Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/235—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids having an aromatic ring attached to a carboxyl group
  • A61K31/24—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids having an aromatic ring attached to a carboxyl group having an amino or nitro group
  • A61K31/245—Amino benzoic acid types, e.g. procaine, novocaine
• • 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
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/191—Tumor necrosis factors [TNF], e.g. lymphotoxin [LT], i.e. TNF-beta
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/20—Interleukins [IL]
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/20—Interleukins [IL]
  • A61K38/204—IL-6
• • 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
  • A61K38/19—Cytokines; Lymphokines; Interferons
  • A61K38/20—Interleukins [IL]
  • A61K38/2086—IL-13 to IL-16
• • 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
  • A61K39/0005—Vertebrate antigens
• • 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
  • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
  • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
  • A61K39/39541—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against normal tissues, cells
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/02—Stomatological preparations, e.g. drugs for caries, aphtae, periodontitis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • 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
• • 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
  • A61K2039/54—Medicinal preparations containing antigens or antibodies characterised by the route of administration
  • A61K2039/541—Mucosal route
  • A61K2039/542—Mucosal route oral/gastrointestinal
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K2317/00—Immunoglobulins specific features
  • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
  • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
  • C07K2317/569—Single domain, e.g. dAb, sdAb, VHH, VNAR or nanobody®

Definitions

• compositions comprising a single variable domain
• biopharmaceuticals particularly therapeutic antibodies and their fragments
• parenteral route e.g. by intravenous or subcutaneous injection.
• routes of administration can often be inconvenient and painful which reduces patient compliance, particularly when multiple injections per day are required. They can also be costly to health care providers, in terms of staff hours, storage and equipment.
• composition optionally a pharmaceutical composition, comprising camostat mesylate and a single variable domain.
• composition of the disclosure for use as a medicament is provided.
• the use of a composition of the disclosure for the manufacture of a medicament is also provided.
• the composition is to be administered orally.
• the disclosure provides a method of treating a gastrointestinal condition comprising the step of administering, optionally orally, a composition of the disclosure to a patient in need thereof.
• the disclosure further provides a method of stabilising a single variable domain in a protease-rich solution comprising formulating the single variable domain in a composition comprising camostat mesylate prior to exposing the composition to a protease-rich solution.
• Figure 1 shows the half-life of a panel of dAbsTM with different transition midpoints (Tm), upon incubation in simulated intestinal fluid (SIF).
• Figure 2 shows the half-life of a panel of high Tm dAbs (TM) , upon incubation in SIF.
• Figure 3 shows the half-life of a panel of dAbs (TM) with different transition midpoints
• Tm simulated intestinal fluid
• Figure 4 shows the half-life of a panel of high Tm dAbs (TM) , upon incubation in SIF, in the presence and absence of CM.
• Figure 5 shows the half-life of two dAbs (TM) with identical predicted trypsin cleavage sites but differing Tm.
• the dAbs (TM) were incubated with trypsin, in the presence and absence of CM.
• Figure 6 shows the amount of the dAb (TM) DOM101 recovered from gut tissue at various time-points after intra-duodenal administration in the absence (a), and presence (b) of CM. Results are expressed as nanograms per gram of tissue.
• Figure 7 shows the amount of the dAb (TM) DOM101 recovered from the large intestine after intra-colonic administration in the presence and absence of CM. Results are expressed as nanograms per gram of tissue.
• the present disclosure provides a solution to the problems discussed above.
• the present disclosure provides a means of stabilising single variable domains.
• a composition in particular a pharmaceutical composition, comprising a single variable domain and camostat mesylate is provided, together with uses of said composition as a medicament and in methods of treatment.
• the examples herein show that camostat mesylate (CM) can be used to stabilise single variable domains (e.g.
• TM domain antibodies
• TM dAbs
• camostat mesylate (CAS No: 59721-29-8) is 4-[[4-
• CM Camostat mesylate
• CM is an orally active serine protease inhibitor, which is licensed in Japan and Korea for the treatment of pancreatitis and post-operative reflux oesophagitis (Foipan Product information sheet; Takasugi et al., Digestion 1982, 24:36-41; Kono et al., Am J Surg. 2005 Sep, 190(3): 412-7).
• CM has a broad spectrum of inhibition, including trypsin, thrombin, kallikrein and plasmin (Tamura et al., 1977, Biochimica et Biophysica Acta 484, 417-422).
• the metabolism of CM within the gut is not clear, however the metabolite of CM, GBPA, is itself active (Beckh et al., Res Exp Med, 1987, 187: 401-406).
• single variable domain refers to a folded polypeptide domain comprising sequences characteristic of antibody variable domains. It therefore includes complete antibody variable domains such as VH, VHH and VL and modified antibody variable domains, for example, in which one or more loops have been replaced by sequences which are not characteristic of antibody variable domains, or antibody variable domains which have been truncated or comprise N- or C-terminal extensions, as well as fragments of variable domains which retain at least the binding activity and specificity of the full-length domain.
• a single variable domain is capable of binding an antigen or epitope independently of a different variable region or domain.
• a "domain antibodyTM" or “dAb 0 ⁇ " may be considered the same as a "single variable domain”.
• a single variable domain may be a human single variable domain, but also includes single variable domains from other species such as rodent (for example, as disclosed in WO 00/29004), nurse shark and Camelid VHH dAbsTM.
• Camelid VHH are immunoglobulin single variable domains that are derived from species including camel, llama, alpaca, dromedary, and guanaco, which produce heavy chain antibodies naturally devoid of light chains.
• Such VHH domains may be humanised according to standard techniques available in the art, and such domains are considered to be "single variable domains".
• VH includes camelid VHH domains.
• An anti-target single variable domain refers to a single variable domain which binds to said target, e.g. TNFa.
• the target may be any suitable target.
• a single variable domain of the disclosure targets any one of the following: TNFa, IL-23, LAG-3, IL-6, IL-13, IL-18, TSLP, CD3 or a receptor of any one of the foregoing, e.g. a TNFa receptor, such as TNFRaRI or TNFRaRII, an IL-23 receptor, a LAG-3 receptor, an IL-6 receptor, an IL-13 receptor, an IL-18 receptor, a TSLP receptor, or a CD3 receptor.
• a single variable domain of the disclosure targets a chemokine or a chemokine receptor e.g. a glutamic acid-leucine-arginine receptor i.e. an ELR receptor such as one comprising the amino acid sequence shown in SEQ ID NO:s 12 and 19- 22.
• a chemokine receptor e.g. a glutamic acid-leucine-arginine receptor i.e. an ELR receptor such as one comprising the amino acid sequence shown in SEQ ID NO:s 12 and 19- 22.
• Affinity is the strength of binding of one molecule, e.g. a single variable domain of the disclosure, to another, e.g. its target, at a single binding site.
• the binding affinity of a single variable domain to its target may be determined by equilibrium methods (e.g. enzyme-linked immunoabsorbent assay (ELISA) or radioimmunoassay (RIA)), or kinetics (e.g. BIACORETM analysis).
• the equilibrium dissociation constant (KD) of the single variable domain-target interaction is 100 nM or less, 10 nM or less, 2 nM or less or 1 nM or less.
• the KD may be between 5 and 10 nM; or between 1 and 2 nM.
• the KD may be between 1 pM and 500 pM; or between 500 pM and 1 nM.
• the reciprocal of KD i.e. 1/KD
• KA equilibrium association constant
• the dissociation rate constant (kd) or "off-rate” describes the stability of the single variable domain-target complex, i.e. the fraction of complexes that decay per second. For example, a kd of 0.01 s "1 equates to 1% of the complexes decaying per second.
• the dissociation rate constant (kd) is 1x10 3 s "1 or less, lxlO "4 s "1 or less, lxlO "5 s "1 or less, or lxlO "6 s "1 or less.
• the kd may be between lxlO "5 s "1 and lxlO "4 s "1 ; or between lxlO "4 s "1 and lxlO "3 s "1 .
• neutralises as used throughout the present specification means that the biological activity of target is reduced in the presence of a single variable domain as described herein in comparison to the activity of target in the absence of the single variable domain, in vitro or in vivo. Neutralisation may be due to one or more of blocking the target binding to its receptor, preventing target from activating its receptor, down regulating the target or its receptor, or affecting effector functionality.
• a single variable domain of the disclosure neutralises its target.
• Tm is the temperature where 50% of the single variable domain is in its native conformation and the other 50% is denatured.
• the single variable domain has a high Tm.
• the Tm is greater than or equal to about 66°C.
• the thermal stability of a single variable domain, including the Tm may be determined using Differential Scanning Calorimetry (DSC).
• Oral administration refers to the administration of compositions as disclosed herein by mouth.
• Compositions of the disclosure are typically swallowed and travel into the gastrointestinal (GI) tract where they act. Small amounts may be absorbed across the intestinal mucosa into the circulation for systemic action. Absorption may begin in the mouth (buccal cavity) and stomach, but usually occurs in the small intestine.
• GI gastrointestinal
• GI tract includes the upper GI tract: mouth, pharynx, oesophagus and stomach; and the lower GI tract: small intestine, duodenum, jejunum, ileum, large intestine (caecum, colon - including the ascending colon, transverse colon, descending colon and sigmoid flexure), rectum and anus; as well as the gall bladder, liver and pancreas.
• compositions of the disclosure may target any one or more of the aforementioned regions of the GI tract.
• compositions target the small intestine.
• compositions target the large intestine.
• compositions disclosed herein may be for the treatment of any one or more of the human diseases described herein.
• the pharmaceutical composition comprises a single variable domain optionally in combination with one or more pharmaceutically acceptable carriers and/or excipients.
• compositions comprise a pharmaceutically acceptable carrier as known and called for by acceptable pharmaceutical practice, see e.g. Remingtons Pharmaceutical
• compositions of the disclosure are to be administered orally.
• dosage forms including liquids (solutions, suspensions (aqueous or oily), and emulsions), semi-solids (pastes), films and solids (tablets, lozenges, capsules, powders, crystals and granules).
• Liquid dispersions for oral administration may be syrups, emulsions and suspensions.
• the syrups may contain as carriers, for example, saccharose or saccharose with glycerine and/or mannitol and/or sorbitol.
• Suspensions and emulsions may contain as carrier, for example a natural gum, agar, sodium alginate, pectin, methylcellulose, carboxymethylcellulose, or polyvinyl alcohol.
• compositions in particular solid compositions such as tablets and capsules, may be enterically coated.
• Materials used for enteric coatings include fatty acids, waxes, shellac, plastics, and plant fibres. Suitable enteric coatings are disclosed in the EURDAGIT ® Application Guidelines (11 th edition, 09/2009).
• Effective doses and treatment regimes for administering the single variable domain may be dependent on factors such as the age, weight and health status of the patient and disease to be treated. Such factors are within the purview of the attending physician.
• the ratio of single variable domain to camostat mesylate in compositions of the disclosure may be about 1:0.1; 1:1; 1:10, 1:25, 1:50, or 1:100. In an embodiment the ratio of single variable domain to camostat mesylate in compositions of the disclosure is about
• the pharmaceutical composition may comprise a kit of parts of the single variable domain together with other medicaments, optionally with instructions for use.
• the kit may comprise the reagents in predetermined amounts with instructions for use.
• the disclosure provides methods of treating diseases disclosed herein comprising the step of administering compositions of the disclosure to a patient in need thereof.
• compositions of the disclosure as described herein in the manufacture of a medicament for the treatment of the diseases and disorders listed herein.
• Diseases and disorders which may be treated by compositions of the disclosure include gastrointestinal disorders.
• a "gastrointestinal disorder” is a disorder affecting the GI tract and includes enteritis, proctitis, inflammatory bowel disease (IBD) including Crohn's disease, colitis including ulcerative colitis, celiac disease, Behet's syndrome and oral mucositis.
• IBD inflammatory bowel disease
• colitis including ulcerative colitis, celiac disease, Behet's syndrome and oral mucositis.
• the gastrointestinal disorder is IBD.
• the gastrointestinal disorder is Crohn's disease.
• the gastrointestinal disorder is ulcerative colitis.
• Any other disease which may be treated by targeting the GI tract is encompassed within diseases to be treated by the methods of the disclosure.
• a single variable domain of the disclosure which binds to a target within the GI tract may result in effects which go beyond the GI tract and result in the treatment of a systemic disease.
• the terms "individual”, “subject” and “patient” are used herein interchangeably.
• the subject is typically a human.
• the subject may also be a mammal, such as a mouse, rat or primate (e.g. a marmoset or monkey).
• the subject can be a non-human animal.
• Treatment can be therapeutic, prophylactic or preventative.
• the subject will be one who is in need thereof.
• Those in need of treatment may include individuals already suffering from a particular medical disease in addition to those who may develop the disease in the future.
• a therapeutically effective amount of the single variable domain described herein is an amount effective to ameliorate or reduce one or more symptoms of, or to prevent or cure, the disease.
• a method of stabilising a single variable domain in a protease-rich solution comprises formulating the single variable domain in a composition comprising camostat mesylate prior to exposing the composition to a protease-rich solution.
• a “protease-rich” solution is a solution comprising a protease, in particular a protease found in the GI tract, for example in a physiological amount.
• a protease is an enzyme that conducts proteolysis by hydrolysing one or more peptide bonds in a polypeptide chain.
• a physiological amount of trypsin inter-digestively in a human is 20-50 U/ml.
• a physiological amount of trypsin early postprandially in a human is 60-100 U/ml.
• a physiological amount of trypsin late postprandially in a human is 500-1500 U/ml (McConnell et al., International Journal of Pharmaceutics 364: 213-226 (2008)).
• the trypsin amount in a protease-rich solution may be any of the aforementioned ranges.
• the protease-rich solution comprises trypsin in an amount greater than any one of the following amounts: 20 U/ml, 30 U/ml, 40 U/ml, 50 U/ml, 60 U/ml, 70 U/ml, 80 U/ml, 90 U/ml, 100 U/ml, 200 U/ml, 300 U/ml, 400 U/ml, 500 U/ml, 600 U/ml, 700 U/ml, 800 U/ml, 900 U/ml, 1000 U/ml, 1100 U/ml, 1200 U/ml, 1300 U/ml, 1400 U/ml or 1500 U/ml.
• the protease-rich solution may further comprise chymotrypsin and/or pancreatin.
• the protease-rich solution comprises trypsin, chymotrypsin and/or pancreatin.
• the protease-rich solution is simulated intestinal fluid (SIF).
• SIF comprises bile, pancreatin and trypsin.
• SIF may also comprise sodium chloride, potassium chloride and calcium chloride.
• the SIF is as described in Example, e.g. comprising the proteases in the amounts specified in Example 1.
• Example 1 Intrinsic stability of a panel of domain antibodies (TM) in Simulated Intestinal Fluid (SIF)
• Simulated intestinal fluid was formulated based on a recipe used in the TNO- " ⁇ ( ⁇ ) gut model system, but with the volume substantially scaled down, as detailed below.
• Simulated intestinal fluid (SIF) preparation :
• Bile solution was prepared by gently adding, with continuous stirring, 2.0g (+/- 0.02g) of bile powder into 250g (+/- 5g) of purified water until a clear solution was obtained.
• Pancreatin solution was prepared by adding 2.1g (+/- 0.2g) of pancreatin powder to 150g (+/- 3g) of purified water. A stirrer was used and care was taken to minimise foaming. Once a homogenous mixture was obtained, the solution was centrifuged at 3500rpm for 20 minutes and the supernatant was then stored on ice.
• Small intestine electrolyte solution (SIES) 25% (concentrated) was produced by adding purified water to 250g (+/- 5g) sodium chloride, 30g (+/- 0.5g) potassium chloride, and 15g (+/- 0.3g) calcium chloride dehydrate to make a total of 2174g. Once the salts had dissolved the pH was adjusted to pH7.0 (+/-0.5) with 1M sodium hydroxide.
• SIES dilute was then prepared using 43.5 (+/-lg) SIES concentrate added to purified water to a total weight of lOOOg.
• Trypsin solution was prepared by dissolving 200 mg (+/- 5mg) of trypsin in lOOg (+/-
• the SIF was then prepared by mixing 25g (+/-0.3g) of bile solution, 12.5g (+/-0.3g) pancreatin solution and 12.5g(+/-0.5g) of SIES dilute (ratio 2:1:1 bile/pancreatin/SIES dilute). 1ml of trypsin solution was then added prior to the immediate use of the solution.
• TM Domain antibodies
• Incubations of dAbTM in SIF were carried out in a final volume of 250 ⁇ .
• the volume of dAbTM spiked into the mixture provided a final concentration of lmg/ml.
• TM dAb
• SDS-PAGE and densitometry The amount of dAb (TM) remaining in the SIF at various time-points was measured by SDS-PAGE and densitometry. Briefly, sample was diluted 1/10 in a water and sample loading buffer mixture, and heated to 80°C for 5 min. Samples were quickly chilled, then 10 ⁇ loaded into a 4-12% Novex (TM) bis-tris gel along with a prepared standard (dAb (TM) in water) and a molecular weight marker. The gel was run at 150V constant in lx MES buffer for 45 minutes, and the protein bands visualised by staining with Instant Blue (TM) overnight.
• TM 4-12% Novex
• Densitometry of the resulting bands was performed using the Odyssey Li-CorTM 5 gel imaging system and the amount of dAb ⁇ present calculated relative to the density of the Oh time-point band (starting amount).
• An exponential curve of time vs. percentage of starting amount of dAb (TM) was prepared, and the time at which 50% of the starting amount of dAb (TM) was present was taken to be the half-life.
• TM dAbs
• T m transition midpoints
• high Tm dAb 0 ⁇ refers to a dAb with a Tm of > 66°C
• low Tm dAb (TM) refers to a dAb 0" ⁇ with a Tm of ⁇ 56°C.
• DOM8 One other dAb 0" ⁇ , DOM8, was extremely stable in SIF.
• the other three dAbs (TM) were not as stable.
• four of the five high Tm dAbs (TM) tested were more stable than dA sTM with a Tm below 66°C.
• the two most stable dAbs (TM) (D0M4 and DOM8) both had a VK framework.
• DOM11 also had a VK framework but was much less stable, so the framework may not be so important for stability.
• DOMll was incubated in SIF on a different occasion to the other three high Tm dAbs (TM) tested here.
• CM camostat mesylate
• TM dAbs
• a perl script was written to scan protein sequences for the trypsin and chymotrypsin (present in pancreatin) cleavage sites. Half-life was then correlated with predicted cleavage sites, and with Tm.
• VK framework dAbs 0 ⁇ were observed to have identical predicted trypsin cleavage sites, but different half-lives in SIF and different Tm. These were DOM4 (half-life 6.1 hours, Tm 72.8°C) and DOM1 (half-life 0.1 hours, Tm 55°C). These two dAbs (TM) were incubated with trypsin, at the same concentration used in the SIF, but without bile salts or pancreatin. Any differences seen in half-life would then be due to Tm. CM was also added to the trypsin/dAb (TM) mixture. Half-life was calculated as before and results are shown in figure 5.
• Example 4 Use of camostat mesylate to stabilise the TNFR1 specific dAb (TM) DOM101 (SEP ID NO:6) administered directly into the duodenum of fasted Han Wistar rats
• CM to determine if CM preserved the dAb (TM) in the gastrointestinal tract.
• Rats were briefly anaesthetised by isoflurane anaesthetic and a midline abdominal incision made to facilitate location of the duodenum for direct intra-duodenal injection (500 ⁇ ) of the dose formulations. Following dosing, the abdominal incisions were closed and the rats allowed to recover prior to their return to study cages. Direct dosing into the duodenum bypassed the acidic conditions of the gastric juices in the stomach and allowed for direct analysis of pharmacokinetics in the intestinal tract.
• Intestinal samples were homogenised using the GentleMACS (TM) Dissociator in lysis buffer containing detergent and protease inhibitors. Samples were screened for DOM101 using a TNFRl-specific MSD (TM) assay. In brief, MSD plates were coated with TNFRl-Fc. Plates were washed and blocked with bovine serum albumin. Tissue samples were diluted and added to the plate, along with a standard curve of dAb (TM , then incubated at room temperature to allow binding. Plates were washed and a sulfo-tag-conjugated anti-Vh antibody was added to the wells. After incubation, the plate was washed and incubated with MSD read buffer. The resulting electrochemiluminescence signal was read on a Sector Imager 6000.
• TM TNFRl-specific MSD
• Results are expressed as nanograms per gram of tissue in Figure 6.
• dAb (TM) was detectable in the duodenum only at 0.5h, and only up to 1.5h in the jejunum. The highest amount was detectable in the jejunum, and it was only detectable in the ileum in small amounts.
• dAb 01* was detectable 7h after dosing, throughout the GI tract. The dAb (TM) was only detectable in the ileum, caecum, colon and rectum at the later time-points. As before, the highest amount of dAb (TM) was recovered from the jejunum.
• dAb ⁇ was also detectable in the duodenum and jejunum at 7h, which suggested that dAb (TM) had penetrated the gut tissue.
• DOMlOl was detectable at low levels in plasma (less than 0.1% of the total dose), after intra-duodenal dosing which confirmed that dAb (TM) can penetrate tissue - data not shown.
• Example 5 Use of camostat mesylate to stabilise the TNFR1 specific dAb (TM) DOMlOl (SEP ID NO:6) administered directly into the colon of fasted Han Wistar rats
• CM dAb
• rats were anaesthetised by isoflurane anaesthetic, a midline abdominal incision made to facilitate location of the colon and 500ul dose of the dose formulations injected directly into the colon. Following dosing, the abdominal incisions were loosely closed and the rats maintained under isoflurane anaesthesia and monitored for the duration of the experiment.
• two doses of CM were studied - lOOmg (as per Example 4) and lOmg per animal.
• dAb (TM) High levels of dAb (TM) were detectable in the caecum, colon and rectum (except lOmg camostat group) at 0.5h, in the presence or absence of CM. There will be lower levels of digestive enzymes in the lower part of the GI tract which may explain this. The lack of dAbTM' in the rectum at 0.5h in the lOmg camostat group is likely to be due to the higher wet weight of the caecum in these animals (data not shown) - dAb (T ) may therefore be retained in this section. However, by 3h dAb (TM) levels in the absence of CM were substantially reduced, particularly in the caecum and rectum, compared with those observed in the two CM groups. The lower dose of CM (lOmg) appeared as effective as the higher dose at preserving dAb (TM) in the large GI tract. Summary of Examples 1-5

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