Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
• • A—HUMAN NECESSITIES
  • A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
  • A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
  • A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
  • A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
  • A23L33/135—Bacteria or derivatives thereof, e.g. probiotics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
  • A61K35/66—Microorganisms or materials therefrom
  • A61K35/74—Bacteria
  • A61K35/741—Probiotics
• • 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
  • A61K9/0031—Rectum, anus
• • 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
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
  • A61P25/16—Anti-Parkinson drugs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/18—Antipsychotics, i.e. neuroleptics; Drugs for mania or schizophrenia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/22—Anxiolytics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/24—Antidepressants
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • C—CHEMISTRY; METALLURGY
  • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
  • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
  • C12N1/00—Microorganisms, e.g. protozoa; Compositions thereof; Processes of propagating, maintaining or preserving microorganisms or compositions thereof; Processes of preparing or isolating a composition containing a microorganism; Culture media therefor
  • C12N1/20—Bacteria; Culture media therefor

Definitions

• This invention is in the field of compositions comprising bacterial strains isolated from the mammalian digestive tract and the use of such compositions in the treatment of disease.
• the human intestine is thought to be sterile in utero, but it is exposed to a large variety of maternal and environmental microbes immediately after birth. Thereafter, a dynamic period of microbial colonization and succession occurs, which is influenced by factors such as delivery mode, environment, diet and host genotype, all of which impact upon the composition of the gut microbiota, particularly during early life. Subsequently, the microbiota stabilizes and becomes adult-like [1].
• the human gut microbiota contains more than 1500 different phylotypes, dominated in abundance levels by two major bacterial divisions ⁇ phyla), the Bacteroidetes and the Firmicutes [2-3].
• the successful symbiotic relationships arising from bacterial colonization of the human gut have yielded a wide variety of metabolic, structural, protective and other beneficial functions.
• the enhanced metabolic activities of the colonized gut ensure that otherwise indigestible dietary components are degraded with release of by-products providing an important nutrient source for the host and additional health benefits.
• the immunological importance of the gut microbiota is well -recognized and is exemplified in germfree animals which have an impaired immune system that is functionally reconstituted following the introduction of commensal bacteria [4-6].
• the discovery of the size and complexity of the human microbiome has resulted in an on-going evaluation of many concepts of health and disease.
• the inventors have developed new therapies for treating and preventing autoimmune and inflammatory disorders of the central nervous system.
• the inventors have identified that bacterial strains from the species Blautia hydrogenotrophica can be effective for treating or preventing autoimmune and inflammatory disorders of the central nervous system.
• administration of compositions comprising Blautia hydrogenotrophica may reduce severity and incidence of symptoms in a mouse model of CNS inflammation and multiple sclerosis (MS). Therefore, in a first embodiment, the invention provides a composition comprising a bacterial strain of the species Blautia hydrogenotrophica, for use in a method of treating or preventing an autoimmune or inflammatory disorder of the central nervous system.
• the bacterial strain in the composition is of Blautia hydrogenotrophica. Closely related strains may also be used, such as bacterial strains that have a 16s rRNA sequence that is at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% identical to the 16s rRNA sequence of a bacterial strain of Blautia hydrogenotrophica. Preferably, the bacterial strain has a 16s rRNA sequence that is at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% identical to SEQ ID NO: l . Most preferably, the bacterial strain in the composition is the Blautia hydrogenotrophica strain deposited under accession number DSM 14294.
• the composition of the invention is for use in treating or preventing a demyelinating autoimmune disease or an inflammatory demyelinating disease.
• the composition of the invention is for use in treating or preventing multiple sclerosis.
• the EAE model studied in the examples is particularly relevant to these diseases and especially MS.
• the composition of the invention is for use in a method of reducing disease incidence or disease severity. In further preferred embodiments, the composition is for use in preventing a decline in motor function or for use in improving motor function. The results obtained in the examples demonstrate that the compositions of the invention can be effective for reducing disease incidence and severity and improving motor function.
• the composition of the invention is for oral administration. Oral administration of the strains of the invention can be effective for treating autoimmune or inflammatory disorders of the central nervous system. Also, oral administration is convenient for patients and practitioners and allows delivery to and / or partial or total colonisation of the intestine.
• the composition of the invention comprises one or more pharmaceutically acceptable excipients or carriers.
• the composition of the invention comprises a bacterial strain that has been lyophilised. Lyophilisation is an effective and convenient technique for preparing stable compositions that allow delivery of bacteria.
• the invention provides a food product comprising the composition as described above.
• the invention provides a vaccine composition comprising the composition as described above.
• the invention provides a method of treating or preventing to an immune or inflammatory disorder of the central nervous system, comprising administering a composition comprising a bacterial strain of the species Blautia hydrogenotrophica.
• Figure la EAE clinical scores from day 0 to day 30.
• Figure lb EAE clinical scores from day 0 to day 35.
• Figure 2a Area under the curve (AUC) analysis of EAE clinical scores from day 0 to day 30.
• Figure 2b Area under the curve (AUC) analysis of EAE clinical scores from day 0 to day 35.
• FIG. 3 Spinal cord and brain histopathology score analysis. Data shows mean ⁇ SEM. * p ⁇ 0.05 and *** p ⁇ 0.001 vs. vehicle (PBS) group.
• Figure 4 Representative pictures of spinal cord sections stained with haematoxylin and eosin.
• Figure 5 Representative pictures of brain sections stained with haematoxylin and eosin.
• FIG. 6 Effect of Blautia hydrogenotrophica (10 10 / day for 14 days) on short chain fatty acids production (RMN 3 ⁇ 4) in caecal contents of healthy HIM rats.
• Figure 7 qPCR evaluation of B. hydrogenotrophica population in faecal samples of IBS-HMA rats treated or not with a composition comprising B. hydrogenotrophica (BlautiX) for 28 days.
• Figure 8 Short chain fatty acids (SCFA) concentrations in caecal samples of IBS-HMA rats treated or not with B. hydrogenotrophica (Blautix) for 28 days.
• Figure 8A shows concentration of total SCFA.
• Figure 8B shows concentration of Acetic acid, Propionic acid and Butyric acid.
• compositions of the invention comprise a bacterial strain of the species Blautia hydrogenotrophica.
• the examples demonstrate that bacteria of this species are useful for treating or preventing an autoimmune or inflammatory disorder of the central nervous system, such as multiple sclerosis.
• the Blautia species are Gram-reaction-positive, non-motile bacteria that may be either coccoid or oval and all are obligate anaerobes that produce acetic acid as the major end product of glucose fermentation [20].
• Blautia may be isolated from the human gut, although B. producta was isolated from a septicaemia sample.
• Blautia hydrogenotrophica (previously known as Ruminococcus hydro genotrophicus) has been isolated from the guts of mammals, is strictly anaerobic, and metabolises H2/CO2 to acetate, which may be important for human nutrition.
• GenBank accession number for the 16S rRNA gene sequence of Blautia hydrogenotrophica strain S5a36 is X95624.1 (disclosed herein as SEQ ID NO: 1). This exemplary Blautia hydrogenotrophica strain is described in [20] and [21].
• the S5a33 strain and the S5a36 strain correspond to two subclones of a strain isolated from a faecal sample of a healthy subject. They show identical morphology, physiology and metabolism and have identical 16S rRNA sequences.
• the Blautia hydrogenotrophica for use in the invention has the 16S rRNA sequence of SEQ ID NO: 1.
• strain BH The Blautia hydrogenotrophica bacterium deposited under accession number DSM 14294 was tested in the examples and is also referred to herein as strain BH or Blautix. It is the preferred strain of the invention.
• Strain BH was deposited with the Deutsche Sammlung von Mikroorganismen [German Microorganism Collection] (Mascheroder Weg lb, 38124 Braunschweig, Germany) under accession DSM 14294 as "S5a33" on 10th May 2001.
• the depositor was INRA Laboratoire de Microbiologie CR de Clermont-Ferrand/Theix 63122 Saint Genes Champanelle, France. Ownership of the deposits has passed to 4D Pharma Pic by way of assignment. 4D Pharma Pic has authorised, by way of an agreement, 4D Pharma Research Limited to refer to the deposited biological material in the application and has given its unreserved and irrevocable consent to the deposited material being made available to the public.
• the bacterial strain for use in the invention has a 16s rRNA sequence that is at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% identical to the 16s rRNA sequence of a bacterial strain of Blautia hydrogenotrophica.
• the bacterial strain for use in the invention has a 16s rRNA sequence that is at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% identical to SEQ ID NO: 1.
• Bacterial strains that are biotypes of the bacterium deposited under accession number DSM 14294 are also expected to be effective for treating or preventing autoimmune or inflammatory disorders of the central nervous system.
• a biotype is a closely related strain that has the same or very similar physiological and biochemical characteristics.
• Strains that are biotypes of a bacterium deposited under accession number DSM 14294 and that are suitable for use in the invention may be identified by sequencing other nucleotide sequences for a bacterium deposited under accession number DSM 14294.
• substantially the whole genome may be sequenced and a biotype strain for use in the invention may have at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% sequence identity across at least 80% of its whole genome (e.g. across at least 85%, 90%, 95% or 99%, or across its whole genome).
• a biotype strain has at least 98% sequence identity across at least 98% of its genome or at least 99% sequence identity across 99% of its genome.
• Biotype strains may have sequences with at least 95%, 96%, 97%, 98%, 99%, 99.5% or 99.9% sequence identity to the corresponding sequence of a bacterium deposited under accession number DSM 14294.
• a biotype strain has a sequence with at least 97%, 98%, 99%, 99.5% or 99.9% sequence identity to the corresponding sequence of the Blautia hydrogenotrophica strain deposited as DSM 14294 and comprises a 16S rRNA sequence that is at least 99% identical (e.g.
• a biotype strain has a sequence with at least 97%, 98%, 99%, 99.5% or 99.9% sequence identity to the corresponding sequence of the Blautia hydrogenotrophica strain deposited as DSM 14294 and has the 16S rRNA sequence of SEQ ID NO 1.
• strains that are biotypes of a bacterium deposited under accession number DSM 14294and that are suitable for use in the invention may be identified by using the accession number DSM 14294 deposit and restriction fragment analysis and/or PCR analysis, for example by using fluorescent amplified fragment length polymorphism (FAFLP) and repetitive DNA element (rep)-PCR fingerprinting, or protein profiling, or partial 16S or 23s rDNA sequencing.
• FAFLP fluorescent amplified fragment length polymorphism
• rep repetitive DNA element
• protein profiling or partial 16S or 23s rDNA sequencing.
• such techniques may be used to identify other Blautia hydrogenotrophica strains.
• strains that are biotypes of a bacterium deposited under accession number DSM 14294 and that are suitable for use in the invention are strains that provide the same pattern as a bacterium deposited under accession number DSM 14294 when analysed by amplified ribosomal DNA restriction analysis (ARDRA), for example when using Sau3AI restriction enzyme (for exemplary methods and guidance see, for example, [23]).
• ARDRA amplified ribosomal DNA restriction analysis
• biotype strains are identified as strains that have the same carbohydrate fermentation patterns as a bacterium deposited under accession number DSM 14294.
• Blautia hydrogenotrophica strains that are useful in the compositions and methods of the invention, such as biotypes of a bacterium deposited under accession number DSM 14294, may be identified using any appropriate method or strategy, including the assays described in the examples.
• strains for use in the invention may be identified by culturing bacteria and administering to mice using an EAE model protocol, such as that used in the examples.
• bacterial strains that have similar growth patterns, metabolic type and/or surface antigens to a bacterium deposited under accession number DSM 14294 may be useful in the invention.
• a useful strain will have comparable microbiota modulatory activity to the DSM 14294 strain.
• a biotype strain will elicit comparable effects on autoimmune or inflammatory disorders of the central nervous system to the effects shown in the examples, which may be identified by using the culturing and administration protocols described in the examples.
• a particularly preferred strain of the invention is the Blautia hydrogenotrophica strain deposited under accession number DSM 14294.
• This is the exemplary BH strain tested in the examples and shown to be effective for treating disease. Therefore, the invention provides a cell, such as an isolated cell, of the Blautia hydrogenotrophica strain deposited under accession number DSM 14294, or a derivative thereof, for use in therapy, in particular for the diseases described herein.
• a derivative of the strain deposited under accession number DSM 14294 may be a daughter strain (progeny) or a strain cultured (subcloned) from the original.
• a derivative of a strain of the invention may be modified, for example at the genetic level, without ablating the biological activity.
• a derivative strain of the invention is therapeutically active.
• a derivative strain will have comparable microbiota modulatory activity to the original DSM 14294 strain.
• a derivative strain will elicit comparable effects on autoimmune or inflammatory disorders of the central nervous system to the effects shown in the Examples, which may be identified by using the culturing and administration protocols described in the Examples.
• a derivative of the DSM 14294 strain will generally be a biotype of the DSM 14294 strain.
• references to cells of the Blautia hydrogenotrophica strain deposited under accession number DSM 14294 encompass any cells that have the same safety and therapeutic efficacy characteristics as the strains deposited under accession number DSM 14294, and such cells are encompassed by the invention.
• the bacterial strains in the compositions of the invention are viable and capable of partially or totally colonising the intestine.
• compositions of the inventor are for use in treating or preventing autoimmune or inflammatory disorders of the central nervous system.
• the examples demonstrate that the compositions of the invention achieve a reduction in the disease incidence and disease severity in a mouse model of CNS inflammation (the EAE model), and so they may be useful in the treatment or prevention of such conditions.
• compositions of the invention are for use in treating or preventing a demyelinating autoimmune disease.
• the effects shown in the examples are particularly relevant for such diseases.
• compositions of the invention are for use in treating or preventing an inflammatory demyelinating disease.
• the effects shown in the examples are particularly relevant for such diseases.
• compositions of the invention are for use in treating or preventing multiple sclerosis, as discussed in more detail below.
• the disorder primarily affects the spine. In certain embodiments, the disorder primarily affects the spinal cord. In certain embodiments, the disorder primarily affects the brain.
• treatment with a composition of the invention reduces inflammation in the spinal cord. In certain embodiments, treatment with a composition of the invention reduces inflammation in the brain. In certain embodiments, treatment with a composition of the invention reduces inflammation in the spinal cord and in the brain.
• the compositions is for use in treating or preventing a disease selected from the list consisting of: multiple sclerosis, neuromyelitis optica, anti-MOG autoimmune encephalomyelitis, chronic relapsing inflammatory optic neuritis, acute disseminated encephalomyelitis, acute hemorrhagic leukoencephalitis, balo concentric sclerosis, diffuse myelinoclastic sclerosis, Marburg multiple sclerosis, Tumefactive multiple sclerosis and solitary sclerosis.
• a disease selected from the list consisting of: multiple sclerosis, neuromyelitis optica, anti-MOG autoimmune encephalomyelitis, chronic relapsing inflammatory optic neuritis, acute disseminated encephalomyelitis, acute hemorrhagic leukoencephalitis, balo concentric sclerosis, diffuse myelinoclastic sclerosis, Marburg multiple sclerosis, Tumefactive multiple sclerosis and solitary sclerosis
• compositions are for use in treating or preventing transverse myelitis, Bickerstaff brainstem encephalitis, Miller Fisher syndrome, CNS vasculitis, neurosarcoidosis, neuropsychiatric manifestations of systemic lupus erythematosus, tropical spastic paraparesis (TSP)/HTLV-I-associated myelopathy (HAM), or West Nile virus infection of the CNS.
• transverse myelitis Bickerstaff brainstem encephalitis
• Miller Fisher syndrome CNS vasculitis
• neurosarcoidosis neuropsychiatric manifestations of systemic lupus erythematosus
• TSP tropical spastic paraparesis
• HAM HTLV-I-associated myelopathy
• the compositions of the invention are for use in a patient diagnosed with an infectious disease known to cause autoimmune or inflammatory disorders of the central nervous system, such as Campylobacter jejuni infection.
• treatment with the compositions of the invention results in a reduction in disease incidence or disease severity.
• the compositions of the invention are for use in reducing disease incidence or disease severity.
• treatment with the compositions of the invention prevents a decline in motor function or results in improved motor function.
• the compositions of the invention are for use in preventing a decline in motor function or for use in improving motor function.
• treatment with the compositions of the invention prevents the development of paralysis.
• the compositions of the invention are for use in treating or preventing multiple sclerosis.
• the examples demonstrate that the compositions of the invention achieve a reduction in the disease incidence and disease severity in a mouse model of multiple sclerosis (the EAE model), and so they may be useful in the treatment or prevention of multiple sclerosis.
• Multiple sclerosis is an inflammatory disorder and a demyelinating disease of the central nervous system associated with damage to the myelin sheaths of neurons, particularly in the brain and spinal column.
• Multiple sclerosis is a chronic disease, which is progressively incapacitating and which evolves in episodes.
• MS is usually found in older patients.
• Inflammation consisting of T cell and B cell infiltrates is usually found in the CNS and lesions of MS patients.
• the degree of lymphocyte infiltration is greater in the earlier phases of the disease as opposed to the later phases of the disease.
• CD8+ T cells are the predominant lymphocyte population with lower levels of CD4+ T cells and B cells.
• the compositions of the invention may be particularly effective for preventing or treating multiple sclerosis.
• treatment with the compositions of the invention results in a reduction in MS incidence or MS severity.
• the compositions of the invention are for use in reducing relapse incidence or relapse severity.
• treatment with the compositions of the invention prevents a decline in motor function or results in improved motor function associated with MS.
• the compositions of the invention are for use in preventing a decline in motor function or for use in improving motor function in the treatment of MS.
• treatment with the compositions of the invention prevents the development of paralysis in MS.
• the compositions of the invention are for use in preventing paralysis in the treatment of MS.
• compositions of the invention are for use in preventing multiple sclerosis in a patient that has been identified as at risk of multiple sclerosis, or that has been diagnosed with early-stage multiple sclerosis or "relapsing-remitting" multiple sclerosis.
• the compositions of the invention may be useful for preventing the development of MS.
• the compositions of the invention may be useful for preventing the progression of MS.
• the compositions of the invention are for use in a patient identified as having a genetic predisposition to MS, such as major histocompatibility complex (MHC) class II phenotype, human leukocyte antigen (HLA)-DR2 or HLA- DR4.
• MHC major histocompatibility complex
• HLA human leukocyte antigen
• compositions of the invention may be useful for managing or alleviating multiple sclerosis.
• the compositions of the invention may be particularly useful for reducing symptoms associated with multiple sclerosis.
• Treatment or prevention of multiple sclerosis may refer to, for example, an alleviation of the severity of symptoms or a reduction in the frequency of exacerbations or the range of triggers that are a problem for the patient.
• the compositions of the invention slow or stop progression of the disease.
• compositions of the invention are for use in treating relapsing-remitting MS.
• compositions of the invention are for use in treating progressive MS, such as secondary progressive MS (SPMS), which develops over time following diagnosis of RRMS, primary progressive MS (PPMS) which exhibits gradual continuous neurologic deterioration and progressive relapsing MS (PRMS), which is similar to PPMS but with overlapping relapses.
• SPMS secondary progressive MS
• PPMS primary progressive MS
• PRMS progressive relapsing MS
• compositions of the invention are for use in treating one or more of symptoms of MS selected from the group consisting of: fatigue, vision problems, numbness, tingling, muscle spasms, muscle stiffness, muscle weakness, mobility problems, pain, problems with thinking, learning and planning, depression and anxiety, sexual problems, bladder problems, bowel problems, speech and swallowing difficulties.
• compositions of the invention are for use in combination with a secondary active agent.
• the compositions of the invention are for use in combination with ⁇ -interferon la or lb or glatiramer acetate.
• Other secondary agents include other interferons, dimethyl fumarate, teriflunomide, fingolimod, mitoxantrone, humanized monoclonal antibodies (such as natalizumab, ofatumumab, ocrelizumab, alemtuzumab, daclizumab), stem cells, DNA vaccines, nanoparticles and altered peptide ligands.
• the compositions of the invention may improve the patient's response to the secondary active agent. Histone deacetylase inhibitors such as butyrate have also been proposed for use in the treatment of multiple sclerosis [24].
• the composition of the invention comprising Blautia hydrogenotrophica inhibits neuro-inflammation.
• the composition of the invention comprising Blautia hydrogenotrophica increases the levels of IL-1RA (an inhibitor of the pro-inflammatory IL- 1 ⁇ ).
• the composition of the invention comprising Blautia hydrogenotrophica decreases the levels pro-inflammatory IL- ⁇ and/or TNFa.
• the composition of the invention comprising Blautia hydrogenotrophica increases IL-4 expression, which increases the levels of IL-1RA.
• the composition of the invention comprising Blautia hydrogenotrophica inhibits nuclear factor ⁇ (NF- ⁇ ) activation.
• composition of the invention comprising Blautia hydrogenotrophica may modulate the expression of early immune inflammatory response genes, including IL-1B, TNFa, IL-2, IL-6, IL-8, IL-12, inducible nitric acid synthase, cyclooxygenase-2, intercellular adhesion molecule- 1, T cell receptor-a and MHC class II molecules.
• early immune inflammatory response genes including IL-1B, TNFa, IL-2, IL-6, IL-8, IL-12, inducible nitric acid synthase, cyclooxygenase-2, intercellular adhesion molecule- 1, T cell receptor-a and MHC class II molecules.
• the compositions of the inventor are for use in treating or preventing autoimmune or inflammatory disorders of the central nervous system.
• the disorder to be treated by the composition of the invention is not an autism spectrum disorder (ASDs); child developmental disorder; obsessive compulsive disorder (OCD); major depressive disorder; depression; seasonal affective disorder; an anxiety disorder; chronic fatigue syndrome (myalgic encephalomyelitis); stress disorder; post-traumatic stress disorder; a schizophrenia spectrum disorder; schizophrenia; bipolar disorder; psychosis; mood disorder; dementia; Alzheimer's; Parkinson's disease; chronic pain, motor neuron disease; Huntington's disease; Guillain-Barre syndrome or meningitis.
• ASSDs autism spectrum disorder
• OCD obsessive compulsive disorder
• major depressive disorder depression
• seasonal affective disorder an anxiety disorder
• chronic fatigue syndrome myalgic encephalomyelitis
• stress disorder post-traumatic stress disorder
• a schizophrenia spectrum disorder schizophrenia; bipolar disorder; psychosis; mood disorder; dementia; Alzheimer's; Parkinson's disease; chronic pain, motor neuron disease; Huntington's disease; Guillain-Barre
• compositions of the invention are to be administered to the gastrointestinal tract in order to enable delivery to and / or partial or total colonisation of the intestine with the bacterial strain of the invention.
• compositions of the invention are administered orally, but they may be administered rectally, intranasally, or via buccal or sublingual routes.
• compositions of the invention may be administered as a foam, as a spray or a gel.
• compositions of the invention may be administered as a suppository, such as a rectal suppository, for example in the form of a theobroma oil (cocoa butter), synthetic hard fat (e.g. suppocire, witepsol), glycero-gelatin, polyethylene glycol, or soap glycerin composition.
• the composition of the invention is administered to the gastrointestinal tract via a tube, such as a nasogastric tube, orogastric tube, gastric tube, jejunostomy tube (J tube), percutaneous endoscopic gastrostomy (PEG), or a port, such as a chest wall port that provides access to the stomach, jejunum and other suitable access ports.
• a tube such as a nasogastric tube, orogastric tube, gastric tube, jejunostomy tube (J tube), percutaneous endoscopic gastrostomy (PEG), or a port, such as a chest wall port that provides access to the stomach, jejunum and other suitable access ports.
• compositions of the invention may be administered once, or they may be administered sequentially as part of a treatment regimen. In certain embodiments, the compositions of the invention are to be administered daily.
• administration provides successful colonisation and clinical benefits in treatment of autoimmune or inflammatory disorders of the central nervous system.
• compositions of the invention are administered regularly, such as daily, every two days, or weekly, for an extended period of time, such as for at least one week, two weeks, one month, two months, six months, or one year.
• extended period of time such as for at least one week, two weeks, one month, two months, six months, or one year.
• compositions of the invention are administered for 7 days, 14 days, 16 days, 21 days or 28 days or no more than 7 days, 14 days, 16 days, 21 days or 28 days.
• compositions of the invention are administered for 16 days.
• treatment according to the invention is accompanied by assessment of the patient's gut microbiota. Treatment may be repeated if delivery of and / or partial or total colonisation with the strain of the invention is not achieved such that efficacy is not observed, or treatment may be ceased if delivery and / or partial or total colonisation is successful and efficacy is observed.
• the composition of the invention may be administered to a pregnant animal, for example a mammal such as a human in order to prevent autoimmune or inflammatory disorders of the central nervous system developing in her child in utero and / or after it is born.
• compositions of the invention may be administered to a patient that has been diagnosed with an autoimmune or inflammatory disorder of the central nervous system, or that has been identified as being at risk of such a disorder.
• the compositions may also be administered as a prophylactic measure to prevent the development of disease in a healthy patient.
• compositions of the invention may be administered to a patient that has been identified as having an abnormal gut microbiota.
• the patient may have reduced or absent colonisation by Blautia, and in particular Blautia hydrogenotrophica.
• compositions of the invention may be administered as a food product, such as a nutritional supplement.
• a food product such as a nutritional supplement.
• the compositions of the invention are for the treatment of humans, although they may be used to treat animals including monogastric mammals such as poultry, pigs, cats, dogs, horses or rabbits.
• the compositions of the invention may be useful for enhancing the growth and performance of animals. If administered to animals, oral gavage may be used.
• the subject to whom the composition is to be administered is an adult human. In some embodiments, the subject to whom the composition is to be administered is an infant human.
• the composition of the invention comprises bacteria.
• the composition is formulated in freeze-dried form.
• the composition of the invention may comprise granules or gelatin capsules, for example hard gelatin capsules, comprising a bacterial strain of the invention.
• the composition of the invention comprises lyophilised bacteria. Lyophilisation of bacteria is a well-established procedure and relevant guidance is available in, for example, references [25-27]. Lyophilisate compositions may be particularly effective.
• the compositions of the invention comprises lyophilised bacteria and is for the treatment of MS.
• the composition of the invention may comprise a live, active bacterial culture.
• the bacterial strain in the composition of the invention has not been inactivated, for example, has not been heat-inactivated.
• the bacterial strain in the composition of the invention has not been killed, for example, has not been heat-killed.
• the bacterial strain in the composition of the invention has not been attenuated, for example, has not been heat-attenuated.
• the bacterial strain in the composition of the invention has not been killed, inactivated and/or attenuated.
• the bacterial strain in the composition of the invention is live.
• the bacterial strain in the composition of the invention is viable.
• the bacterial strain in the composition of the invention is capable of partially or totally colonising the intestine.
• the bacterial strain in the composition of the invention is viable and capable of partially or totally colonising the intestine.
• the composition comprises a mixture of live bacterial strains and bacterial strains that have been killed.
• the composition of the invention is encapsulated to enable delivery of the bacterial strain to the intestine.
• Encapsulation protects the composition from degradation until delivery at the target location through, for example, rupturing with chemical or physical stimuli such as pressure, enzymatic activity, or physical disintegration, which may be triggered by changes in pH. Any appropriate encapsulation method may be used. Exemplary encapsulation techniques include entrapment within a porous matrix, attachment or adsorption on solid carrier surfaces, self-aggregation by flocculation or with cross-linking agents, and mechanical containment behind a microporous membrane or a microcapsule. Guidance on encapsulation that may be useful for preparing compositions of the invention is available in, for example, references [28-29].
• the composition may be administered orally and may be in the form of a tablet, capsule or powder. Encapsulated products are preferred because Blautia are anaerobes. Other ingredients (such as vitamin C, for example), may be included as oxygen scavengers and prebiotic substrates to improve the delivery and / or partial or total colonisation and survival in vivo.
• the probiotic composition of the invention may be administered orally as a food or nutritional product, such as milk or whey based fermented dairy product, or as a pharmaceutical product.
• composition may be formulated as a probiotic.
• a composition of the invention includes a therapeutically effective amount of a bacterial strain of the invention.
• a therapeutically effective amount of a bacterial strain is sufficient to exert a beneficial effect upon a patient.
• a therapeutically effective amount of abacterial strain may be sufficient to result in delivery to and / or partial or total colonisation of the patient' s intestine.
• a suitable daily dose of the bacteria may be from about 1 x 10 3 to about 1 x 10 11 colony forming units (CFU); for example, from about 1 x 10 7 to about 1 x 10 10 CFU; in another example from about 1 x 10 6 to about 1 x 10 10 CFU; in another example from about 1 x 10 7 to about 1 x 10 11 CFU; in another example from about 1 x 10 8 to about 1 x 10 10 CFU; in another example from about 1 x 10 8 to about 1 x 10 11 CFU.
• CFU colony forming units
• the dose of the bacteria is at least 10 9 cells per day, such as at least 10 10 , at least 10 11 , or at least 10 12 cells per day.
• the composition contains the bacterial strain in an amount of from about 1 x 10 6 to about 1 x 10 11 CFU/g, respect to the weight of the composition; for example, from about 1 x 10 8 to about 1 x 10 10 CFU/g.
• the dose may be, for example, 1 g, 3g, 5g, and lOg. In some embodiments, the dose may be lg or less, for example, from about 0.5g to about lg, for example, about 0.5g, 0.6g, 0.75g, 0.8g, 0.9g or lg.
• a probiotic such as the composition of the invention
• a probiotic compound is usually a non-digestible carbohydrate such as an oligo- or polysaccharide, or a sugar alcohol, which is not degraded or absorbed in the upper digestive tract.
• Known prebiotics include commercial products such as inulin and transgalacto- oligosaccharides.
• the probiotic composition of the present invention includes a prebiotic compound in an amount of from about 1 to about 30% by weight, respect to the total weight composition, (e.g. from 5 to 20% by weight).
• Carbohydrates may be selected from the group consisting of: fructo- oligosaccharides (or FOS), short-chain fructo-oligosaccharides, inulin, isomalt- oligosaccharides, pectins, xylo-oligosaccharides (or XOS), chitosan-oligosaccharides (or COS), beta- glucans, arable gum modified and resistant starches, polydextrose, D-tagatose, acacia fibers, carob, oats, and citrus fibers.
• FOS fructo- oligosaccharides
• FOS short-chain fructo-oligosaccharides
• inulin isomalt- oligosaccharides
• pectins or xylo-oligosaccharides
• XOS xylo-oligosaccharides
• COS chitosan-oligosaccharides
• the prebiotics are the short-chain fructo-oligosaccharides (for simplicity shown herein below as FOSs-c.c); said FOSs-c.c. are not digestible carbohydrates, generally obtained by the conversion of the beet sugar and including a saccharose molecule to which three glucose molecules are bonded.
• compositions of the invention may comprise pharmaceutically acceptable excipients or carriers.
• suitable excipients may be found in the reference [30].
• Acceptable carriers or diluents for therapeutic use are well known in the pharmaceutical art and are described, for example, in reference [31].
• suitable carriers include lactose, starch, glucose, methyl cellulose, magnesium stearate, mannitol, sorbitol and the like.
• suitable diluents include ethanol, glycerol and water.
• the choice of pharmaceutical carrier, excipient or diluent can be selected with regard to the intended route of administration and standard pharmaceutical practice.
• the pharmaceutical compositions may comprise as, or in addition to, the carrier, excipient or diluent any suitable binder(s), lubricant(s), suspending agent(s), coating agent(s), solubilising agent(s).
• suitable binders include starch, gelatin, natural sugars such as glucose, anhydrous lactose, free-flow lactose, beta-lactose, com sweeteners, natural and synthetic gums, such as acacia, tragacanth or sodium alginate, carboxymethyl cellulose and polyethylene glycol.
• suitable lubricants include sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride and the like.
• Preservatives, stabilizers, dyes and even flavouring agents may be provided in the pharmaceutical composition.
• preservatives include sodium benzoate, sorbic acid, cysteine and esters of p-hydroxybenzoic acid, for example, in some embodiments the preservative is selected from sodium benzoate, sorbic acid and esters of p-hydroxybenzoic acid.
• Antioxidants and suspending agents may be also used.
• a further example of a suitable carrier is saccharose.
• a further example of a preservative is cysteine.
• compositions of the invention may be formulated as a food product.
• a food product may provide nutritional benefit in addition to the therapeutic effect of the invention, such as in a nutritional supplement.
• a food product may be formulated to enhance the taste of the composition of the invention or to make the composition more attractive to consume by being more similar to a common food item, rather than to a pharmaceutical composition.
• the composition of the invention is formulated as a milk-based product.
• milk-based product means any liquid or semi-solid milk- or whey- based product having a varying fat content.
• the milk- based product can be, e.g., cow's milk, goat's milk, sheep's milk, skimmed milk, whole milk, milk recombined from powdered milk and whey without any processing, or a processed product, such as yoghurt, curdled milk, curd, sour milk, sour whole milk, butter milk and other sour milk products.
• milk beverages such as whey beverages, fermented milks, condensed milks, infant or baby milks; flavoured milks, ice cream; milk-containing food such as sweets.
• compositions of the invention comprise one or more bacterial strains of the genus Blautia and do not contain bacteria from any other genus, or comprise only de minimis or biologically irrelevant amounts of bacteria from another genus.
• compositions of the invention comprise one or more bacterial strains of the species Blautia hydrogenotrophica and do not contain bacteria from any other species, or comprise only de minimis or biologically irrelevant amounts of bacteria from another species.
• the composition of the invention comprises a single strain of Blautia hydrogenotrophica, preferably strain BH, and does not contain bacteria from any other strains, or comprise only de minimis or biologically irrelevant amounts of bacteria from another strain.
• compositions of the invention contain a single bacterial strain or species and do not contain any other bacterial strains or species. Such compositions may comprise only de minimis or biologically irrelevant amounts of other bacterial strains or species. Such compositions may be a culture that is substantially free from other species of organism. In some embodiments, such compositions may be a lyophilisate that is substantially free from other species of organism.
• compositions of the invention comprise one or more bacterial strains of the genus Blautia, for example, a Blautia hydrogenotrophica, and do not contain any other bacterial genus, or which comprise only de minimis or biologically irrelevant amounts of bacteria from another genus.
• compositions of the invention comprise a single species of Blautia, for example, a Blautia hydrogenotrophica, and do not contain any other bacterial species, or which comprise only de minimis or biologically irrelevant amounts of bacteria from another species.
• compositions of the invention comprise a single strain of Blautia, for example, of Blautia hydrogenotrophica, and do not contain any other bacterial strains or species, or which comprise only de minimis or biologically irrelevant amounts of bacteria from another strain or species.
• the compositions of the invention comprise more than one bacterial strain or species.
• the compositions of the invention comprise more than one strain from within the same species (e.g. more than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40 or 45 strains), and, optionally, do not contain bacteria from any other species.
• the compositions of the invention comprise less than 50 strains from within the same species (e.g. less than 45, 40, 35, 30, 25, 20, 15, 12, 10, 9, 8, 7, 6, 5, 4 or 3 strains), and, optionally, do not contain bacteria from any other species.
• compositions of the invention comprise 1-40, 1-30, 1-20, 1-19, 1-18, 1-15, 1-10, 1-9, 1-8, 1-7, 1-6, 1-5, 1-4, 1-3, 1-2, 2-50, 2-40, 2- 30, 2-20, 2-15, 2-10, 2-5, 6-30, 6-15, 16-25, or 31-50 strains from within the same species and, optionally, do not contain bacteria from any other species.
• the compositions of the invention comprise more than one species from within the same genus (e.g. more than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 17, 20, 23, 25, 30, 35 or 40 species), and, optionally, do not contain bacteria from any other genus.
• the compositions of the invention comprise less than 50 species from within the same genus (e.g. less than 50, 45, 40, 35, 30, 25, 20, 15, 12, 10, 8, 7, 6, 5, 4 or 3 species), and, optionally, do not contain bacteria from any other genus.
• the compositions of the invention comprise 1-50, 1-40, 1-30, 1-20, 1-15, 1-10, 1-9, 1-8, 1-7, 1-6, 1-5, 1-4, 1-3, 1-2, 2-50, 2-40, 2-30, 2-20, 2-15, 2-10, 2-5, 6-30, 6-15, 16-25, or 31-50 species from within the same genus and, optionally, do not contain bacteria from any other genus.
• the invention comprises any combination of the foregoing.
• the composition comprises a microbial consortium.
• the composition comprises the Blautia hydrogenotrophica bacterial strain as part of a microbial consortium.
• the Blautia hydrogenotrophica bacterial strain is present in combination with one or more (e.g. at least 2, 3, 4, 5, 10, 15 or 20) other bacterial strains from other genera with which it can live symbiotically in vivo in the intestine.
• the composition comprises a bacterial strain of Blautia hydrogenotrophica in combination with a bacterial strain from a different genus.
• the microbial consortium comprises two or more bacterial strains obtained from a faeces sample of a single organism, e.g. a human. In some embodiments, the microbial consortium is not found together in nature.
• the microbial consortium comprises bacterial strains obtained from faeces samples of at least two different organisms. In some embodiments, the two different organisms are from the same species, e.g. two different humans. In some embodiments, the two different organisms are an infant human and an adult human. In some embodiments, the two different organisms are a human and a non-human mammal.
• the composition of the invention additionally comprises a bacterial strain that has the same safety and therapeutic efficacy characteristics as the Blautia hydrogenotrophica strain deposited under accession number DSM 14294, but which is not the Blautia hydrogenotrophica strain deposited under accession number DSM 14294, or which is not a Blautia hydrogenotrophica or which is not a Blautia.
• the composition of the invention comprises more than one bacterial strain, species or genus
• the individual bacterial strains, species or genera may be for separate, simultaneous or sequential administration.
• the composition may comprise all of the more than one bacterial strain, species or genera, or the bacterial strains, species or genera may be stored separately and be administered separately, simultaneously or sequentially.
• the more than one bacterial strains, species or genera are stored separately but are mixed together prior to use.
• the bacterial strain for use in the invention is obtained from human adult faeces. In some embodiments in which the composition of the invention comprises more than one bacterial strain, all of the bacterial strains are obtained from human adult faeces or if other bacterial strains are present they are present only in de minimis amounts.
• the bacteria may have been cultured subsequent to being obtained from the human adult faeces and being used in a composition of the invention.
• the one or more Blautia bacterial strains is/are the only therapeutically active agent(s) in a composition of the invention. In some embodiments, the bacterial strain(s) in the composition is/are the only therapeutically active agent(s) in a composition of the invention.
• compositions for use in accordance with the invention may or may not require marketing approval.
• the invention provides the above pharmaceutical composition, wherein said bacterial strain is lyophilised. In certain embodiments, the invention provides the above pharmaceutical composition, wherein said bacterial strain is spray dried. In certain embodiments, the invention provides the above pharmaceutical composition, wherein the bacterial strain is lyophilised or spray dried and wherein it is live. In certain embodiments, the invention provides the above pharmaceutical composition, wherein the bacterial strain is lyophilised or spray dried and wherein it is viable. In certain embodiments, the invention provides the above pharmaceutical composition, wherein the bacterial strain is lyophilised or spray dried and wherein it is capable of partially or totally colonising the intestine. In certain embodiments, the invention provides the above pharmaceutical composition, wherein the bacterial strain is lyophilised or spray dried and wherein it is viable and capable of partially or totally colonising the intestine.
• the lyophilised or spray dried bacterial strain is reconstituted prior to administration.
• the reconstitution is by use of a diluent described herein.
• compositions of the invention can comprise pharmaceutically acceptable excipients, diluents or carriers.
• the invention provides a pharmaceutical composition
• a pharmaceutical composition comprising: a bacterial strain of the invention; and a pharmaceutically acceptable excipient, carrier or diluent; wherein the bacterial strain is in an amount sufficient to treat a disorder when administered to a subject in need thereof; and wherein the disorder is an autoimmune or inflammatory disorder of the central nervous system.
• the invention provides the above pharmaceutical composition, wherein the amount of the bacterial strain is from about 1 ⁇ 10 3 to about 1 ⁇ 10 11 colony forming units per gram with respect to a weight of the composition.
• the invention provides the above pharmaceutical composition, wherein the composition is administered at a dose of 1 g, 3 g, 5 g or 10 g.
• the invention provides the above pharmaceutical composition, wherein the composition is administered by a method selected from the group consisting of oral, rectal, subcutaneous, nasal, buccal, and sublingual.
• the invention provides the above pharmaceutical composition, comprising a carrier selected from the group consisting of lactose, starch, glucose, methyl cellulose, magnesium stearate, mannitol and sorbitol.
• the invention provides the above pharmaceutical composition, comprising a diluent selected from the group consisting of ethanol, glycerol and water.
• the invention provides the above pharmaceutical composition, comprising an excipient selected from the group consisting of starch, gelatin, glucose, anhydrous lactose, free-flow lactose, beta-lactose, corn sweetener, acacia, tragacanth, sodium alginate, carboxymethyl cellulose, polyethylene glycol, sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate and sodium chloride.
• an excipient selected from the group consisting of starch, gelatin, glucose, anhydrous lactose, free-flow lactose, beta-lactose, corn sweetener, acacia, tragacanth, sodium alginate, carboxymethyl cellulose, polyethylene glycol, sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate and sodium chloride.
• the invention provides the above pharmaceutical composition, further comprising at least one of a preservative, an antioxidant and a stabilizer.
• the invention provides the above pharmaceutical composition, comprising a preservative selected from the group consisting of sodium benzoate, sorbic acid and esters of p- hydroxybenzoic acid.
• the invention provides the above pharmaceutical composition, wherein said bacterial strain is lyophilised.
• the invention provides the above pharmaceutical composition, wherein when the composition is stored in a sealed container at about 4°C or about 25 °C and the container is placed in an atmosphere having 50% relative humidity, at least 80% of the bacterial strain as measured in colony forming units, remains after a period of at least about: 1 month, 3 months, 6 months, 1 year, 1.5 years, 2 years, 2.5 years or 3 years.
• the composition of the invention is provided in a sealed container comprising a composition as described herein.
• the sealed container is a sachet or bottle.
• the composition of the invention is provided in a syringe comprising a composition as described herein.
• composition of the present invention may, in some embodiments, be provided as a pharmaceutical formulation.
• the composition may be provided as a tablet or capsule.
• the composition may be provided in the form of one tablet or capsule or more than one tablet or capsule, for example, 1, 2, 3, 4, 5 or more tablets or capsules.
• the capsule is a gelatine capsule ("gel-cap").
• compositions of the invention are administered orally.
• Oral administration may involve swallowing, so that the compound enters the gastrointestinal tract, and/or buccal, lingual, or sublingual administration by which the compound enters the blood stream directly from the mouth.
• compositions suitable for oral administration include solid plugs, solid microparticulates, semi-solid and liquid (including multiple phases or dispersed systems) such as tablets; soft or hard capsules containing multi- or nano-particulates, liquids (e.g. aqueous solutions), emulsions or powders; lozenges (including liquid-filled); chews; gels; fast dispersing dosage forms; films; ovules; sprays; and buccal/mucoadhesive patches.
• solid plugs solid microparticulates, semi-solid and liquid (including multiple phases or dispersed systems) such as tablets; soft or hard capsules containing multi- or nano-particulates, liquids (e.g. aqueous solutions), emulsions or powders; lozenges (including liquid-filled); chews; gels; fast dispersing dosage forms; films; ovules; sprays; and buccal/mucoadhesive patches.
• the pharmaceutical formulation is an enteric formulation, i.e. a gastro-resistant formulation (for example, resistant to gastric pH) that is suitable for delivery of the composition of the invention to the intestine by oral administration.
• Enteric formulations may be particularly useful when the bacteria or another component of the composition is acid-sensitive, e.g. prone to degradation under gastric conditions.
• the enteric formulation comprises an enteric coating.
• the formulation is an enteric-coated dosage form.
• the formulation may be an enteric- coated tablet or an enteric-coated capsule, or the like.
• the enteric coating may be a conventional enteric coating, for example, a conventional coating for a tablet, capsule, or the like for oral delivery.
• the formulation may comprise a film coating, for example, a thin film layer of an enteric polymer, e.g. an acid-insoluble polymer.
• the enteric formulation is intrinsically enteric, for example, gastro-resistant without the need for an enteric coating.
• the formulation is an enteric formulation that does not comprise an enteric coating.
• the formulation is a capsule made from a thermogelling material.
• the thermogelling material is a cellulosic material, such as methylcellulose, hydroxymethylcellulose or hydroxypropylmethylcellulose (HPMC).
• the capsule comprises a shell that does not contain any film forming polymer.
• the capsule comprises a shell and the shell comprises hydroxypropylmethylcellulose and does not comprise any film forming polymer (e.g. see [32 ]).
• the formulation is an intrinsically enteric capsule (for example, Vcaps® from Capsugel).
• the formulation is a soft capsule.
• Soft capsules are capsules which may, owing to additions of softeners, such as, for example, glycerol, sorbitol, maltitol and polyethylene glycols, present in the capsule shell, have a certain elasticity and softness.
• Soft capsules can be produced, for example, on the basis of gelatine or starch. Gelatine-based soft capsules are commercially available from various suppliers.
• soft capsules can have various shapes, they can be, for example, round, oval, oblong or torpedo-shaped.
• Soft capsules can be produced by conventional processes, such as, for example, by the Scherer process, the Accogel process or the droplet or blowing process.
• the bacterial strains for use in the present invention can be cultured using standard microbiology techniques as detailed in, for example, references [33-35].
• the solid or liquid medium used for culture may for example be YCFA agar or YCFA medium.
• YCFA medium may include (per 100ml, approximate values): Casitone (1.0 g), yeast extract (0.25 g), NaHCOs (0.4 g), cysteine (0.1 g), K2HPO4 (0.045 g), KH2PO4 (0.045 g), NaCl (0.09 g), (NH 4 ) 2 S04 (0.09 g), MgS0 4 ⁇ 7H2O (0.009 g), CaCh (0.009 g), resazurin (0.1 mg), hemin (1 mg), biotin (1 cobalamin (1 ⁇ g), /?-aminobenzoic acid (3 ⁇ g), folic acid (5 ⁇ g), and pyridoxamine (15 ⁇ g).
• references to a percentage sequence identity between two nucleotide sequences means that, when aligned, that percentage of nucleotides are the same in comparing the two sequences.
• This alignment and the percent homology or sequence identity can be determined using software programs known in the art, for example those described in section 7.7.18 of ref. [44].
• a preferred alignment is determined by the Smith-Waterman homology search algorithm using an affine gap search with a gap open penalty of 12 and a gap extension penalty of 2, BLOSUM matrix of 62.
• the Smith-Waterman homology search algorithm is disclosed in ref. [45].
• a process or method comprising numerous steps may comprise additional steps at the beginning or end of the method, or may comprise additional intervening steps. Also, steps may be combined, omitted or performed in an alternative order, if appropriate.
• EAE Experimental Autoimmune Encephalomyelitis
• MS human disease
• EAE is the most commonly used experimental model for human MS.
• EAE is also used more generally as a model for CNS-specific autoimmune disorders [46] and for other specific conditions, including acute disseminated encephalomyelitis.
• EAE is induced using immunisation with myelin peptides and adjuvants to elicit an immune and inflammatory response that closely corresponds to the mechanisms underlying many autoimmune and inflammatory disorders of the CNS, and in particular MS.
• Many therapies showing efficacy in EAE have also shown efficacy in treatment of MS in human patients [46].
• EAE reproduces key features of MS, including inflammation, demyelination, axonal loss and gliosis.
• the effects of demyelination are mainly restricted to the spinal cord in EAE, with little alteration of the brain stem and the cerebellum.
• the CD4+ T cells are the dominant cell population found in the CNS.
• Blautia hydrogenotrophica (“Blautix", strain deposited under accession number DSM 14294) was used as a freeze-dried powder and reconstituted as required.
• mice in Groups 2, 3, 8 and 9 were administered with an emulsion containing MOG35-55 and complete Freund's adjuvant (CFA) supplemented with Mycobacterium Tuberculosis H37Ra by subcutaneous injections under gas (isoflurane) anaesthesia.
• CFA complete Freund's adjuvant
• Mycobacterium Tuberculosis H37Ra Mycobacterium Tuberculosis H37Ra
• two subcutaneous injections were performed in the flanks; one in each of the lower quadrant of the back.
• two subcutaneous injections were performed in the flanks, one in each of the upper quadrant of the back.
• mice in Groups 2, 3, 8 and 9 were administered with pertussis toxin (PTx) in phosphate buffered saline (PBS) by intra-peritoneal injections.
• PTx pertussis toxin
• PBS phosphate buffered saline
• PTx administration was performed after MOG injections.
• n/a not applicable, SID: once per day, PO: oral administration (gavage), SC: subcutaneous injection, IP: intra-peritoneal injection, MOG: myelin oligodendrocyte glycoprotein, CFA: complete Freund's adjuvant, PTx: pertussis toxin, PBS: phosphate-buffered saline
• Treatments were administered within 15 minutes of their preparation.
• mice were treated with the Reference dexamethasone as a positive control.
• a dose of 1 mg/kg (5 ml/kg) was used with mice being treated from Day -14 - Day -1 via the PO route with vehicle (PBS) only, 5 times a week (2 Days on, 1 Day off, 3 Days on, 1 Day off); and from Day 0 - End via the SC route with vehicle and Dexamethasone, 5 times a week (2 Days on, 1 Day off, 3 Days on, 1 Day off).
• Blautix was administered at a dose of 2 x 10 8 ; ⁇ /mouse.
• mice were weighed three times per week. From Day 0 until the end of the experiment, animals were weighed daily. From Day 0 until the end of the experiment, animals were scored daily for clinical signs of EAE, including paresis and paralysis of the tail and/or limbs.
• blood samples were collected and processed to isolate serum.
• Day -14 and Day 35 samples were collected from a caudal (tail) vein in restrained animals. Samples were stored at -20°C until further optional analysis of anti-MOG antibodies by ELISA.
• animals were culled; brains and spinal cords were dissected out, one brain hemisphere and the spinal cord were transferred in tissue fixative then embedded in paraffin and stored in blocks until optional histopathology analysis.
• One brain hemisphere was dissected out and was snap-frozen then stored at -80°C.
• spleens were dissected out, weighed and processed to cell suspension.
• One aliquot per animal was used for cell proliferation assays.
• One aliquot per animal was snap-frozen then stored at -80°C.
• Mouse In addition to: Mouse is moving around the cage, but when placed on its side, is unable to right itself.
• Hind legs are together on one side of body.
• mice with scores judged too severe were culled prior to the scheduled end of the experiment.
• Mice with a score of (5) corresponding to a moribund state, on any occasion were culled immediately.
• Mice with a score of (4) corresponding to a paralysis affecting both hind limbs and a front limb, on two consecutive occasions were culled.
• Mice with a score of (3) corresponding to a paralysis affecting both hind limb, on four consecutive occasions were culled.
• 2 mice in Group 2 were terminated due to EAE scores before the end of the experiment.
• 1 mouse in each of Groups 3 and 8 was terminated due to clinical observations before the end of the experiment. All mice in Groups 1 and 9 were terminated at the end of the experiment.
• Sections of whole brains and longitudinal and cross-sections of spinal cords were stained with haematoxylin and eosin. Sections were evaluated in blinded fashion without knowledge of the experimental protocol.
• Grade 2 Numerous discrete small to medium perivascular cuffs affecting parenchyma and meninges. May be focal demyelination of individual axons associated with mild extension of cuff to surrounding parenchyma.
• Grade 3 Numerous medium to large perivascular cuffs may coalesce and extend significantly into parenchyma. Meninges also involved. May be demyelination of axonal groups associated with extension into parenchyma.
• Figures la and 2a show the results of the study at day 30.
• Figures lb and 2b show the results of the study at day 35.
• Group 9 (Blautix- vehicle) shows that disease induction was successful and the model replicates some of the clinical features of MS with increased clinical scores relative to Group 1 (control).
• Group 3 (Dexamethasone) is a positive control showing successful amelioration of clinical signs.
• Histopathological analysis revealed changes that are expected for this model in spinal cord and brain.
• Group 1 showed no pathology and Group 2 showed the most severe pathology in the highest proportion of animals of any group, as expected.
• Group 3 showed very limited pathology in only 2 animals.
• Groups 8 and 9 were more homogenous, showing less severe pathology than Group 2 affecting relatively fewer animals per group.
• Data was analysed using Mann-Whitney test to compare each treatment group to vehicle (PBS) group. This analysis revealed significantly decreased pathology in the dexamethasone and Blautix groups compared to vehicle (PBS) group (p ⁇ 0.001 and p ⁇ 0.05, respectively; Figure 3).
• Figure 4 shows representative pictures of spinal cord sections stained with haematoxylin and eosin.
• A Mouse 1.12, spinal cord xlO. There are no histological abnormalities.
• B. and C Mouse 2.7, spinal cord xlO and x20. Severe diffuse inflammation and demyelination of peripheral white matter with focal perivascular cuffing.
• D Mouse 3.3, spinal cord x20. Discrete focus inflammation in peripheral white matter.
• I Mouse 9.3, spinal cord, xlO. Diffuse inflammation, demyelination and spheroid formation.
• Group 1 animals showed no histological changes and there was a negligible change in group 3 with only one animal affected and very low mean pathology score. Although there were similar mean severity scores in groups 2, 8 and 9, there were fewer animals affected in groups 8 and 9 compared with group 2. There were some correlations with the spinal cord data (i.e. group 1 normal and group 3 limited pathology), but also some differences (i.e. group 2 has the most severe cord pathology, but not for brain). This is not unexpected for this model, in which cord pathology is often more consistent within groups than that occurring in the brain. Mann-Whitney test revealed significantly lower brain pathology score in the dexamethasone group compared to vehicle (PBS) group (p ⁇ 0.05), as shown in Figure 3.
• PBS vehicle
• Figure 5 shows representative pictures of brain sections stained with haematoxylin and eosin.
• A Mouse 1.1 xlO, normal cerebellum.
• B Mouse 2.7 xlO, score 3.
• H Mouse 8.5 xlO, score 2.
• Blautix significantly improved spinal cord pathology compared to vehicle (PBS). Blautix also statistically significantly reduced inflammation in the spinal cord. There was also a strong trend showing a positive effect in the brain.
• Serum from day -14 animals showed no IgG antibody responses to MOG 35-55 peptide, as expected for naive animals.
• Serum from day 35 animals showed increased IgG antibody responses to MOG 35- 55 in all EAE groups in comparison with control group animals ( Figure 9). The increased antibody responses were not statistically significant, due to variability in antibody titres within each group, which is to be expected in the EAE model.
• spleens from groups 2, 3, 8 and 9 were dissected out and processed to single cell suspensions.
• Splenocytes were cultured in the presence and absence of MOG 35-55 peptide for three days and tritiated thymidine incorporation was quantified to reveal levels of cell proliferation.
• Unstimulated and anti-CD3/anti-CD28 (positive control) stimulated control cultures were also established.
• a two-way ANOVA followed by Sidak's post-test for multiple comparison was used to determine differences within in vivo treatment groups.
• a two-way ANOVA followed by Dunnett's post-test for multiple comparisons was used to determine differences within ex vivo treatment groups (media, MOG 35-55 or anti CD3/CD8).
• MOG T cell proliferative responses in splenocytes at day 35 were increased above unstimulated (media alone) proliferative responses (Figure 10).
• Proliferative responses to an anti-CD3/CD28 stimulus were significantly increased (p ⁇ 0.0001), confirming the viability of the splenocytes and ability to proliferate strongly with a highly positive stimulus.
• Groups of 16 germ-free rats (comprising 8 rats in the control group and 8 rats in the treatment group) were inoculated with the faecal microbiota from a human IBS subject (IBS-HMA rats).
• IBS-HMA rats Three successive experiments were carried out using faecal samples from 3 different IBS patients.
• Half of the IBS-HMA rats were then administered for 28 days with composition comprising the bacterial strain of B. hydro genotrophica according to the invention while the other half animals received a control solution.
• BH lyophilisate was suspended in sterile mineral solution to a concentration of 10 10 bacteria per ml. Two ml of this suspension was administered daily per IBS-HMA rat, by oral gavage, for a 28 days period.
• the control solution was the sterile mineral solution that was administered daily (2 ml per rat) by oral gavage to the control group of IBS-HMA rats.
• Germ-Free male Fisher rats (aged 10 weeks) were inoculated with human faecal microbiota from an IBS subject (IBS-HMA rats). Sixteen rats were inoculated with the same human faecal inoculum. Three successive experiments were performed with faecal samples from three different IBS subjects. Two other groups of ten rats were inoculated with faecal sample from 2 healthy subjects (normo-sensitivity control groups).
• Figure 7 presents the results of qPCR analysis of the B. hydro genotrophica population in faecal samples from IBS-HMA rats receiving control solution or BH lyophilisate. A significant increase in the BH population was observed at the end of the administration period (D 28) in rats receiving the BH lyophilisate, which confirms successful delivery of BH in the colon.
• Figure 8 reports on the impact of administration of BH on the main fermentative metabolites, short chain fatty acids, in caecal samples of IBS-HMA rats.
• a composition described herein containing at least one bacterial strain described herein is stored in a sealed container at 25 ° C or 4 ° C and the container is placed in an atmosphere having 30%, 40%, 50%, 60%, 70%, 75%, 80%, 90% or 95% relative humidity. After 1 month, 2 months, 3 months, 6 months, 1 year, 1.5 years, 2 years, 2.5 years or 3 years, at least 50%, 60%, 70%, 80% or 90% of the bacterial strain shall remain as measured in colony forming units determined by standard protocols.

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