WO2020221450A1 - Antibodies and methods for treatment of influenza a infection - Google Patents

Antibodies and methods for treatment of influenza a infection Download PDF

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Publication number
WO2020221450A1
WO2020221450A1 PCT/EP2019/061134 EP2019061134W WO2020221450A1 WO 2020221450 A1 WO2020221450 A1 WO 2020221450A1 EP 2019061134 W EP2019061134 W EP 2019061134W WO 2020221450 A1 WO2020221450 A1 WO 2020221450A1
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Prior art keywords
antibody
influenza
seq
dose
present
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English (en)
French (fr)
Inventor
Davide Corti
Fabio Benigni
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Humabs Biomed SA
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Humabs Biomed SA
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Priority to PCT/EP2019/061134 priority Critical patent/WO2020221450A1/en
Priority to TW109107093A priority patent/TW202106707A/zh
Priority to JP2021562803A priority patent/JP7719725B2/ja
Priority to BR112021018409A priority patent/BR112021018409A2/pt
Priority to SG11202109683TA priority patent/SG11202109683TA/en
Priority to CN202411518877.XA priority patent/CN119192357A/zh
Priority to CA3132536A priority patent/CA3132536A1/en
Priority to MX2021012984A priority patent/MX2021012984A/es
Priority to PH1/2021/552176A priority patent/PH12021552176A1/en
Priority to EA202192923A priority patent/EA202192923A1/ru
Priority to PCT/EP2020/062160 priority patent/WO2020221908A1/en
Priority to US17/607,383 priority patent/US20220226470A1/en
Priority to CN202080034142.3A priority patent/CN114269381A/zh
Priority to KR1020217038260A priority patent/KR20220003000A/ko
Priority to EP20721638.3A priority patent/EP3962530A1/en
Priority to AU2020265407A priority patent/AU2020265407B2/en
Publication of WO2020221450A1 publication Critical patent/WO2020221450A1/en
Priority to CONC2021/0012583A priority patent/CO2021012583A2/es
Priority to IL287423A priority patent/IL287423A/en
Priority to CL2021002807A priority patent/CL2021002807A1/es
Anticipated expiration legal-status Critical
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/42—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum viral
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61P31/16—Antivirals for RNA viruses for influenza or rhinoviruses
    • 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
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/08—Antiallergic agents
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K16/00—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies
    • C07K16/08—Immunoglobulins [IG], e.g. monoclonal or polyclonal antibodies against material from viruses
    • C07K16/10—RNA viruses
    • C07K16/108—Orthomyxoviridae (F), e.g. influenza virus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K2039/545—Medicinal preparations containing antigens or antibodies characterised by the dose, timing or administration schedule
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/51—Complete heavy chain or Fd fragment, i.e. VH + CH1
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/515—Complete light chain, i.e. VL + CL
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C07K2317/524—CH2 domain
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/52—Constant or Fc region; Isotype
    • C07K2317/526—CH3 domain
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/50—Immunoglobulins specific features characterized by immunoglobulin fragments
    • C07K2317/56—Immunoglobulins specific features characterized by immunoglobulin fragments variable (Fv) region, i.e. VH and/or VL
    • C07K2317/565—Complementarity determining region [CDR]
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/70—Immunoglobulins specific features characterized by effect upon binding to a cell or to an antigen
    • C07K2317/76—Antagonist effect on antigen, e.g. neutralization or inhibition of binding
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07K—PEPTIDES
    • C07K2317/00—Immunoglobulins specific features
    • C07K2317/90—Immunoglobulins specific features characterized by (pharmaco)kinetic aspects or by stability of the immunoglobulin
    • 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
    • C12N2760/00—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA ssRNA viruses negative-sense
    • C12N2760/00011—Details
    • C12N2760/16011—Orthomyxoviridae
    • C12N2760/16111—Influenzavirus A, i.e. influenza A virus

Definitions

  • the invention relates to antibodies that potently reduce influenza A infection and to the use of such antibodies.
  • the invention relates to the prophylaxis and treatment of influenza A infection.
  • Influenza is an infectious disease, which spreads around the world in yearly outbreaks resulting per year in about three to five million cases of severe i llness and about 290,000 to 650,000 respiratory deaths (WHO, Influenza (Seasonal) Fact sheet, November 6, 2018).
  • the most common symptoms include: a sudden onset of fever, cough (usual ly dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose.
  • the incubation period varies between one to four days, although usually the symptoms begin about two days after exposure to the virus.
  • Complications of influenza may include pneumonia, sinus infections, and worsening of previous health problems such as asthma or heart failure, sepsis or exacerbation of chronic underling diseases.
  • Influenza is caused by influenza virus, an antigenically and genetically diverse group of viruses of the fami ly Orthomyxoviridae that contains a negative-sense, single-stranded, segmented RNA genome.
  • influenza virus an antigenically and genetically diverse group of viruses of the fami ly Orthomyxoviridae that contains a negative-sense, single-stranded, segmented RNA genome.
  • A, B, C and D three types affect humans.
  • Influenza type A viruses are the most virulent human pathogens and cause the severest disease.
  • Influenza A viruses can be categorized based on the different subtypes of major surface proteins present Hemagglutinin (HA) and Neuraminidase (NA). There are at least 1 8 influenza A subtypes defined by their hemagglutinin ("HA”) protei ns. The HAs can be classified into two groups.
  • HA hemagglutinin
  • Group 1 contains H 1 , H2, H5, H6, H8, H9, H11, H12, H1 3, H 1 6 and H1 7 subtypes, and group 2 includes H3, H4, H 7, H 1 0, H14 and H15 subtypes. While all subtypes are present in birds, mostly H1 , H2 and H3 subtypes cause disease in humans. H5, H7 and H9 subtypes are causing sporadic severe infections in humans and may generate a new pandemic. Influenza A viruses continuously evolve generating new variants, a phenomenon called antigenic drift. As a consequence, antibodies produced in response to past viruses are poorly- or non-protective against new drifted viruses. A consequence is that a new vaccine has to be produced every year against H1 and H3 viruses that are predicted to emerge, a process that is very costly as well as not always efficient. The same applies to the production of a H5 influenza vaccine.
  • HA is a major surface protein of influenza A virus, which is the main target of neutralizing antibodies that are induced by infection or vaccination. HA is responsible for binding the virus to cells with sialic acid on the membranes, such as cells in the upper respiratory tract or erythrocytes. In addition, HA mediates the fusion of the viral envelope with the enclosome membrane, after the pH has been reduced. HA is a homotrimeric integral membrane glycoprotein.
  • the HA trimer is composed of three identical monomers, each made of an intact HAO single polypeptide chain with HA1 and HA2 regions linked by 2 disulfide bridges.
  • Each HA2 region adopts alpha helical coiled coil structure and primarily forms the "stem” or "stalk" region of HA, while the HA1 region is a small globular domain containing a mix of a/b structures ("head" region of HA).
  • the globular HA head region mediates binding to the sialic acid receptor, while the HA stem mediates the subsequent fusion between the viral and cellular membranes that is triggered in endosomes by the low pH.
  • the immunodominant HA globular head domain has high plasticity with distinct antigenic sites undergoing constant antigenic drift, the HA stem region is relatively conserved among subtypes.
  • influenza-neutralizing antibodies that target conserved sites in the HA stem were developed as influenza virus therapeutics. These antibodies targeting the stem region of HA are usually broader neutralizing compared to antibodies targeting the head region of HA.
  • An overview over broadly neutralizing influenza A antibodies is provided in Corti D. and Lanzavecchia A., Broadly neutralizing antiviral antibodies. Annu. Rev. Immunol. 2013;31 :705-742. Okuno et al.
  • HA-stem region targeting antibodies include CR6261 (Throsby M, van den Brink E, Jongeneelen M, Poon LLM, Alard P, Cornelissen L, et al.
  • antibody MEDI8852 potently neutralizes group 1 and 2 influenza A viruses with unprecedented breadth, being able to neutralize a diverse panel of representative viruses spanning >80 years of antigenic evolution (Kallewaard NL, Corti D, Collins PJ, et al. Structure and Function Analysis of an Antibody Recognizing All Influenza A Subtypes. Cell. 201 6;1 66(3):596-608; Paules, C. I. et al.
  • MEDI8852 The Hemagglutinin A Stem Antibody MEDI8852 Prevents and Controls Disease and Limits Transmission of Pandemic Influenza Viruses. J Infect Dis 216, 356-365, https://doi.org/10.1093/infdis/jix292 (201 7)). MEDI8852 was shown to bind to a highly conserved epitope that is markedly different from other structurally characterized stem-reactive neutralizing antibodies (Kallewaard NL, Corti D, Collins PJ, et al. Structure and Function Analysis of an Antibody Recognizing All Influenza A Subtypes. Cell. 201 6;1 66(3):596-608).
  • x means x ⁇ 10%, for example, x + 5%, or x ⁇ 7%, or x ⁇ 10%, or x ⁇ 12%, or x + 15%, or x ⁇ 20%.
  • disease as used herein is intended to be generally synonymous, and is used interchangeably with, the terms “disorder” and “condition” (as in medical condition), in that all reflect an abnormal condition of the human or animal body or of one of its parts that impairs normal functioning, is typically manifested by distinguishing signs and symptoms, and causes the human or animal to have a reduced duration or quality of life.
  • treatment of a subject or patient is intended to include prevention, prophylaxis, attenuation, amelioration and therapy.
  • subject or “patient” are used interchangeably herein to mean all mammals including humans. Examples of subjects include humans, cows, dogs, cats, horses, goats, sheep, pigs, and rabbits. In some embodiments, the patient is a human.
  • a dose which is expressed as [g, mg, or other unit]/kg (or g, mg etc.) usually refers to [g, mg, or other unit] "per kg (or g, mg etc.) bodyweight", even if the term "bodyweight” is not explicitly mentioned.
  • the term "antibody” encompasses various forms of antibodies including, without being limited to, whole antibodies, antibody fragments, human antibodies, chimeric antibodies, humanized antibodies, recombinant antibodies and genetically engineered antibodies (variant or mutant antibodies) as long as the characteristic properties according to the invention are retained.
  • the antibody is a human antibody.
  • the antibody is a monoclonal antibody.
  • the antibody is a human monoclonal antibody.
  • Human antibodies are well-known in the state of the art (van Dijk, M. A., and van de Winkel, J. G., Curr. Opin. Chem. Biol. 5 (2001 ) 368-374). Human antibodies can also be produced in transgenic animals (e.g., mice) that are capable, upon immunization, of producing a full repertoire or a selection of human antibodies in the absence of endogenous immunoglobulin production. Transfer of the human germ-line immunoglobulin gene array in such germ-line mutant mice will result in the production of human antibodies upon antigen challenge (see, e.g., Jakobovits, A., et al., Proc. Natl. Acad. Sci.
  • human monoclonal antibodies are also available for the preparation of human monoclonal antibodies (Cole et al., Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, p. 77 (1985); and Boerner, P., et al., J. Immunol. 147 (1991 ) 86-95).
  • human monoclonal antibodies are prepared by using improved EBV-B cell immortalization as described in Traggiai E, Becker S, Subbarao K, Kolesnikova L, Uematsu Y, Gismondo MR, Murphy BR, Rappuoli R, Lanzavecchia A. (2004): An efficient method to make human monoclonal antibodies from memory B cells: potent neutralization of SARS coronavirus. Nat Med.
  • variable region denotes each of the pair of light and heavy chains which is involved directly in binding the antibody to the antigen.
  • Antibodies of the invention can be of any isotype (e.g., IgA, IgG, IgM i.e. an a, y or m heavy chain).
  • the antibody is of the IgG type.
  • antibodies may be IgG 1 , lgG2, lgG3 or IgG4 subclass, for example IgGI .
  • Antibodies of the invention may have a k or a l light chain. In some embodiments, the antibody is of IgG 1 type and has a k light chain.
  • Antibodies according to the present invention may be provided in purified form. Typically, the antibody will be present in a composition that is substantially free of other polypeptides e.g., where less than 90% (by weight), usually less than 60% and more usually less than 50% of the composition is made up of other polypeptides.
  • Antibodies according to the present invention may be immunogenic in human and/or in non-human (or heterologous) hosts e.g., in mice.
  • the antibodies may have an idiotope that is immunogenic in non-human hosts, but not in a human host.
  • Antibodies of the invention for human use include those that cannot be easily isolated from hosts such as mice, goats, rabbits, rats, non-primate mammals, etc. and cannot generally be obtained by humanization or from xeno-mice.
  • neutralizing antibody is one that can neutralize, i.e., prevent, inhibit, reduce, impede or interfere with, the ability of a pathogen to initiate and/or perpetuate an infection in a host.
  • neutralizing antibody and “an antibody that neutralizes” or “antibodies that neutralize” are used interchangeably herein. These antibodies can be used alone, or in combination, as prophylactic or therapeutic agents upon appropriate formulation, in association with active vaccination, as a diagnostic tool, or as a production tool as described herein.
  • mutation relates to a change in the nucleic acid sequence and/or in the amino acid sequence in comparison to a reference sequence, e.g. a corresponding genomic sequence.
  • a mutation e.g. in comparison to a genomic sequence, may be, for example, a (naturally occurring) somatic mutation, a spontaneous mutation, an induced mutation, e.g. induced by enzymes, chemicals or radiation, or a mutation obtained by site- directed mutagenesis (molecular biology methods for making specific and intentional changes in the nucleic acid sequence and/or in the amino acid sequence).
  • mutation or “mutating” shall be understood to also include physically making a mutation, e.g.
  • a mutation includes substitution, deletion and insertion of one or more nucleotides or amino acids as well as inversion of several successive nucleotides or amino acids.
  • a mutation may be introduced into the nucleotide sequence encoding said amino acid sequence in order to express a (recombinant) mutated polypeptide.
  • a mutation may be achieved e.g., by altering, e.g., by site-directed mutagenesis, a codon of a nucleic acid molecule encoding one amino acid to result in a codon encoding a different amino acid, or by synthesizing a sequence variant, e.g., by knowing the nucleotide sequence of a nucleic acid molecule encoding a polypeptide and by designing the synthesis of a nucleic acid molecule comprising a nucleotide sequence encoding a variant of the polypeptide without the need for mutating one or more nucleotides of a nucleic acid molecule.
  • the invention is based, amongst other findings, on the identification of antibodies that potently reduce influenza A infection even when administered at very low doses.
  • the antibodies of the invention show an increased half-life.
  • the present inventors assume that the increased potency of the antibody of the present invention is independent from the increased half-life. For example, in comparison to a comparative antibody, the antibody of the invention showed increased potency despite similar plasma concentrations of the antibody.
  • the present invention provides an (isolated) antibody comprising the heavy chain CDR1 , CDR2, and CDR3 sequences as set forth in SEQ ID NO: 1 , SEQ ID NO: 2, and SEQ ID NO: 3, respectively; the light chain CDR1 , CDR2, and CDR3 sequences as set forth in SEQ ID NO: 4, SEQ ID NO: 5, and SEQ ID NO: 6, respectively; and the mutations M428L and N434S in the constant region of the heavy chain.
  • the antibody according to the present invention typically comprises (at least) three complementarity determining regions (CDRs) on a heavy chain and (at least) three CDRs on a light chain.
  • complementarity determining regions are the hypervariable regions present in heavy chain variable domains and light chain variable domains.
  • CDRs CDRs of a heavy chain and the connected light chain of an antibody together form the antigen receptor.
  • CDR1 , CDR2, and CDR3 are arranged non- consecutively in the variable domain.
  • antigen receptors are typically composed of two variable domains (on two different polypeptide chains, i.e. heavy and light chain), there are six CDRs for each antigen receptor (heavy chain: CDRH1 , CDRH2, and CDRH3; light chain: CDRL1 , CDRL2, and CDRL3).
  • a single antibody molecule usually has two antigen receptors and therefore contains twelve CDRs.
  • the CDRs on the heavy and/or light chain may be separated by framework regions, whereby a framework region (FR) is a region in the variable domain which is less "variable" than the CDR.
  • FR framework region
  • a chain (or each chain, respectively) may be composed of four framework regions, separated by three CDR's.
  • the sequences of the heavy chains and light chains of exemplary antibodies of the invention, comprising three different CDRs on the heavy chain and three different CDRs on the light chain were determined.
  • the position of the CDR amino acids are defined according to the IMGT numbering system (IMGT: http://www.imgt.org/; cf. Lefranc, M.-P. et al. (2009) Nucleic Acids Res. 37, D1006-D1012).
  • the antibody of the invention binds to hemagglutinin of an influenza A virus.
  • the antibody of the invention can neutralize infection of influenza A virus.
  • the antibody according to the present invention binds to the same epitope of the influenza A virus hemagglutinin (IAV HA) stem region as MEDI8852 (Kallewaard NL, Corti D, Collins PJ, et al. Structure and Function Analysis of an Antibody Recognizing All Influenza A Subtypes. Cell. 201 6;166(3):596-608), thereby providing the same broad protection against various influenza A serotypes of all influenza A subtypes.
  • the antibody of the present invention includes two mutations in the constant region of the heavy chain (in the CH3 region): M428L and N434S.
  • the amino acid positions have been numbered according to the art-recognized EU numbering system.
  • the EU index or EU index as in Rabat or EU numbering refers to the numbering of the EU antibody (Edelman GM, Cunningham BA, Gall WE, Gottlieb PD, Rutishauser U, Waxdal MJ.
  • the covalent structure of an entire gammaG immunoglobulin molecule Proc Natl Acad Sci U S A.
  • the antibody of the invention neutralizes influenza A infection at a dose, which does not exceed half of the dose required for neutralization of influenza A with a comparative antibody, which differs from said antibody only in that it does not contain the mutations M428L and N434S in the constant region of the heavy chain.
  • the dose of the antibody of the invention does not exceed one third of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one quarter of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one fifth of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one sixth of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one seventh of the dose required for neutralization of influenza A with said comparative antibody.
  • the dose of the antibody of the invention does not exceed one eighth of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one ninth of the dose required for neutralization of influenza A with said comparative antibody. In some embodiments, the dose of the antibody of the invention does not exceed one tenth of the dose required for neutralization of influenza A with said comparative antibody. It is understood that for such comparative tests comparable neutralization assays are used (similar test assays, test conditions etc.). For example, the same test (differing only in the antibodies to be tested) may be used to determine the dose for the antibody of the invention for neutralization of influenza A and for determining the dose for the comparative antibody for neutralization of influenza A.
  • the person skilled in the art knows various standard "neutralization assays".
  • Animal viruses are typically propagated in cells and/or cell lines.
  • a neutralization assay cultured cells may be incubated with a fixed amount of influenza A virus (IAV) in the presence (or absence) of the antibody to be tested.
  • IAV influenza A virus
  • flow cytometry may be used.
  • the antibody of the invention is a human antibody.
  • the antibody of the invention is a monoclonal antibody.
  • the antibody of the invention is a human monoclonal antibody.
  • Antibodies of the invention can be of any isotype (e.g., IgA, IgG, IgM i.e. an a, g or m heavy chain).
  • the antibody is of the IgG type.
  • antibodies may be IgG 1 , lgG2, lgG3 or lgG4 subclass, for example IgGI .
  • Antibodies of the invention may have a K or a A light chain.
  • the antibody has a kappa (K) light chain.
  • the antibody is of IgG 1 type and has a k light chain.
  • the antibody is of the human IgGI type.
  • the antibody may be of any allotype.
  • allotype refers to the allelic variation found among the IgG subclasses.
  • the antibody may be of the G1 ml (or G1 m(a)) allotype, of the G1 m2 (or G1 m(x)) allotype, of the G1 m3 (or G1 m(f)) allotype, and/or of the G1 m17 (or Gm(z)) allotype.
  • the G1 m3 and G1 m1 7 allotypes are located at the same position in the CH1 domain (position 214 according to EU numbering).
  • G1 m3 corresponds to R214 (EU), while G1 m1 7 corresponds to K214 (EU).
  • the G1 ml allotype is located in the CH3 domain (at positions 356 and 358 (EU)) and refers to the replacements E356D and M358L.
  • the G1 m2 allotype refers to a replacement of the alanine in position 431 (EU) by a glycine.
  • the G1 ml allotype may be combined, for example, with the G1 m3 or the G1 m1 7 allotype.
  • the antibody is of the allotype G1 m3 with no G1 m1 (G1 m3,-1 ).
  • the antibody is of the G1 m1 7,1 allotype. In some embodiments, the antibody is of the G1 m3,1 allotype. In some embodiments, the antibody is of the allotype G1 m1 7 with no G1 m1 (G1 ml 7,-1 ). Optionally, these allotypes may be combined (or not combined) with the G1 m2, G1 m27 or G1 m28 allotype. For example, the antibody may be of the G1 ml 7,1 ,2 allotype.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 70% or more (i.e. 71 %, 72%, 73%, 74%, 75%, 76%, 77%, 78%, 79%, 80%, 81 %, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91 %, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more) identity to SEQ ID NO: 7 and a light chain variable region comprising the amino acid sequence having at least 70% identity to SEQ ID NO: 8, wherein the CDR sequences as defined above (heavy chain CDR1 , CDR2, and CDR3 sequences as set forth in SEQ ID NO: 1 , SEQ ID NO: 2, and SEQ ID NO: 3, respectively; and light chain CDR1 , CDR2, and CDR3 sequences as set forth in SEQ ID NO: 4, SEQ ID NO: 5, and SEQ ID NO: 6, respectively
  • amino acid sequence variant has an altered sequence in which one or more of the amino acids in the reference sequence is/are deleted or substituted, and/or one or more amino acids is/are inserted into the sequence of the reference amino acid sequence.
  • the amino acid sequence variant has an amino acid sequence which is at least 70% identical to the reference sequence.
  • Variant sequences which are at least 70% identical have no more than 30 alterations, i.e. any combination of deletions, insertions or substitutions, per 1 00 amino acids of the reference sequence.
  • conservative amino acid substitutions involve substitution of one aliphatic or hydrophobic amino acids, e.g. alanine, valine, leucine and isoleucine, with another; substitution of one hydoxyl-containing amino acid, e.g. serine and threonine, with another; substitution of one acidic residue, e.g. glutamic acid or aspartic acid, with another; replacement of one amide-containing residue, e.g.
  • Amino acid sequence insertions include amino- and/or carboxyl-terminal fusions ranging in length from one residue to polypeptides containing a hundred or more residues, as well as intrasequence insertions of single or multiple amino acid residues. Examples of terminal insertions include the fusion to the N- or C-terminus of an amino acid sequence to a reporter molecule or an enzyme.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 75% or more (i.e. 76%, 77%, 78%, 79%, 80%, 81 %, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91 %, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or more) identity to SEQ ID NO: 7 and a light chain variable region comprising the amino acid sequence having at least 75% identity to SEQ ID NO: 8, wherein the CDR sequences as defined above are maintained.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 80% or more (i.e.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 85% or more (i.e.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 90% or more (i.e.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 95% or more (i.e. 96%, 97%, 98%, 99% or more) identity to SEQ ID NO: 7 and a light chain variable region comprising the amino acid sequence having at least 95% identity to SEQ ID NO: 8, wherein the CDR sequences as defined above are maintained.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence having 95% or more (i.e. 96%, 97%, 98%, 99% or more) identity to SEQ ID NO: 7 and a light chain variable region comprising the amino acid sequence having at least 95% identity to SEQ ID NO: 8, wherein the CDR sequences as defined above are maintained.
  • the antibody of the invention comprises a heavy chain variable region comprising an amino acid sequence as set forth in SEQ ID NO: 7 and a light chain variable region comprising the amino add sequence as set forth in SEQ ID NO: 8, wherein the CDR sequences as defined above are maintained.
  • the antibody of the invention comprises one or more further mutations (in addition to M428L and N434S) in the Fc region (e.g., in the CFi2 or CH3 region).
  • the antibody of the invention does not comprise any further mutation in addition to M428L and N434S in its CH3 region (in comparison to the respective wild-type CH3 region).
  • the antibody of the invention does not comprise any further mutation in addition to M428L and N434S in its Fc region (in comparison to the respective wild-type Fc region).
  • wild-type refers to the reference sequence, for example as occurring in nature.
  • wild-type may refer to the sequence with the highest prevalence occurring in nature.
  • the antibody of the invention comprises a heavy chain comprising an amino acid sequence as set forth in SEQ ID NO: 9 and a light chain comprising an amino acid sequence as set forth in SEQ ID NO: 10.
  • the antibody of the invention may have a heavy chain consisting of an amino acid sequence as set forth in SEQ ID NO: 9 and a light chain consisting of an amino acid sequence as set forth in SEQ ID NO: 10.
  • Antibodies of the invention also include hybrid antibody molecules that comprise the six CDRs from an antibody of the invention as defined above and one or more CDRs from another antibody to the same or a different epitope or antigen.
  • such hybrid antibodies comprise six CDRs from an antibody of the invention and six CDRs from another antibody to a different epitope or antigen.
  • variants of the sequences recited in the application are also included within the scope of the invention.
  • variants include natural variants generated by somatic mutation in vivo during the immune response or in vitro upon culture of immortalized B cell clones.
  • variants may arise due to the degeneracy of the genetic code or may be produced due to errors in transcription or translation.
  • Antibodies of the invention may be provided in purified form. Typically, the antibody will be present in a composition that is substantially free of other polypeptides e.g., where less than 90% (by weight), usually less than 60% and more usually less than 50% of the composition is made up of other polypeptides.
  • Antibodies of the invention may be immunogenic in non-human (or heterologous) hosts e.g., in mice.
  • the antibodies may have an idiotope that is immunogenic in non-human hosts, but not in a human host.
  • antibodies of the invention for human use include those that cannot be easily isolated from hosts such as mice, goats, rabbits, rats, non-primate mammals, etc. and cannot generally be obtained by humanization or from xeno-mice.
  • the invention also provides a nucleic acid molecule comprising a polynucleotide encoding the antibody according to the present invention as described above.
  • nucleic acid molecules and/or polynucleotides include, e.g., a recombinant polynucleotide, a vector, an oligonucleotide, an RNA molecule such as an rRNA, an mRNA, an miRNA, an siRNA, or a tRNA, or a DNA molecule such as a cDNA.
  • Nucleic acids may encode the light chain and/or the heavy chain of the antibody of the invention.
  • the light chain and the heavy chain of the antibody may be encoded by the same nucleic acid molecule (e.g., in bicistronic manner).
  • the light chain and the heavy chain of the antibody may be encoded by distinct nucleic acid molecules.
  • the present invention also comprises sequence variants of nucleic acid sequences, which encode the same amino acid sequences.
  • the polynucleotide encoding the antibody (or the complete nucleic acid molecule) may be optimized for expression of the antibody. For example, codon optimization of the nucleotide sequence may be used to improve the efficiency of translation in expression systems for the production of the antibody.
  • the nucleic acid molecule may comprise heterologous elements (i.e., elements, which in nature do not occur on the same nucleic acid molecule as the coding sequence for the (heavy or light chain of) an antibody.
  • a nucleic acid molecule may comprise a heterologous promotor, a heterologous enhancer, a heterologous UTR (e.g., for optimal translation/expression), a heterologous Poly-A-tail, and the like.
  • a nucleic acid molecule is a molecule comprising nucleic acid components.
  • the term nucleic acid molecule usually refers to DNA or RNA molecules. It may be used synonymous with the term "polynucleotide", i.e. the nucleic acid molecule may consist of a polynucleotide encoding the antibody. Alternatively, the nucleic acid molecule may also comprise further elements in addition to the polynucleotide encoding the antibody.
  • a nucleic acid molecule is a polymer comprising or consisting of nucleotide monomers which are covalently linked to each other by phosphodiester-bonds of a sugar/phosphate-backbone.
  • the term "nucleic acid molecule” also encompasses modified nucleic acid molecules, such as base- modified, sugar-modified or backbone-modified etc. DNA or RNA molecules.
  • the nucleic acid molecule may be manipulated to insert, delete or alter certain nucleic acid sequences. Changes from such manipulation include, but are not limited to, changes to introduce restriction sites, to amend codon usage, to add or optimize transcription and/or translation regulatory sequences, etc. It is also possible to change the nucleic acid to alter the encoded amino acids. For example, it may be useful to introduce one or more (e.g., 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, etc.) amino acid substitutions, deletions and/or insertions into the antibody's amino acid sequence.
  • Such point mutations can modify effector functions, antigen-binding affinity, post-translational modifications, immunogenicity, etc., can introduce amino acids for the attachment of covalent groups (e.g., labels) or can introduce tags (e.g., for purification purposes).
  • a mutation in a nucleic acid sequence may be "silent", i.e. not reflected in the amino acid sequence due to the redundancy of the genetic code.
  • mutations can be introduced in specific sites or can be introduced at random, followed by selection (e.g., molecular evolution).
  • one or more nucleic acids encoding any of the light or heavy chains of an (exemplary) antibody of the invention can be randomly or directionally mutated to introduce different properties in the encoded amino acids.
  • Such changes can be the result of an iterative process wherein initial changes are retained and new changes at other nucleotide positions are introduced. Further, changes achieved in independent steps may be combined.
  • the polynucleotide encoding the antibody, or an antigen-binding fragment thereof, (or the (complete) nucleic acid molecule) may be codon-optimized.
  • codon optimization such as those described in: Ju Xin Chin, Bevan Kai-Sheng Chung, Dong-Yup Lee, Codon Optimization OnLine (COOL): a web-based multi-objective optimization platform for synthetic gene design, Bioinformatics, Volume 30, Issue 1 5, 1 August 2014, Pages 2210-2212; or in: Grote A, Hiller K, Scheer M, Munch R, Nortemann B, Hempel DC, Jahn D, JCat: a novel tool to adapt codon usage of a target gene to its potential expression host.
  • the present invention also provides a combination of a first and a second nucleic acid molecule, wherein the first nucleic acid molecule comprises a polynucleotide encoding the heavy chain of the antibody of the present invention; and the second nucleic acid molecule comprises a polynucleotide encoding the corresponding light chain of the same antibody.
  • the above description regarding the (general) features of the nucleic acid molecule of the invention applies accordingly to the first and second nucleic acid molecule of the combination.
  • one or both of the polynucleotides encoding the heavy and/or light chain(s) of the antibody, or an antigen-binding fragment thereof may be codon- optimized.
  • vectors for example, expression vectors, comprising a nucleic acid molecule according to the present invention.
  • a vector comprises a nucleic acid molecule as described above.
  • the present invention also provides a combination of a first and a second vector, wherein the first vector comprises a first nucleic acid molecule as described above (for the combination of nucleic acid molecules) and the second vector comprises a second nucleic acid molecule as described above (for the combination of nucleic acid molecules).
  • a vector is usually a recombinant nucleic acid molecule, i.e. a nucleic acid molecule which does not occur in nature.
  • the vector may comprise heterologous elements (i.e., sequence elements of different origin in nature).
  • the vector may comprise a multi cloning site, a heterologous promotor, a heterologous enhancer, a heterologous selection marker (to identify cells comprising said vector in comparison to cells not comprising said vector) and the like.
  • a vector in the context of the present invention is suitable for incorporating or harboring a desired nucleic acid sequence.
  • Such vectors may be storage vectors, expression vectors, cloning vectors, transfer vectors etc.
  • a storage vector is a vector which allows the convenient storage of a nucleic acid molecule.
  • the vector may comprise a sequence corresponding, e.g., to a (heavy and/or light chain of a) desired antibody according to the present invention.
  • An expression vector may be used for production of expression products such as RNA, e.g. mRNA, or peptides, polypeptides or proteins.
  • an expression vector may comprise sequences needed for transcription of a sequence stretch of the vector, such as a (heterologous) promoter sequence.
  • a cloning vector is typically a vector that contains a cloning site, which may be used to incorporate nucleic acid sequences into the vector.
  • a cloning vector may be, e.g., a plasmid vector or a bacteriophage vector.
  • a transfer vector may be a vector which is suitable for transferring nucleic acid molecules into cells or organisms, for example, viral vectors.
  • a vector in the context of the present invention may be, e.g., an RNA vector or a DNA vector.
  • a vector in the sense of the present application comprises a cloning site, a selection marker, such as an antibiotic resistance factor, and a sequence suitable for multiplication of the vector, such as an origin of replication.
  • a vector in the context of the present application may be a plasmid vector.
  • the present invention also provides cell expressing the antibody according to the present invention; and/or comprising the vector according the present invention.
  • the cells include but are not limited to, eukaryotic cells, e.g., yeast cells, animal cells or plant cells or prokaryotic cells, including £ coH.
  • the cells are mammalian cells, such as a mammalian cell line. Examples include human cells, CHO cells, HEK293T cells, PER.C6 cells, NSO cells, human liver cells, myeloma cells or hybridoma cells.
  • the cell may be transfected with a vector according to the present invention, for example with an expression vector.
  • transfection refers to the introduction of nucleic acid molecules, such as DNA or RNA (e.g. mRNA) molecules, into cells, e.g. into eukaryotic or prokaryotic cells.
  • RNA e.g. mRNA
  • transfection encompasses any method known to the skilled person for introducing nucleic acid molecules into cells, such as into mammalian cells. Such methods encompass, for example, electroporation, lipofection, e.g.
  • the introduction is non-viral.
  • the cells of the present invention may be transfected stably or transiently with the vector according to the present invention, e.g. for expressing the antibody according to the present invention.
  • the cells are stably transfected with the vector according to the present invention encoding the antibody according to the present invention.
  • the cells are transiently transfected with the vector according to the present invention encoding the antibody according to the present invention.
  • the present invention also provides a recombinant host cell, which heterologously expresses the antibody of the invention or the antigen-binding fragment thereof.
  • the cell may be of another species than the antibody (e.g., CHO cells expressing human antibodies).
  • the cell type of the cell does not express (such) antibodies in nature.
  • the host cell may impart a post-translational modification (PTM; e.g., glycosylation) on the antibody that is not present in their native state.
  • PTM post-translational modification
  • the antibody of the invention, or the antigen-binding fragment thereof may have a post-translational modification, which is distinct from the naturally produced antibody (e.g., an antibody of an immune response in a human).
  • Antibodies according to the invention can be made by any method known in the art.
  • the general methodology for making monoclonal antibodies using hybridoma technology is well known (Kohler, G. and Milstein, C,. 1975; Kozbar et al. 1983).
  • the alternative EBV immortalization method described in W02004/076677 is used.
  • the method as described in WO 2004/076677 which is incorporated herein by reference, is used.
  • B cells producing the antibody of the invention are transformed with EBV and a polyclonal B cell activator. Additional stimulants of cellular growth and differentiation may optionally be added during the transformation step to further enhance the efficiency. These stimulants may be cytokines such as IL-2 and IL-15. In one aspect, IL-2 is added during the immortalization step to further improve the efficiency of immortalization, but its use is not essential.
  • the immortalized B cells produced using these methods can then be cultured using methods known in the art and antibodies isolated therefrom.
  • WO 2010/046775 Another exemplified method is described in WO 2010/046775.
  • plasma cells are cultured in limited numbers, or as single plasma cells in microwell culture plates.
  • Antibodies can be isolated from the plasma cell cultures. Further, from the plasma cell cultures, RNA can be extracted and PCR can be performed using methods known in the art.
  • the VH and VL regions of the antibodies can be amplified by RT-PCR (reverse transcriptase PCR), sequenced and cloned into an expression vector that is then transfected into HEK293T cells or other host cells.
  • RT-PCR reverse transcriptase PCR
  • the cloning of nucleic acid in expression vectors, the transfection of host cells, the culture of the transfected host cells and the isolation of the produced antibody can be done using any methods known to one of skill in the art.
  • the antibodies may be further purified, if desired, using filtration, centrifugation and various chromatographic methods such as HPLC or affinity chromatography. Techniques for purification of antibodies, e.g., monoclonal antibodies, including techniques for producing pharmaceutical-grade antibodies, are well known in the art.
  • Standard techniques of molecular biology may be used to prepare DNA sequences encoding the antibodies of the present invention. Desired DNA sequences may be synthesized completely or in part using oligonucleotide synthesis techniques. Site-directed mutagenesis and polymerase chain reaction (PCR) techniques may be used as appropriate.
  • PCR polymerase chain reaction
  • Any suitable host cell/vector system may be used for expression of the DNA sequences encoding the antibody molecules of the present invention.
  • Eukaryotic, e.g., mammalian, host cell expression systems may be used for production of antibody molecules, such as complete antibody molecules.
  • Suitable mammalian host cells include, but are not limited to, CHO, HEK293T, PER.C6, NSO, myeloma or hybridoma cells.
  • the expression of the DNA sequence encoding the antibody molecules of the present invention to be used may be expressed in prokaryotic cells, including, but not limited to, E coli.
  • the present invention also provides a process for the production of an antibody molecule according to the present invention comprising culturing a (heterologous) host cell comprising a vector encoding a nucleic acid of the present invention under conditions suitable for expression of protein from DNA encoding the antibody molecule of the present invention, and isolating the antibody molecule.
  • a cell line may be transfected with two vectors, a first vector encoding a light chain polypeptide and a second vector encoding a heavy chain polypeptide.
  • a single vector may be used, the vector including sequences encoding light chain and heavy chain polypeptides.
  • Antibodies according to the invention may be produced by (i) expressing a nucleic acid sequence according to the invention in a host cell, e.g. by use of a vector according to the present invention, and (ii) isolating the expressed antibody product. Additionally, the method may include (iii) purifying the isolated antibody. Transformed B cells and cultured plasma cells may be screened for those producing antibodies of the desired specificity or function.
  • the screening step may be carried out by any immunoassay, e.g., ELISA, by staining of tissues or cells (including transfected cells), by neutralization assay or by one of a number of other methods known in the art for identifying desired specificity or function.
  • the assay may select on the basis of simple recognition of one or more antigens, or may select on the additional basis of a desired function e.g., to select neutralizing antibodies rather than just antigen binding antibodies, to select antibodies that can change characteristics of targeted cells, such as their signaling cascades, their shape, their growth rate, their capability of influencing other cells, their response to the influence by other cells or by other reagents or by a change in conditions, their differentiation status, etc.
  • Individual transformed B cell clones may then be produced from the positive transformed B cell culture.
  • the cloning step for separating individual clones from the mixture of positive cells may be carried out using limiting dilution, micromanipulation, single cell deposition by cell sorting or another method known in the art.
  • Nucleic acid from the cultured plasma cells can be isolated, cloned and expressed in HEK293T cells or other known host cells using methods known in the art.
  • the immortalized B cell clones or the transfected host-cells of the invention can be used in various ways e.g., as a source of monoclonal antibodies, as a source of nucleic acid (DNA or mRNA) encoding a monoclonal antibody of interest, for research, etc.
  • the invention also provides a composition comprising immortalized B memory cells or transfected host cells that produce antibodies according to the present invention.
  • the immortalized B cell clone or the cultured plasma cells of the invention may also be used as a source of nucleic acid for the cloning of antibody genes for subsequent recombinant expression. Expression from recombinant sources may be more common for pharmaceutical purposes than expression from B cells or hybridomas e.g., for reasons of stability, reproducibility, culture ease, etc.
  • the invention also provides a method for preparing a recombinant cell, comprising the steps of: (i) obtaining one or more nucleic acids (e.g., heavy and/or light chain mRNAs) from the B cell clone or the cultured plasma cells that encodes the antibody of interest; (ii) inserting the nucleic acid into an expression vector and (iii) transfecting the vector into a (heterologous) host cell in order to permit expression of the antibody of interest in that host cell.
  • nucleic acids e.g., heavy and/or light chain mRNAs
  • the invention also provides a method for preparing a recombinant cell, comprising the steps of: (i) sequencing nucleic acid(s) from the B cell clone or the cultured plasma cells that encodes the antibody of interest; and (ii) using the sequence information from step (i) to prepare nucleic acid(s) for insertion into a host cell in order to permit expression of the antibody of interest in that host cell.
  • the nucleic acid may, but need not, be manipulated between steps (i) and (ii) to introduce restriction sites, to change codon usage, and/or to optimize transcription and/or translation regulatory sequences.
  • the invention also provides a method of preparing a transfected host cell, comprising the step of transfecting a host cell with one or more nucleic acids that encode an antibody of interest, wherein the nucleic acids are nucleic acids that were derived from an immortalized B cell clone or a cultured plasma cell of the invention.
  • the procedures for first preparing the nucleic acid(s) and then using it to transfect a host cell can be performed at different times by different people in different places (e.g., in different countries).
  • recombinant cells of the invention can then be used for expression and culture purposes. They are particularly useful for expression of antibodies for large-scale pharmaceutical production. They can also be used as the active ingredient of a pharmaceutical composition. Any suitable culture technique can be used, including but not limited to static culture, roller bottle culture, ascites fluid, hollow-fiber type bioreactor cartridge, modular minifermenter, stirred tank, microcarrier culture, ceramic core perfusion, etc.
  • the transfected host cell may be a eukaryotic cell, including yeast and animal cells, particularly mammalian cells (e.g., CHO cells, NS0 cells, human cells such as PER.C6 or HKB-1 1 cells, myeloma cells, or a human liver cell), as well as plant cells.
  • the transfected host cell may a prokaryotic cell, including £ co/I.
  • the transfected host cell is a mammalian cell, such as a human cell.
  • expression hosts can glycosylate the antibody of the invention, particularly with carbohydrate structures that are not themselves immunogenic in humans.
  • the transfected host cell may be able to grow in serum-free media.
  • the transfected host cell may be able to grow in culture without the presence of animal-derived products.
  • the transfected host cell may also be cultured to give a cell line.
  • the invention also provides a method for preparing one or more nucleic acid molecules (e.g., heavy and light chain genes) that encode an antibody of interest, comprising the steps of:
  • the invention provides a method for obtaining a nucleic acid sequence that encodes an antibody of interest, comprising the steps of: (i) preparing an immortalized B cell clone or culturing plasma cells according to the invention;
  • the invention further provides a method of preparing nucleic acid molecule(s) that encode an antibody of interest, comprising the step of obtaining the nucleic acid that was obtained from a transformed B cell clone or cultured plasma cells of the invention.
  • a method of preparing nucleic acid molecule(s) that encode an antibody of interest comprising the step of obtaining the nucleic acid that was obtained from a transformed B cell clone or cultured plasma cells of the invention.
  • the invention also comprises a method for preparing an antibody (e.g., for pharmaceutical use) according to the present invention, comprising the steps of: (i) obtaining and/or sequencing one or more nucleic acids (e.g., heavy and light chain genes) from the selected B cell clone or the cultured plasma cells expressing the antibody of interest; (ii) inserting the nucleic acid(s) into or using the nucleic acid(s) sequence(s) to prepare an expression vector; (iii) transfecting a host cell that can express the antibody of interest; (iv) culturing or sub culturing the transfected host cells under conditions where the antibody of interest is expressed; and, optionally, (v) purifying the antibody of interest.
  • nucleic acids e.g., heavy and light chain genes
  • the invention also provides a method of preparing the antibody of interest comprising the steps of: culturing or sub-culturing a transfected host cell population, e.g. a stably transfected host cell population, under conditions where the antibody of interest is expressed and, optionally, purifying the antibody of interest, wherein said transfected host cell population has been prepared by (i) providing nucleic acid(s) encoding a selected antibody of interest that is produced by a B cell clone or cultured plasma cells prepared as described above, (ii) inserting the nucleic acid(s) into an expression vector, (iii) transfecting the vector in a host cell that can express the antibody of interest, and (iv) culturing or sub-culturing the transfected host cell comprising the inserted nucleic acids to produce the antibody of interest.
  • a transfected host cell population e.g. a stably transfected host cell population
  • purifying the antibody of interest wherein said transfected host cell population
  • the present invention also provides a pharmaceutical composition comprising one or more of:
  • nucleic acid encoding the antibody according to the present invention
  • vector comprising the nucleic acid according to the present invention
  • the present invention also provides a pharmaceutical composition comprising the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention and/or the cell according to the present invention.
  • the pharmaceutical composition may optionally also contain a pharmaceutically acceptable carrier, diluent and/or excipient.
  • a pharmaceutically acceptable carrier may facilitate administration, it should not itself induce the production of antibodies harmful to the individual receiving the composition. Nor should it be toxic.
  • Suitable carriers may be large, slowly metabolized macromolecules such as proteins, polypeptides, liposomes, polysaccharides, polylactic acids, polyglycolic acids, polymeric amino acids, amino acid copolymers and inactive virus particles.
  • the pharmaceutically acceptable carrier, diluent and/or excipient in the pharmaceutical composition according to the present invention is not an active component in respect to influenza A virus infection.
  • salts can be used, for example mineral acid salts, such as hydrochlorides, hydrobromides, phosphates and sulphates, or salts of organic acids, such as acetates, propionates, malonates and benzoates.
  • mineral acid salts such as hydrochlorides, hydrobromides, phosphates and sulphates
  • organic acids such as acetates, propionates, malonates and benzoates.
  • compositions of a pharmaceutical composition may additionally contain liquids such as water, saline, glycerol and ethanol. Additionally, auxiliary substances, such as wetting or emulsifying agents or pH buffering substances, may be present in such compositions. Such carriers enable the pharmaceutical compositions to be formulated as tablets, pills, dragees, capsules, liquids, gels, syrups, slurries and suspensions, for ingestion by the subject.
  • Pharmaceutical compositions of the invention may be prepared in various forms. For example, the compositions may be prepared as injectables, either as liquid solutions or suspensions.
  • Solid forms suitable for solution in, or suspension in, liquid vehicles prior to injection can also be prepared (e.g., a lyophilized composition, similar to SynagisTM and Herceptin ® , for reconstitution with sterile water containing a preservative).
  • the composition may be prepared for topical administration e.g., as an ointment, cream or powder.
  • the composition may be prepared for oral administration e.g., as a tablet or capsule, as a spray, or as a syrup (optionally flavored).
  • the composition may be prepared for pulmonary administration e.g., as an inhaler, using a fine powder or a spray.
  • the composition may be prepared as a suppository or pessary.
  • the composition may be prepared for nasal, aural or ocular administration e.g., as drops.
  • the composition may be in kit form, designed such that a combined composition is reconstituted just prior to administration to a subject.
  • a lyophilized antibody may be provided in kit form with sterile water or a sterile buffer.
  • the (only) active ingredient in the composition is the antibody according to the present invention. As such, it may be susceptible to degradation in the gastrointestinal tract. Thus, if the composition is to be administered by a route using the gastrointestinal tract, the composition may contain agents which protect the antibody from degradation but which release the antibody once it has been absorbed from the gastrointestinal tract.
  • compositions of the invention generally have a pH between 5.5 and 8.5, in some embodiments this may be between 6 and 8, for example about 7.
  • the pH may be maintained by the use of a buffer.
  • the composition may be sterile and/or pyrogen free.
  • the composition may be isotonic with respect to humans.
  • pharmaceutical compositions of the invention are supplied in hermetically-sealed containers.
  • compositions present in several forms of administration include, but are not limited to, those forms suitable for parenteral administration, e.g., by injection or infusion, for example by bolus injection or continuous infusion.
  • parenteral administration e.g., by injection or infusion
  • the product may take the form of a suspension, solution or emulsion in an oily or aqueous vehicle and it may contain formulatory agents, such as suspending, preservative, stabilizing and/or dispersing agents.
  • the antibody may be in dry form, for reconstitution before use with an appropriate sterile liquid.
  • a vehicle is typically understood to be a material that is suitable for storing, transporting, and/or administering a compound, such as a pharmaceutically active compound, in particular the antibodies according to the present invention.
  • the vehicle may be a physiologically acceptable liquid, which is suitable for storing, transporting, and/or administering a pharmaceutically active compound, in particular the antibodies according to the present invention.
  • compositions of this invention may be administered by any number of routes including, but not limited to, oral, intravenous, intramuscular, intra-arterial, intramedullary, intraperitoneal, intrathecal, intraventricular, transdermal, transcutaneous, topical, subcutaneous, intranasal, enteral, sublingual, intravaginal or rectal routes. Hyposprays may also be used to administer the pharmaceutical compositions of the invention.
  • the pharmaceutical composition may be prepared for oral administration, e.g. as tablets, capsules and the like, for topical administration, or as injectable, e.g. as liquid solutions or suspensions.
  • the pharmaceutical composition is an injectable. Solid forms suitable for solution in, or suspension in, liquid vehicles prior to injection are also encompassed, for example the pharmaceutical composition may be in lyophilized form.
  • the active ingredient may be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability.
  • a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability.
  • isotonic vehicles such as Sodium Chloride Injection, Ringer's Injection, Lactated Ringer's Injection.
  • Preservatives, stabilizers, buffers, antioxidants and/or other additives may be included, as required.
  • administration is usually in a "prophylactically effective amount” or a “therapeutically effective amount” (as the case may be), this being sufficient to show benefit to the individual.
  • a proliferatively effective amount or a “therapeutically effective amount” (as the case may be)
  • the actual amount administered, and rate and time-course of administration will depend on the nature and severity of what is being treated.
  • the pharmaceutical composition according to the present invention may be provided for example in a pre-filled syringe.
  • inventive pharmaceutical composition as defined above may also be administered orally in any orally acceptable dosage form including, but not limited to, capsules, tablets, aqueous suspensions or solutions.
  • carriers commonly used include lactose and corn starch.
  • Lubricating agents such as magnesium stearate, are also typically added.
  • useful diluents include lactose and dried cornstarch.
  • the active ingredient i.e. the inventive transporter cargo conjugate molecule as defined above, is combined with emulsifying and suspending agents. If desired, certain sweetening, flavoring or coloring agents may also be added.
  • inventive pharmaceutical composition may also be administered topically, especially when the target of treatment includes areas or organs readily accessible by topical application, e.g. including accessible epithelial tissue. Suitable topical formulations are readily prepared for each of these areas or organs.
  • inventive pharmaceutical composition may be formulated in a suitable ointment, containing the inventive pharmaceutical composition, particularly its components as defined above, suspended or dissolved in one or more carriers. Carriers for topical administration include, but are not limited to, mineral oil, liquid petrolatum, white petrolatum, propylene glycol, polyoxyethylene, polyoxypropylene compound, emulsifying wax and water.
  • the inventive pharmaceutical composition can be formulated in a suitable lotion or cream.
  • suitable carriers include, but are not limited to, mineral oil, sorbitan monostearate, polysorbate 60, cetyl esters wax, cetearyl alcohol, 2- octyldodecanol, benzyl alcohol and water.
  • Dosage treatment may be a single dose schedule or a multiple dose schedule.
  • the pharmaceutical composition may be provided as single-dose product.
  • the amount of the antibody in the pharmaceutical composition - in particular if provided as single-dose product - does not exceed 200 mg, for example it does not exceed 100 mg or 50 mg.
  • the pharmaceutical composition according to the present invention may be administered daily, e.g. once or several times per day, e.g. once, twice, three times or four times per day, for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 14, 1 5, 1 6, 1 7, 18, 19, 20 or 21 or more days, e.g. daily for 1 , 2, 3, 4, 5, 6 months.
  • the pharmaceutical composition according to the present invention may be administered weekly, e.g. once or twice per week, for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 14, 15, 16, 1 7, 18, 19, 20 or 21 or more weeks, e.g.
  • the pharmaceutical composition according to the present invention may be administered monthly, e.g. once per month or every second month for 1 , 2, 3, 4, or 5 or more years. Administration may also continue for the lifetime.
  • one single administration only is also envisaged, in particular in respect to certain indications, e.g. for prophylaxis of influenza A virus infection.
  • a single administration is administered and further doses may be administered at one or more later time points, when the titer of the antibody is insufficient or assumed to be insufficient for protection.
  • the amount of the antibody in the pharmaceutical composition according to the present invention may not exceed 1 g or 500 mg. In some embodiments, for a single dose, the amount of the antibody in the pharmaceutical composition according to the present invention, may not exceed 200 mg, or 100 mg. For example, for a single dose, the amount of the antibody in the pharmaceutical composition according to the present invention, may not exceed 50 mg.
  • Pharmaceutical compositions typically include an "effective" amount of one or more antibodies of the invention, i.e. an amount that is sufficient to treat, ameliorate, attenuate, reduce or prevent a desired disease or condition, or to exhibit a detectable therapeutic effect. Therapeutic effects also include reduction or attenuation in pathogenic potency or physical symptoms.
  • an effective dose may generally be from about 0.005 to about 100 mg/kg, for example from about 0.0075 to about 50 mg/kg or from about 0.01 to about 10 mg/kg. In some embodiments, the effective dose will be from about 0.02 to about 5 mg/kg, of the antibody of the present invention (e.g. amount of the antibody in the pharmaceutical composition) in relation to the bodyweight (e.g., in kg) of the individual to which it is administered.
  • the pharmaceutical composition according to the present invention may also comprise an additional active component, which may be a further antibody or a component, which is not an antibody.
  • the pharmaceutical composition may comprise one or more antivirals (which are not antibodies).
  • the pharmaceutical composition may also comprise one or more antibodies (which are not according to the invention), for example an antibody against other influenza virus antigens (other than hemagglutinin) or an antibody against another influenza virus (e.g., against an influenza B virus or against an influenza C virus).
  • the pharmaceutical composition according to the present invention may comprise one or more of the additional active components.
  • the antibody according to the present invention can be present either in the same pharmaceutical composition as the additional active component or, alternatively, the antibody according to the present invention is comprised by a first pharmaceutical composition and the additional active component is comprised by a second pharmaceutical composition different from the first pharmaceutical composition. Accordingly, if more than one additional active component is envisaged, each additional active component and the antibody according to the present invention may be comprised in a different pharmaceutical composition. Such different pharmaceutical compositions may be administered either combined/simultaneously or at separate times or at separate locations (e.g. separate parts of the body).
  • the antibody according to the present invention and the additional active component may provide an additive therapeutic effect, such as a synergistic therapeutic effect.
  • a synergistic therapeutic effect is used to describe a combined effect of two or more active agents that is greater than the sum of the individual effects of each respective active agent.
  • the combined effect of two or more agents results in “synergistic inhibition” of an activity or process, it is intended that the inhibition of the activity or process is greater than the sum of the inhibitory effects of each respective active agent.
  • the term “synergistic therapeutic effect” refers to a therapeutic effect observed with a combination of two or more therapies wherein the therapeutic effect (as measured by any of a number of parameters) is greater than the sum of the individual therapeutic effects observed with the respective individual therapies.
  • a composition of the invention may include antibodies of the invention, wherein the antibodies may make up at least 50% by weight (e.g., 60%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99% or more) of the total protein in the composition.
  • the antibodies may be in purified form.
  • the present invention also provides a method of preparing a pharmaceutical composition comprising the steps of: (i) preparing an antibody of the invention; and (ii) admixing the purified antibody with one or more pharmaceutically-acceptable carriers.
  • a method of preparing a pharmaceutical composition comprises the step of: admixing an antibody with one or more pharmaceutically-acceptable carriers, wherein the antibody is a monoclonal antibody that was obtained from a transformed B cell or a cultured plasma cell of the invention.
  • nucleic acid typically DNA
  • Suitable gene therapy and nucleic acid delivery vectors are known in the art.
  • compositions may include an antimicrobial, particularly if packaged in a multiple dose format. They may comprise detergent e.g., a Tween (polysorbate), such as Tween 80. Detergents are generally present at low levels e.g., less than 0.01 %. Compositions may also include sodium salts (e.g., sodium chloride) to give tonicity. For example, a concentration of 10+2mg/ml NaCI is typical.
  • a concentration of 10+2mg/ml NaCI is typical.
  • compositions may comprise a sugar alcohol (e.g., mannitol) or a disaccharide (e.g., sucrose or trehalose) e.g., at around 15-30 mg/ml (e.g., 25 mg/ml), particularly if they are to be lyophilized or if they include material which has been reconstituted from lyophilized material.
  • a sugar alcohol e.g., mannitol
  • a disaccharide e.g., sucrose or trehalose
  • the pH of a composition for lyophilization may be adjusted to between 5 and 8, or between 5.5 and 7, or around 6.1 prior to lyophilization.
  • compositions of the invention may also comprise one or more immunoregulatory agents.
  • one or more of the immunoregulatory agents include(s) an adjuvant.
  • the present invention provides the use of the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention in prophylaxis and/or treatment of infection with influenza A virus; or in (ii) diagnosis of infection with influenza A virus.
  • the present invention also provides a method of reducing influenza A virus infection, or lowering the risk of influenza A virus infection, comprising: administering to a subject in need thereof, a therapeutically effective amount of the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention.
  • the present invention also provides the use of the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention in the manufacture of a medicament for prophylaxis, treatment or attenuation of influenza A virus infection.
  • Methods of diagnosis may include contacting an antibody with a sample.
  • samples may be isolated from a subject, for example an isolated tissue sample taken from, for example, nasal passages, sinus cavities, salivary glands, lung, liver, pancreas, kidney, ear, eye, placenta, alimentary tract, heart, ovaries, pituitary, adrenals, thyroid, brain, skin or blood, such as plasma or serum.
  • the methods of diagnosis may also include the detection of an antigen/antibody complex, in particular following the contacting of an antibody with a sample. Such a detection step is typically performed at the bench, i.e. without any contact to the human or animal body. Examples of detection methods are well-known to the person skilled in the art and include, e.g., ELISA (enzyme-linked immunosorbent assay).
  • Prophylaxis of infection with influenza A virus refers in particular to prophylactic settings, wherein the subject was not diagnosed with infection with influenza A virus (either no diagnosis was performed or diagnosis results were negative) and/or the subject does not show symptoms of infection with influenza A virus.
  • Prophylaxis of infection with influenza A virus is particularly useful in subjects at greater risk of severe disease or complications when infected, such as pregnant women, children (such as children under 59 months), the elderly, individuals with chronic medical conditions (such as chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental, liver or hematologic diseases) and individuals with immunosuppressive conditions (such as HIV/AIDS, receiving chemotherapy or steroids, or malignancy).
  • prophylaxis of infection with influenza A virus is also particularly useful in subjects at greater risk acquiring influenza A virus infection, e.g. due to increased exposure, for example subjects working or staying in public areas, in particular health care workers.
  • influenza A virus infection In therapeutic settings, in contrast, the subject is typically infected with influenza A virus, diagnosed with influenza A virus infection and/or showing symptoms of influenza A virus infection.
  • treatment and “therapy”/"therapeutic” of influenza A virus infection include (complete) cure as well as attenuation/reduction of influenza A virus infection and/or related symptoms.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention may be used for treatment of influenza A virus infection in subjects diagnosed with influenza A virus infection or in subjects showing symptoms of influenza A virus infection.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention may also be used for prophylaxis and/or treatment of influenza A virus infection in asymptomatic subjects. Those subjects may be diagnosed or not diagnosed with influenza A virus infection.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is used for prophylaxis and/or treatment of influenza A virus infection, wherein the antibody, the nucleic acid, the vector, the cell, or the pharmaceutical composition is administered up to three months before (a possible) influenza A virus infection or up to one month before (a possible) influenza A virus infection, such as up to two weeks before (a possible) influenza A virus infection or up to one week before (a possible) influenza A virus infection.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is used for prophylaxis and/or treatment of influenza A virus infection, wherein the antibody, the nucleic acid, the vector, the cell, or the pharmaceutical composition is administered up to one day before (a possible) influenza A virus infection.
  • a treatment schedule refers in particular to a prophylactic setting.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention may be used for prophylaxis and/or treatment of influenza A virus infection, wherein the antibody, the nucleic acid, the vector, the cell, or the pharmaceutical composition is administered up to three months before the first symptoms of influenza A infection occur or up to one month before the first symptoms of influenza A infection occur, such as up to two weeks the first symptoms of influenza A infection occur or up to one week before the first symptoms of influenza A infection occur.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is used for prophylaxis and/or treatment of influenza A virus infection, wherein the antibody, the nucleic acid, the vector, the cell, or the pharmaceutical composition is administered up to three days or two days before the first symptoms of influenza A infection occur.
  • one or more subsequent administrations may follow, for example a single dose per day or per every second day for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 1 , 15, 1 6, 1 7, 1 8, 19, 20, or 21 days.
  • one or more subsequent administrations may follow, for example a single dose once or twice per week for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 1 , 15, 1 6, 1 7, 1 8, 1 9, 20, or 21 weeks.
  • one or more subsequent administrations may follow, for example a single dose every 2 or 4 weeks for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 1 , 1 5, 16, 1 7, 1 8, 1 9, 20, or 21 weeks.
  • one or more subsequent administrations may follow, for example a single dose every two or four months for 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , 12, 13, 1 , 15, 16, 1 7, 18, 1 9, 20, or 21 months.
  • one or more subsequent administrations may follow, for example a single dose once or twice per year for 1 , 2, 3, 4, 5, 6, 7, 8, 9, or 10 years.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is administered at a (single) dose of 0.005 to 100 mg/kg bodyweight or 0.0075 to 50 mg/kg bodyweight, such as at a (single) dose of 0.01 to 10 mg/kg bodyweight or at a (single) dose of 0.05 to 5 mg/kg bodyweight.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is administered at a (single) dose of 0.1 to 1 mg/kg bodyweight.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention may be administered by any number of routes such as oral, intravenous, intramuscular, intra-arterial, intramedullary, intraperitoneal, intrathecal, intraventricular, transdermal, transcutaneous, topical, subcutaneous, intranasal, enteral, sublingual, intravaginal or rectal routes.
  • routes such as oral, intravenous, intramuscular, intra-arterial, intramedullary, intraperitoneal, intrathecal, intraventricular, transdermal, transcutaneous, topical, subcutaneous, intranasal, enteral, sublingual, intravaginal or rectal routes.
  • the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is administered prophylactically, i.e. before diagnosis of influenza A infection.
  • the antibody of the invention is administered at a dose which does not exceed half of the dose required for prophylaxis or treatment of influenza A infection with a comparative antibody, which differs from said antibody only in that it does not contain the mutations M428L and N434S in the constant region of the heavy chain.
  • the dose of the antibody of the invention does not exceed one third, one fourth, one fifth, one sixth, one seventh, one eighth or one ninth of the dose required for prophylaxis or treatment of influenza A infection with said comparative antibody.
  • the antibody of the invention is administered at a dose which does not exceed one tenth of the dose required for prophylaxis or treatment of influenza A infection with a comparative antibody, which differs from said antibody only in that it does not contain the mutations M428L and N434S in the constant region of the heavy chain.
  • Example 5 of the present specification shows that the antibody of the invention comprising the mutations M428L and N434S in the constant region of the heavy chain is effective at much lower doses as compared to a comparative antibody, which differs from the inventive antibody only in that it does not contain the mutations M428L and N434S in the constant region of the heavy chain.
  • Example 5 also shows that the increased efficacy of the antibody of the invention was independent of the circulating antibody levels.
  • the antibody of the invention may be administered to subjects at immediate risk of influenza A infection.
  • An immediate risk of influenza A infection typically occurs during an influenza A epidemic.
  • Influenza A viruses are known to circulate and cause seasonal epidemics of disease (WHO, Influenza (Seasonal) Fact sheet, November 6, 2018).
  • WHO Influenza (Seasonal) Fact sheet
  • seasonal epidemics occur mainly during winter, while in tropical regions, influenza may occur throughout the year, causing outbreaks more irregularly.
  • the risk of an influenza A epidemic is high during November, December, January, February and March
  • the risk of an influenza A epidemic is high during May, June, July, August and September.
  • the administration of the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention in the methods and uses according to the invention can be carried out alone or in combination with a co-agent (also referred to as "additional active component” herein), which may be useful for preventing and/or treating influenza infection.
  • a co-agent also referred to as "additional active component” herein
  • the invention encompasses the administration of the antibody according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention, wherein it is administered to a subject prior to, simultaneously with or after a co-agent or another therapeutic regimen useful for treating and/or preventing influenza.
  • Said antibody, nucleic acid, vector, cell or pharmaceutical composition, that is administered in combination with said co-agent can be administered in the same or different composition(s) and by the same or different route(s) of administration.
  • expressions like "combination therapy”, “combined administration”, “administered in combination” and the like are intended to refer to a combined action of the drugs (which are to be administered “in combination”).
  • the combined drugs are usually present at a site of action at the same time and/or at an overlapping time window. It may also be possible that the effects triggered by one of the drugs are still ongoing (even if the drug itself may not be present anymore) while the other drug is administered, such that effects of both drugs can interact.
  • a drug which was administered long before another drug e.g., more than one, two, three or more months or a year
  • another drug e.g., more than one, two, three or more months or a year
  • influenza medications administered in distinct influenza seasons are usually not administered "in combination”.
  • Said other therapeutic regimens or co-agents may be, for example, an antiviral.
  • An antiviral or “antiviral agent” or “antiviral drug” refers to a class of medication used specifically for treating viral infections.
  • antivirals may be broad spectrum antivirals useful against various viruses or specific antivirals that are used for specific viruses. Unlike most antibiotics, antiviral drugs do usually not destroy their target pathogen; instead they typically inhibit their development.
  • the antibody, or an antigen binding fragment thereof, according to the present invention, the nucleic acid according to the present invention, the vector according to the present invention, the cell according to the present invention or the pharmaceutical composition according to the present invention is administered in combination with (prior to, simultaneously or after) an antiviral for the (medical) uses as described herein.
  • an antiviral may be a broad spectrum antiviral (which is useful against influenza viruses and other viruses) or an influenza virus-specific antiviral.
  • the antiviral is not an antibody.
  • the antiviral may be a small molecule drug. Examples of small molecule antivirals useful in prophylaxis and/or treatment of influenza are described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics. 201 7;7(4):826-845. As described in Wu et al., 201 7, the skilled artisan is familiar with various antivirals useful in prophylaxis and/or treatment of influenza.
  • Antivirals useful in prophylaxis and/or treatment of influenza include (i) agents targeting functional proteins of the influenza virus itself and (ii) agents targeting host cells, e.g. the epithelium.
  • Host cell targeting agents include the thiazolide class of broad-spectrum antivirals, sialidase fusion proteins, type III interferons, Bcl-2 (B cell lymphoma 2) inhibitors, protease inhibitors, V-ATPase inhibitors and antioxidants.
  • Examples of the thiazolide class of broad-spectrum antivirals include nitazoxanide (NTZ), which is rapidly deacetylated in the blood to the active metabolic form tizoxanide (TIZ), and second generation thiazolide compounds, which are structurally related to NTZ, such as RM5061 .
  • Fludase (DAS1 81 ) is an example for sialidase fusion proteins.
  • Type III IFNs include, for example, !FNX.
  • Bcl-2 inhibitors include ABT-737, ABT-263, ABT-1 99, WEHI-539 and A-1331852 (Davidson S. Treating Influenza Infection, From Now and Into the Future. Front Immunol. 20 ⁇ 8;9:1946).
  • protease inhibitors include nafamostat, Leupeptin, epsilon-aminocapronic acid, Camostat and Aprotinin.
  • V-ATPase inhibitors include NorakinR, ParkopanR, AntiparkinR and AkinetonR.
  • An example of an antioxidant is alpha-tocopherol.
  • the antiviral is an agent targeting a functional protein of the influenza virus itself.
  • the antiviral may target a functional protein of the influenza virus, which is not hemagglutinin.
  • antivirals targeting a functional protein of the influenza virus include entry inhibitors, hemagglutinin inhibitors, neuraminidase inhibitors, influenza polymerase inhibitors (RNA-dependent RNA polymerase (RdRp) inhibitors), nucleocapsid protein inhibitors, M2 ion channel inhibitors and arbidol hydrochloride.
  • Non limiting examples of entry inhibitors include triterpenoids derivatives, such as glycyrrhizic acid (glycyrrhizin) and glycyrrhetinic acid; saponins; uralsaponins M-Y (such as uralsaponins M); dextran sulphate (DS); silymarin; curcumin; and lysosomotropic agents, such as Concanamycin A, Bafilomycin A1 , and Chloroquine.
  • triterpenoids derivatives such as glycyrrhizic acid (glycyrrhizin) and glycyrrhetinic acid
  • saponins such as uralsaponins M-Y (such as uralsaponins M)
  • uralsaponins M-Y such as uralsaponins M
  • dextran sulphate (DS) such as silymarin
  • curcumin such as
  • Non-limiting examples of hemagglutinin inhibitors include BMY-27709; stachyflin; natural products, such as Gossypol, Rutin, Quercetin, Xylopine, and Theaflavins; trivalent glycopeptide mimetics, such as compound 1 described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics. 201 7;7(4):826-845; podocarpic acid derivatives, such as compound 2 described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics.
  • 201 7;7(4):826-845 natural product pentacyclic triterpenoids, such as compound 3 described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics. 201 7;7(4):826-845; and prenylated indole diketopiperazine alkaloids, such as Neoechinulin B.
  • nucelocapsid protein inhibitors include nucleozin, Cycloheximide, Naproxen and Ingavirin.
  • M2 ion channel inhibitors include the approved M2 inhibitors Amantadine and Rimantadine and derivatives thereof; as well as non-adamantane derivatives, such as Spermine, Spermidine, Spiropiperidine and pinanamine derivatives.
  • the antiviral is selected from neuraminidase (NA) inhibitors and influenza polymerase inhibitors (RNA-dependent RNA polymerase (RdRp) inhibitors).
  • NA neuraminidase
  • RdRp influenza polymerase inhibitors
  • Non limiting examples of neuraminidase (NA) inhibitors include zanamivir; oseltamivir; peramivir; laninamivir; derivatives thereof such as compounds 4 - 10 described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics. 201 7;7(4):826-845, and dimeric zanamivir conjugates (e.g., as described in Wu X, Wu X, Sun Q, et al.
  • 201 7;7(4):826-845 such as compounds 15 - 1 8); ginkgetin-sialic acid conjugates; flavanones and flavonoids isoscutel!arein and its derivatives (e.g., as described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti- influenza virus agents. Theranostics. 201 7;7(4):826-845); AV5080; and N-substituted oseltamivir analogues (e.g., as described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents.
  • RNA-dependent RNA polymerase (RdRp) inhibitors include RdRp disrupting compounds, such as those described in Wu X, Wu X, Sun Q, et al. Progress of small molecular inhibitors in the development of anti-influenza virus agents. Theranostics.
  • PB2 cap binding inhibitors such as JNJ63623872 (VX-787); cap-dependent endonuclease inhibitors, such as baloxavir marboxil (S-033188); PA endonuclease inhibitors, such as AL-794, EGCG and its aliphatic analogues, N-hydroxamic acids and N-hydroxyimides, flutimide and its aromatic analogues, tetramic acid derivatives, L-742,001 , ANA-0, polyphenolic catechins, phenethyl-phenylphthalimide analogues, macrocyclic bisbibenzyls, pyrimidinoles, fullerenes, hydroxyquinolinones, hydroxypyridinones, hydroxypyridazinones, trihydroxy- phenyl-bearing compounds, 2-hydroxy-benzamides, hydroxy-pyrimidinones, b-diketo acid and its bio
  • PA endonuclease inhibitors
  • the pharmaceutical composition according to the present invention may comprise one or more of the additional active components.
  • the antibody according to the present invention can be present in the same pharmaceutical composition as the additional active component (co-agent).
  • the antibody according to the present invention and the additional active component (co-agent) are comprised in distinct pharmaceutical compositions (e.g., not in the same composition). Accordingly, if more than one additional active component (co agent) is envisaged, each additional active component (co-agent) and the antibody, or the antigen binding fragment, according to the present invention may be comprised by a different pharmaceutical composition.
  • Such different pharmaceutical compositions may be administered either combined/simultaneously or at separate times and/or by separate routes of administration.
  • the antibody according to the present invention and the additional active component (co agent) may provide an additive or a synergistic therapeutic effect.
  • the term “synergy” is used to describe a combined effect of two or more active agents that is greater than the sum of the individual effects of each respective active agent. Thus, where the combined effect of two or more agents results in “synergistic inhibition" of an activity or process, it is intended that the inhibition of the activity or process is greater than the sum of the inhibitory effects of each respective active agent.
  • the term “synergistic therapeutic effect” refers to a therapeutic effect observed with a combination of two or more therapies wherein the therapeutic effect (as measured by any of a number of parameters) is greater than the sum of the individual therapeutic effects observed with the respective individual therapies.
  • the present invention also provides a combination of (i) the antibody of the invention as described herein, and (ii) an antiviral agent as described above.
  • FIG. 1 shows for Example 2 the plasma concentration of human antibodies
  • FluAB_MLNS open squares
  • FluAB_wt comparative antibody
  • FIG. 2 shows for Example 3 plasma concentrations of FluAB_MLNS (animals C90142,
  • Figure 3 shows for Example 4 (A) the concentrations of human antibodies FluAB_MLNS and FluAB_wt in nasal swabs as measured using ELISA and normalized to urea content; and (B) Biodistribution of of human antibodies FluAB_ MLNS and FluAB_wt, expressed as % urea-normalized concentration in nasal swabs over plasma concentrations. Individual animal IDs and inoculated human antibody variant (FluAB_MLNS or FluAB_wt) are indicated below.
  • Figure 4 shows for Example 5 the cumulative bodyweight change over time in Tg32 mice treated with either FluAB__wt (panels B, D, circles), FluAB_MLNS (panels C, E, squares) at 1 mg/kg (panels B, C, grey symbols) and 0.3 mg/kg (panels D, E, light gray symbols) or left untreated (panel A, triangles); all mice infected intranasally with PR8 virus. Individual animals are shown; The thick black line represents the average trend of BW ⁇ SD. The number of individuals per group is indicated.
  • Figure 5 shows for Example 5 the % of survival comparison between 1 mg/kg dose (left panel) and 0.3 mg/kg dose (right panel) in infected Tg32 male mice treated with nothing (dashed line), FluAB_wt, or FluAB_MLNS. ** p ⁇ 0.01 vs untreated mice (CTR) and FluAB_MLNS 0.3 mg/kg; °°° p ⁇ 0.001 vs FluAB_wt, log-rank analysis, Mantel-Cox method.
  • Figure 6 shows for Example 5 the circulating levels of the injected antibodies.
  • the individual levels (mg/ml) of circulating FluAB_wt (circles) and FluAB_MLNS (squares) measured in the serum of mice, immediately before (Day 0) and 6 days after infection are shown. Bars represent the mean ⁇ SD.
  • Figure 7 shows for Example 6 the plate scheme used in the in vitro neutralization assay.
  • Figure 8 shows for Example 6 the neutralization activity of FluAB_MLNS and
  • Figure 9 shows for Example 6 the combined neutralization activity of FluAB_MLNS and
  • Oseltamivir on H1 (A) and H3 (B) virus infection show the inhibited fraction by FluAB_MLNS alone and in combination with heteromolar concentrations of Oseltamivir both in H1 N1 (A) and H3N2 (B) viral infection of MDCK cells. Data are represented as mean +SD of triplicate values, each replicate obtained in three independent culture plates.
  • Figure 10 shows for Example 6 the median effect plots of combined FluAB_MLNS and
  • Oseltamivir The two compounds were serially diluted at the indicated constant ratios and added to MDCK cells infected with either H1 (A) and H3 (B) viral strains. The values obtained from selected combinations at non- constant ratios (NCR) are also shown.
  • Figure 1 ⁇ shows for Example 6 the combination indexes of FluAB_MLNS and Oseltamivir for H1 N1 virus infection. Dots represent the actual experimental points at the indicated constant ratios with the cumulated drug-drug concentration denoted aside. The dotted curves show the predicted combination index across the complete effect range.
  • Figure 12 shows for Example 6 the combination indexes of FluAB_MLNS and
  • Oseltamivir for H3N2 virus infection Dots represent the actual experimental points at the indicated constant ratios with the cumulated drug-drug concentration denoted aside. The dotted curves show the predicted combination index across the complete effect range.
  • Figure 13 shows for Example 6 isobolograms of FluAB_MLNS-Oseltamivir combinations for H1 N1 virus infection. Dots show the IC 50 , IC 75 and IC 90 values on different constant ratio FluAB_MLNS-Oseltamivir combinations. For each experimental point, the cumulated concentration is shown.
  • Figure 14 shows for Example 6 isobolograms of FluAB_MLNS-Oseltamivir combinations for H3N2 virus infection. Dots show the ICso, lC-s and IC 90 values on different constant ratio FluAB_MLNS-Oseltamivir combinations. For each experimental point, the cumulated concentration is shown.
  • Figure 1 5 shows for Example 6 the neutralization activity of FluAB_MLNS and Zanamivir alone on H1 N1 (A, C) and H3N2 (B, D) virus infection.
  • Figure 1 6 shows for Example 6 the combined neutralization activity of FluAB_ MLNS and
  • Zanamivir on H1 (A) and H3 (B) virus infection show the inhibited fraction by FluAB_MLNS alone and in combination with heteromolar concentrations of Zanamivir both in H1 N1 (A) and H3N2 (B) viral infection of MDCK cells. Data are represented as mean +SD of triplicate values, each replicate obtained in three independent culture plates.
  • Figure 1 7 shows for Example 6 the median effect plots of combined FluAB_ MLNS and Zanamivir The two compounds were serially diluted at the indicated constant ratios and added to MDCK cells infected with either H1 (A) and H3 (B) viral strains. The values obtained from selected combinations at non-constant ratios (NCR) are also shown.
  • Figure 1 8 shows for Example 6 the combination indexes of FluAB_ MLNS and Zanamivir for H 1 N1 virus infection. Dots represent the actual experimental points at the indicated constant ratios with the cumulated drug-drug concentration denoted aside. The dotted curves show the predicted combination index across the complete effect range.
  • Figure 1 9 shows for Example 6 the combination indexes of FluAB_ MLNS and Zanamivir for H3N2 virus infection. Dots represent the actual experimental points at the indicated constant ratios with the cumulated drug-drug concentration denoted aside. The dotted curves show the predicted combination index across the complete effect range.
  • Figure 20 shows for Example 6 isobolograms of FluAB_MLNS-Zanamivir combinations for H1 N1 virus infection. Dots show the IC 50 , IC 75 and IC 90 values on different constant ratio FluAB_MLNS-Zanamivir combinations. For each experimental point, the cumulated concentration is shown.
  • Figure 21 shows for Example 6 isobolograms of FluAB_MLNS-Zanamivir combinations for H3N2 virus infection. Dots show the IC 50 , IC75 and IC90 values on different constant ratio FluAB_MLNS-Zanamivir combinations. For each experimental point, the cumulated concentration is shown.
  • Figure 22 shows for Example 6 the neutralization activity of FluAB_MLNS and Baloxavir alone on H 1 N1 (A, C) and F13N2 (B, D) virus infection.
  • Figure 23 shows for Example 6 the combined neutralization activity of FluAB_MLNS and Baloxavir on H1 (A) and H3 (B) virus infection.
  • Data show the inhibited fraction by FluAB_MLNS alone and in combination with heteromolar concentrations of Baloxavir both in H1 N1 (A) and H3N2 (B) viral infection of MDCK cells. Data are represented as mean +SD of triplicate values, each replicate obtained in three independent culture plates.
  • Figure 24 shows for Example 6 the median effect plots of combined FluAB_ MLNS and
  • Baloxavir The two compounds were serially diluted at the indicated constant ratios and added to MDCK cells infected with either H1 (A) and H3 (B) viral strains. The values obtained from selected combinations at non-constant ratios (NCR) are also plotted.
  • Figure 25 shows for Example 6 the combination indexes of FluAB_MLNS and Baloxavir.
  • Dots represent the actual experimental points at the indicated constant ratios with the cumulated drug-drug concentration denoted aside.
  • the dotted curves show the predicted combination index across the complete effect range.
  • Figure 26 shows for Example 6 isobolograms of FluAB_MLNS-Baloxavir combinations.
  • Example 1 Safety and tolerability of an antibody according to the present invention in cynomolgus macaques
  • an antibody according to the present invention which comprises (i) the CDR sequences as set forth in SEQ ID NOs 1 - 6 and (ii) the two mutations M428L and N434S in the heavy chain constant regions, was designed and produced. More specifically, the antibody comprises (i) the heavy chain variable region (VH) sequence as set forth in SEQ ID NO: 7 and the light chain variable region (VL) sequence as set forth in SEQ ID NO: 8; and (ii) the two mutations M428L and N434S in the heavy chain constant regions. Even more specifically, the antibody comprises a heavy chain having an amino acid sequence as set forth in SEQ ID NO: 9 and a light chain having an amino acid sequence as set forth in SEQ ID NO: 10. This antibody is referred to herein as "FluAB_MLNS".
  • antibody “FluAB_wt” was used, which differs from antibody “FluAB_MLNS” only in that it does not contain the two mutations M428L and N434S in the heavy chain constant regions. Accordingly, comparative antibody “FluAB_wt” comprises a heavy chain having an amino acid sequence as set forth in SEQ ID NO: 1 1 and a light chain having an amino acid sequence as set forth in SEQ ID NO: 10.
  • Example 2 Determination of plasma concentration and pharmacokinetics
  • IAV-HA antigen Influenza A virus H1 N1 A/California/07/2009 Hemagglutinin Protein Antigen (with His Tag); Sino Biologicals
  • IAV-HA antigen Influenza A virus H1 N1 A/California/07/2009 Hemagglutinin Protein Antigen (with His Tag); Sino Biologicals
  • PBS PBS
  • 25 pi 25 pi were added to the wells of a 96-well flat bottom V2-area ELISA plate for coating over night at 4°C. After coating, the plates were washed twice with 0.5x PBS supplemented with 0.05% Tween20 (wash solution) using an automated ELISA washer.
  • Plasma samples were centrifuged at 10 ⁇ 00 g for 10 min at 4°C and then diluted (1 :10 and then 1 :30) for a final 1 :300 dilution in blocking solution in 96-well cell culture plates.
  • the minimum dilution (1 :300) of the macaque plasma used for quantification was tested and set to ensure that the matrix effect was negligible. Samples were then diluted 1 :2 stepwise in triplicates for a total of 12 dilutions.
  • Standards for each antibody to be tested were prepared similarly via diluting the antibodies 1 :300 to 1 mg/ml in a pool of pre inoculation plasma from all test animals, mimicking the matrix of the test samples. Standards were then diluted 1 :3 stepwise in blocking solution in triplicates for a total of 12 dilutions. Twenty-five pi of the prepared samples or standards were added to hemagglutinin (HA)- coated wells and incubated for 1 h at RT.
  • HA hemagglutinin
  • OD values from ELISA data were plotted vs. concentration in the Gen5 software (BioTek).
  • Gen5 software BioTek
  • the OD values of the sample dilutions that fell within the predictable assay range of the standard curve— as determined in setup experiment by quality control samples in the upper, medium or lower range of the curve— were interpolated to quantify the samples. Plasma concentration of the antibodies were then determined considering the final dilution of the sample.
  • PK data were analyzed by using WINNONLIN NONCOMPARTMENTAL ANALYSIS PROGRAM (8.1 .0.3530 Core Version, Phoenix software, Certara) with the following settings: Model: Plasma Data, Constant Infusion Administration; Number of non-missing observations: 8; Steady state interval Tau: 1 .00; Dose time: 0.00; Dose amount: 5.00 mg/kg; Length of Infusion: 0.04 days; Calculation method: Linear Trapezoidal with Linear Interpolation; Weighting for lambda_z calculations: Uniform weighting; Lambda__z method: Find best fit for lambda_z, Log regression.
  • Results are shown in Figure 1 .
  • the T 1 was estimated as 1 9.5 days for the antibody according to the present invention FluAB_MLNS, while T 1 was estimated as 1 1 .6 days for the comparative antibody FluAB_wt.
  • the lower limit of quantification was 300 ng/ml.
  • the antibody according to the present invention FluAB MLNS had an extended in-vivo half-live compared to comparative antibody FluAB_wt at least up to day 56 post- inoculation.
  • Example 3 Long-term stability in vivo
  • total human antibodies in macaque plasma was quantified using a specific anti-CH2 ELISA, using a capture mAb that specifically binds the CH2 region of human but not of monkey Abs.
  • an ELISA capturing with mouse anti-CH2 domain-specific to human IgG (clone R10Z8E9; Thermo Scientific) was used. It was verified that this mAb does not cross-react with monkey IgG.
  • mouse anti-human IgG CH2 was added in PBS at 0.5 mg/ml and incubated over night at 4°C.
  • the antibody according to the present invention FluAB_MLNS demonstrated functional antigen binding and thus good long-term stability in vivo up to day 1 13 post- inoculation during study extension.
  • Example 4 Antibody concentration in nasal swabs and biodistribution
  • Concentrations of antibodies FluAB_MLNS and FluAB_wt in nasal swabs were determined essentially as described in Example 2 for for determination in plasma with the following minor adaptations: (a) ELISA plates were blocked 2 h at RT; (b) Nasal swab samples were diluted starting at 1 :2 with 1 % BSA in PBS and then serially diluted step-wise 1 :2 for a total of 8 dilution points; (c) nasal swab medium (RT MINI Viral Transport Medium; Copan) was used as assay matrix control.
  • samples were diluted 1 :3 in PBS and mixed with the kit reagents A and B and incubated at room temperature for 30 minutes.
  • the colored product of the redox reaction was read at 450 nm using a 96-well microplate reader. Quantification was performed via comparing samples to BUN standards, which were provided with the kit and treated equivalently.
  • nasal swab samples did not reveal any significant differences in biodistribution between the nasal mucus and plasma amongst the three mAb variants.
  • mice 9- to 14-week-old FcRn-/- hFcRn line 32 Tg mice (C57B6 background) were intravenously (i.v.)-injected (via the tail vein) with 5 ml/kg of a solution containing the antibody according to the present invention FluAB_MLNS or the comparative antibody FluAB_wt at doses ranging from 0.3 to 1 mg/kg. Twenty-four hours after the i.v. injection, mice were bled from the tail vein to determine the serum antibody levels before infection. Bleedings were also repeated on day 6 and 13 post infection (p.i).
  • mice Both antibody-injected and untreated mice were anaesthetized (isoflurane, 4% in O 2 , 0.3 L/min) and challenged intranasally (i.n.) by slow instillation in both nostrils of 50 pi (25 mI/each) of PBS containing 5 mouse lethal dose fifty percent (5 MLD 50 , equivalent to 1200 TCID 50 /mouse) of influenza virus A (H ⁇ N ⁇ , A/Puerto Rico/8/34, as described in Cottey, R., Rowe, C.A., and Bender, B.S. (2001 ). Influenza virus. Curr Protoc Immunol Chapter 1 9, Unitl 9.1 1-1 9.1 1 .32).
  • mice were held upright with its head tilted slightly back for about 1 minute to reduce the likelihood of inoculum dripping from the nares. After the procedure and upon righting reflex occurrence, animals were returned to the cage. The mice were monitored daily for weight loss and disease symptoms until day 14 p.i. and euthanized if they lost more than 20% of their initial body weight (whereby 0% is set on the day of infection) or reached morbidity score of 4. Table 1 details the applied morbidity score: Table 1 - Morbidity Score of PR8-infected mice
  • HA hemagglutinin
  • mice treated with either 1 mg/kg (panel D) or 0.3 mg/kg (panel E) of FluAB_MLNS showed lower body weight loss, in comparison with both untreated (panel A) and FluAB_wt-injected (panels B and C) mice.
  • FluAB_MLNS demonstrated, in Tg32 mice, a better protective capacity against H1 N1 PR8 intranasal virus challenge over the comparative antibody FluAB_wt.
  • the efficacy was independent of the circulating antibody levels.
  • Influenza medications currently approved by FDA include the neuraminidase inhibitors oseltamivir and zanamivir as well as the recently approved baloxavir marboxil, which belongs to the endonuclease inhibitors class.
  • MDCK Mesarby canine kidney cells were seeded at 30,000 cells/well into 96- well plates (flat bottom, black). Cells were cultured at 37°C 5% CO2 overnight. Twenty-four hours later, 4x antibody and antiviral (oseltamivir, zanamivir or baloxavir marboxil) dilutions in 60 pi infection medium (MEM (Sigma Aldrich, cat. n.
  • Virus solution was prepared at concentrations of 120x the TCID50 in 60 pi, further diluted either 1 :1 in MEM or mixed 1 :1 with FluABJvlLNS dilutions and incubated 1 h at 33°C. Cells were washed 2 times using 200 pl/well MEM without supplements, followed by the addition of either 100 pi of virus alone or 100 pi of FluABJvlLNS /virus mix (1 OOx TCID50/well) and incubated 4 hours at 33°C 5% C02.
  • MuNANA (-MUNANA (2_- (4-Methylumbelliferyl)-a-D-N-acetylneuraminic acid sodium salt hydrate (Sigma-Aldrich) #69587) solution was prepared in MuNANA buffer (MES 32.5 mM/CaCh 4mM, pH 6.5) and 50 m l/well was dispensed into black 96-well plates. Fifty ml of either neutralization or virus- alone titration supernatant were transferred to the plates and incubated 60 min at 37°C. The reaction was then stopped with 100 ml/well 0.2 M glycine/50% EtOH, pH 10.7. Fluorescence was quantified at 460 nm with a fluorimeter (Bio-Tek).
  • the neutralized fraction data were used to compute the quantitative analysis of dose-effect relationships for drug-drug combinations according to the Chou and Talalay method (Chou TC, Talalay P: Quantitative analysis of dose-effect relationships: the combined effects of multiple drugs or enzyme inhibitors. Adv. Enzyme Regul. 1984, 22:27-55).
  • the combination Index, the fraction affected (Fa), and isobolograms were obtained by using the CompuSyn software (ComboSyn Inc., Paramus, NJ, USA) (Chou T-C: Theoretical basis, experimental design, and computerized simulation of synergism and antagonism in drug combination studies. Pharmacological Reviews 2006, 58:621 -681 ).
  • Results are shown in Figures 8 - 26 and described below.
  • the CompuSyn software applies the logarithmic transformation of the median-effect equation to the experimental data and calculates both the potency (IC 50 ) and the so-called combination index (Cl) of the various drug combinations.
  • the Cl is a Chou-Talalay (median-effect) equation-derived parameter that considers the physico-chemical properties of the mass- action law and results from the sum of the two ratios between the portion of the dose of drug 1 combined with drug 2 to achieve a certain effect divided by dose of the single drug 1 and
  • the isobolograms denote a strong synergistic effect across the IC 50 , IC 75 , and IC 90 values (shown in Figures 20 and 21 ), which are all significantly below the IC values with the single drug.
  • baloxavir marboxil was initially compared with FluAB_ MLNS alone on both H1 and H3 strains, similarly as described above for oseltamivir and zanamivir. Results are shown in Figure 22.
  • the relative calculated IC 50 values were 20.1 -15.4 nM for FluAB_MLNS and 4.9-2.3 nM for baloxavir marboxil.

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