) dsRNA by modifying the ribosyl backbone of polyriboinosinic acid (rl n ), e.g., by including 2'-O-methyl ribosyl residues.
• Mismatched dsRNA may be complexed with an RNA-stabilizing polymer such as lysine cellulose.
• RNA-stabilizing polymer such as lysine cellulose.
• the preferred ones are of the general formula N n T(Cn -14 U) n and are described in U.S. Patents 4,024,222 and 4,130,641 ; which are incorporated by reference.
• the dsRNA described therein generally are suitable for use according to the present invention. See also U.S. Patent 5,258,369.
• dsRNA may be administered by any suitable local or systemic route including enteral (e.g., oral, feeding tube, enema), topical (e.g., patch acting epicutaneously, suppository acting in the rectum or vagina), and parenteral (e.g., transdermal patch; subcutaneous, intravenous, intramuscular, intradermal, or intraperitoneal injection; buccal, sublingual, or y
• enteral e.g., oral, feeding tube, enema
• topical e.g., patch acting epicutaneously, suppository acting in the rectum or vagina
• parenteral e.g., transdermal patch; subcutaneous, intravenous, intramuscular, intradermal, or intraperitoneal injection; buccal, sublingual, or y
• the nucleic acid may be micronized for inhalation, dissolved in a vehicle (e.g., sterile buffered saline or water) for injection or instillation, or encapsulated in a liposome or other carrier for targeted delivery.
• a vehicle e.g., sterile buffered saline or water
• immature dendritic cells may be contacted in skin, mucosa, or lymphoid tissues. It will be appreciated that the preferred route may vary with condition and age of the subject, the nature of the infectious or neoplastic disease, and the chosen active ingredient.
• the recommended dosage of the nucleic acid will depend on the clinical status of the subject and the experience of the physician or veterinarian in treating the viral infection or tumor burden.
• Specifically-configured dsRNA may be dosed at about 200 mg to about 400 mg by intravenous infusion to a 70 kg subject on a schedule of twice weekly, albeit the dose amount and/or frequency may be varied by the physician or veterinarian in response to the subject's condition.
• Cells or tissues that express TLR3 are preferred sites for delivering the nucleic acid, especially antigen presenting cells (e.g., dendritic cells and macrophages) and endothelium (e.g., respiratory and gastric systems).
• dsRNA may be inhibited or blocked by muta- tion of the TLR3 gene (e.g., deletion), down regulating its expression (e.g., siRNA), binding with a competitor for TLR3's ligand-binding site (e.g., neutralizing antibody) or a receptor antagonist, or interfering with a downstream component of the TLR3 signaling pathway (e.g., MyD88 or TRIF).
• muta- tion of the TLR3 gene e.g., deletion
• down regulating its expression e.g., siRNA
• binding with a competitor for TLR3's ligand-binding site e.g., neutralizing antibody
• a receptor antagonist e.g., a receptor antagonist
• AMPLIGEN® poly(l:Ci 2 U) provides a selective agent for dissecting out the effects of TLR3 activation on the immune system that was not previously available.
• Other agents like TLR adapters MyD88 and TRIF mediate signaling by all TLR or TLR3/TLR4, respectively.
• activation or inhibition of signaling through MyD88 or TRIF would not restrict the biological effects to those mediated by TLR3.
• TLR3 and its signaling is a require- ment for AMPLIGEN® poly(l:Ci 2 U) to act as a receptor agonist
• Such confirmation of TLR3 activity can be performed before, during, or after administration of the agonist.
• the agonist can be used to restrict the immune response to activation of TLR3 without activating other Toll-like receptors or RNA helicases.
• abnormal cytokine e.g., IFN- ⁇ , IFN- ⁇ , IFN- ⁇ , TNF- ⁇ , IL-6, IL-10, IL-12
• co-stimulatory molecule e.g., CD80, CD83, CD86
• This abnormality may be remodulated by using poly(l:Ci 2 U) as a specific agonist of TLR3.
• Antigen presentation may be improved by conjugating the antigen (or a peptide analog thereof) to a ligand (or a receptor) that specifically binds to the cell surface (especially a component of the endosome-phagosome internalizing pathway) of one or more antigen presenting cells.
• the specific binding molecule may be an antibody to a cell surface molecule, or a derivative thereof (e.g., Fab, scFv).
• Interferons IFN- ⁇ , IFN- ⁇ , IFN- ⁇
• TNF- ⁇ inflammatory cytokines
• IL-12p70 enzyme-linked immunosorbant assay
• Kits were from PBL Biomedical Laboratories, Piscataway, NJ and BioSource International, Camarillo, CA.
• Dendex Therapeutics, Inc. was contracted for flow cytometric analyses of CD80, CD83, and CD86 expression. Following overnight shipment, blood samples were stained within one hour of receipt. Standard flow cytometry methods were employed for cell marker analyses and lysis of red blood cells. Dendritic cells were identified based on low level expression of monocyte, lymphocyte, and NK cell markers along with high HLA-DR expression. Dendritic cells were also characterized according to CD11c and CD123 expression. Monocytes were identified by side scatter analysis and expression of a monocyte lineage marker. Analyses of CD80, CD83, and CD86 expression were performed after cell type identification. Measure-ments from healthy volunteers served as controls and indicated normal distribution and levels of marker expression for mature DC such as CD80, CD83, and CD86.
• Cytokine Levels Results of cytokine analyses for each patient are presented in Tables 1 and 2. Zero was used as the value for results that had a negative absorbance value relative to a blank standard, or that were at or below the kit's detection limit (DL) as reported by the manufacturer. If the manufacturer did not specify a DL or indicated that the DL was less than a given value, all results were used. If the manufacturer provided expected normal cytokine ranges, they have been included for reference. :
• IL-12p70 (pg/ml_) Pre-lnfusion 4 hr Post- 24 hr Post- 72 hr Post- NR: ⁇ 0.79 pg/mL Infusion Infusion Infusion
• IFN- ⁇ levels Considering changes in IFN- ⁇ levels, one patient (LDM-010) had levels lower than pre-infusion at all subsequent time points, one patient (JOG-020) had undetectable levels at all time points, and two patients increased for at least one post-infusion time point. Maximum increases in IFN- ⁇ were 2% to 15% above pre-infusion levels. The same patient who had undetectable levels of IFN- ⁇ at all time points (JOG-020) also had undetectable levels of IFN- ⁇ . All other patients had increased IFN- ⁇ levels for at least one time point, although the increase for one patient (DMM- 1 1 1 ) was substantially lower (about 0.1 %) than the levels measured for other patients.
• IL-12p70 (expected range up to 0.79 pg/mL), and all but one demonstrated sustained increases over pre-infusion levels for all time points.
• Pre-infusion values for CFS patients were comparable with healthy volunteers' levels; the percentage of CD11+ cells was at the low end of the range for healthy volunteers as defined by the mean and SD. Mean values were below those measured for healthy volunteers for CD123+ cells 4 hours post-infusion and for CD11 + cells and monocytes 24 hours post-infusion. Due to the small population sample, changes experienced by one patient could noticeably affect results. For example, patient DMM-111 experienced a 10-fold drop in percentage of CD123+ cells from pre-infusion to 4 hours post-infusion (see Table 5). One consistent change was a decrease in the percentage of monocytes demonstrated by CFS patients 24 hours post-infusion. Monocyte numbers recovered by 72 hours post infusion (see Table 5). Overall, percentages of CD123+ cells, CD11 + cells, and monocytes (mono) were slightly low, but not out of the range of values for healthy volunteers.
• poly(l:Ci 2 U) infusion did not dramatically affect the numbers of CD123+ DC, CD11+ DC, or monocytes.
• CFS patients experienced normalization in the percentages of DC expressing maturation markers and in CD maturation marker expression levels. These trends, particularly the increase in CD maturation markers, were consistently observed in all four patients, revealing a distinct pattern not recognized in cytokine level modulation.
• CD4+ Th1-type immunity is implicated in resistance to global infectious diseases.
• DC dendritic cells
• Antigenic proteins are selectively delivered to dendritic cells by antibodies targeted to DEC-205, a receptor for antigen presentation.
• DsRNAs independently serve as adjuvants to allow a DC- targeted protein to induce protective CD4+ T cell responses at a mucosal surface (i.e., the airway).
• the immune CD4+ T cells have qualitative features that are correlated with protective function.
• the T cells simultaneously produce IFN- ⁇ , TNF- ⁇ , and IL-2 in high amounts and for prolonged times.
• the T cells also proliferate and continue to secrete IFN- ⁇ in response to HIV gag p24.
• the adjuvant role of poly(l:C) requires TLR3 and MDA5 receptors, but the analo- gous poly(l:Ci 2 U) requires TLR3 only (see results below).
• Both poly(l:C) and poly(l:Ci 2 U) are safe adjuvants when used with DC-targeted vaccines to induce abundant CD4+ Th1 cells with features like multifunctionality and proliferative capacity.
• T cell mediated immunity is implicated in the resistance to global infec- tious diseases like HIV, malaria, and tuberculosis.
• a critical component is the CD4+ Th1 helper cell, which can produce large amounts of IFN- ⁇ and TNF- ⁇ , exert cytolytic activity on MHC class II+ targets, and sustain functional CD8+ T memory cells.
• Dendritic cells are antigen presenting cells that induce strong T cell- based responses. For example, when a subset of dendritic cells that express the endocytic receptor DEC-205 (“DEC") is loaded with antigen ex vivo and reinfused into mice, the dendritic cells expand antigen-specific helper T cells to primarily produce IFN- ⁇ . In vivo, DEC+ dendritic cells mediate antigen presentation on both MHC class I and Il products, leading to clonal expansion of killer and T helper cells respectively. To better harness DC biology in vaccine design, we have been developing an approach that targets antigens directly to the endocytic receptor DEC-205.
• DEC endocytic receptor DEC-205
• TLRs Toll-like receptors
• Ligands for pattern recognition receptors have not been evaluated as potential safe adjuvants for T cell based protective immunity with DC-targeted HIV vaccines.
• dsRNA was introduced alone as an adjuvant to show that it adjuvants a DC-targeted vaccine to induce CD4+ T cell immunity that is quantitatively and qualitatively robust by current criteria, and also protective in a lung infection model.
• DsRNA is shown to be a superior adjuvant for inducing a strong CD4+ T cell response to ⁇ -DEC-HIV gag p24: i.e., the frequency of IFN- Y secreting T cells corresponded to 0.2-6% of total CD3+ CD4+ T cells.
• poly(l:C) was needed during both priming and booster doses of vaccine.
• a long felt need in the art is to define criteria for high quality protective T cells during natural infection or vaccination.
• ⁇ -DEC-p24 and graded doses of poly(l:C) were given over six weeks.
• One group received ⁇ -DEC-p24 and poly(l:C) only at the boost.
• Two weeks after the boost the frequency of gag- specific, CD4+ T cells producing IFN- ⁇ , TNF- ⁇ , or IL-2 was greatest with two doses of ⁇ -DEC-p24 mAb and 50 ⁇ g poly(l:C).
• gag-specific T cells The capacity of individual gag-specific T cells to secrete multiple cytokines was examined. Such multifunctional T cells contribute more effectively to protective immunity to select infectious pathogens including HIV.
• Total frequencies of cytokine producers were less with two doses of ⁇ -DEC-p24 and 10 ⁇ g poly(l:C), or a single dose of ⁇ -DEC-p24 and 50 ⁇ g poly(l:C).
• the amount of each cytokine (median fluorescence intensity or MFI) made by gag-responsive cells was assessed because this parameter is an important correlate for protective CD4+ immunity in the L major model.
• MFI median fluorescence intensity
• the MFI of cells producing three cytokines i.e., IFN- ⁇ , TNF- ⁇ , and IL-2
• IFN- ⁇ , TNF- ⁇ , and IL-2 was higher than the MFI of cells producing two or only one cytokine. Therefore, the effector CD4+ T cells induced with ⁇ -DEC-p24 and dsRNA have features which are currently associated with superior Th1 immunity, such as polyfunctionality and high cytokine production.
• poly(l:C) also serves as an adjuvant for CD4+ T cell response to ⁇ -DEC-nef.
• Proliferating, IFN- ⁇ secreting CD4+ T cells were eli- cited by immunization. They indicate that a good quantity and quality of CD4+ T cells will respond to HIV antigens, both nef and gag, when dsRNA is used as adjuvant.
• mice were vaccinated and then challenged intranasally with recombinant vaccinia-gag virus six to eight weeks after prime-boost immunization with ⁇ -DEC-gag and poly(l:C).
• a dose of 50 ⁇ g poly(l:C) gave optimal protection and reduced virus titers in the lung. More detailed studies with this dose of poly(l:C) were carried out.
• mice injected with the negative control i.e., PBS
• lost weight and developed high titers of virus in the lung > 10 8 PFU/ml
• two doses of ⁇ -DEC-p24 and 50 ⁇ g poly(l:C) provided better protection relative to two doses of control Ig-p24 or one dose of ⁇ -DEC-p24 plus poly(l:C).
• prime-boost immunization with ⁇ -DEC-gag and dsRNA elicits protection at a mucosal surface.
• CxB6 F1 mice were injected with two doses of ⁇ -DEC ⁇ p24 plus increasing doses of poly(l:C) or poly(l:Ci 2 U).
• Proliferation of CD3+CD4+ T cells in response to HIV gag p24 peptides was measured one week after boosting. Both forms of dsRNA induced CD4+ T cell responses that were dose-dependent and antigen specific.
• mice of wild-type, TLR3-/- null, or MDA5-/- null genetic background were compared.
• Poly(l:C) showed some adjuvant activity in TLR3-/- null mice, whereas poly(l:C 12 U) surprisingly could not elicit CD4+ IFN-Y secreting T cells in the same genetic background. Both adjuvants elicited responses in MDA5-/- null mice.
• TLR3 is essential for the adjuvant role of poly(l:Ci 2 U), but poly(l:C) may be able to utilize both the cell-surface receptor TLR3 and the cytosolic sensor MDA5.
• Dendritic cells are potent inducers of T cell-mediated immunity. There- fore, they are attractive targets when improvement in vaccine efficacy is sought. As an example, when antigenic proteins are selectively delivered through conjugates with antibodies targeting them to APC-specific surface molecules, antigen presentation and immune responses develop with much greater efficacy relative to nontargeted antigen.
• One receptor used here is endocytic receptor DEC-205 or CD205, which is expressed on dendritic cells in the T cell areas.
• dsRNA was used alone as a DC maturation stimulus and several features of the quality of CD4+ T cell immunity were studied, including memory. Our data reveal the potential of dsRNA to serve as an adjuvant for a prime-boost, protein vaccine, inducing long-lived and protective Th1 CD4+ T cells of superior quality and quantity.
• the quality of the CD4+ T cell response with dsRNA as an adjuvant is shown first by its polyfunctionality, i.e., the T cells produced multiple cytokines such as IFN-Y, TNF- ⁇ , and IL-2, and in high amounts. It was also found that DEC-targeted vaccine induced high frequencies of IFN- ⁇ -producing and proli- ferating CD4+ T cells, a feature of T cell immunity that has not been demonstrated in the prior art by other vaccine approaches. Increased frequencies of proliferating and multifunctional CD4+ T cells are currently regarded to be O U
• Th1 immunity valuable features of Th1 immunity and are associated with better control of HIV and better protection in the L. major model.
• DC-targeted HIV gag p24 Another interesting result of using DC-targeted HIV gag p24 was the induction of long-lasting protective CD4+ T cell immunity to vaccinia-gag in a DEC dependent manner. A contribution of CD4+ T cells to protection against vaccinia was detected.
• high levels of IFN- ⁇ as well as lysis by infected MHC class II+ targets by CD+ Th1 helper cells may both contribute to resistance induced by DEC targeted proteins together with dsRNA.
• poly(l:C) can be recognized by both TLR3 endosomal and MDA5 cyto- solic receptors. TLR3 and MDA5 were both found to contribute to adjuvant action and protective immunity with poly(l:C). In contrast, TLR3 is exclusively needed for the adjuvant role of poly(l:Ci 2 U).
• dsRNA induces type I interferons, which promotes cross-presentation by dendritic cells and survival of CD8+ T cells.
• dsRNA has been used as adjuvant to enhance the immuno- genicity to a vaccine protein in mice, its ability to induce CD4+ T cell responses that are also protective has not been demonstrated previously.
• Targeting of dsRNA-adjuvanted vaccine protein to dendritic cells and their endocytic receptor DEC-205 should favor the development of the particular kind of Th1 CD4+ T cell immunity that is implicated in resistance to several global infectious diseases.

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