Selective inhibition of the membrane attack complex
of complement and C3 convertase by low molecular weight components of the aurin
tricarboxylic acid synthetic complex
Technical Field
Synthesis of the aurin tricarboxylic acid
complex
Synthesis of the aurin tricarboxylic acid complex
was carried out according to the published standard procedure (Cushman and
Kanamathareddy, 1990).
- Synthesis of
3,3'-dichloro-5,5'-dicarboxy-4,4'-dihydroxydiphenylmethane:
3-Chlorosalicylic acid (1 g) was dissolved in methanol (10 ml). Water (2.5 ml)
was added and the flask was cooled to -5°C in an ice-salt (NaCl) bath.
Concentrated sulfuric acid (30 ml) was slowly added over 20 min with the
temperature being maintained at -5ºC. The reaction mixture was then stirred at
this temperature for 1 h while a solution of 37% formaldehyde (4 ml) was added.
The temperature was maintained at 0°C for 1 h and then the mixture was left at
room temperature for a further 24 h. The reaction mixture was poured into
crushed ice (150 g) and the precipitate filtered and dried to give the
product,3,3'-dichloro-5,5'-dicarboxy-4,4'-dihydroxydiphenylmethane (yield
0.92g, 92%) as a powder. The sample was recrystallized from methanol.
- Synthesis of 3,3'-
dicarboxy-4,4'-dlhydroxydiphenylmethane:
3,3'-Dichloro-5,5'-dicarboxy-4,4'-dihydroxydiphenylmethane (0.92 g) was
dissolved in ethanol (18 ml) and triethylamine (10 ml). Pallidiun on carbon was
added to the solution and the mixture was stirred under an atmosphere of
hydrogen for 48 h. The catalyst was filtered off, the solvent evaporated, and
water (100 ml) added to the residue. The solution was cooled, and concentrated
hydrochloric acid (5 ml) added. The white precipitate was filtered and dried to
give the product, 3,3'-dicarboxy-4,4'-dihydroxydiphenylmethane (0.75 g, 90%) as
a solid. It was dissolved and recrystallized from methanol. Powdered sodium
nitrite (4 g) was added with vigorous stirring to concentrated sulfuric acid (4
ml). A mixture of the compound 3,3'-Dicarboxy-4,4'-dihydroxydiphenylmethane
(0.75 g) and salicylic acid (0.38 g) was stirred until it was homogeneous. It
was then poured into the solution of sodium nitrite-sulfuric acid. Stirring was
continued at room temperature for an additional 18 h. The mixture was poured
into crushed ice (100 g) with stirring. The dark orange precipitate was
filtered and dried to give the crude product (0.6 g, yield 60 %). The powder
was dissolved in 2% ammonium hydroxide for analysis.
- 3,3',3'-tricarboxy-4,4',4'-trihydroxytriphenylcarbinol
complex (aurin tricarboxylic acid complex): Powdered sodium nitrite (4 g) was
added with vigorous stirring to concentrated sulfuric acid (4 ml). A mixture of
the compound 3,3'-Dicarboxy-4,4'-dihydroxydiphenylmethane (0.75 g) and
salicylic acid (0.38 g) was stirred until it was homogeneous. It was then
poured into the solution of sodium nitrite-sulfuric acid. Stirring was
continued at room temperature for an additional 18 h. The mixture was poured
into crushed ice (100 g) with stirring. The dark orange precipitate was
filtered and dried to give the crude product (0.6 g, yield 60 %). The powder
was dissolved in 2% ammonium hydroxide for analysis.
Separation and analysis of ATAC
The powder we obtained from synthesis, or
commercially purchased 'aurin tricarboxylic acid' from Sigma-Aldrich, or
Aluminon from GFS Chemicals Inc. (Columbus, OH) were separated into high and
low molecular weight components. In a typical experiment, five grams of
material were dissolved in 0.2 % ammonium hydroxide (45 ml) and forced through
a 1kDa filter (PLAC04310, Millipore, Ballerica, MA) under air pressure (70-75
Psi, 5.3 kg/cm2 for 6 h). The filtered material was recrystal l ized
by lyophilization. The filtrate (4.5 mg in 1 ml) was then loaded onto a size
exclusion chromatography column (Sephadex LH-20 packed in 60% ethanol, GE
healthcare, Piscataway, NJ). Three different eluant fractions were collected.
The three fractions, as well as the starting mixture, were analyzed by mass
spectrometry on a Waters ZQ apparatus equipped with an ESCI ion source and a
Waters Alliance Quadrupole detector. All samples were exposed to electron spray
ionization in positive and negative modes, as well as atmospheric pressure
chemical ionization. Scans ranged from m/z 0-1100 and m/z 500-1500. Three
molecules were detected of MW 422, 572, and 858. These molecular weights
correspond to ATA, AQA, and AHA respectively as shown in Figure 3. There was no
other derivative of less than 1.5 kDa detected. The components were separated
and analyzed by mass spectroscopy. Results from the three sources were almost
identical. The low MW components made up only 12- 16% of the total. They all
contained three molecules of MW 422, 572, and 858.
Evaluation of the low molecular weight products
as selective inhibitors of the membrane attack complex and C3 convertase
To evaluate the strength of blockade of the
classical complement pathway by the low molecular weight products of the aurin
tricarboxylic acid complex, (i.e. ATA plus AQA plus AHA), the standard CH50
assay was employed. Sheep red blood cells were sensitized by incubation
overnight with rabbit anti sheep red blood cell antibody. Then dilutions of
serum, with and without various amounts of the low molecular weight aurin
tricarboxylic acid fraction (ATAC), were incubated with the sensitized red
blood cells for 1 hour at 37°C. The incubates were centrifuged at 5,000 rpm for
10 min. The hemoglobin released into the serum from red blood cells that had
been destroyed by complement attack, was determined by reading the optical
density (OD) at 405 nm. As a positive control, red blood cells were 100% lysed
with water, and as a negative control, no serum was added to the incubate.
The results are shown in Figure 3. Each of these
components inhibited human complement-mediated red blood cell hemolysis almost
identically. IC50 values were for ATA 544 nM, for AQA 576 nM, for
AHA 559 nM and for ATAC 580 nM. The IC50 for ATAC in rat serum was
268 nM. These data establish that inhibition of complement activation by low
molecular weight aurin tricarboxylic acid derivatives is in the nanomolar range
and includes rodent as well as human serum
To determine at which stage of the complement
cascade blockade was occurring, a variation of the CH50 assay was carried out.
Instead of measuring hemolysis, western blot analyses were run to determine
which serum complement proteins were consumed and converted into activated
complement products on susceptible membranes. Complement proteins are consumed
and converted only up to the stage of blockade. At stages beyond the blockade,
they remain unchanged in the serum but their activated products appear on cell
membranes. Results are shown in Figure 4. Human serum was diluted 16 fold. It
was then treated for 30 min with ATA, AQA, AHA or ATAC. Then
antibody-conjugated sheep red blood cells in an equal volume were added. The
mixtures were incubated at 370C for 1 h. They were then treated with
a lysis buffer followed by a loading buffer for western blots. Equal amounts of
protein from each sample were loaded onto gels and separated by 10% SDS.
Following SDS, proteins were transferred to a PVDF membrane. The membranes were
then treated with various primary antibodies followed by labeled secondary
antibodies using well established techniques (Lee et al ., 2011). The list of
antibodies that were utilized is shown in Table 1. Bands recognized by the
antibodies were visualized by use of an enhanced chemiluminescence system and
exposure to photographic film. For probing the same membrane with different
antibodies, the membranes were treated with stripping buffer (Lee et al., 2011)
and then treated as before with a different primary antibody.
Typical results are shown in Figure 4a. The left
lane was loaded with serum only and shows that bands for C1q, C3, C4, and C5
were readily detected. The adjacent lane illustrates the effect of adding
sensitized red blood cells, which then become hemolyzed by complement attack.
Native serum proteins are consumed and become incorporated into the red cell
membranes. C1q was not metabolized, but the band was intensified due to its
dissociation from the C1 complex. Native C3 was no longer detected because it
had been cleaved, and the C3b fragment had become covalently attached to the
membrane. The degradation product C3d was detected. C4 was no longer detected
because it had similarly been cleaved and the C4b fragment attached to the
membrane and metabolized into the degradation product C4d. This fragment was
also detected. C5 was cleaved and a band for the C5a product detected. Finally,
the C5b-9 membrane attack complex, which had formed on the red cell membrane
causing its hemolysis, was detected.
The next membrane shows the effect of incubation
of serum plus sensitized red blood cells in the presence of the ATAC. Identical
bands for the opsonization steps were detected, but the red cells were not
hemolyzed and the membrane attack complex was not detected.
To determine at which stage of assembly of the
membrane attack complex was being blocked, additional analyses were carried.
The incubations were the same as before except that the red blood cells were
separated from the residual serum and washed prior to being treated for western
blot analysis. The blots were probed with antibodies to C6, C7, C8 and C9. The
results are shown in Figure 4b for ATAC, 4c for ATA, for 4d for AQA and 4e for
AHA. The results were identical for each component. Lane 1 for human serum
alone shows that C6, C7, C8 and C9 were readily detected in the untreated
serum. Lane 2 shows that in unprotected red blood cells that have become
hemolyzed by complement attack, these antibodies detected only C5b-9, the fully
formed membrane attack complex. Lane 3, in which the cells have been protected
by ATAC, shows that the membrane attack complex does not fully form but becomes
arrested at the C8 stage. The C6 antibody detected C5b6, C5b67, and C5b678. The
C7 antibody detected C5b67 and C5b678, while the C8 antibody detected C5b678.
These data establish that ATAC arrests formation of the membrane attack complex
at the stage where C9 attaches to C5b678. Since C9(n) is required for creating
the membrane destroying holes, this blockade is highly specific to preventing
C9 attachment.
To determine the effects of ATAC on the
alternative pathway, experiments were carried out where the classical pathway
was blocked with C1 inhibitor (1.8 micrograms/ml) or with a C4b antibody
(1,1000 dilution). For these experiments, human serum (15-fold dilution) was
incubated with C1 inhibitor and ATA (5 microM, lane 3), or ATA with either
properdin (1 microgm/ml, lane 4) or Factor D (0.1 microgm/ml, lane 5) for 1 h
before opsonized zymosan (1 microgm/ml) was added. The mixtures were incubated
for 1 h at 37ºC and centrifuged at 5,000 rpm for 10 min. The pellets were
washed two times with Hank's balanced salt solution (HBSS) and treated with
sample loading buffer for SDS-PAGE and immunoblotting. The buffer consisted of
50 mM Tris (pH 6.8), 0.1% SDS, 0.1% bromophenol blue and 10% glycerol. To
preserve the molecular complexes that had formed, mild conditions for SDS-PAGE
were followed. For C1q blotting, conventional sample loading buffer (50 mM Tris
(pH 6.8), 1% SDS, 0.1% bromophenol blue and 10% glycerol and 2%
beta-mercaptoethanol) was used.
Figure 5a shows the results when western blots of
these erythrocyte membranes were developed with monoclonal antibodies to
properdin (1/2,000), C3b (1/2,000), Factor B/Bb (1/2,000) and Factor D
(1/2,000) respectively. Lane 1 in each blot shows that the native
proteins were detected in untreated serum. Lane 2 shows that, in red blood
cells that have become hemolyzed by complement attack mediated by zymosan in
the presence of C1 inhibitor, similar bands were detected by antibodies to
properdin, C3b and Factor B/Bb corresponding in MW to PC3b (~240kDa), PC3bB
(~340 kDa), PC3bBb (~300 kDa) and PC3bBbC3b (>410 kDa). These data show that
C3 convertase and C5 convertase were present on the membranes. However an
independent band for C3b was not detected. This result indicates that C3b
required properdin to bind and direct its binding to the erythrocyte membranes.
The antibody to Factor D did not detect any bands for Factor D, indicating that
Factor D did not form any SDS stable complexes on the membranes. Lane 3 shows
the results obtained in the presence of 5 microM ATA. Bands for PC3bBb and
PC3bBbC3b did not form. Instead, strong bands for the earlier steps of PC3b and
PC3bB appeared. These results indicate that arrest of activation occurred at
the stage where PC3bB becomes cleaved by Factor D to form the C3 convertase
enzyme. Lanes 4 and 5 illustrate the effect of supplementing the serum with
properdin (1 microgm/ml) or Factor D (0.1 microgm/ml). The effect of ATA was
partially overcome. Weak bands for PC3bBb and PC3bBbC3b reappeared, although
the band for PC3bB persisted. No bands Factor D were observed. This result
provides further evidence that Factor D does not form a stable bond attached to
membranes but remains in the serum.
Figure 5b illustrates the effects on the residual
serum as shown by western blots developed with an antibody to C5/C5a. Treatment
with zymosan and C1 inhibitor resulted in disappearance of the C5 band and
appearance of the activation product C5a (lane 2). The addition of ATA and C1
inhibitor (lane 3) prevented cleavage of C5, which was partially antagonized by
treatment with properdin (lane 4) and Factor D (lane 5). Weaker bands for C5
appeared as well as faint bands for C5a indicating partial activation of serum
C5.
Figure 5c shows the effects of these treatments on
erythrocyte membranes developed with antibodies to the MAC components C5/C5b,
C6, C7, C8 and C9. Lane 1 shows that bands for C5, C6, C7, C8 and C9 were
readily detected in untreated serum. Lane 2 of membranes following serum
treatment with zymosan and C1 inhibitor, resulted in disappearance of each of
the protein bands and appearance of the MAC formation components C5b6, C5b67,
C5b678, and the fully formed C5b-9. Lane 3 in which ATA was added shows that
complete blockade appeared with no activation bands appearing on the membranes.
Lanes 4 and 5, where the serum was supplemented with properdin and Factor D
respectively, demonstrated partial activation of the complement system with
weaker bands for C5b6, C5b67, and C5b678 appearing, but there was still
blockade at the C5b-9 stage indicating that ATA was also blocking the addition
of C9 to C5b-8.
The next set of experiments directly tested the
binding of ATA to properdin, Factor D and complement proteins. These proteins
were immobilized on microwell plates in a concentration range of 1-32 ng/ml.
ATA was then added at a concentration of 100 microgm/ml and the solution
incubated as described in methods. ATA binding to the proteins was then assayed
according to our previously published fluorometric method (Lee et al. 2011)).
Figure 6 shows the results. There was no binding of ATA to properdin. Only
background fluorescence was observed. This result is consistent with
observations that properdin binding to erythrocyte membranes is unaffected by
ATA. But ATA bound to both Factor D and C9 in a concentration dependent manner.
Such binding explains why ATA blocks the alternative pathway at the stage where
Factor D cleaves PC3B to form PC3Bb, and both the classical and alternative
pathways at the stage where C9 adds to C5b678. However, other complement
proteins such as C2, C3, C4, C5, C6, C7, C8 and Factor B (32 ng/ml each) did
not bind with ATA .
In summary, Figure 7 is a diagram of the
alternative complement pathway showing the steps where ATA interferes.
Activation of the alternative pathway first requires properdin binding to a
target on the membrane. C3b can then attach to the bound properdin.
Subsequently Factor B can be added. The critical stage is cleavage of Factor B
on that complex to form C3 convertase (PC3bBb). Only then can significant
amounts of C3 still remaining in the serum be cleaved and joined to C3
convertase to form C5 convertase (PC3bBbC3b). Factor D carries out this
cleavage of Factor B. Since no bands incorporating Factor D were observed on
Western blots of erythrocyte membranes, Factor D in the serum is unlikely to
form a stable bond with membrane bound PC3bB. It may briefly attach to and
cleave bound Factor B, then dissociating and returning to the serum along with
Factor Ba. ATA interferes at this step, perhaps by binding to Factor D in
solution preventing its access to bound PC3bB. If this step is overcome, so
that C5 convertase can form (PC3bBbC3b), then ATA still blocks the addition of
C9 to C5b678, preventing formation of the MAC. Thus ATA provides a two step
inhibition of the alternative pathway and may be particularly efficacious in
conditions where unwanted activation of the alternative pathway occurs.
Synthesis and filtration of ATA-methylester
To illustrate that simple derivatives of ATAC also
have complement inhibiting properties, the methyl ester was synthesized and
tested by the CH50 assay on human serum. Briefly, ATAC (0.8 g) was dissolved in
methanol (16 ml). Concentrated sulfuric acid (610 microliters) was added. The
reaction mixture was refluxed at 55 °C for 1 h. The solvent was evaporated and
the remaining solid collected. The product was tested in a CH50 assay compared
with the non-esterified material and was found to be 29% as active (Figure 8,
IC50 0. 6 4 microM vs 2.52 microM assuming a MW of 422) .
In Vivo Testing
Since the invention requires material that can be
safely administered on a continuing basis, it requires testing in vivo in
animals. This can be achieved by feeding to mice or other species, a mixture of
the powder obtained added to their normal chow. Our example was with mice that
are transgenic for Alzheimer disease mutations (B6SJL-Tg). By employing such
mice, the product was tested not only for safety, but also for potential
efficacy in Alzheimer disease.
Control B6SJL-Tg mice were fed normal chow, and
test B6SJL-Tg mice were fed show supplemented with 0.5mg/kg ATAC. Based on chow
consumption, it was calculated that test mice were receiving 5mg/kg/day of
ATAC. Feeding was started at ages from 56-63 days and was continued for a
further 30 days or 48 days before sacrifice. Upon autopsy, no evidence of
pathology in any organ of either the ATAC fortified or normal chow fed mice was
observed. These data indicate that ATAC is well tolerated and apparently safe
when continuously consumed at a dose of 5 mg/kg/day for 44 days.
The results of CH50 assays are shown in Figure 9.
Serum at various dilutions (1-16 fold) was incubated with antibody-conjugated
sheep red blood cells for 1 h. Serum from the fed mice required less dilution,
consistent with inhibition of the membrane attack complex (IC50 1.92
fold vs. 6. 8 9 fold for mice fed normal chow). These data indicate that a 3.59
fold protection was achieved. They establish that ATAC is absorbed after oral
administration, and, at the doses tested, is an effective inhibitor of MAC
formation.
B6SJL-Tg mice develop early memory deficits due to
the rapid buildup of beta amyloid protein deposits. The memory of B6SJL-Tg mice
fed normal or ATAC chow was tested using a standard water maze test. It was
performed in a pool of 1.5 meter diameter with opaque fluid and a 10 cm
diameter hidden platform. Mice were placed in the pool for first-day visible
training, followed by four days of training where the platform was hidden. The
next day they were measured with the hidden platform removed to determine how
quickly they returned to where the hidden platform had been placed and thus how
well they remembered its location. The tracking of animal movements in the area
where the platform had been located was captured by an HVS2020 plus image
analyzer. Data were analyzed by two-way ANOVA. It was found that ATAC treated
mice performed 2.5 fold better than the untreated mice. The data are shown in
Figure 10. In summary, these in vivo data on Alzheimer disease transgenic mice
show that ATAC is not only safe, but beneficial in these animals. It improves
weight gain and memory retention, which correlates with its ability to inhibit
formation of the membrane attack complex of complement.
Applicability of the invention to the treatment
of human disease.
General considerations . The complement
system has usually been interpreted as serving only the adaptive immune system.
But it is also a mainstay of the innate immune system. It is called into play
in all chronic degenerative diseases. If it is activated to the extent that the
MAC is formed, there is danger of the pathology being exacerbated through
bystander lysis. Damage can also occur by chronic activation of the alternative
complement pathway. Therapeutic opportunities for intervention in a spectrum of
human disease states have never been explored because there has never been
previously described an orally effective complement inhibitor which is
selective for blocking the MAC and alternative pathway activation. The
invention described here illustrates examples of diseases where benefit in
common degenerative diseases can be expected from utilization of the invention
described here.
Rheumatoid arthritis . There is strong
evidence that both the classical and alternative pathways of complement are
pathologically activated in rheumatoid arthritis (Okroj et al. 2007). The
arthritic joint contains proteins capable of activating complement as well as
proteins signifying that both the classical and alternative pathways have been
activated. In mouse models of rheumatoid arthritis, resistance can be achieved
by deletion of C3, C5, or factor B (Okroj et al. 2007). These data indicate
that ATA or ATAC should be effective in rheumatoid arthritis.
Multiple sclerosis : Multiple sclerosis is a
relapsing-remitting disease characterized by inflammation of the white matter
of brain. Specific antibodies have been detected which target myelin antigens
indicating that it is an autoimmune disorder (Genain et al. 1999). Complement
will be activated in this process indicating the appropriateness of ATAC
therapy.
Malaria infection : Malaria is a prevalent
disease in Africa and south East Asia, resulting in an estimated 650,000 deaths
per year. The infective agent, plasmodium falciparum, transmitted by mosquitos,
produces enhanced complement activation in humans and susceptible animals. IgG
and C3bBb complexes have been identified on erythrocytes of infected humans
indicating damage caused by activation of both the classical and alternative
pathways (Silver et al. 2010). Accordingly, treatment with ATAC should have
beneficial effects.
Paroxysmal nocturnal hemoglobinemia :
Paroxysmal nocturnal hemoglobinemia results from a clonal deficiency in
erythrocytes of the X chromosome gene PIGA. As a consequence, the
glycosal phophatidylinosotol moiety necessary for anchoring membrane proteins
such as CD 55 and CD 59 is non functional. Erythrocytes and platelets lack the
capacity to restrict cell-surface activation of the alternative pathway.
Patients are subject to fatal thrombotic and hemolytic attacks. A treatment
which is partially effective is to administer at biweekly intervals the
monoclonal antibody eculizumab, which blocks C5 cleavage, preventing synthesis
of the membrane attack complex. However this treatment is less than
satisfactory being effective in only 49% of patients (Hillmen et al. 2006). A
probable reason is that it does not block C3 convertase activity. C3 convertase
is unregulated due to the CD 55 deficiency (Parker 2010). ATAC, because it is
orally effective and compensates for both deficiencies, should be a truly
definitive treatment for paroxysmal nocturnal hemoglobinemia.
Alzheimer 's disease . It has long been
known that beta amyloid protein deposits in brain, which are believed to be the
primary cause of the disease, can be identified by the opsonizing components of
complement. It was demonstrated that this was due to C1q binding to beta
amyloid protein (Rogers et al. , 1992). It was also demonstrated that the
membrane attack complex of complement decorated damaged neurites in the
vicinity of the deposits, indicating self damage by the complement system
(McGeer et al ., 1989). Taken together, these data illustrate that the
opsonizing aspects of complement need to be preserved so that phagocytosis of
the beta amyloid deposits can occur, while the membrane attack complex needs to
be selectively blocked so that self damage to host neurons can be
eliminated.
Age related macular degeneration. Opsonizing
components of complement have been identified in association with drusen, which
are the extracellular deposits associated with the disease. The membrane attack
complex has been found near the degenerating retinal pigment epithelial cells
(Anderson et al. , 2002). Genetic analyses have revealed that polymorphisms in
Factor H, Complement Factor B, and C3 all significantly influence the risk of
suffering from age related macular degeneration (Anderson et al. , 2010). These
data illustrate that the opsonizing aspects of complement need to be preserved
so that phagocytosis of drusen can occur, while the membrane attack complex
needs to be selectively blocked so that self damage to retinal pigment
epitheleial cells can be eliminated.
Atherosclerosis. Atherosclerosis has not
generally been considered to be exacerbated by the complement system. However
the mRNA for C-reactive protein, a known activator of complement, is
upregulated more than ten fold in the area of atherosclerotic plaques. Plaque
areas showing upregulation of C-reactive protein and the opsonization
components of complement also demonstrate presence of the membrane attack
complex (Yasojima et al. , 2001). This is a further example of a common human
degenerative condition where the membrane attack complex is present in a
sterile situation and can therefore only damage host tissue. Again, the
invention described here will preserve the desirable phagocytosis stimulating
aspect of complement, while eliminating the self damaging aspect of the
membrane attack complex.
As those skilled in the art will know, these
diseases are only examples of many that may be found where the invention
described here will have therapeutic benefit.
Background Art
Numerous agents have been described which will
inhibit the complement system. These include heparin, suramin, epsilon-
aminocaproic acid, and tranexamic acid. However, no orally effective agents
have been described that will leave the necessary opsonization of the classical
complement pathway functional, but which will prevent self damage either by
blocking C3 convertase activity of the alternative pathway, as well as assembly
of the membrane attack complex by both pathways. The only approved agent for
treating aberrant complement activation is eculizumab, a humanized monoclonal
antibody which blocks C5 conversion of the alternative pathway. It has been
approved for the treatment of paroxysmal nocturnal hemoglobinemia. It is
effective in 49% of cases (Hillmen et al. 2006). However it does not block the
earlier step of C3 convertase, which can result in ongoing hemolysis of
erythrocytes (Parker 2012). Moreover, as a high MW immunoglobulin antibody, it
will not cross the blood brain barrier and will not be effective in CNS
disorders.
We show in this invention that components of less
than 1 kDa MW of the aurin tricarboxylic acid synthetic complex (ATAC) block C3
convertase of the alternative pathway, as well as MAC assembly at the final
stage of C9 addition to C5b8 of both the alternative and classical pathways. We
further show that they are safe and effective following oral
administration.
Complement is a key component of both the innate
and adaptive immune systems. It carries out four major functions: recognition
of a target for disposal, opsonization to assist phagocytosis, generation of
anaphylatoxins, and direct killing of cells by insertion of the membrane attack
complex (MAC) into viable cell surfaces. Although complement is an essential
defense system of living organisms, it is widely regarded as a two edged sword.
Its opsonizing components are beneficial, but the membrane attack complex is
potentially self damaging.
The complement system as it is understood today is
illustrated in Figure 1. It consists of two main pathways: the classical and
the alternative. The pathways have differing opsonizing mechanisms, but they
have in common assembly of the terminal components to form the membrane attack
complex (C5b-9). The classical pathway commences with the C1q component of the
C1 complex recognizing a target that needs to be phagocytosed. Subsequent steps
involve dissociation of the C1 complex, cleavage of C2, C4, and C3 to provide
amplification as well as covalent attachment of the activated complement
components to the target. By this means the target is disposed of by phagocytes
that have receptors for the activated complement components so attached.
Both pathways result in C5 being cleaved into C5a
and C5b. The released C5b fragment can then insert itself into the membranes of
nearby cells. C6, C7, C8 and C9 (n) can then become sequentially attached to
the membranes. The addition of C9 renders the complex functional by opening
holes in the membranes, thus leading to death of the cells. Its physiological
purpose is to kill foreign pathogens, but in the case of sterile lesions, it
can destroy host cells by the phenomenon known as bystander lysis.
The complement system therefore operates in two
parts. The first part is opsonization, which prepares targeted tissue for
phagocytosis. The second part is assembly of the membrane attack complex, which
has the purpose of killing cells. The former is essential, but the latter is
not. For example, approximately 0.12% of Japanese are homozygous for the
nonsense CGA-TGA (arginine 95stop) mutation in exon 4 of C9 (Kira et al. ,
1999). These individuals cannot make a functioning membrane attack complex.
This means that there are more than 150,000 Japanese leading healthy lives
despite this deficiency. The Japanese experience indicates that selective
inhibition of membrane attack complex formation on a long term basis is a
viable therapeutic strategy.
The membrane attack complex exacerbates the
pathology in all diseases where there is persistent overactivity of the
complement system. In addition, pathology can be exacerbated in diseases in
which there is alternative pathway C3 convertase over activity. Such diseases
include, but are not limited to, rheumatoid arthritis, paroxysmal nocturnal
hemoglobinemia, multiple sclerosis, malaria infection, Alzheimer disease, age
related macular degeneration, and atherosclerosis. The purpose of this
invention is to provide a method for successfully treating such conditions. We
screened a large library of organic compounds for any that might have promise
of being a selective inhibitor of these pathways. Commercially supplied 'aurin
tricarboxylic acid' was the only material to pass the initial screening test.
We found that the product contained only a small amount of aurin tricarboxylic
acid. It consisted mostly of a complex of high molecular weight materials. We
fractionated the crude material and investigated the properties of components
of less than 1kDa MW. The desired properties were identified in true aurin
tricarboxylic acid (ATA, MW422), aurin quadracarboxylic acid (AQA, MW572),
aurin hexacarboxylic acid (AHA, MW858), and their combination which we term the
low molecular weight aurin tricarboxylic acid complex (ATAC).
Related Publications
Patent Documents
McGeer et al. United States Patent
application 13/195,216 filed August 1, 2011.
Bernstein et al. United States Patent 4,007,290
issued Feb. 8, 1977.
Other Publications
Anderson DH, Mullins RF, Hageman GS, Johnson LV .
2002. A role for local inflammation in the formation of drusen in the aging
eye. Am. J. Ophthalmol. 134(3): 411-431 .
Anderson DH, Radeke MJ, Gallo NB, Chapin EA,
Johnson PT, Curlettie CR, Hancox LS, Hu J, Ebright JN, Malek G, Hauser MA,
Rickman CB, Bok D, Hageman GS, Johnson LV . 2010. The pivotal role of the
complement system in aging and age-related macular degeneration: hypothesis
revisited. Prog. Ret. Eye Res. 29: 95-112.
Cushman M, Kanamathareddy S . 1990. Synthesis of
the covalent hydrate of the incorrectly assumed structure of aurintricarboxylic
acid. Tetrahedron 46(5): 1491-1498 .
Cushman M, Kananathareddy S, De Clercq E, Scols D,
Goldman ME, Bowen JA . 1991. Synthesis and anti-HIV activities of low molecular
weight aurintricarboxylic acid fragments and related compounds. J. Med. Chem
34: 337-342.
Cushman M, Wang P, Stowell JG, Schols D, De Clercq
E . 1992. Structural investigation and anti-HIV activities of high molecular
weight ATA polymers. J. Org. Chem. 57 : 7 2 41-7248 .
Genain CP, Cannelloa B, Hauser SI et al. 1999.
Identification of autoantibodies associated with myelin damage in multiple
sclerosis. Nat. Med. 5, 170-175.
Gonzalez RG, Blackburn BJ, Schleich T . 1979.
Fractionation and structural elucidation of the active components of
aurintricarboxylic acid, a potent inhibitor of protein nucleic acid
interactions. Biochimica et Biophysica Acta 562 : 534-545.
Heisig GB, Lauer M . 1941. Ammonium salt of aurin
tricarboxylic acid. Organic Syntheses 1: 54 .
Hillmen, P. , Young, N.S., Schubert, J., et al.
2006. The complement inhibitor eculizumab in paroxysmal nocturnal
hemoglobinuria. N. Engl. J. Med. 355, 1233-1243.
Kira S, Ihara K, Takada H, Gondo K, Hara T . 1998.
Nonsense mutation in exon 4 of human complement C9 gene is the major cause of
Japanese complement C9 deficiency. Human Gen. 102(6): 605-610 .
Lee, M. , Guo, J. P., Schwab, C., McGeer, E. G.,
and McGeer, P. L. (2012)Selective inhibition of the membrane attack complex of
complement by low molecular weight components of the aurin tricarboxylic acid
synthetic complex.Neurobiol. Aging. doi:
http://dx.doi.org/10.1016/j.neurobiolaging.2011.12.005.
McGeer PL, Akiyama H, Itagaki S, McGeer EG . 1989.
Activation of the classical complement pathway in brain tissue of Alzheimer
patients. Neuroscience Letters 107: 341-346
Okraj, M., Heinegard, d., Holmdahl, R., and Blom,
A.M. (2007) Rheumatoid arthritis and the complement system. Ann. Med.
39, 517-530.
Owens MR , Holme S . 1996. Aurin tricarboxylic acid
inhibits adhesion of platelets to subendothelium. Thrombosis Res. 81 : 177-185
.
Parker CJ. 2012 Paroxysmal nocturnal hemoglobinuria
19(3):141-148
Rogers J, Cooper NR, Webster S, Schultz J, McGeer
PL, Styren SD, Civin WH, Brachova L, Bradt B, Ward P, Lieberburg I. Complement
activation by b-amyloid in Alzheimer disease. 1992. Proc Natl Acad Sci USA
89:10016-10020, 1992
Silver KL, Higgins SJ, McDonald CR, and Kain KC
2010. Complement driven immune responses to malaria: fuelling severe malarial
diseases. Cellular Microbial. 8, 1036-1045.
Yasojima K, Schwab C, McGeer EG, McGeer PL . 2001.
Generation of C-reactive protein and complement components in atherosclerotic
plaques. American J. Pathol. 158(3): 1039-1051.
Technical Problem: For many years it has been known
that complement activation which exceeds the limitations of endogenous
controlling factors, can result in self damage to viable host tissue. The
organs and cells damaged may be brain and spinal cord cells, especially neurons
and oligodendroglia; retinal cells, especially pigment epithelial cells; heart
and arterial muscle cells; joint cells; and kidney cells. Heretofore there has
been no satisfactory method of treating the various conditions which generate
such unwanted complement activation in these organs and tissues.
Technical Solution:
The solution to this general problem is to
administer ATA, AQA, AHA and their derivatives, alone or in combination, in
sufficient doses to block selectively formation of C3 convertase and the
membrane attack complex of complement in these tissues. The active ingredients
may be administered orally, intravenously, subcutaneously, or by direct
injection into an affected area such as an inflamed joint or muscle.
Advantageous Effects. th effects will be to prevent
further self damage by the unwanted complement activation with amelioration of
the pathology.
Description of Drawings
Figure 1. Shows a standard schematic
representation of the classical complement pathway as activated in Alzheimer
disease, and the alternative complement pathway as activated in age related
macular degeneration. Notice that assembly of the membrane attack complex is
common to both the classical and alternative pathways.
Figure 2. Shows the putative structure and
mass of the three components of the aurin tricaboxylic acid synthetic complex
(ATAC) of less than 1 KDa with c orresponding mass-spec analyses of the
separated components. (a) ATA, MW 422
(5,5'-((3-carboxy-4-oxocyclohexa-2,5-dienn-1-ylidene)methylene)bis(2-hydroxybenzoic
acid) ( b ) AQA, MW 572 (putative structure
5,5-((3-carboxy-5-((3carboxy-4-oxocyclohexa-2,5-dien-1-ylidene)methyl)-4-hydroxyphenyl)methylene)bis(2hydroxybenzoic
acid)) ( c ) AHA, MW858 (putative structure,
5.5'-((3-carboxy-5-((3-carboxy-4-oxocyclohexa-2,5-dien-1-ylidene)methyl)-4-hydroxybenzyl)-4-hydroxyphenyl)methylene)bis(2-hydroxybenzoic
acid)). ES- means negative scan mode, giving values of -1 to the true mass. ES+
mean positive scan mode giving values of +1 to the true mass.
Figure 3. Shows the CH50 analyses of human
and rat serum . Notice the almost identical IC50 values of each
component . They were (nM) for ATA 544, for AQA 576, for AHA 559 and for ATAC
580. The IC50 for ATAC in rat serum was 268 nM.
Figure 4. Shows Western blot analyses
demonstrating that ATA, AQA, AHA, and ATAC act selectively by blocking the
addition of C9 to C5b678 thus preventing formation of the membrane attack
complex. Normal human serum was pre treated with aliquots of aqueous solutions
of ATA, AQA, AHA and ATAC prior to adding sheep red blood cells sensitized to
human complement. The reaction mixtures were incubated at 37ºC for 1 h.
Aliquots were loaded on 10% polyacrylamide gels and subjected to SDS-PAGE.
Proteins were transferred to membranes and developed with appropriate primary
antibodies to complement proteins (Table 1): (a) Western blots of
membranes developed with antibodies to C1q, C3, C4 and C5. Lane 1, untreated
serum; lane 2, serum with red blood cells added; lane 3 serum with red blood
cells protected with ATAC. Notice that in untreated serum, bands for C1q, C3,
C4, and C5 were readily detected. In lanes 2 and 3, the activated products C3d,
C4d, and C5a were detected indicating opsonization had taken place. In lane 2,
the MAC was detected, but not in lane 3, indicating that ATAC was blocking MAC
formation. To analyze which step in MAC formation was involved, western blot
membranes were treated with antibodies to C6, C7, C8, and C9 for (b)
ATAC, (c) ATA, (d) AQA and (e) AHA. The results are
identical. In each panel, lane 1 is serum, lane 2 is unprotected red blood
cells, lane 3 is red blood cells protected with either ATA, AQA, AHA, or ATAC ,
and lane 4 is the same as lane 3 but with C9 protein supplementation. It shows
that C6, C7, C8 and C9 are readily detected in untreated serum. Lane 2 shows
that, in unprotected red blood cells that have become hemolysed by complement
attack, only C5b-9, the fully formed membrane attack complex, is detected. Lane
3, in which the cells have been protected either by ATA, AQA, AHA or ATAC, the
membrane attack complex does not fully form but becomes arrested at the C8
stage. The C6 antibody detects C5b6, C5b67, and C5b678. The C7 antibody detects
C5b67 and C5b678, while the C8 antibody detects C5b678. Lane 4 provides
confirmation that the blockade occurs only at the C9 stage. It can be seen that
C5b-9 is now detected upon probing with C6, C7, C8 and C9, thus establishing
that the ATAC block was at the C9 stage. A very faint C9 band is still visible
in the blots indicating that not all the added C9 was consumed in the
process.
Figure 5 . Shows western blots of membranes
developed with antibodies to properdin, C3/C3b, Factor B/Bb and Factor D,
demonstrating the effect of inhibiting classical pathway activation with C1
inhibitor or C4b antibody, and showing inhibition of C3 convertase by ATA . (a)
Normal serum demonstrates detectable bands for properdin, C3, Factor B and
Factor D (lane1). Upon activation with zymosan in the presence of C1 inhibitor,
bands corresponding to PC3b, PC3bBb and PC3bBbC3b appear on blots developed
with properdin and C3b antibodies, and PC3bBb and PC3bBb and PC3bBbC3b on the
one developed with Factor Bb antibody (lane 2). These data demonstrate that
properdin is required for C3b binding to initiate the alternative pathway, and
that C3 and C5 convertases are activated. The addition of ATA results in bands
appearing only for PC3b and PC3bB, indicating a block at the stage of Factor D
cleavage of bound Factor B (lane 3). Lane 4 where properdin is added, and lane
5 where Factor D is added, both show reappearance of weak bands for PC3bBb and
PC3bBbC3b, indicating partial recovery of alternative pathway activation. No
bands for Factor D were detected on the erythrocyte membranes, indicating that
this protease did not become bound but remained in solution. Three independent
experiments were performed and these are representative. (b) Western blots of
the residual serum developed with the antibody to C5/C5a. A band for C5 was
readily detected in normal serum (lane 1). Treatment with zymosan and C1
inhibitor resulted in disappearance of the C5 band and appearance of the
activation product C5a (lane 2). The addition of ATA and C1 inhibitor (lane 3)
prevented cleavage of C5, which was partially antagonized by treatment with
properdin (1 microgm/ml, lane 4) and Factor D (0.1microgm/ml, lane 5). (c)
Treatment of the residual membranes with antibodies to C5/C5b, C6, C7, C8 and
C9. Lane 1 of normal serum shows that each complement protein was detected in
normal serum. Lane 2 of membranes following serum treatment with zymosan and C1
inhibitor resulted in disappearance of each of the protein bands and appearance
of the MAC formation components C5b6, C5b67, C5b678, and the fully formed
C5b-9. Lane 3 in which ATA was added shows that complete blockade appeared with
no activation bands appearing on the membranes. Lanes 4 and 5, where the serum
was supplemented with properdin and Factor D respectively, showed partial
activation of the complement system with weaker bands for C5b6, C5b67, and
C5b678 appearing, but there was still blockade at the C5b-9 stage indicating
that ATA was also blocking the addition of C9 to C5b-8.
Figure 6 . Is a diagram showing the binding
of ATA to Factor D and C9, but not to properdin, factor B, C2, C3, C4, C5, C6,
C7, or C8. These proteins were applied to microwell plates in concentrations of
1-32 ng/ml, following which ATA at 100 micrograms/ml was added.
Figure 7. Is a schematic diagram of the
alternative complement pathway illustrating blockade by ATA at the C3
convertase and C9 addition to C5b-8 stages.
Figure 8 . Shows a comparison of CH50
results in human serum of ATAC and the methyl derivatives of ATAC. The methyl
derivatives were less effective than ATA with an estimated IC50 of
2.52 microM.
Figure 9. Shows the effects of orally
administered ATAC on complement activation of mouse serum. Serum from six
B6SJL-Tg mice fed normal chow was combined and compared with the combined serum
from six B6SJL-Tg mice fed ATAC supplemented chow. The sera were subjected to
1-16 fold dilutions. The solutions (25 microliters) were incubated with 100
microliters of antibody-conjugated sheep red blood cells (5×106
cells) for 1 h. The mixtures were centrifuged, and the relative amount of
hemoglobin released into 100 microliters of supernatant recorded by the
absorbance at 405 nanometers. Serum from mice fed normal chow required more
dilution than ATAC-fed mice for hemolysis to occur. The IC50s were
6.89 and 1.92 fold respectively corresponding to a 3.59 fold protection.
Figure 10 . Shows memory retention of ATAC
fed B6SJL-Tg mice compared with normal chow fed B6SJL-Tg mice as assessed by
the rate of searching in the vicinity of the hidden platform after its removal
on day 6 of testing. ATAC fed mice showed a significantly greater time
searching in the correct area of the missing platform than mice fed normal
chow, indicating a better retention of memory.
Table 1 . Lists the antibodies used to
detect complement proteins in Western blots.
Best Mode The preferred mode for delivering ATA, AQA,
AHA, its ammonium or other salts, its methyl or other derivatives, or mixtures
thereof, to a person or animal in need thereof, is by the oral route. Capsules
or pills with any combination of the above active ingredients may be formulated
with acceptable conventional pharmaceutical carriers to prolong release,
enhance effectiveness, and decrease metabolism of the active ingredients. These
may include, but are not limited to, lactose, stearic acid, propylene glycol,
cellulose or other ingredients that are well known to those skilled in the art.
The dosage of the active ingredients may vary from 50 mg to 10 grams per day
depending on the needs of each particular subject.
Mode for Invention: In addition to the preferred
mode,alternative modes of delivery include intravenous, subcutaneous, and
direct injection into a joint or muscle. These modes would become desirable in
situations where oral administration was not possible, or where high
concentrations were necessary or desirable at some localized site.
Industrial Applicability
This invention should open a major new treatment
field for several chronic degenerative conditions of the brain and peripheral
organs for which there is currently no satisfactory treatment. These diseases
include, but are not limited to, paroxysmal nocturnal hemoglobinemia,
rheumatoid arthritis, multiple sclerosis, malaria infection, Alzheimer disease,
age related macular degeneration, and atherosclerosis.
Sequence List Text