WO2010093814A1 - Procédés de traitement de la démence en utilisant un antagoniste de gm-csf - Google Patents

Procédés de traitement de la démence en utilisant un antagoniste de gm-csf Download PDF

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WO2010093814A1
WO2010093814A1 PCT/US2010/023931 US2010023931W WO2010093814A1 WO 2010093814 A1 WO2010093814 A1 WO 2010093814A1 US 2010023931 W US2010023931 W US 2010023931W WO 2010093814 A1 WO2010093814 A1 WO 2010093814A1
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csf
antibody
region
antagonist
patient
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PCT/US2010/023931
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English (en)
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Christopher R. Bebbington
Geoffrey T. Yarranton
Varghese Palath
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Kalobios Pharmaceuticals, Inc.
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Publication of WO2010093814A1 publication Critical patent/WO2010093814A1/fr

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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
    • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
    • C07K16/24—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against cytokines, lymphokines or interferons
    • C07K16/243—Colony Stimulating Factors
    • 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
    • A61K31/13—Amines
    • 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
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/177—Receptors; Cell surface antigens; Cell surface determinants
    • A61K38/1793—Receptors; Cell surface antigens; Cell surface determinants for cytokines; for lymphokines; for interferons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/20—Immunoglobulins specific features characterized by taxonomic origin
    • C07K2317/24—Immunoglobulins specific features characterized by taxonomic origin containing regions, domains or residues from different species, e.g. chimeric, humanized or veneered
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/30—Immunoglobulins specific features characterized by aspects of specificity or valency
    • C07K2317/34—Identification of a linear epitope shorter than 20 amino acid residues or of a conformational epitope defined by amino acid residues
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/55—Fab or Fab'
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/73—Inducing cell death, e.g. apoptosis, necrosis or inhibition of cell proliferation
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
    • C07K2317/92—Affinity (KD), association rate (Ka), dissociation rate (Kd) or EC50 value

Definitions

  • Granulocyte-macrophage colony- stimulating factor is a cytokine that plays a role in the inflammatory response and has been reported to be involved in mediating aspects of a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriasis, ankylosing spondylitis, juvenile idiopathic arthritic, and systemic lupus erythematosus. Elevated levels of GM-CSF have been also observed in the cerebrospinal fluid and sera of patients with Alzheimer's disease and vascular dementia (Tarkowski et al. Acta Neurol.
  • GM-CSF antagonist can be used for the treatment of dementia, or a patient at risk of developing dementia.
  • the present invention provides methods to treat a patient suffering from dementia, such as Alzheimer's disease, vascular dementia, cerebral amyloid angiopathy (CAA); or a patient at risk of developing dementia such as Alzheimer's disease, vascular dementia, or CAA, e.g., where the patient is diagnosed with mild cognitive impairment or a has a family history of familial Alzheimer's disease.
  • the methods of the invention comprise administering a GM-CSF antagonist to the patient in a therapeutically effective amount, which at least partially arrests symptoms and/or slows the progression or onset of the disease.
  • the GM-CSF antagonist is a recombinant protein.
  • a patient treated as described herein may be diagnosed with one of the disease conditions (Alzheimer's, vascular dementia, or CAA), or may be diagnosed with a combination of these conditions.
  • a patient treated in accordance with the invention may have CAA as well as vascular dementia, or CAA as well as Alzheimer's, or vascular dementia and Alzheimer's disease, or all three of the conditions.
  • Treatment with the GM-CSF antagonist can be performed alone, or in conjunction with other therapies, such as treatment with an anti- beta- amyloid antibody, a beta-amyloid vaccine, an acetylcholinesterase inhibitor, an NMDA receptor antagonist, or IVIG.
  • the invention provides a method of administering a GM-CSF antagonist, e.g.., an antibody, to a patient that has dementia, such as Alzheimer's disease, with the proviso that the GM-CSF antagonist is not human IVIG.
  • a GM-CSF antagonist e.g.., an antibody
  • the invention additionally provides a GM-CSF antagonist as described herein for use in treating dementia, or risk or dementia as described in the preceding paragraph.
  • the methods, uses and pharmaceutical compositions for treating a patient in accordance with the invention can employ any GM-CSF antagonist described herein including any of the following antagonists:
  • the GM-CSF antagonist is recombinantly produced, e.g., a recombinant monoclonal antibody.
  • the GM-CSF antagonist e.g., purified anti-GM-CSF from human plasma, is purified from a natural source.
  • the GM-CSF antagonist is a recombinant anti-GM-CSF antibody, an anti-GM-CSF receptor antibody; a GM-CSF analog, e.g., such as a peptide analog, a soluble GM-CSF receptor; a cytochrome b562 antibody mimetic; an adnectin, a lipocalin scaffold antibody mimetic; a calixarene antibody mimetic, or an antibody-like binding peptidomimetic.
  • the GM-CSF antagonist is an antibody to GM-CSF, i.e., an anti-GM-CSF antibody.
  • the anti-GM-CSF antibody is a recombinant antibody.
  • the antibody can be a polyclonal antibody, a monoclonal antibody, or an antibody such as a nanobody or a camelid antibody.
  • the antibody is an antibody fragment, such as a Fab, a Fab', a F(ab')2, a scFv, or a domain antibody (dAB).
  • the antibody can also be modified, e.g., to enhance stability.
  • the antibody is conjugated to polyethylene glycol.
  • the antibody has an affinity of about 100 pM to about 10 nM, e.g., from about 100 pM, about 200 pM, about 300 pM, about 400 pM, about 500 pM, about 600 pM, about 700 pM, about 800 pM, about 900 pM, or about 1 nM to about 10 nM.
  • the antibody has an affinity of about 1 pM to about 100 pM, e.g., an affinity of about 1 pM, about 5 pM, about 10 pM, about 15 pM, about 20 pM, about 25 pM, about 30 pM, about 40 pM, about 50 pM, about 60 pM, about 70 pM, about 80 pM, or about 90 pM to about 100 pM.
  • the antibody has an affinity of from about 10 to about 30 pM. In some embodiments, the antibody has from 10-1000 fM affinity.
  • the antibody is a neutralizing antibody. In further embodiments, the antibody is a recombinant or chimeric antibody. In some embodiments, the antibody is a human antibody. In some embodiments, the antibody comprises a human variable region. In some embodiments, the antibody comprises a human light chain constant region. In some embodiments, the antibody comprises a human heavy chain constant region, such as a gamma chain.
  • the antibody competes for binding to the same epitope as a chimeric 19/2 antibody, which is a chimeric antibody obtained from the mouse monoclonal antibody LMM 102.
  • the antibody can, e.g., comprise the V H and V L regions of chimeric 19/2.
  • the antibody can also comprise a human heavy chain constant region such as a gamma region.
  • the antibody comprises the CDRl, CDR2, and CDR3 of the V H region of chimeric 19/2.
  • the antibody comprises the CDRl, CDR2, and CDR3 of the V L region of chimeric 19/2.
  • the antibody comprises the CDRl, CDR2, and CDR3 of the V H and V L regions of a chimeric 19/2 antibody. In some embodiments, the antibody comprises the V H region CDR3 and V L region CDR3 of chimeric 19/2.
  • an anti-GM-CSF antibody for use in the invention comprises a V H region that has a CDR3 binding specificity determinant RQRFPY or RDRFPY, a J segment, and a V-segment, wherein the J-segment comprises at least 95% identity to human JH4 (YFDYWGQGTLVTVSS) and the V-segment comprises at least 90% identity to a human germ line VHl 1-02 or VHl 1-03 sequence.
  • the antibody comprise a V H region that comprises a CDR3 binding specificity determinant comprising RQRFPY.
  • the J segment comprises YFDYWGQGTLVTVSS.
  • the anti-GM-CSF antibody has a CDR3 that comprises RQRFPYYFDY or RDRFPYYFDY.
  • the V H region CDRl is a human germline VHl CDRl; the V H region CDR2 is a human germline VHl CDR2; or both V H region the CDRl and CDR2 are human germline VHl .
  • the antibody comprises a V H CDRl, or a V H CDR2, or both a V H CDRl and a V H CDR2 as shown in a V H region set forth in Figure 1.
  • the V-segment sequence has a V H V segment sequence shown in Figure 1.
  • an anti-GM-CSF antibody of the invention e.g., an anti-GM- CSF antibody having V H region as described herein, comprises a V L region that comprises a CDR3 binding specificity determinant FNK or FNR.
  • the antibody comprises a human germline JK4 region.
  • the V L region CDR3 comprises QQFN(K/R)SPLT.
  • the V L region comprises a CDRl, or a CDR2, or both a CDRl and CDR2 of a sequence V L region shown in Figure 1.
  • the V L region comprises a V segment that has at least 95% identity to the VKIIIA27 V-segment sequence as shown in Figure 1.
  • the V L region has the sequence of VK#1, VK#2, VK#3, or VK#4 set forth in Figure 1.
  • an anti-GM-CSF antibody for use in the invention has a half- life of about 7 to about 25 days.
  • the GM-CSF antagonist e.g., an anti-GMCSF antibody
  • the GM-CSF antagonist is administered by injection or by infusion.
  • the GM- CSF antagonist can be administered intravenously over a period between about 15 minutes and about 2 hours.
  • the GM-CSF antagonist is administered subcutaneously by bolus injection.
  • the GM-CSF antagonist is administered by intranasal administration, perispinal administration, intrathecal administration, or subcutaneous administration.
  • a GM-CSF antibody can, for example, be administered at a dose between about 1 mg/kg of body weight and about 10 mg/kg of body weight.
  • treatment with the GM-CSF antagonist comprises a second administration of the GM-CSF antagonist.
  • the invention also provides a method of treating a patient having Alzheimer's disease, vascular dementia, or CAA, or who is at risk for developing Alzheimer's disease or vascular dementia, the method comprising administering an anti-GM-CSF antibody as described herein to the patient in a therapeutically effective amount.
  • Figure 1 provides exemplary V H and V L sequences of anti-GM-CSF antibodies.
  • Figure 2 Uptake of 22E9 into the hippocampus region of the brain of a hAPP751- SL transgenic mouse. The mouse was administered 22E9 antibody (rat anti-mouse anti-GM- CSF neutralizing antibody) 48 hours prior to sacrifice and sectioning of the brain. 22E9 is detected using anti-rat IgG specific antibody. The figure shows 22E9 antibody uptake associated with amyloid plaques in the hippocampus region of the brain after A) intravenous (i.v.) administration or B) intranasal (i.n.) administration
  • FIG. 1 Performance of anti-GM-CSF antibody 22E9 treated and control mice in the Morris Water Maze beginning 44 days after treatment initiation. Mean swimming path length is shown (+ standard error). * Difference between rat IgG2a treated and 22E9 treated mice is statistically significant.
  • Figure 4. Performance of anti-GM-CSF antibody 22E9 treated and control mice in the Contextual fear conditioning analysis beginning 51 days after treatment initiation. Context conditioned freezing response is shown for animals transferred to the training chamber 24 hours after initial training. Results are means + standard errors.
  • Figure 5 Mean size of amyloid plaques in the brains of mice treated with anti-GM- CSF antibody 22E9 or control-treated mice. Mean plaque size (+ standard error) from 6 mice in each group was determined by staining with 6E10 antibody to human amyloid. Data were analyzed by one-way Analysis of variance (ANOVA).
  • Alzheimer's disease refers to senile dementia as diagnosed using commonly accepted criteria in the art, such as the criteria set forth by The National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association and/or the criteria as listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) published by the American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, revised in 2000), also known as the DSM-IV-TR, outlines a detailed set of criteria for the diagnosis of Alzheimer's disease. For purposes of this application, the terms “Alzheimer's” and “Alzheimer's disease” and “AD” are used interchangeably.
  • Vascular dementia is a common form of dementia.
  • the term “vascular dementia” refers to a group of syndromes relating to different vascular mechanisms. Various subtypes of vascular dementia have been described to date. The spectrum of disease includes (1) mild vascular cognitive impairment, (2) multi-infarct dementia, (3) vascular dementia due to a strategic single infarct, (4) vascular dementia due to lacunar lesions, (5) vascular dementia due to hemorrhagic lesions, (6) Binswanger disease, (7) subcortical vascular dementia, and (8) mixed dementia (combination of AD and vascular dementia). Vascular dementia is sometimes further classified as cortical or subcortical dementia. Vascular dementia can be diagnosed by clinical criteria, often in combination with brain imaging.
  • Cerebral amyloid angiopathy refers to a disorder characterized by deposition of amyloid within the walls of the cerebral arteries. Severe CAA is associated with vasculopathic changes, vessel rupture, and cerebral hemorrhage. CAA is a component of any disorder in which amyloid is deposited in the brain, e.g., Alzheimer's disease, and it is not associated with systemic amyloidosis.
  • a patient with "mild to moderate" dementia, or early-stage Alzheimer's disease can be identified using neurological testing and other clinical endpoints.
  • a subject with mild to moderate dementia e.g., Alzheimer's disease
  • MMSE Mini-Mental State Examination
  • a score of 16 to 26 is indicative of mild to moderate Alzheimer's disease.
  • Patients with advanced Alzheimer's disease can also be identified based on clinical parameters. Subjects with this form of Alzheimer's disease may no longer respond to therapy with acetylcholinesterase inhibitors, and may have a markedly reduced acetylcholine level.
  • G-CSF Gnulocyte Macrophage-Colony Stimulating Factor
  • GM-CSF is produced in response to a number of inflammatory mediators by mesenchymal cells present in the hemopoietic environment and at peripheral sites of inflammation. GM-CSF is able to stimulate the production of neutrophilic granulocytes, macrophages, and mixed granulocyte- macrophage colonies from bone marrow cells and can stimulate the formation of eosinophil colonies from fetal liver progenitor cells. GM-CSF can also stimulate some functional activities in mature granulocytes and macrophages.
  • GM-CSFR granulocyte macrophage-colony stimulating factor receptor
  • GM-CSF granulocyte macrophage colony-stimulating factor
  • the cytoplasmic region of GM-CSFR alpha consists of a membrane-proximal conserved region shared by the alpha 1 and alpha 2 isoforms and a C-terminal variable region that is divergent between alpha 1 and alpha 2.
  • the cytoplasmic region of beta-c contains membrane proximal serine and acidic domains that are important for the proliferative response induced by GM-CSF.
  • soluble granulocyte macrophage-colony stimulating factor receptor refers to a non-membrane bound receptor that binds GM-CSF, but does not transduce a signal when bound to the ligand.
  • a "peptide GM-CSF antagonist” refers to a peptide that interacts with GM-CSF, or its receptor, to reduce or block (either partially or completely) signal transduction that would otherwise result from the binding of GM-CSF to its cognate receptor expressed on cells.
  • GM-CSF antagonists may act by reducing the amount of GM-CSF ligand available to bind the receptor (e.g., antibodies that once bound to GM-CSF increase the clearance rate of GM-CSF) or prevent the ligand from binding to its receptor either by binding to GM-CSF or the receptor (e.g., neutralizing antibodies).
  • GM-CSF antagonists may also include other peptide inhibitors, which may include polypeptides, that bind GM-CSF or its receptor to partially or completely inhibit signaling.
  • a peptide GM-CSF antagonist can be, e.g., an antibody; a natural or synthetic GM-CSF receptor ligand that antagonizes GM- CSF, or other polypeptides.
  • An exemplary assay to detect GM-CSF antagonist activity is provided in Example 1.
  • a peptide GM-CSF antagonist such as a neutralizing antibody, has an EC50 of 10 nM or less.
  • a "purified" GM-CSF antagonist as used herein refers to a GM-CSF antagonist that is substantially or essentially free from components that normally accompany it as found in its native state.
  • a GM-CSF antagonist such as an anti-GM-CSF antibody, that is purified from blood or plasma is substantially free of other blood or plasma components such as other immunoglobulin molecules. Purity and homogeneity are typically determined using analytical chemistry techniques such as polyacrylamide gel electrophoresis or high performance liquid chromatography.
  • a protein that is the predominant species present in a preparation is substantially purified. Typically, "purified” means that the protein is at least 85% pure, more preferably at least 95% pure, and most preferably at least 99% pure relative to the components with which the protein naturally occurs.
  • an "antibody” refers to a protein functionally defined as a binding protein and structurally defined as comprising an amino acid sequence that is recognized by one of skill as being derived from the framework region of an immunoglobulin-encoding gene of an animal that produces antibodies.
  • An antibody can consist of one or more polypeptides substantially encoded by immunoglobulin genes or fragments of immunoglobulin genes.
  • the recognized immunoglobulin genes include the kappa, lambda, alpha, gamma, delta, epsilon and mu constant region genes, as well as myriad immunoglobulin variable region genes.
  • Light chains are classified as either kappa or lambda.
  • Heavy chains are classified as gamma, mu, alpha, delta, or epsilon, which in turn define the immunoglobulin classes, IgG, IgM, IgA, IgD and IgE, respectively.
  • a typical immunoglobulin (antibody) structural unit is known to comprise a tetramer.
  • Each tetramer is composed of two identical pairs of polypeptide chains, each pair having one "light” (about 25 kD) and one "heavy” chain (about 50-70 kD).
  • the N-terminus of each chain defines a variable region of about 100 to 110 or more amino acids primarily responsible for antigen recognition.
  • the terms variable light chain (V L ) and variable heavy chain (V R ) refer to these light and heavy chains, respectively.
  • the term antibody includes antibody fragments that retain binding specificity. For example, there are a number of well characterized antibody fragments.
  • pepsin digests an antibody C-terminal to the disulfide linkages in the hinge region to produce F(ab) T 2 , a dimer of Fab which itself is a light chain joined to VH-CHl by a disulfide bond.
  • the F(ab)' 2 may be reduced under mild conditions to break the disulfide linkage in the hinge region thereby converting the (FaV) 2 dimer into an Fab' monomer.
  • the Fab' monomer is essentially a Fab with part of the hinge region (see, Fundamental Immunology, W.E.
  • antibody fragments are defined in terms of the digestion of an intact antibody, one of skill will appreciate that fragments can be synthesized de novo either chemically or by utilizing recombinant DNA methodology.
  • fragments can be synthesized de novo either chemically or by utilizing recombinant DNA methodology.
  • the term antibody as used herein also includes antibody fragments either produced by the modification of whole antibodies or synthesized using recombinant DNA methodologies.
  • Antibodies include dimers such as V H -V L dimers, V H dimers, or V L dimers, including single chain antibodies (antibodies that exist as a single polypeptide chain), such as single chain Fv antibodies (sFv or scFv) in which a variable heavy and a variable light region are joined together (directly or through a peptide linker) to form a continuous polypeptide.
  • the single chain Fv antibody is a covalently linked V H -V L heterodimer which may be expressed from a nucleic acid including V H - and V L - encoding sequences either joined directly or joined by a peptide-encoding linker (e.g., Huston, et al. Proc. Nat.
  • V H and V L are connected to each as a single polypeptide chain, the V H and V L domains associate non-covalently.
  • the antibody can be another fragment, such as a disulfide-stabilized Fv (dsFv).
  • dsFv disulfide-stabilized Fv
  • Other fragments can also be generated, including using recombinant techniques.
  • the scFv antibodies and a number of other structures converting the naturally aggregated, but chemically separated light and heavy polypeptide chains from an antibody V region into a molecule that folds into a three dimensional structure substantially similar to the structure of an antigen-binding site are known to those of skill in the art (see e.g., U.S. Patent Nos.
  • antibodies include those that have been displayed on phage or generated by recombinant technology using vectors where the chains are secreted as soluble proteins, e.g., scFv, Fv, Fab, (Fab') 2 or generated by recombinant technology using vectors where the chains are secreted as soluble proteins.
  • Antibodies for use in the invention can also include diantibodies and miniantibodies.
  • Antibodies of the invention also include heavy chain dimers, such as antibodies from camelids.
  • VHH domains VHH domains.
  • Antibodies for use in the current invention include single domain antibodies (dAbs) and nanobodies (see, e.g., Cortez- Retamozo, et al, Cancer Res. 64:2853-2857, 2004).
  • V-region refers to an antibody variable region domain comprising the segments of Framework 1, CDRl, Framework 2, CDR2, and Framework 3, including CDR3 and Framework 4, which segments are added to the V-segment as a consequence of rearrangement of the heavy chain and light chain V-region genes during B-cell differentiation.
  • a "V-segment” as used herein refers to the region of the V-region (heavy or light chain) that is encoded by a V gene.
  • J-segment refers to a subsequence of the encoded variable region comprising a C-terminal portion of a CDR3 and the FR4. An endogenous J-segment is encoded by an immunoglobulin J-gene.
  • CDR complementarity-determining region
  • the sequences of the framework regions of different light or heavy chains are relatively conserved within a species.
  • the framework region of an antibody that is the combined framework regions of the constituent light and heavy chains, serves to position and align the CDRs in three dimensional space.
  • the amino acid sequences of the CDRs and framework regions can be determined using various well known definitions in the art, e.g., Kabat, Chothia, international ImMunoGeneTics database (IMGT), and AbM (see, e.g., Johnson et al., supra; Chothia & Lesk, 1987, Canonical structures for the hypervariable regions of immunoglobulins. J. MoI. Biol. 196, 901-917; Chothia C. et al., 1989, Conformations of immunoglobulin hypervariable regions. Nature 342, 877-883; Chothia C. et al., 1992, structural repertoire of the human VH segments J. MoI. Biol.
  • Epitopes refers to a site on an antigen to which an antibody binds.
  • Epitopes can be formed both from contiguous amino acids or noncontiguous amino acids juxtaposed by tertiary folding of a protein. Epitopes formed from contiguous amino acids are typically retained on exposure to denaturing solvents whereas epitopes formed by tertiary folding are typically lost on treatment with denaturing solvents.
  • An epitope typically includes at least 3, and more usually, at least 5 or 8-10 amino acids in a unique spatial conformation. Methods of determining spatial conformation of epitopes include, for example, x-ray crystallography and 2-dimensional nuclear magnetic resonance. See, e.g., Epitope Mapping Protocols in Methods in Molecular Biology, Vol. 66, Glenn E. Morris, Ed (1996).
  • neutralizing antibody refers to an antibody that binds to GM-CSF and prevents signaling by the GM-CSF receptor, or inhibits binding of GM-CSF to its receptor.
  • chimeric antibody refers to an immunoglobulin molecule in which (a) the constant region, or a portion thereof, is altered, replaced or exchanged so that the antigen binding site (variable region) is linked to a constant region of a different or altered class, effector function and/or species, or an entirely different molecule that confers new properties to the chimeric antibody, e.g., an enzyme, toxin, hormone, growth factor, drug, etc.; or (b) the variable region, or a portion thereof, is altered, replaced or exchanged with a variable region, or portion thereof, having a different or altered antigen specificity; or with corresponding sequences from another species or from another antibody class or subclass.
  • humanized antibody refers to an immunoglobulin molecule in CDRs from a donor antibody are grafted onto human framework sequences. Humanized antibodies may also comprise residues of donor origin in the framework sequences. The humanized antibody can also comprise at least a portion of a human immunoglobulin constant region. Humanized antibodies may also comprise residues which are found neither in the recipient antibody nor in the imported CDR or framework sequences.
  • Humanization can be performed using methods known in the art (e.g., Jones et ah, Nature 321 :522-525; 1986; Riechmann et ah, Nature 332:323-327, 1988; Verhoeyen et ah, Science 239:1534- 1536, 1988); Presta, Curr. Op. Struct. Biol. 2:593-596, 1992; U.S. Patent No. 4,816,567), including techniques such as "superhumanizing” antibodies (Tan Qt ah, J. Immunol. 169: 1119, 2002) and "resurfacing" ⁇ e.g., Staelens et al, MoI. Immunol.
  • a ⁇ UMANEEREDTM antibody in the context of this invention refers to an engineered human antibody having a binding specificity of a reference antibody.
  • a engineered human antibody for use in this invention has an immunoglobulin molecule that contains minimal sequence derived from a donor immunoglobulin.
  • the engineered human antibody may retain only the minimal essential binding specificity determinant from the CDR3 regions of a reference antibody.
  • an engineered human antibody is engineered by joining a DNA sequence encoding a binding specificity determinant (BSD) from the CDR3 region of the heavy chain of the reference antibody to human V H segment sequence and a light chain CDR3 BSD from the reference antibody to a human V L segment sequence.
  • BSD binding specificity determinant
  • a binding specificity determinant therefore can be a CDR3-FR4, a CDR3, a minimal essential binding specificity determinant of a CDR3 (which refers to any region smaller than the CDR3 that confers binding specificity when present in the V region of an antibody), the D segment (with regard to a heavy chain region), or other regions of CDR3- FR4 that confer the binding specificity of a reference antibody.
  • Methods for engineering human antibodies are provided in US patent application publication no. 20050255552 and US patent application publication no. 20060134098.
  • human antibody refers to an antibody that is substantially human, i.e., has FR regions, and often CDR regions, from a human immune system. Accordingly, the term includes humanized and humaneered antibodies as well as antibodies isolated from mice reconstituted with a human immune system and antibodies isolated from display libraries.
  • heterologous when used with reference to portions of a nucleic acid indicates that the nucleic acid comprises two or more subsequences that are not normally found in the same relationship to each other in nature. For instance, the nucleic acid is typically recombinantly produced, having two or more sequences, e.g., from unrelated genes arranged to make a new functional nucleic acid. Similarly, a heterologous protein will often refer to two or more subsequences that are not found in the same relationship to each other in nature.
  • recombinant when used with reference, e.g., to a cell, or nucleic acid, protein, or vector, indicates that the cell, nucleic acid, protein or vector, has been modified by the introduction of a heterologous nucleic acid or protein or the alteration of a native nucleic acid or protein, or that the cell is derived from a cell so modified.
  • recombinant cells express genes that are not found within the native (non-recombinant) form of the cell or express native genes that are otherwise abnormally expressed, under expressed or not expressed at all.
  • nucleic acid By the term “recombinant nucleic acid” herein is meant nucleic acid, originally formed in vitro, in general, by the manipulation of nucleic acid, e.g., using polymerases and endonucleases, in a form not normally found in nature. In this manner, operably linkage of different sequences is achieved.
  • an isolated nucleic acid, in a linear form, or an expression vector formed in vitro by ligating DNA molecules that are not normally joined are both considered recombinant for the purposes of this invention.
  • a recombinant nucleic acid is made and reintroduced into a host cell or organism, it will replicate non-recombinantly, i.e., using the in vivo cellular machinery of the host cell rather than in vitro manipulations; however, such nucleic acids, once produced recombinantly, although subsequently replicated non-recombinantly, are still considered recombinant for the purposes of the invention.
  • a "recombinant protein” is a protein made using recombinant techniques, i.e., through the expression of a recombinant nucleic acid.
  • the antibody typically binds to the antigen, e.g., GM-CSF, with an affinity of 500 nM or less, and has an affinity of 500OnM or greater, for other antigens.
  • nucleic acid sequences refer to two or more sequences or subsequences that are the same or have a specified percentage of amino acid residues (or nucleotides) that are the same (i.e., about 60% identity, preferably 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or higher identity over a specified region, when compared and aligned for maximum correspondence over a comparison window or designated region) as measured using a BLAST or BLAST 2.0 sequence comparison algorithms with default parameters described below, or by manual alignment and visual inspection (see, e.g., NCBI web site).
  • sequences are then said to be “substantially identical.”
  • “Substantially identical” sequences also includes sequences that have deletions and/or additions, as well as those that have substitutions, as well as naturally occurring, e.g., polymorphic or allelic variants, and man-made variants.
  • the preferred algorithms can account for gaps and the like.
  • a “comparison window”, as used herein, includes reference to a segment of one of the number of contiguous positions selected from the group consisting typically of from 20 to 600, usually about 50 to about 200, more usually about 100 to about 150 in which a sequence may be compared to a reference sequence of the same number of contiguous positions after the two sequences are optimally aligned.
  • Methods of alignment of sequences for comparison are well-known in the art.
  • Optimal alignment of sequences for comparison can be conducted, e.g., by the local homology algorithm of Smith & Waterman, Adv. Appl. Math. 2:482 (1981), by the homology alignment algorithm of Needleman & Wunsch, J. MoI. Biol.
  • BLAST and BLAST 2.0 are used, with the parameters described herein, to determine percent sequence identity for the nucleic acids and proteins of the invention.
  • polypeptides are substantially identical is that the first polypeptide is immunologically cross reactive with the antibodies raised against the second polypeptide.
  • a polypeptide is typically substantially identical to a second polypeptide, e.g., where the two peptides differ only by conservative substitutions.
  • isolated refers to material that is substantially or essentially free from components that normally accompany it as found in its native state. Purity and homogeneity are typically determined using analytical chemistry techniques such as polyacrylamide gel electrophoresis or high performance liquid chromatography. A protein that is the predominant species present in a preparation is substantially purified.
  • purified in some embodiments denotes that a protein gives rise to essentially one band in an electrophoretic gel. Preferably, it means that the protein is at least 85% pure, more preferably at least 95% pure, and most preferably at least 99% pure.
  • polypeptide peptide
  • protein protein
  • amino acid polymers in which one or more amino acid residue is an artificial chemical mimetic of a corresponding naturally occurring amino acid, as well as to naturally occurring amino acid polymers, those containing modified residues, and non-naturally occurring amino acid polymer.
  • amino acid refers to naturally occurring and synthetic amino acids, as well as amino acid analogs and amino acid mimetics that function similarly to the naturally occurring amino acids.
  • Naturally occurring amino acids are those encoded by the genetic code, as well as those amino acids that are later modified, e.g., hydroxyproline, ⁇ - carboxyglutamate, and O-phosphoserine.
  • Amino acid analogs refers to compounds that have the same basic chemical structure as a naturally occurring amino acid, e.g., an ⁇ carbon that is bound to a hydrogen, a carboxyl group, an amino group, and an R group, e.g., homoserine, norleucine, methionine sulfoxide, methionine methyl sulfonium. Such analogs may have modified R groups (e.g., norleucine) or modified peptide backbones, but retain the same basic chemical structure as a naturally occurring amino acid.
  • Amino acid mimetics refers to chemical compounds that have a structure that is different from the general chemical structure of an amino acid, but that functions similarly to a naturally occurring amino acid.
  • Amino acids may be referred to herein by either their commonly known three letter symbols or by the one-letter symbols recommended by the IUPAC-IUB Biochemical
  • Constantly modified variants applies to both amino acid and nucleic acid sequences.
  • conservatively modified variants refers to those nucleic acids which encode identical or essentially identical amino acid sequences, or where the nucleic acid does not encode an amino acid sequence, to essentially identical or associated, e.g., naturally contiguous, sequences.
  • a large number of functionally identical nucleic acids encode most proteins. For instance, the codons GCA, GCC, GCG and GCU all encode the amino acid alanine.
  • nucleic acid variations are "silent variations," which are one species of conservatively modified variations. Every nucleic acid sequence herein which encodes a polypeptide also describes silent variations of the nucleic acid.
  • AUG which is ordinarily the only codon for methionine
  • TGG which is ordinarily the only codon for tryptophan
  • nucleic acid which encodes a polypeptide is implicit in a described sequence with respect to the expression product, but not with respect to actual probe sequences.
  • amino acid sequences one of skill will recognize that individual substitutions, deletions or additions to a nucleic acid, peptide, polypeptide, or protein sequence which alters, adds or deletes a single amino acid or a small percentage of amino acids in the encoded sequence is a "conservatively modified variant" where the alteration results in the substitution of an amino acid with a chemically similar amino acid.
  • Conservative substitution tables and substitution matrices such as BLOSUM providing functionally similar amino acids are well known in the art.
  • Such conservatively modified variants are in addition to and do not exclude polymorphic variants, interspecies homo logs, and alleles of the invention.
  • Typical conservative substitutions for one another include: 1) Alanine (A), Glycine (G); 2) Aspartic acid (D), Glutamic acid (E); 3) Asparagine (N), Glutamine (Q); 4) Arginine (R), Lysine (K); 5) Isoleucine (I), Leucine (L), Methionine (M), Valine (V); 6) Phenylalanine (F), Tyrosine (Y), Tryptophan (W); 7) Serine (S), Threonine (T); and 8) Cysteine (C), Methionine (M) (see, e.g., Creighton, Proteins (1984)).
  • the invention relates to methods of administering a GM-CSF antagonist to a patient for the treatment of dementia, such as Alzheimer's disease, vascular dementia or CAA.
  • dementia such as Alzheimer's disease, vascular dementia or CAA.
  • Patient to be treated in accordance with the invention include patients having Alzheimer's disease, vascular dementia, or CAA; or a patient at risk for developing Alzheimer's disease, or vascular dementia.
  • GM-CSF antagonists may include anti-GM-CSF antibodies, anti-GM- CSF receptor antibodies, or other inhibitors that prevent signaling that normally results from the binding of GM-CSF to its cognate receptor.
  • Antibodies e.g., anti-GM-CSF or anti-GM-CSF receptor antibodies, suitable for use with the present invention may be monoclonal, polyclonal, chimeric, humanized, engineered human antibodies that contain only minimal sequence from a reference antibody, or human.
  • Other GM-CSF antagonists suitable for use with the present invention may include naturally occurring or synthetic ligands (or fragments thereof) that compete with GM-CSF for binding to the receptor, but do not result in signaling when bound to the receptor.
  • Additional non-limiting GM-CSF antagonists may include polypeptides, nucleic acids, small molecules and the like that either partially or completely block signaling that would naturally result from the binding of GM-CSF to its receptor in the absence of the GM-CSF antagonist.
  • beta-amyloid In the context of the present specification, "beta-amyloid”, “ ⁇ -amyloid”, “amyloid- beta”, “amyloid- ⁇ ” and “a ⁇ ” are used interchangeably to refer to beta amyloid peptides and include reference to various peptides, including a ⁇ i_ 40 , a ⁇ i_ 42 , a ⁇ i_ 43 , a ⁇ i_ 44 , and the like.
  • Typical patients to be treated with the GM-CSF antagonist are those diagnosed with Alzheimer's disease or who have a familial disposition to Alzheimer's disease.
  • an Alzheimer's patient is diagnosed according to accepted clinical criteria.
  • the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association also referred to as NINCDS-ADRDA
  • NINCDS-ADRDA For the NINCDS-ADRDA criteria, the presence of cognitive impairment, and a suspected dementia syndrome is confirmed by neuropsychological testing for a clinical diagnosis of possible or probable AD. A definitive diagnosis is obtained by histopathological confirmation.
  • the terms "diagnosed with Alzheimer's disease” or a patient "having Alzheimer's disease” includes patients that have probable or possible Alzheimer's, as a definitive diagnosis under NINCDS-ADRDA diagnostic criteria is based on histopathologic evidence that is often obtained post-mortem.
  • NINCDS-ADRDA diagnostic criteria are:
  • Definite Alzheimer's disease The patient meets the criteria for probable Alzheimer's disease and has histopathologic evidence of AD via autopsy or biopsy.
  • Probable Alzheimer's disease Dementia has been established by clinical and neuropsychological examination. Cognitive impairments is progressive and is present in two or more areas of cognition. The onset of the deficits has been between the ages of 40 and 90 years and there is an absence of other diseases capable of producing a dementia syndrome. Possible Alzheimer's disease: There is a dementia syndrome with an atypical onset, presentation or progression; and without a known etiology; but no co-morbid diseases capable of producing dementia are believed to be in the origin of it.
  • the patient presents a dementia syndrome with a sudden onset, focal neurologic signs, or seizures or gait disturbance early in the course of the illness.
  • Alzheimer's disease can also be diagnosed based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, 2000) published by the American Psychiatric Association.
  • DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders
  • the criteria for diagnosis of Alzheimer's disease under DSM-IV-TR include the development of multiple cognitive deficits manifested by both (1) memory impairment (impaired ability to learn new information or to recall previously learned information) and (2) one (or more) of the following cognitive disturbances: (a) aphasia (language disturbance), (b) apraxia (impaired ability to carry out motor activities despite intact motor function), (c) agnosia (failure to recognize or identify objects despite intact sensory function), (d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting).
  • the cognitive deficits cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning. The course is characterized by gradual onset and continuing cognitive decline, and the all other specific
  • Alzheimer's disease Other diagnostic procedures can also be used to diagnose Alzheimer's disease (see, e.g., Dubois et al., Lancet Neurol, Vol. 6:734-746, 2007).
  • Such procedures include tests of episodic memory, e.g. delayed recall and double memory tests to differentiate between memory storage or encoding problems, which are indicative of Alzheimer's disease, and problems involving memory retrieval.
  • Biochemical tests can also be used for diagnosis. For example, low amyloid ⁇ (1 _ 42) concentrations, increased total tau concentrations, or increased phospho-tau concentrations or combinations of these three in a CSF sample, or other appropriate sample, from a patient is indicative of Alzheimer's disease.
  • Neopterin levels in the serum of a patient may also be evaluated to determine whether an elevated level, which is associated with Alzheimer's disease, is present (Leblhuber et al, Clin. Chem. Lab. Med. 37:429-431, 1999).
  • Structural and metabolic evaluation can also be performed on the brain, e.g., PET scanning to identify diminished glucose metabolism in the bilateral temporoparietal regions and posterior cingulate.
  • the presence of atrophy in the medial temporal lobe regions of the brain may also be determined using computed tomographic scanning (CT), and magnetic resonance imaging (MRI) (Leedom and Miller, "CT, MRI, and NMR Spectroscopy in Alzheimer's disease,” Alzheimer's disease, Current Research in Early Diagnosis, Becker and Giacobini (eds.), pp. 297-313, 1990).
  • CT computed tomographic scanning
  • MRI magnetic resonance imaging
  • subjects that may have an increased risk for developing Alzheimer's disease can also be treated with a GM-CSF antagonist, e.g., an antibody as described herein.
  • a GM-CSF antagonist e.g., an antibody as described herein.
  • subjects can be screened based on a number of biochemical and genetic markers. For example, genetic abnormality in a few families has been traced to chromosome 21 (St. George-Hyslop et al., Science 235:885-890, 1987).
  • One genetic marker is, for example, the presence of mutations in the APP gene, particularly mutations at position 717 and positions 670 and 671, which are referred to as the Hardy and Swedish mutations, respectively.
  • Other markers of risk are mutations in the presenilin genes, PSl and PS2, the ApoE4 profile of a subject, family history of Alzheimer's disease, and the presence of risk factors such as hypercholesterolemia or atherosclerosis.
  • Subjects with APP, PSl or PS2 mutations are highly likely to develop Alzheimer's disease.
  • Subjects having the E4 isoform of ApoE (ApoE4 isoform) have an increased risk of developing Alzheimer's disease.
  • Alzheimer's patients that can be treated in accordance with the methods of the invention include those with mild or moderate impairment as well as patients with more advanced impairment.
  • a patient who has mild cognitive impairment may be treated with a GM-CSF antagonist.
  • MCI patients are at risk for development of Alzheimer's disease.
  • MCI can be diagnosed and evaluated using any of the many objective tests or criteria well-known and accepted in the fields of psychology or psychiatry.
  • one criterion for the diagnosis of MCI is that the patient receives a clinical dementia rating of 0.5 as described, e.g., in Hughes et al, Brit. J. Psychiat. 140:566-572, 1982 and Morris, Neurology 43:2412-2414, 1993.
  • a patient In determining the clinical dementia rating, a patient is typically assessed and rated in each of six cognitive and behavioural categories: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The patient is assessed and rated in each of these areas and the overall rating, (0, 0.5, 1.0, 2.0 or 3.0) determined. A rating of 0 is considered normal. A rating of 1.0 is considered to correspond to mild dementia.
  • a patient with cognitive impairment demonstrates impaired performance on a memory task test. Memory may be measured by such tests known in the art as the Wechsler Memory Scale or a pair-associated memory task. A patient is considered to exhibit impaired performance on such a test if the score is below the education and age-adjusted cutoff for that test.
  • a patient diagnosed with Alzheimer's disease or at risk of developing Alzheimer's disease e.g., has mild cognitive impairment, a family history of familial Alzheimer's, or a risk factor for developing Alzheimer's such as the Alzheimer's disease-associated ApoE subtype (ApoE4 subtype), may be treated with a GM-CSF antagonist as described herein.
  • vascular dementia e.g., vascular dementia
  • a GM-CSF antagonist e.g., an anti-GM-CSF antibody
  • vascular dementia is also known as ischemic vascular dementia or multi-infarct dementia. These terms refer to a group of syndromes caused by different mechanisms all resulting in vascular lesions in the brain.
  • the main subtypes of vascular dementia described to date are vascular mild cognitive impairment, multi-infarct dementia, vascular dementia due to a strategic single infarct, vascular dementia due to hemorrhagic lesions, small vessel disease (which includes vascular dementia due to lacunar lesions and Binswanger disease), and Alzheimer's disease mixed with vascular dementia.
  • Vascular lesions can be the result of diffuse cerebrovascular disease or focal lesions (or a combination of both, which is what is observed in the majority of cases).
  • Vascular dementia is diagnosed based on clinical criteria, often in conjunction with neurological imaging to detect ischemic lesions.
  • Mixed dementia is diagnosed when patients have evidence of Alzheimer's disease and cerebrovascular disease, either clinically or based on neuroimaging evidence of ischemic lesions .
  • a patient who is at risk for vascular dementia may be treated with a GM-CSF antagonist.
  • a patient treated with a GM-CSF antagonist may have cerebral amyloid angiopathy (CAA), in which amyloid is deposited in the walls of the cerebral arteries.
  • CAA cerebral amyloid angiopathy
  • ICH Incranial hemorrhage
  • a commonly used guideline for the diagnosis of CAA is the Boston Cerebral Amyloid Angiopathy Group guidelines. Often, CAA is accompanied by hemorrhage. The Boston Criteria for the diagnosis of C AA-related hemorrhage are based on a combination of clinical, radiologic, and pathologic data to differentiate lobar intracerebral hemorrhage into categories of possible, probable, or definite based on the likelihood of underlying cerebral amyloid angiopathy. As used herein in the context of this invention, a patient diagnosed with CAA may be diagnosed with possible or probable CAA and need not be definitively diagnosed, as definite CAA is typically determined postmortem.
  • Definite CAA Full postmortem examination reveals lobar, cortical, or corticosubcortical hemorrhage and evidence of severe CAA.
  • Probable CAA with supporting pathological evidence The clinical data and pathological tissue (evacuated hematoma or cortical biopsy specimen) demonstrate a hemorrhage with certain characteristics and some degree of vascular amyloid deposition.
  • Probable CAA Clinical data and MRI findings (in the absence of a pathological specimen) demonstrate multiple hematomas (as described above) in a patient older than 60 years.
  • Possible CAA This is considered if the patient is older than 60 years, and clinical and MRI data reveal a single lobar, cortical, or corticosubcortical hemorrhage without another cause, multiple hemorrhages with a possible but not a definite cause, or some hemorrhage in an atypical location.
  • a patient that has Alzheimer's disease, vascular dementia, CAA, or is a candidate for developing Alzheimer's disease, vascular dementia, or both and is treated with a GM-CSF antagonist exhibits elevated GM-CSF levels, in comparison to normal healthy controls, in the cerebrospinal fluid or other sample, e.g., serum. Elevated levels of GM-CSF can be detected using many techniques commonly known in the art, e.g., an immunoassay.
  • GM-CSF antagonists As noted above, the invention provides methods for treating Alzheimer's disease, vascular dementia, or CAA by administering a GM-CSF antagonist to a patient suffering from the disease, or at risk of developing the disease.
  • GM-CSF antagonists suitable for use in the invention selectively interfere with the induction of signaling by the GM-CSF receptor by causing a reduction in the binding of GM-CSF to the receptor.
  • Such antagonists may include antibodies that bind the GM-CSF receptor, antibodies that bind to GM-CSF, GM-CSF analogs such as E21R, and other proteins or small molecules that compete for binding of GM-CSF to its receptor or inhibit signaling that normally results from the binding of the ligand to the receptor.
  • the GM-CSF antagonist used in the invention is a polypeptide e.g., an anti-GM-CSF antibody, an anti-GM-CSF receptor antibody, a soluble GM-CSF receptor, or a modified GM-CSF polypeptide that competes for binding with GM- CSF to a receptor, but is inactive.
  • proteins are often produced using recombinant expression technology. Such methods are widely are widely known in the art. General molecular biology methods, including expression methods, can be found, e.g., in instruction manuals, such as, Sambrook and Russell (2001) Molecular Cloning: A laboratory manual 3rd ed. Cold Spring Harbor Laboratory Press; Current Protocols in Molecular Biology (2006) John Wiley and Sons ISBN: 0-471-50338-X.
  • prokaryotic and/or eukaryotic based protein expression systems may be employed to produce a GM-CSF antagonist protein. Many such systems are widely available from commercial suppliers. These include both prokaryotic and eukaryotic expression systems.
  • the GM-CSF antagonist is an antibody that binds to GM- CSF or an antibody that binds to the GM-CSF receptor ⁇ or ⁇ subunit.
  • the antibodies can be raised against GM-CSF (or GM-CSF receptor) proteins, or fragments, or produced recombinantly.
  • Antibodies to GM-CSF for use in the invention can be neutralizing or can be non-neutralizing antibodies that bind GM-CSF and increase the rate of in vivo clearance of GM-CSF such that the GM-CSF level in the circulation is reduced. Often, the GM-CSF antibody is a neutralizing antibody.
  • Polyclonal antibodies can be raised in a mammal by one or more injections of an immunizing agent and, if desired, an adjuvant.
  • the immunizing agent includes a GM-CSF or GM-CSF receptor protein, e.g., a human GM-CSF or GM-CSF receptor protein, or fragment thereof.
  • a GM-CSF antibody for use in the invention is purified from human plasma.
  • the GM-CSF antibody is typically a polyclonal antibody that is isolated from other antibodies present in human plasma. Such an isolation procedure can be performed, e.g., using known techniques, such as affinity chromatography.
  • the GM-CSF antagonist is a monoclonal antibody.
  • Monoclonal antibodies may be prepared using hybridoma methods, such as those described by Kohler & Milstein, Nature 256:495 (1975).
  • a hybridoma method a mouse, hamster, or other appropriate host animal, is typically immunized with an immunizing agent, such as human GM-CSF, to elicit lymphocytes that produce or are capable of producing antibodies that will specifically bind to the immunizing agent.
  • the lymphocytes may be immunized in vitro.
  • the immunizing agent preferably includes human GM-CSF protein, fragments thereof, or fusion protein thereof.
  • Human monoclonal antibodies can be produced using various techniques known in the art, including phage display libraries (Hoogenboom & Winter, J. MoI. Biol. 227:381 (1991); Marks et al, J. MoI. Biol. 222:581 (1991)). The techniques of Cole et al. and Boerner et al. are also available for the preparation of human monoclonal antibodies (Cole et al., Monoclonal Antibodies and Cancer Therapy, p. 77 (1985) and Boerner et al., J. Immunol. 147(l):86-95 (1991)).
  • human antibodies can be made by introducing of human immunoglobulin loci into transgenic animals, e.g., mice in which the endogenous immunoglobulin genes have been partially or completely inactivated. Upon challenge, human antibody production is observed, which closely resembles that seen in humans in all respects, including gene rearrangement, assembly, and antibody repertoire. This approach is described, e.g., in U.S. Patent Nos.
  • the anti-GM-CSF antibodies are chimeric or humanized monoclonal antibodies.
  • humanized forms of antibodies are chimeric immunoglobulins in which residues from a complementary determining region (CDR) of human antibody are replaced by residues from a CDR of a non-human species such as mouse, rat or rabbit having the desired specificity, affinity and capacity.
  • CDR complementary determining region
  • an antibody that is employed in the invention can be in any format.
  • the antibody can be a complete antibody including a constant region, e.g., a human constant region, or can be a fragment or derivative of a complete antibody, e.g., an Fd, a Fab, Fab', F(ab')2, a scFv, an Fv fragment, or a single domain antibody, such as a nanobody or a camelid antibody.
  • Such antibodies may additionally be recombinantly engineered by methods well known to persons of skill in the art. As noted above, such antibodies can be produced using known techniques.
  • the antibody is additionally engineered to reduced immunogenicity, e.g., so that the antibody is suitable for repeat administration.
  • Methods for generating antibodies with reduced immunogenicity include humanization/humaneering procedures and modification techniques such as de- immunization, in which an antibody is further engineered, e.g., in one or more framework regions, to remove T cell epitopes.
  • the antibody is a humaneered antibody.
  • a humaneered antibody is an engineered human antibody having a binding specificity of a reference antibody, obtained by joining a DNA sequence encoding a binding specificity determinant (BSD) from the CDR3 region of the heavy chain of the reference antibody to human VH segment sequence and a light chain CDR3 BSD from the reference antibody to a human VL segment sequence.
  • BSD binding specificity determinant
  • An antibody can further be de-immunized to remove one or more predicted T-cell epitopes from the V-region of an antibody. Such procedures are described, for example, in WO 00/34317.
  • variable region is comprised of human V-gene sequences.
  • a variable region sequence can have at least 80% identity, or at least 85% identity, at least 90% identity, at least 95% identity, at least 96% identity, at least 97% identity, at least 98% identity, or at least 99% identity, or greater, with a human germ-line V- gene sequence.
  • An antibody used in the invention can include a human constant region.
  • the constant region of the light chain may be a human kappa or lambda constant region.
  • the heavy chain constant region is often a gamma chain constant region, for example, a gamma- 1, gamma-2, gamma-3, or gamma-4 constant region.
  • the antibody can be conjugated to another molecule, e.g., to provide an extended half-life in vivo such as a polyethylene glycol (pegylation) or serum albumin.
  • An antibody for use in the invention binds to GM-CSF or GM-CSF receptor. Any number of techniques can be used to determine antibody binding specificity. See, e.g., Harlow & Lane, Antibodies, A Laboratory Manual (1988) for a description of immunoassay formats and conditions that can be used to determine specific immunoreactivity of an antibody.
  • An exemplary antibody suitable for use with the present invention is cl9/2 (a human mouse chimeric anti-GM-CSF antibody).
  • a monoclonal antibody that competes for binding to the same epitope as cl9/2, or that binds the same epitope as cl9/2 is used.
  • the ability of a particular antibody to recognize the same epitope as another antibody is typically determined by the ability of the first antibody to competitively inhibit binding of the second antibody to the antigen.
  • Any of a number of competitive binding assays can be used to measure competition between two antibodies to the same antigen.
  • a sandwich ELISA assay can be used for this purpose. This is carried out by using a capture antibody to coat the surface of a well.
  • a subsaturating concentration of tagged-antigen is then added to the capture surface.
  • This protein will be bound to the antibody through a specific antibody:epitope interaction.
  • a second antibody which has been covalently linked to a detectable moiety (e.g., HRP, with the labeled antibody being defined as the detection antibody) is added to the ELISA. If this antibody recognizes the same epitope as the capture antibody it will be unable to bind to the target protein as that particular epitope will no longer be available for binding. If however this second antibody recognizes a different epitope on the target protein it will be able to bind and this binding can be detected by quantifying the level of activity (and hence antibody bound) using a relevant substrate.
  • HRP detectable moiety
  • the background is defined by using a single antibody as both capture and detection antibody, whereas the maximal signal can be established by capturing with an antigen specific antibody and detecting with an antibody to the tag on the antigen.
  • antibodies can be assessed in a pair-wise manner to determine epitope specificity.
  • a first antibody is considered to competitively inhibit binding of a second antibody, if binding of the second antibody to the antigen is reduced by at least 30%, usually at least about 40%, 50%, 60% or 75%, and often by at least about 90%, in the presence of the first antibody using any of the assays described above.
  • an antibody is employed that competes with binding, or bind, to the same epitope as a known antibody, e.g., cl9/2.
  • Method of mapping epitopes are well known in the art. For example, one approach to the localization of functionally active regions of human granulocyte -macrophage colony-stimulating factor (hGM-CSF) is to map the epitopes recognized by neutralizing anti-hGM-CSF monoclonal antibodies.
  • hGM-CSF human granulocyte -macrophage colony-stimulating factor
  • the epitope to which cl9/2 (which has the same variable regions as the neutralizing antibody LMM 102) binds has been defined using proteolytic fragments obtained by enzymic digestion of bacterially synthesized hGM-CSF (Dempsey, et al, Hybridoma 9:545-558, 1990). RP-HPLC fractionation of a tryptic digest resulted in the identification of an immunoreactive "tryptic core" peptide containing 66 amino acids (52% of the protein). Further digestion of this "tryptic core" with S.
  • aureus V8 protease produced a unique immunoreactive hGM-CSF product comprising two peptides, residues 86-93 and 112- 127, linked by a disulfide bond between residues 88 and 121. The individual peptides, were not recognized by the antibody.
  • the antibodies suitable for use with the present invention have a high affinity binding for human GM-CSF or GM-CSF receptor.
  • High affinity binding between an antibody and an antigen exists if the dissociation constant (K D ) of the antibody is ⁇ about 10 nM, typically ⁇ 1 nM, and preferably ⁇ 100 pM.
  • the antibody has a dissociation rate of about 10 "4 per second or better.
  • a variety of methods can be used to determine the binding affinity of an antibody for its target antigen such as surface plasmon resonance assays, saturation assays, or immunoassays such as ELISA or RIA, as are well known to persons of skill in the art.
  • An exemplary method for determining binding affinity is by surface plasmon resonance analysis on a BIAcoreTM 2000 instrument (Biacore AB, Freiburg, Germany) using CM5 sensor chips, as described by Krinner et al, (2007) MoI. Immunol. Feb;44(5):916-25. (Epub 2006 May H)).
  • the GM-CSF antagonists are neutralizing antibodies to GM- CSF, or its receptor, which bind in a manner that interferes with the binding of GM- CSF.
  • an anti-GM-CSF antibody for use in the invention inhibits binding to the alpha subunit of the GM-CSF receptor.
  • Such an antibody can, for example, bind to GM-CSF at the region where GM-CSF binds to the receptor and thereby inhibit binding.
  • Neutralizing antibodies and other GM-CSF antagonists may be identified using any number of assays that assess GM-CSF function.
  • cell-based assays for GM-CSF receptor signaling such as assays which determine the rate of proliferation of a GM-CSF- dependent cell line in response to a limiting amount of GM-CSF, are conveniently used.
  • the human TF-I cell line is suitable for use in such an assay. See, Krinner et al., (2007) MoI. Immunol.
  • the neutralizing antibodies of the invention inhibit GM- CSF-stimulated TF-I cell proliferation by at least 50% when a GM-CSF concentration is used which stimulates 90% maximal TF-I cell proliferation.
  • the neutralizing antibodies inhibit GM-CSF stimulated proliferation by at least 90%.
  • a neutralizing antibody, or other GM-CSF antagonist for use in the invention has an EC50 of less than 10 nM ⁇ e.g., Table 1). Additional assays suitable for use in identifying neutralizing antibodies suitable for use with the present invention will be well known to persons of skill in the art.
  • Antibodies for use in the invention are known in the art and can be produced using routine techniques. Exemplary antibodies are described. It is understood that the exemplary antibodies can be engineered in accordance with the procedures known in the art and summarized herein to produce antibody fragments, chimeras, and the like by either chemical or recombinant technology.
  • An exemplary chimeric antibody suitable for use as a GM-CSF antagonist is cl9/2.
  • the c 19/2 antibody binds GM-CSF with a monovalent binding affinity of about lOpM as determined by surface plasmon resonance analysis.
  • the heavy and light chain variable region sequences of cl9/2 are known (e.g., WO03/068920).
  • the CDRs, as defined according to Kabat, are:
  • the CDRs can also be determined using other well known definitions in the art, e.g., Chothia, international ImMunoGeneTics database (IMGT), and AbM.
  • IMGT international ImMunoGeneTics database
  • an antibody used in the invention competes for binding to, or binds to, the same epitope as cl9/2.
  • the GM-CSF epitope recognized by cl9/2 has been identified as a product that has two peptides, residues 86-93 and residues 112-127, linked by a disulfide bond between residues 88 and 121.
  • the cl9/2 antibody inhibits the GM-CSF- dependent proliferation of a human TF-I leukemia cell line with an EC 50 of 30 pM when the cells are stimulated with 0.5 ng/ml GM-CSF.
  • the antibody used in the invention binds to the same epitope as cl9/2.
  • An antibody for administration such as cl9/2
  • the cl9/2 antibody can be further engineered to contain human V gene segments.
  • a GM-CSF-binding antibody of the invention is generated where, an antibody that has a CDR from one of the VH-regions of the invention shown in Figure 1, is combined with one an antibody having a CDR of one of the V L -regions shown in Figure 1, and expressed in any of a number of formats in a suitable expression system.
  • the antibody may be expressed as a scFv, Fab, Fab' (containing an immunoglobulin hinge sequence), F(ab') 2 , (formed by di-sulfide bond formation between the hinge sequences of two Fab' molecules), whole immunoglobulin or truncated immunoglobulin or as a fusion protein in a prokaryotic or eukaryotic host cell, either inside the host cell or by secretion.
  • a methionine residue may optionally be present at the N-terminus, for example, in polypeptides produced in signal-less expression systems.
  • Each of the VH-regions described herein may be paired with each of the V L regions to generate an anti-GM-CSF antibody.
  • the antibody VL region e.g., VK#1 , VK#2, VK#3, or VK#4 of Figure 1
  • a human kappa constant region to form the complete light- chain.
  • the VH region is combined a human gamma- 1 constant regions. Any suitable gamma- 1 allotype can be chose, such as the f-allotype.
  • the antibody is an IgG , e.g., having an f-allotype, that has a V H selected from VH#1, VH#2, VH#3, VH#4, or VH#5 ( Figure 1), and a V L selected from VK#1, VK#2, VK#3, or VK#4 ( Figure 1.)
  • the antibody can be conjugated to another molecule, e.g., polyethylene glycol (PEGylation) or serum albumin, to provide an extended half-life in vivo .
  • PEGylation polyethylene glycol
  • serum albumin serum albumin
  • the antibodies of the invention are in the form of a Fab' fragment.
  • a full-length light chain is generated by fusion of a V L -region to human kappa or lambda constant region.
  • Either constant region may be used for any light chain; however, in typical embodiments, a kappa constant region is used in combination with a Vkappa variable region and a lambda constant region is used with a Vlambda variable region.
  • the heavy chain of the Fab' is a Fd' fragment generated by fusion of a V H -region of the invention to human heavy chain constant region sequences, the first constant (CHl) domain and hinge region.
  • the heavy chain constant region sequences can be from any of the immunoglobulin classes, but is often from an IgG, and may be from an IgGl, IgG2, IgG3 or IgG4.
  • the Fab' antibodies of the invention may also be hybrid sequences, e.g., a hinge sequence may be from one immunoglobulin sub-class and the CHl domain may be from a different sub-class.
  • Two other examples of neutralizing anti-GM-CSF antibody are the human ElO antibody and human G9 antibody described in Li et al, (2006) PNAS 103(10):3557-3562.
  • ElO and G9 are IgG class antibodies.
  • ElO has an 870 pM binding affinity for GM-CSF and G9 has a 14 pM affinity for GM-CSF. Both antibodies are specific for binding to human GM-CSF and show strong neutralizing activity as assessed with a TFl cell proliferation assay.
  • An additional exemplary neutralizing anti-GM-CSF antibody is the MT203 antibody described by Krinner et al, (MoI Immunol. 44:916-25, 2007; Epub 2006 May 112006).
  • MT203 is an IgGl class antibody that binds GM-CSF with picomolar affinity. The antibody shows potent inhibitory activity as assessed by TF-I cell proliferation assay and its ability to block IL-8 production in U937 cells.
  • GM-CSF antagonists that are anti-GM-CSF receptor antibodies can also be employed in the invention.
  • Such GM-CSF antagonists include antibodies to the GM-CSF receptor alpha chain or beta chain.
  • An anti-GM-CSF receptor antibody employed in the invention can be in any antibody format as explained above, e.g., intact, chimeric, monoclonal, polyclonal, antibody fragment, humanized, humaneered, and the like.
  • anti-GM-CSF receptor antibodies e.g., neutralizing, high-affinity antibodies, suitable for use in the invention are known (see,, e.g., US Patent 5,747,032 and Nicola et al., Blood 82: 1724, 1993).
  • GM-CSF receptor antagonist can be prepared by fusing the coding region of the sGM-CSFRalpha with the CH2-CH3 regions of murine IgG2a.
  • An exemplary soluble GM-CSF receptor is described by Raines et al. (1991) Proc. Natl. Acad. Sci USA 88: 8203.
  • GM-CSFRalpha- Fc fusion protein An example of a GM-CSFRalpha- Fc fusion protein is provided, e.g., in Brown et al (1995) Blood 85: 1488.
  • the Fc component of such a fusion can be engineered to modulate binding, e.g., to increase binding, to the Fc receptor.
  • GM-CSF antagonists include GM-CSF mutants.
  • GM-CSF having a mutation of amino acid residue 21 of GM-CSF to Arginine or Lysine (E21R or E21K) described by Hercus et al. Proc. Natl. Acad. Sci USA 91 :5838, 1994 has been shown to have in vivo activity in preventing dissemination of GM-CSF-dependent leukemia cells in mouse xenograft models (Iversen et al. Blood 90:4910, 1997).
  • such antagonists can include conservatively modified variants of GM-CSF that have substitutions, such as the substitution noted at amino acid residue 21, or GM-CSF variants that have, e.g., amino acid analogs to prolong half-life.
  • the GM-CSF antagonist may be a peptide.
  • a GM-CSF peptide antagonist may be a peptide designed to structurally mimic the positions of specific residues on the B and C helices of human GM-CSF that are implicated in receptor binding and bioactivity (e.g., Monfardini et al, J. Biol. Chem 271 :2966-2971, 1996).
  • the GM-CSF antagonist is an "antibody mimetic" that targets and binds to the antigen in a manner similar to antibodies.
  • Certain of these "antibody mimics” use non-immunoglobulin protein scaffolds as alternative protein frameworks for the variable regions of antibodies. For example, Ku et al. (Proc. Natl. Acad. Sci. U.S.A.
  • 92(14):6552-6556 (1995) discloses an alternative to antibodies based on cytochrome b562 in which two of the loops of cytochrome b562 were randomized and selected for binding against bovine serum albumin. The individual mutants were found to bind selectively with BSA similarly with anti-BSA antibodies.
  • U.S. Patent Nos. 6,818,418 and 7,115,396 disclose an antibody mimic featuring a fibronectin or f ⁇ bronectin-like protein scaffold and at least one variable loop. Known as Adnectins, these fibronectin-based antibody mimics exhibit many of the same characteristics of natural or engineered antibodies, including high affinity and specificity for any targeted ligand.
  • these f ⁇ bronectin-based antibody mimics are similar to the structure of the variable region of the IgG heavy chain. Therefore, these mimics display antigen binding properties similar in nature and affinity to those of native antibodies. Further, these fibronectin-based antibody mimics exhibit certain benefits over antibodies and antibody fragments. For example, these antibody mimics do not rely on disulfide bonds for native fold stability, and are, therefore, stable under conditions which would normally break down antibodies. In addition, since the structure of these fibronectin-based antibody mimics is similar to that of the IgG heavy chain, the process for loop randomization and shuffling may be employed in vitro that is similar to the process of affinity maturation of antibodies in vivo.
  • Lipocalins are composed of a ⁇ - barrel with four hypervariable loops at the terminus of the protein. The loops were subjected to random mutagenesis and selected for binding with, for example, fluorescein. Three variants exhibited specific binding with fluorescein, with one variant showing binding similar to that of an anti-fluorescein antibody. Further analysis revealed that all of the randomized positions are variable, indicating that Anticalin® would be suitable to be used as an alternative to antibodies. Thus, Anticalins® are small, single chain peptides, typically between 160 and 180 residues, which provides several advantages over antibodies, including decreased cost of production, increased stability in storage and decreased immunological reaction.
  • U.S. Patent No. 5,770,380 discloses a synthetic antibody mimetic using the rigid, non-peptide organic scaffold of calixarene, attached with multiple variable peptide loops used as binding sites.
  • the peptide loops all project from the same side geometrically from the calixarene, with respect to each other. Because of this geometric confirmation, all of the loops are available for binding, increasing the binding affinity to a ligand.
  • the calixarene-based antibody mimic does not consist exclusively of a peptide, and therefore it is less vulnerable to attack by protease enzymes.
  • the scaffold consist purely of a peptide, DNA or RNA, meaning this antibody mimic is relatively stable in extreme environmental conditions and has a long life span. Further, since the calixarene-based antibody mimic is relatively small, it is less likely to produce an immunogenic response.
  • non-antibody GM-CSF antagonists can also include such compounds.
  • the methods of the invention typically comprise administering a GM-CSF antagonist, (e.g., an anti-GM-CSF antibody) as a pharmaceutical composition to a patient suffering from one or more of Alzheimer's disease, vascular dementia, or CAA; or to a patient at risk of developing Alzheimer's and/or vascular dementia, in a therapeutically effective amount using a dosing regimen suitable for treatment of the disease.
  • a therapeutically effective amount is an amount that at least partially arrests symptoms and/or slows the progression or onset of Alzheimer's disease, vascular dementia, or CAA.
  • a therapeutically effective amount may slow deposition of amyloid, or reduce the size or number of amyloid plaques, in the brain and/or blood vessels.
  • the methods of the invention successfully treat a patient having Alzheimer's disease or vascular dementia by improving performance of memory task tests and/or slowing or preventing the rate of, or extent of, cognitive decline. Effectiveness may also be measured by assessing other parameters, such as biochemical markers or evaluating brain structure using CT scanning, MRI or PET scanning.
  • the composition can be formulated for use in a variety of drug delivery systems.
  • One or more physiologically acceptable excipients or carriers can also be included in the compositions for proper formulation.
  • Suitable formulations for use in the present invention are found in Remington: The Science and Practice of Pharmacy, 21st Edition, Philadelphia, PA. Lippincott Williams & Wilkins, 2005. For a brief review of methods for drug delivery, see, Langer, Science 249: 1527-1533 (1990).
  • the GM-CSF antagonist for use in the methods of the invention is provided in a solution suitable for injection into the patient such as a sterile isotonic aqueous solution for injection.
  • the GM-CSF antagonist is dissolved or suspended at a suitable concentration in an acceptable carrier.
  • the carrier is aqueous, e.g., water, saline, phosphate buffered saline, and the like.
  • the compositions may contain auxiliary pharmaceutical substances as required to approximate physiological conditions, such as pH adjusting and buffering agents, tonicity adjusting agents, and the like.
  • Amounts that are administered that are effective will depend upon the severity of the disease and the general state of the patient's health, including other factors such as age, weight, gender, administration route, etc. Single or multiple administrations of the antagonist may be administered depending on the dosage and frequency as required and tolerated by the patient. In any event, the methods provide a sufficient quantity of GM-CSF antagonist in an amount to effectively treat the patient.
  • the quantity of GM-CSF antagonist, e.g., anti-GM-CSF administered to the patient is an amount that results in improvement in performance on cognition tests used to measure cognitive function in dementia (see, e.g. Qaseem et al, Annals of Internal Medicine 148:370-378, 2008).
  • the primary scales used to measure the domain of cognition deficits include the Alzheimer's Disease Assessment Scale (ADAS) cognitive subscale (ADAS-cog), noncognitive subscale (ADAS-noncog) and total score (ADAS-tot); Mini-Mental State Examination (MMSE) or standardized MMSE; and the Severe Impairment Battery (SIB).
  • ADAS Alzheimer's Disease Assessment Scale
  • ADAS-cog cognitive subscale
  • ADAS-noncog noncognitive subscale
  • ADAS-tot total score
  • MMSE Mini-Mental State Examination
  • SIB Severe Impairment Battery
  • the primary scale used include clinician-based impression of change (CIBIC) (with caregiver input [CIBIC- plus] and other modified versions).
  • CIBIC clinician-based impression of change
  • a patient receiving a therapeutically effective amount of a GM-CSF antagonist, e.g., an anti-GM-CSF antibody may demonstrate improvement in performance on any one of these tests, or alternative measures of cognitive function known in the art, or on multiple tests. Improvement is generally determined relative to a baseline value for cognitive function in the patient prior to treatment with a GM-CSF antagonist.
  • administration of an GM-CSF antagonist, e.g., an anti-GM-CSF antibody to a patient results in maintained cognitive function where a patient does not exhibit a decline in cognitive function as measure by any a standard test.
  • the GM-CSF antagonist used to treat a patient suffering from at least one of Alzheimer's disease, vascular dementia, or CAA; or who is at risk for developing Alzheimer's disease and/or vascular dementia is provided in combination with one or more additional therapeutic agents for the treatment of the disease.
  • Patients can receive the one or more additional therapeutic agents as concomitant therapy.
  • patients may be treated sequentially, in any order, with the additional therapeutic agent(s) and GM-CSF antagonist.
  • additional therapeutic agents include an anti-beta-amyloid antibody, e.g., bapineuzumab; an amyloid-beta (a ⁇ ) vaccine; cholesterol-lowering agents such as statins or inhibitors of acyl-coenzyme Axholesterol acyltransferase (ACAT); nonsteroidal anti-inflammatory drugs; an acetyl cholinesterase inhibitor, such as ARICEPT® (donepezil), EXELON® (rivastigmine), or RAZAD YNE® (galantamine); an NMDA receptor antagonist, such as NAMEND A® (memantine); an antagonist to the receptor for advanced glycation endproducts (RAGE); a beta-secretase inhibitor; a gamma secretase inhibitor; IVIG, or a neuroprotective agent such as DIMEBON® (dimebolin).
  • ACAT acyl-coenzyme Axholesterol acyltransferase
  • the GM-CSF antagonist is administered by injection or infusion through any suitable route including but not limited to intravenous, perispinal, subcutaneous, intramuscular, intranasal, perispinal, intrathecal, intraspinal or intraperitoneal routes.
  • the GM-CSF antagonist is diluted in a physiological saline solution for injection prior to administration to the patient.
  • Such an antagonist is administered, for example, by intravenous infusion over a period of between 15 minutes and 2 hours.
  • the administration procedure is via sub-cutaneous or intramuscular injection.
  • the GM-CSF antagonist e.g., an anti-GM-CSF antibody
  • a perispinal route is administered by a perispinal route.
  • Perispinal administration involves anatomically localized delivery performed so as to place the therapeutic molecule directly in the vicinity of the spine at the time of initial administration. Perispinal administration is described, e.g., in U.S. Patent No. 7,214,658 and in Tobinick & Gross, J. Neuroinflammation 5:2, 2008.
  • the dose of GM-CSF antagonist is chosen in order to provide effective therapy for a patient that has been diagnosed with one ore more of Alzheimer's disease, vascular dementia, or CAA, or is at risk for developing Alzheimer's disease or vascular dementia.
  • the dose is typically in the range of about 0.1 mg/kg body weight to about 25 mg/kg body weight or in the range about 1 mg to about 2 g per patient.
  • the dose is often in the range of about 1 to about 10 mg/kg or approximately about 50 mg to about 1000 mg / patient.
  • the dose may be repeated at an appropriate frequency which may be in the range once per day to once every three months, depending on the pharmacokinetics of the antagonists (e.g.
  • the in vivo half- life of the antibody in the circulation is repeated between once per week and once every 3 months. In other embodiments, the antibody is administered approximately once per month.
  • a panel of engineered Fab' molecules with the specificity of cl9/2 were generated from epitope-focused human V-segment libraries as described in US patent application publication nos. 20060134098 and 20050255552.
  • Full-length engineered V-regions from a VhI -restricted library were selected that supported binding to recombinant human GM-CSF.
  • the "full-length" V-kappa library was used as a base for construction of "cassette” libraries as described in US patent application publication no. 20060134098, in which only part of the murine cl9/2 V-segment was initially replaced by a library of human sequences. Two types of cassettes were constructed.
  • Binding activity was determined by surface plasmon resonance (spr) analysis. Biotinylated GM-CSF was captured on a streptavidin-coated CM5 biosensor chip. Humaneered Fab fragments expressed from E. coli were diluted to a starting concentration of 30 nM in 10 mM HEPES, 150 mM NaCl, 0.1 mg/ml BSA and 0.005% P20 at pH 7.4. Each Fab was diluted 4 times using a 3 -fold dilution series and each concentration was tested twice at 37 degrees C to determine the binding kinetics with the different density antigen surfaces. The data from all three surfaces were fit globally to extract the dissociation constants.
  • spr surface plasmon resonance
  • Binding kinetics were analyzed by Biacore 3000 surface plasmon resonance (SPR). Recombinant human GM-CSF antigen was biotinylated and immobilized on a streptavidin CM5 sensor chip. Fab samples were diluted to a starting concentration of 3 nM and run in a 3 fold dilution series. Assays were run in 10 mM HEPES, 150 mM NaCl, 0.1 mg/mL BSA and 0.005% p20 at pH 7.4 and 37°C. Each concentration was tested twice. Fab' binding assays were run on two antigen density surfaces providing duplicate data sets. The mean affinity (K D ) for each of 6 various humaneered anti-GM-CSF Fab clones, calculated using a 1 : 1 Langmuir binding model, is shown in Table 1.
  • Fabs were tested for GM-CSF neutralization using a TF-I cell proliferation assay.
  • GM-CSF-dependent proliferation of human TF-I cells was measured after incubation for 4 days with 0.5 ng/ml GM-CSF using a MTS assay (Cell titer 96, Promega) to determine viable cells. All Fabs inhibited cell proliferation in this assay indicating that these are neutralizing antibodies.
  • MTS assay Cell titer 96, Promega
  • Table 1 Affinity of anti-GM-CSF Fabs determined by surface plasmon resonance analysis in comparison with activity (EC 50 ) in a GM-CSF dependent TF-I cell proliferation assay
  • Example 2 Administration of a GM-CSF antibody in a mouse model of Alzheimer's disease
  • Transgenic mice over-expressing a mutant human amyloid precursor protein (hAPP) were used to evaluate the role of anti-mouse GM-CSF antibody 22E9 in an animal model of amyloid deposit-associated dementia.
  • Mice over-expressing human APP(751) protein with three point mutations (K670M, N671L and V717I) under the control of the murine Thy-1 promoter were used (APP751-SL mice) on a C57BL/6xDBA genetic background. This line of transgenic mice shows a consistent age-dependent increase in accumulation of amyloid beta peptides 40 and 42 (A ⁇ 40, A ⁇ 42) in the brain.
  • mice develop plaques in the brain consisting of amyloid deposits, starting at approximately 4 to 6 months and show progressive deficits in learning and memory. By 8 months of age, the mice show a strongly developed amyloid pathology accompanied by inflammatory processes including prominent astrocytosis and microgliosis around mature neuritic amyloid plaques (Wang et al., Vaccine 25:3041, 2007; Hutter-Paier et al., Neuron 44:227, 2004).
  • 22E9 rat monoclonal anti-mouse GM-CSF antibody (R&D Systems) was administered by three different routes to female hAPP751-SL mice aged at least 10 months. Intracerebroventricular injection (i.e.); intranasal administration (i.n.); and intravenous injection (i.v.) were evaluated using a single dose of antibody (0.25 mg i.n., 0.25 mg iv. and 25 ⁇ g i.c). Mice were sacrificed 48 hours post inoculation and brain histology was carried out.
  • mice at an age of 8 months ( ⁇ 2 weeks) were randomly allocated to treatment groups (13 mice per group) and treated with rat anti-mouse GM-CSF antibody 22E9 (R&D Systems), or with rat IgG2a isotype control antibody, or with the vehicle phosphate buffered saline solution (PBS).
  • Antibody or vehicle were administered intravenously twice weekly for 2 months.
  • mice Forty four days after the initiation of treatment, mice were trained in the MWM spatial navigation task in which mice swim to locate a hidden platform using visual cues. The task is based on the principle that mice are motivated to escape from a water environment by the most direct route.
  • the Morris Water Maze task was conducted in a black circular pool of diameter 100 cm filled with water at a temperature of 21 ⁇ 2°C, divided virtually into four sectors. A transparent platform was placed in the southwest quadrant 0.5 cm beneath the water surface.
  • animals were evaluated in a "pre-test" consisting of two 60 s trials, to ensure that the vision of each animal was normal.
  • mice were evaluated in three trials per day (each lasting 1 minute) for four consecutive days. Escape latency (time to find the hidden platform) and length of swimming path were measured. Differences between animals in treatment and control groups were analyzed by Student's t-tests to determine statistical significance.
  • CFC Contextual Fear Conditioning Task
  • mice were trained and tested on 2 consecutive days starting at Day 51 of the study. Training consisted of placing a subject into the test chamber and allowing exploration for 2 min. Thereafter, an auditory cue [2 Hz; conditional stimulus (CS)] was presented for 15 sec. An electric shock [1.5 mAmp; unconditioned stimulus (US)] was given for the final 2 sec of the CS. This procedure was repeated, and mice were removed from the chamber. Twenty hours after training, mice were returned to the training chambers (context conditioned response), and freezing behavior was recorded automatically. At the end of the 5 min contextual testing, mice were returned to their home cage. Approximately 1 h later, freezing was recorded in a novel environment and in response to the cue. In the CFC task, duration of freezing behavior of each subject, expressed as a percentage of each part of the test, was recorded. Histology
  • Brain hemispheres from 6 animals in each treatment group were used to provide sagittal sections (10 ⁇ m thick) using a cryotome for the determination of plaque load visualized by a ThioflavinS staining or with an amyloid specific antibody (anti-hAPP clone 6E10 (Signet 1 : 5000)) and fluorescent Cy3-labeled secondary antibody (Jackson Immunoresearch).
  • the estimation of plaque size, area and number were determined using computer-aided quantification. Uptake of 22E9 antibody into the brain was visualized using an anti-rat IgG antibody labeled with HistoGreen (Linaris®).
  • Uptake of 22E9 into the brain was first evaluated by three different routes of administration in hAPP751-SL mice: intracerebroventricular injection (i.e.); intranasal administration (i.n.); and intravenous injection (i.v.).
  • a single dose of antibody was administered (0.25 mg i.n., 0.25 mg iv. and 25 ⁇ g i.c) to mice aged at least 10 months and brain histology was carried out 48 hours post-administration.
  • Staining with anti-rat IgG- specific antibody demonstrated that i.c. treatment led to clear uptake of 22E9 with particularly intense labeling of regions associated with hippocampal and thalamic plaques. Both i.v. and i.n.
  • mice Eight-month old male transgenic APP751 -SL mice were then treated by twice weekly i.v. administration with 22E9 anti-GM-CSF antibody at 10 mg/kg or with isotype- matched (rat IgG2a) control antibody at the same dose level or vehicle alone (PBS). From Day 44 after the initiation of treatment (after 13 doses of antibody), mice were evaluated in the Morris Water Maze. Mice treated with anti-GM-CSF antibody 22E9 showed improved learning ability in this task over the 4 days of evaluation compared with vehicle treated or isotype control-treated mice (see Figure 3). The difference in swimming path length between anti-GM-CSF treated and isotype control treated mice achieved statistical significance by Day 4 of the test. The escape latency also showed a trend to improvement by Day 4 of the test in the anti-GM-CSF treated mice compared with the group receiving the control antibody but the difference did not achieve statistical significance.
  • mice were evaluated in a contextual fear study in which the freezing behavior in response to a training chamber and auditory cue was evaluated.
  • Anti-GM-CSF treated mice showed a tendency to freeze for a longer time when placed in the training chamber compared with vehicle or isotype-control treated mice (see Figure 4). No differences in response to auditory cues were observed in this experiment.
  • Tg2576 The effects of administration of an anti-GM-CSF antibody in another transgenic AD mouse model were also investigated, the Tg2576 model.
  • This Alzheimer's disease mouse model was generated using mutant human APP gene 695 amino acid isoform with a double mutation (K670N and M671L).
  • Administration of anti-GM-CSF directly into the brains of Tg2576 mice decreased soluble a ⁇ i_ 42 production and suppressed microglial activity in the mice (Maczak et al, Hum. Molec. Genet. 18:3876-3893, 2009).
  • the above examples are provided by way of illustration only and not by way of limitation. Those of skill in the art will readily recognize a variety of noncritical parameters that could be changed or modified to yield essentially similar results.

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Abstract

La présente invention concerne la découverte que des antagonistes de GM-CSF peuvent être utilisés pour le traitement d'un patient qui a la maladie d'Alzheimer ou une démence vasculaire, ou présente un risque de développer la maladie d'Alzheimer. En conséquence, l'invention concerne des procédés d'administration d'un antagoniste de GM-CSF, par exemple, un anticorps anti-GM-CSF et des compositions pharmaceutiques comprenant de tels antagonistes.
PCT/US2010/023931 2009-02-11 2010-02-11 Procédés de traitement de la démence en utilisant un antagoniste de gm-csf WO2010093814A1 (fr)

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