Classifications

• • 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
  • A61K38/164—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from bacteria
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P11/00—Drugs for disorders of the respiratory system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/04—Antibacterial agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
  • A61P31/12—Antivirals
  • A61P31/14—Antivirals for RNA viruses
  • A61P31/18—Antivirals for RNA viruses for HIV
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
  • A61P37/02—Immunomodulators
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P9/00—Drugs for disorders of the cardiovascular system
  • A61P9/04—Inotropic agents, i.e. stimulants of cardiac contraction; Drugs for heart failure
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/195—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from bacteria
  • C07K14/21—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from bacteria from Pseudomonadaceae (F)
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
• • 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
  • A61K9/007—Pulmonary tract; Aromatherapy
  • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• the invention relates to the treatment of bacterial
• antibiotics produced by many bacteria for intraspecies competition In P. aeruginosa, K. pneumoniae and E. coli these take the form of multi-domain protein antibiotics known as the S-type pyocins, klebicins and colicins respectively 16 ⁇ 18 . These bacteriocins have evolved to efficiently cross the Gram- negative outer membrane through the parasitisation of existing active nutrient uptake pathways, which are an Achilles' heel for Gram-negative bacteria 19-2 .
• the cellular targets of these protein antibiotics are highly conserved, with cytotoxic activity most commonly taking the form of a nuclease activity targeting DNA, rRNA or tRNA, or a pore-forming activity targeting the cytoplasmic membrane 17 .
• pyocins SI, S2, S3 and AP41 display DNase activity
• pyocin S4 is a tRNase
• pyocin S5 is a pore-forming toxin 16 .
• lectin-like pyocin LI the mechanism of cell killing is unknown .
• pyocin S2 is active in an invertebrate model of P. aeruginosa infection 25 . pyocins have not previously been suggested or shown to be good candidates for clinical use. As bacterially-derived polypeptides, they would appear
• the present inventors have found that S-type pyocins can be successfully delivered to the lung, providing a dramatic reduction in bacterial load, but without provoking an immune response or causing other tissue damage.
• the invention provides an S-type pyocin for use in a method of prophylaxis or treatment of a bacterial respiratory infection, wherein the pyocin is delivered by pulmonary administration.
• the invention further provides the use of an S-type pyocin in the manufacture of a medicament for the prophylaxis or treatment of a bacterial respiratory infection, wherein the pyocin is delivered by pulmonary administration.
• the invention further provides a method for prophylaxis or treatment of bacterial respiratory infection in a subject wherein an S-type pyocin is delivered to the subject by pulmonary administration.
• the infecting bacteria typically comprise Pseudomonas species, such as Pseudomonas aeruginosa.
• the subject to be treated may have, or may be at risk of developing a bacterial pneumonia as a result of the infection.
• the S-type pyocins may be used for the prophylaxis and/or treatment of bacterial pneumonia.
• the subject to be treated may have compromised respiratory tract function and/or compromised immune function.
• the subject to be treated may be suffering from cystic fibrosis or chronic obstructive pulmonary disease (COPD) .
• COPD chronic obstructive pulmonary disease
• the subject may be a cancer patient (especially one undergoing chemotherapy) , or a patient affected by congestive heart failure or AIDS.
• the subject to be treated may have, or be at risk of
• S-type pyocins comprise a targeting portion and an effector portion.
• the S-type pyocin may, for example, comprise an S2, SD2, S5 or AP41 targeting portion.
• the pyocin comprises an S5 targeting portion.
• the S-type pyocin may, for example, comprise an S2, SD2, S5 or AP41 effector portion. Alternatively it may comprise a cytotoxic domain from a colicin, e.g. from an E2 or E3 colicin. In some embodiments, the pyocin comprises an S5 effector portion.
• the S-type pyocin is an SD2, SD2, S5, AP41 or Ll pyocin, e.g. an S5 pyocin.
• the combination may comprise S-type pyocins having at least two different receptor
• the combination may comprise an S5 pyocin.
• the combination may comprise an Ll pyocin.
• the combination may comprise an S2 pyocin.
• the combination may comprise an AP41 pyocin.
• the combination may comprise an SD2 pyocin.
• the combination may comprise an Ll pyocin and an S2 pyocin; an Ll pyocin and an AP41 pyocin; an S2 pyocin and an AP41 pyocin; or an Ll pyocin, an S2 pyocin and an AP41 pyocin. Any of these combinations may additionally comprise an S5 pyocin and/or an SD2 pyocin. Whichever other pyocins are present, it may be desirable that the combination comprises an S5 pyocin.
• the invention further provides a method of preparing a medicament for the prophylaxis or treatment of bacterial respiratory infection comprising providing an S-type pyocin and formulating said S-type pyocin for pulmonary
• the S-type pyocin may have been expressed by recombinant methods .
• the method may comprise the steps of recombinantly expressing the S-type pyocin and optionally isolating the S-type pyocin.
• the invention further provides a device for pulmonary
• the device may, for example, be an inhaler (e.g. metered-dose inhaler, dry powder inhaler) or nebuliser (e.g. ultrasonic nebuliser, jet nebuliser, vibrating mesh nebuliser) .
• inhaler e.g. metered-dose inhaler, dry powder inhaler
• nebuliser e.g. ultrasonic nebuliser, jet nebuliser, vibrating mesh nebuliser
• FIG. 1 P. aeruginosa P8 bacterial recovery from pyocin treated mice. All pyocins were given at 3 mg ml "1 . Bacterial counts determined by CFU counts of homogenized lungs, (a) Mice treated with pyocin 6 h pre-infection, all mice culled 5 h post-infection (b) Mice treated with pyocin 6 h pre-infection, pyocin treated mice survived to 24 h (c) Mice treated with pyocin 1 h post-infection, all mice culled 4.5 h postinfection (d) Mice treated with pyocin 1 h post-infection, pyocin treated mice survived to 24 h.
• FIG. 1 Pyocin S5 and tobramycin treatment of P. aeruginosa P8 infected mice.
• A Mice treated 1 h post-infection, all mice culled 4.5 h post-infection
• B Mice treated 1 h postinfection, S5 30 ng ml "1 and tobramycin 300 ]ig ml -1 mice survived to 24 h. All other mice culled 5.5 h post-infection. Bars represent Mean ⁇ SEM, * denotes statistical significance for comparison of treatment versus control by a one-sided Mann-
• mice aeruginosa P8 infected mice.
• Mice treated 1 h post-infection with pyocins at stock concentrations of 300 ⁇ g ml "1 ; pyocin treated mice survived to 24 h.
• Bars represent Mean ⁇ SEM, * denotes statistical significance for comparison of treatment versus control by a one-sided Mann-Whitney U test with
• FIG. 5 Biological repeats of experiments in Figures 1 (c) and (d) .
• FIG. 6 Repeat of experiment in Figure 2 (a) . Pyocin S5 and tobramycin treatment of P. aeruginosa P8 infected mice. Mice treated 1 h post-infection, all mice culled 4.5 h post- infection. Bars represent Mean + SEM, * denotes statistical significance for comparison of treatment versus control by a one-sided Mann-Whitney U test with Bonferroni correction applied .
• Figure 7. Pyocin SD2 for the treatment of P. aeruginosa PA01 infected mice. Mice treated 1 h post-infection with pyocin SD2 at a stock concentration of 3 mg ml "1 .
• mice were culled at 6 h post-infection and pyocin SD2 treated mice survived to 24 h. Bars represent Mean ⁇ SEM, * denotes statistical significance for comparison of treatment versus control by a one-sided Mann-Whitney U test with Bonferroni correction applied.
• mice were repeatedly exposed to pyocin S5 via the intraperitoneal (I. P.) route.
• Pyocins are proteinaceous anti-microbial toxins produced by and effective against Pseudomonas species, especially P.
• Pyocins generally fall into three classes, namely S-type, R- type and F-type.
• R-type (rod-like) and F-type (flexible and non-contractile) pyocins are both related to phage tail proteins (from P2 phage and lambda phage respectively) and act by forming pores in the bacterial membrane.
• S-type (soluble) pyocins have characteristic multi-domain structures similar to colicins (to which they are believed to be evolutionarily related) .
• the term "pyocin” is used in this specification to refer to S-type pyocins except where the context demands otherwise.
• Organisms which produce S-type pyocins are normally unaffected by their own pyocins because they also produce "immunity proteins" which act as antagonists to the corresponding pyocins.
• S-type pyocins comprise a targeting portion and an effector portion. Typically the targeting portion is at the N-terminal end of the molecule and the effector portion at the C-terminal end. However, the order of these portions may not be
• the effector portion may constitute a single independently folded domain.
• the targeting portion may also constitute a single independently folded domain or may be sub-divided into two or more independently folded domains.
• the targeting portion binds to a receptor at the surface of the target organism (i.e. at the Gram negative outer membrane) and mediates translocation of the pyocin across the outer membrane.
• a receptor i.e. at the Gram negative outer membrane
• the term "receptor” is used simply to designate the molecule on the target organism to which the targeting portion binds, and should not be taken to imply a cooperative receptor-ligand interaction in the sense usually intended for a pair of molecules expressed by a single organism.
• the targeting portion of the pyocin determines the species and strain specificity (or tropism) of the pyocin.
• the receptors to which they bind are often specific to pseudomonads , e.g. to Pseudomonas, or even to P. aeruginosa or strains thereof.
• the targeting portions of most naturally occurring S-type pyocins have a characteristic modular structure containing up to three identifiable sub-regions, each of which may represent an separately folded domain or may lack recognisable secondary structure and thus form a flexible region of the molecule. These sub-regions are often referred to in the literature as a receptor binding region, a region of unknown function, and a translocation region, and typically (although not exclusively) occur in that order in an N- to C-terminal direction.
• regions I, II and III of the targeting portion will therefore be referred to herein as regions I, II and III of the targeting portion respectively.
• regions I, II and III may be interchangeable between pyocin molecules, at least to some extent, and that region II may be dispensable in whole or in part.
• the targeting portion may comprise at least a region I sequence and a region III sequence, optionally separated by a region II sequence, a fragment thereof, or a peptide linker. It may be desirable that region I, region II or fragment or linker (if present) , and region III occur in that order in an N- to C- terminal direction.
• the effector portion typically has cell-killing activity once across the outer membrane. It may act in the periplasm or may require transport to the cytoplasm to exert its cell-killing effect. Regardless of mechanism, the effector portion may be referred to as a "cytotoxic" portion of the pyocin molecule.
• the effector or cytotoxic portions of pyocin molecules are typically pore-forming or enzymatic.
• Pore-forming pyocins e.g. pyocin S5
• Enzymatic pyocins typically act as nucleases in the cytoplasm and include those with DNase activity (e.g. pyocins SI, S2, SD2, S3 and AP41) and tRNase activity (e.g. pyocin S4) .
• the targets on which the effector portions act tend to be highly conserved across the bacterial kingdom and their mechanisms of action are similar to those of other anti- bacterial toxins such as the effector domains of colicins.
• the pyocin may comprise any suitable anti-bacterial protein or protein domain as an effector portion, as long as the protein or domain retains cytotoxic activity against one or more pseudomonad organisms.
• the effector component may be a cytotoxic domain from a colicin, such as (but not limited to) an E2 or E3 colicin .
• the targeting domains of S2 pyocins bind to the TonB-dependent iron-siderophore receptor FpvAI .
• S2 effector domains have DNase activity.
• S2 pyocin has the sequence:
• Region I of the S2 targeting portion has the sequence:
• Region II of the S2 targeting portion has the sequence:
• Region III of the S2 targeting portion has the sequence:
• the effector portion of the S2 pyocin has the sequence:
• a prototypical SD2 pyocin sequence is described by McCaughey et al . (in press) .
• the targeting domains of SD2 pyocins bind to lipopolysaccharide (LPS) from P. aeruginosa and more specifically to the common polysaccharide antigen (CPA) within LPS, which is predominantly a homo-polymer of D-rhamnose.
• LPS lipopolysaccharide
• CPA common polysaccharide antigen
• SD2 effector domains are believed to have tRNase activity.
• An example of an SD2 pyocin has the sequence:
• Region I of the SD2 targeting portion has the sequence:
• Region II of said pyocin SD2 targeting portion is a region II of said pyocin SD2 targeting portion
• Region III of the SD2 targeting portion has the sequence:
• the targeting domains of S5 pyocins bind to the TonB-dependent iron-siderophore receptor FptA.
• S5 effector domains have pore-forming activity. Sequence analysis of the targeting portion of pyocin S5 suggests that region III may occur N-terminal of region I, and that region II may be absent.
• S5 pyocin has the sequence:
• the targeting portion of the S5 pyocin has the sequence:
• Region I of the S5 targeting portion has the sequence:
• Region III of the S5 targeting portion has the sequence:
• the effector portion of the S5 pyocin has the sequence:
• the effector domains of AP41 pyocins have DNase activity.
• An example of an AP41 pyocin has the sequence:
• the targeting portion of the AP41 pyocin has the sequence:
• Region I of the AP41 targeting portion has the sequence:
• Region II of the AP41 targeting portion has the sequence:
• Region III of the AP41 targeting portion has the sequence: GSLVPTFPDFPTFPSFPGVGVPAAAKPLIPAGGGAASVSRTLKTAVDLLSVARKTPGAMLGQ VAAVVATMAVSSFWPKLNNGERQASFAIPVAELSPPLAVDWQAIAAAKGTVDLPYRLKTLNV DGSIQIIAVPTEPGSAAVPVRALTLDSASGTYKYTTTGPGGGTILVTPDTPPGQIDPSSSTP AVPRGPLIMPGTLLIPKEPQIESYPELDQREFNDGIYVYPEDSGIPPLYIVYRD [SEQ ID NO: 22]
• the effector portion of the AP41 pyocin has the sequence:
• Pyocin LI can be regarded as a "lectin-like" pyocin, which binds to carbohydrate moieties on the bacterial surface. Its receptor on P. aeruginosa is believed to be LPS, and more specifically the common polysaccharide antigen (CPA) within LPS, which is predominantly a homo-polymer of D-rhamnose.
• CPA common polysaccharide antigen
• an S- type pyocin because it is soluble and has no homology to phage tail proteins (and thus is not readily classifiable with R- type or F-type pyocins) .
• An example of an LI pyocin has the sequence:
• An LI pyocin typically comprises one, two, three or four carbohydrate-binding motifs having the consensus sequence Q-X-D-X-N/D-X-V/G-Y/F .
• the S-type pyocin for use in the present invention comprises a targeting portion which may comprise: a region I sequence having at least 80% sequence identity, e.g. at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity, to the region I sequence from pyocin S2, SD2, S5 or AP41 (SEQ ID NOs : 3, 9, 15 and 20 respectively); a region III sequence having at least 80% sequence identity, e.g.
• telomere sequence identity at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity, to the region III sequence from pyocin S2, SD2, S5 or AP41 (SEQ ID NOs: 5, 11, 16 and 22 respectively); and optionally: a region II sequence having at least 80% sequence identity, e.g. at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity, to the region II sequence from pyocin S2, SD2 or AP41 (SEQ ID NOs: 4, 10 and 21 respectively) .
• the targeting portion may have at least 80% sequence identity, e.g. at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity to the targeting portion sequence from pyocin S2, SD2, S5 or AP41 (SEQ ID NOs: 2, 8, 14 and 19 respectively) . 1
• Such targeting portions may be described as S2, SD2, S5 and AP41 targeting portions respectively. Typically they will bind to the same receptor as the exemplary sequences provided here .
• the S-type pyocin for use in the present invention comprises an effector portion which may have at least 80% sequence identity, e.g. at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity to the effector region sequence from pyocin S2, SD2, S5 or AP41 (SEQ ID NOs : 6, 12, 17 and 23
• effector portions may be described as S2, SD2, S5 and AP41 effector portions respectively.
• they have the same cytotoxic activity as the exemplary sequences provided, i.e. DNase (S2, SD2, ⁇ 41) or pore-forming (S5) .
• the effector portion may be a cytotoxic domain from a colicin (e.g. a cytotoxic domain from colicin El, E3, E9, D, la, E2, E7, E8, E4, E6, E5, A, B, N, M or S4.
• a colicin e.g. a cytotoxic domain from colicin El, E3, E9, D, la, E2, E7, E8, E4, E6, E5, A, B, N, M or S4.
• Exemplary sequences are provided in WO2014 /009744 ) or any other suitable cytotoxic protein.
• the pyocin molecule may have at least 80% sequence identity, e.g. at least 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity to the exemplary sequences of pyocin S2, SD2, S5, AP41 or LI provided above ( SEQ ID NOs: 1, 7, 13, 18 and 24 respectively) .
• Such molecules may be described as SD2, SD2, S5, AP41 or LI pyocins respectively.
• they bind to the same receptors and have the same cytotoxic activity as the exemplary sequences provided.
• An LI pyocin typically
• an LI pyocin comprises one, two, three or all four of the specific carbohydrate binding motifs
• Percent (%) amino acid sequence identity with respect to a reference sequence is defined as the percentage of amino acid residues in a candidate sequence that are identical with the amino acid residues in the reference sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity, and not considering any conservative substitutions as part of the sequence identity.
• % identity values may be determined by WU-BLAST-2 (Altschul et al., Methods in Enzymology, 266:460-480 (1996)) .
• a % amino acid sequence identity value is determined by the number of matching identical residues as determined by WD-BLAST-2, divided by the total number of residues of the reference sequence (gaps introduced by WU-BLAST-2 into the reference sequence to maximize the alignment score being ignored), multiplied by 100.
• Pyocin proteins may be synthesised or purified by any method.
• they may be purified from organisms (Pseudomonas sp.) which naturally express them, they may be synthesised by chemical methods, they may be expressed in cell-free systems, or they may be expressed by non- Pseudomonas host cells comprising nucleic acid encoding the relevant pyocin.
• organisms Pseudomonas sp.
• they may be purified from organisms (Pseudomonas sp.) which naturally express them, they may be synthesised by chemical methods, they may be expressed in cell-free systems, or they may be expressed by non- Pseudomonas host cells comprising nucleic acid encoding the relevant pyocin.
• the host cell may be prokaryotic or eukaryotic, although prokaryotic hosts may be preferred since the pyocins are themselves bacterial proteins.
• Prokaryotic hosts may be gram- positive or gram-negative.
• E. coli is an example of a common gram-positive host cell which can readily be engineered to express pyocins by introduction of nucleic acid encoding the desired pyocin, e.g. as described in the Examples below. Pyocins are typically encoded on plasmids.
• host cells may be engineered for pyocin production by introducing a plasmid encoding a pyocin, although other expression vectors or constructs may be employed, including chromosomally- integrated expression constructs.
• the host cell may be sensitive to the pyocin. In such cases it is desirable that the host cell also
• nucleic acid encoding a complementary immunity protein (i.e. one capable of antagonising the activity of the pyocin) and is capable of expressing that immunity protein.
• a complementary immunity protein i.e. one capable of antagonising the activity of the pyocin
• co-expression of an immunity protein is desirable.
• Pyocins Ll and S5 can typically be expressed in E. coli in the absence of an immunity protein.
• the pyocin and the immunity protein may be encoded on the same expression construct (e.g. plasmid) or on different expression constructs.
• immunity protein sequences include the following:
• MDIKNNLSDYTESEFLEIIEEFFKNKSGLKGSELEKRMDKLVKHFEEVTSHPRKSGVIFHPK PGFETPEGIVKEVKEWRAANGLPGFKAG [SEQ ID NO: 28]
• the mechanism by which pyocins are released from the host cell is not well characterised. When expressed in non-Pseudomonas host cells, certain pyocins may be naturally secreted and thus may be recovered from the culture medium. For other pyocins, it may be convenient to recover the pyocin from the cell itself, e.g. by an appropriate lysis and purification
• the materials and methods of the present invention are suitable for prophylaxis and/or treatment of infection by Pseudomonas, especially Pseudomonas aeruginosa , and the bacterial pneumonia associated with such infection.
• the infection may be acute or chronic.
• P. aeruginosa infection of the lower respiratory tract is particularly common in patients with cystic fibrosis (where it represents the leading cause of mortality) and chronic obstructive pulmonary disease (COPD) .
• cystic fibrosis where it represents the leading cause of mortality
• COPD chronic obstructive pulmonary disease
• Other patients with compromised respiratory tract function and/or compromised immune function may also be susceptible to infection,
• immunosuppressive medications e.g. for cancer (especially chemotherapy) rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, focal segmental glomerulosclerosis, Crohn's disease, Behcet's Disease, pemphigus, ulcerative colitis, etc..
• Acute conditions associated with or caused by Pseudomonas infection include community-acquired pneumonia and nosocomial infections such as ventilator-associated pneumonia and hospital-acquired pneumonia. It will be appreciated that, due to variability between clinical strains of P. aeruginosa , not all pyocins may be effective against all strains. Factors affecting pyocin effectiveness or toxicity include differential distribution of immunity proteins amongst different strains and genetic variability in the surface receptor bound by the pyocin' s targeting portion.
• the pyocin to be administered should be effective against one or more of the infecting strains of P. aeruginosa. Thus it may be desirable to provide a sample of the infecting strain or strains from a subject, determine the identity of said strain or strains, and select the pyocin (s) to be administered accordingly.
• the infection comprises strain P5, it may be desirable to administer a pyocin other than S2.
• the infection comprises strain E2
• the infection comprises strain P17, it may be desirable to administer a pyocin other than LI.
• any infection may involve more than one strain of bacterium, it may still be desirable to include these pyocins as part of a cocktail comprising a plurality of pyocins. However, it will usually be advisable also to administer one or more pyocins having activity against the predominant species or strain(s) .
• the methods described above may comprise the step of obtaining the sample from the subject, or may utilise a sample already obtained .
• the subject to be treated is a mammal.
• the subject is typically human, but may be any other primate (great ape, old world monkey or new world monkey) , or a domestic,
• mice such as a mouse, rat, guinea pig, lagomorph (e.g. rabbit), cat, dog, pig, cow, horse, sheep or goat.
• lagomorph e.g. rabbit
• pulmonary administration is intended to encompass any suitable delivery method by which the active agent is delivered to the lungs via the respiratory tract .
• pulmonary administration is oral and/or nasal inhalation.
• intra-tracheal instillation may be employed, although this is typically not considered a suitable route for clinical administration to human subjects.
• the active agents i.e. S-type pyocins, are typically provided in therapeutic compositions or pharmaceutically acceptable compositions. They may be formulated for pulmonary
• Formulations may be delivered by any suitable mechanism or delivery device including an inhaler (e.g. metered-dose inhaler, dry powder inhaler) nebuliser (e.g. ultrasonic nebuliser, jet nebuliser, vibrating mesh nebuliser), etc.
• inhaler e.g. metered-dose inhaler, dry powder inhaler
• nebuliser e.g. ultrasonic nebuliser, jet nebuliser, vibrating mesh nebuliser
• the invention further provides a device for pulmonary administration of a therapeutic composition to a subject, the composition comprising an S-type pyocin as described elsewhere in this specification.
• the device may be an inhaler (e.g. metered-dose inhaler, dry powder inhaler) or nebuliser (e.g. ultrasonic nebuliser, jet nebuliser, vibrating mesh
• compositions for delivery may comprise, in addition to one or more of the active agents, a pharmaceutically acceptable excipient, carrier, buffer, stabiliser or other materials well known to those skilled in the art. Such materials should be non-toxic and should not interfere with the efficacy of the active ingredient.
• a pharmaceutically acceptable excipient such materials should be non-toxic and should not interfere with the efficacy of the active ingredient.
• the precise nature of the carrier or other material may depend on the precise nature of the formulation and delivery device to be employed.
• Liquid compositions generally include an aqueous carrier such as water or physiological saline solution. Dextrose or other saccharide solutions or glycols such as ethylene glycol, propylene glycol or polyethylene glycol may be included.
• Emulsions and nano-particle encapsulations both employing lipids, may also be employed.
• Solid (e.g. powder) preparations may utilise carriers such as sugars, cyclodextrins , etc. They may be prepared by any suitable method including spray drying, spray freeze drying, solvent precipitation, jet milling, etc..
• antioxidants and/or other additives may be included, as required .
• Administration is preferably in a "prophylactically effective amount” or a “therapeutically effective amount” (as the case may be, although prophylaxis may be considered therapy) , this being sufficient to show benefit to the individual.
• the actual amount administered, and rate and time-course of administration, will depend on the nature and severity of what is being treated. Prescription of treatment, e.g. decisions on dosage etc., is within the responsibility of general practitioners and other medical doctors, and typically takes account of the disorder to be treated, the condition of the individual patient, the site of delivery, the method of administration and other factors known to practitioners.
• the inventors have shown that repeated exposure to pyocins does not significantly compromise efficacy of treatment.
• a course of treatment may comprise or consist of a single administration or of multiple administrations.
• a multiple dose regime may comprise or consist of two, three, four, five, or even more individual administrations, e.g. up to ten administrations.
• Consecutive doses may independently be spaced by any appropriate time interval, e.g. up to 12 hours, up to one day, up to one week, up to 2 weeks, or up to one month.
• a composition may be administered alone or in combination with other treatments, either simultaneously or sequentially dependent upon the condition to be treated.
• mice were culled when required as determined by a scoring system or culled at the pre-determined 24 h time point. All mice, including outliers were included in the statistical analysis. Experiments were either carried out once only or repeated once (defined for each experiment) .
• the genes encoding pyocin AP41 and its immunity protein (ImAP41) were amplified from the genomic DNA of P. aeruginosa C763 by PCR using primers designed to introduce an Ndel site at the start of the pyocin encoding gene (AC GAT CAT ATG AGC GAC GTT TTT GAC CTT GG) and an Xhol in place of the stop codon of the ImAP41 encoding gene
• pyocin S5 was similarly amplified from the genomic DNA of strain PAOl using primers designed to introduce and Ndel site at the start of the gene
• pETPyoS5 which encodes pyocin S5 with an N- terminal Hise-tag.
• Pyocins AP41 and S5 were overexpressed from E. coli BL21 (DE3) pLysS carrying the relevant plasmid.
• IPTG isopropyl ⁇ -D-l-thiogalactopyranoside
• Pyocin sensitivity assays overlay spot plate method.
• Soft agar overlay spot plates were performed using the method of 35 .
• 150 ⁇ of test strain culture at OD6oc nr, 0.6 was added to 6 ml of 0.8% soft agar and poured over an LB agar plate.
• isofluorane Mice were culled at 24 h by carbon dioxide asphyxiation. A cannula was inserted into the trachea and lungs were fixed in situ by gentle infusion of 10% formalin solution at a constant pressure for 2 min. The lungs were then removed and placed in a container with more fixative.
• H&E staining was carried out by the Veterinary Diagnostic Services Laboratory within the School of Veterinary Medicine at the University of Glasgow. High-resolution whole slide images were captured on the Leica SCN400 slide scanner and slides were scored blind by two independent assessors for peribronchial infiltrate and alveolar involvement.
• mice Female C57/BL6 mice were inoculated intranasally with 25 ⁇ of bacterial culture containing approximately 10 7 CFU of the selected P. aeruginosa strain 36 . Antibiotic treatments were administered at either 6 h pre-infection or 1 h post-infection and were administered only once. Pyocins or tobramycin dissolved in PBS were administered via intranasal administration as described above. Two different end-points were used in these experiments. In order to determine a reduction in the bacterial load of the lungs compared to the untreated controls, all mice in the experiment were culled by carbon dioxide asphyxiation at the same time; 4-6 h post infection.
• mice were monitored closely, culled by carbon dioxide asphyxiation when required as determined by a scoring system or culled at the pre-determined 24 h time point. Uninfected mice, treated with pyocins, were used as controls in the first series of experiments in order to ensure no adverse effects from pyocin treatment. These controls were stopped in later experiments in order to reduce the number of animals used, once it was clear that the pyocins were not harmful. For CFU determination, lungs were removed aseptically and kept on ice in 750 ⁇ of PBS until homogenised.
• P. aeruginosa P8 I.N group infected with 1.4xl0 7 CFU, I.P group infected with 5.0xl0 6 CFU
• mice were washed three times with phosphate buffered saline + 0.05% TWEEN20 (PBST) and then blocked for 1 h at 37°C with 150 ⁇ of blocking buffer (1% bovine serum albumin (BSA) in PBS) . After washing, five-fold serially diluted samples were added, starting at a dilution of 1/50 in blocking buffer, and incubated for 2 h at 37 °C. Serum from mice given pyocin S5 + Freunds complete/incomplete subcutaneously three times over four weeks was used as a positive control and uncoated wells were used as negative controls. Serum from individual mice were analysed and replicate samples were carried out on separate days. After washing with PBST, 50 ⁇ of anti-mouse IgG (Fc specific) -peroxidase antibody ((1/1000 dilution)
• Pyocins are stable in the murine lung and do not cause inflammation or tissue damage
• pyocins can be effectively delivered to the lungs and if they are stable in this environment.
• recombinant pyocins S2, S5, AP41 and Ll were administered intranasally to healthy C57/BL6 mice. After a 24 h incubation period, the postcaval lobe was removed from treated mice, homogenized and tested for the presence of active pyocin by spotting onto a growing lawn of P. aeruginosa (strain P8 for most pyocins and P17 for pyocin S2) . Killing of P.
• aeruginosa was detected with lung homogenates from pyocin Ll, S2 and S5 treated mice, but was not observed in homogenates from pyocin AP41 or PBS treated mice (data not shown) .
• These data indicate that pyocins are well distributed through the lung after intranasal administration and in the case of pyocins Ll, S2 and S5 are stable in this environment.
• aeruginosa indicator strain or could indicate that this pyocin may be more rapidly degraded than the other tested pyocins in vivo.
• pyocins were again administered intranasally and after 24 h pyocin treated lungs were fixed. Lung tissues visualised using hematoxylin and eosin staining were then scored for
• Pyocins can afford protection against lethal P. aeruginosa infections
• pyocins S2, S5, AP41 and LI (3 mg ml " -) , or PBS for control mice were administered intranasally 6 h pre-infection with a normally lethal dose of P. aeruginosa P8 (approx 10 7 CFU) . All mice were culled 4 h post-infection and viable bacterial counts from lung homogenates determined ( Figure la) . All pyocins reduced bacterial load, although at this time point differences in efficacy were noted, with pyocins S2, AP41 and Ll reducing bacterial numbers by
• mice were similarly pre-treated with pyocins 6 h pre-infection with P. aeruginosa P8, monitored for sickness and culled on reaching a pre-determined severity of illness clinical score.
• Five out of six of the PBS control mice were culled at 5 h post-infection whereas all pyocin treated mice survived to the endpoint of the experiment at 24 h.
• Viable bacterial counts at this time point indicated a similar killing activity for pyocins S2, AP41 and Ll, which all significantly reduced bacterial counts more than 10,000-fold. Again, at this time point no viable bacteria were recovered from pyocin S5 treated mice ( Figure lb) .
• mice were treated 1 h post-infection with pyocins S2, S5, AP41 and LI at 3 mg ml ""1 .
• mice were culled at 4.5 h post-infection and bacterial counts from lung homogenates were compared to PBS treated controls.
• pyocin S5 showed greatest efficacy in reducing bacterial numbers, although in this experiment viable bacteria were recovered from three out of six S5 treated mice.
• Pyocins LI, S2, and AP41 significantly reduced the bacterial load by approximately 20-, 80- and 130-fold, respectively ( Figure lc) . This experiment was repeated and again all pyocin treated groups showed significantly reduced bacterial counts (Figure 5a) .
• mice were similarly infected with P. aeruginosa P8 and treated 1 h postinfection with pyocins S2, S5, AP41 and pyocin Ll at 3 mg ml "1 . Infected mice were monitored for sickness and culled if sufficient clinical score were reached, or alternatively at the endpoint of the experiment, 24 h post-infection. All PBS treated mice were culled at 4.5 h post-infection and all pyocin treated mice survived to the endpoint of the experiment at 24 h.
• aeruginosa are phenotypically diverse, we tested the efficacy of the pyocins against three additional isolates: P. aeruginosa P17 and P. aeruginosa P5 (mucoid), both from cystic fibrosis patients and P. aeruginosa E2, an environmental isolate. Pyocin S2 was not active against P. aeruginosa P5 or P. aeruginosa E2 in vitro therefore was not used to treat these strains in vivo and similarly pyocin LI was not used against P. aeruginosa P17. All three P.
• aeruginosa strains showed levels of virulence similar to that of P. aeruginosa P8 in the model of acute lung infection and P. aeruginosa P5, P17 and E2 infected controls all required culling at 4.5 h, 4 h and 5.5 h post-infection, respectively.
• Pyocin S5, LI and S2 treated mice infected with P. aeruginosa P17, P5 or E2 all survived until the 24 h endpoint of the experiment and viable bacterial counts were either reduced to significantly low levels or absent (Table 1) .
• treatment of P. aeruginosa E2 with pyocin AP41 failed to afford protection and these mice were culled at 5.5 h postinfection.
• Lung homogenates from P. aeruginosa E2-infected AP41-treated mice contained high levels of viable bacteria, reduced only 10-fold relative to control mice (Table 1) .
• pyocins show strong efficacy against diverse strains of P. aeruginosa with pyocin S5 treatment displaying the largest effect on reducing bacterial load.
• mice were infected with a lethal dose of P.
• mice Untreated mice were culled 4 h-5.5 h post
• Pyocin S5 shows improved killing of P. aeruginosa in the
• the minimum effective concentration of pyocins S2 and AP41 is ⁇ 30 pg ml "1 and the minimum effective concentration of pyocin LI is between 30 and 300 ⁇ gml ⁇ 1 .
• Table SI shows that all pyocins tested in vivo displayed a potency that was comparable to or greater than tobramycin.
• Viable bacteria were recovered at a low level from pyocin treated mice and for the combination of L1/S2/AP41, bacteria were recovered from only one of six treated mice, indicating that pyocin combinations show enhanced efficacy over the use of individual pyocins ( Figure 4) . No pyocin resistance or tolerance was observed for bacteria recovered after treatment with multiple pyocins.
• Pyocin S5 can afford protection against lethal P. aeruginosa. infections in the presence of pyocin S5 antibodies
• mice were repeatedly exposed to pyocin S5 to induce an antibody response and the efficacy of pyocin treatment was determined as before after infection with P. aeruginosa P8. Pyocin S5 was
• mice were infected intranasally with P.
• aeruginosa P8 (I.N. group infected with 1.4xl0 7 CFU, I. P. group infected with 5.0x10 s CFU) and treated intranasally 1 h postinfection with 75 ⁇ g of pyocin S5 or PBS.
• a control group administered only PBS intranasally prior to infection was also included.
• I.N. groups all pyocin S5 treated mice survived to the 24 h time-point, while all PBS-treated mice were culled 5 h post-infection due to severity of symptoms. The bacterial load of the lungs was determined and no viable bacteria were recovered from any of the pyocin S5 treated mice
• mice For the mice repeatedly exposed to pyocin S5 via the I. P.
• pyocin S5 shows strong efficacy after repeated administration and in the presence of pyocin-S5 specific antibodies.
• pyocins are highly effective in reducing bacterial load and affording protection in a lethal model of acute P. aeruginosa lung infection when delivered directly to the lung.
• pyocin S5 was shown to afford protection at a concentration that is at least 100- fold lower than the minimum effective concentration of tobramycin, an antibiotic that is widely used to treat P.
• aeruginosa lung infections All pyocins tested in vivo displayed a potency that was comparable to or greater than tobramycin. In addition, the administration of these highly stable, chromosomally encoded pyocins at high concentrations did not lead to overt inflammation or tissue damage in the lung. Taken together, these data suggest that pyocins have the potential to make useful therapeutics for the treatment of P. aeruginosa lung infections. These include P. aeruginosa infections associated with cystic fibrosis, hospital-acquired and ventilator-associated pneumonia and chronic obstructive pulmonary disease (COPD) , all of which are areas of current unmet medical need 10,11 .
• COPD chronic obstructive pulmonary disease
• colicin-like and lectin-like bacteriocins may also make useful therapeutics for the treatment of respiratory infections with frequently antibiotic-resistant pathogens such as Klebsiella pneumoniae and Burkholderia spp.
• an additional advantage of the colicin-like bacteriocins is their narrow spectrum of killing. This allows for the possibility of successfully treating bacterial infections while leaving the normal bacterial flora intact.
• Well-established complications associated with the use of broad-spectrum antibiotics and dysbiosis include
• the receptors for pyocins S2 and S5 are known to be the TonB-dependent iron-siderophore receptors FpvAI and FptA, respectively 21,22 and the receptor for pyocin Ll has recently been shown to be the common
• polysaccharide antigen of lipopolysaccharide 32 .
• CPA polysaccharide antigen
• FptA and the CPA are known to be widely distributed among strains of P. aeruginosa 33 and interestingly CPA production by P.
• aeruginosa has been shown to be up-regulated in the cystic fibrosis lung 34 , meaning that pyocin Ll may be active against strains in vivo for which no in vitro activity can be
• Pore-forming pyocin S5 utilizes the FptA ferripyochelin receptor to kill Pseudomonas aeruginosa.

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