WO2021175339A1 - 人体共生菌群在提高肿瘤免疫治疗应答中的作用 - Google Patents

人体共生菌群在提高肿瘤免疫治疗应答中的作用 Download PDF

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WO2021175339A1
WO2021175339A1 PCT/CN2021/087593 CN2021087593W WO2021175339A1 WO 2021175339 A1 WO2021175339 A1 WO 2021175339A1 CN 2021087593 W CN2021087593 W CN 2021087593W WO 2021175339 A1 WO2021175339 A1 WO 2021175339A1
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intestinal flora
cancer
composition
human intestinal
sterile
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French (fr)
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尹意铭
谭验
刘玎
张聪
高婷
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深圳未知君生物科技有限公司
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00—Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/66—Microorganisms or materials therefrom
    • A61K35/74—Bacteria
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K39/00—Medicinal preparations containing antigens or antibodies
    • A61K39/395—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum
    • A61K39/39533—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals
    • A61K39/3955—Antibodies; Immunoglobulins; Immune serum, e.g. antilymphocytic serum against materials from animals against proteinaceous materials, e.g. enzymes, hormones, lymphokines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00—Drugs for immunological or allergic disorders
    • A61P37/02—Immunomodulators
    • A61P37/04—Immunostimulants
    • 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
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

  • the present disclosure relates to the field of biomedicine, and more specifically, it relates to the use of human gut microbiome to improve tumor immunotherapy response.
  • Colorectal cancer also known as colorectal cancer, rectal cancer, colorectal cancer, colorectal cancer, or bowel cancer, is cancer originating from the colon or rectum (which is a part of the large intestine). Because cells grow abnormally, they may invade or metastasize to other parts of the body. Colorectal cancer is one of the most common malignant tumors in the world.
  • the second human genome Human microbes are called "the second human genome".
  • the intestine is the largest microecological environment in the human body, and it participates in a variety of important physiological processes such as nutrient absorption, energy metabolism, tissue and organ development, immune defense, and endocrine regulation.
  • intestinal microecology has made great progress, and humans have continuously deepened its understanding.
  • Intestinal microecology is considered to be the "second brain” and "second genome” of the human body and is closely related to human health.
  • Fecal microbiota transplantation is defined as transplanting the functional flora in the feces of healthy people into the patient's gastrointestinal tract, rebuilding new intestinal flora, and realizing the treatment of intestinal and extra-intestinal diseases.
  • FMT Fecal microbiota transplantation
  • PD-1 programmed death 1, programmed death receptor 1
  • PD-1 is a type of immune checkpoint molecule expressed by T cells and a member of the CD28 superfamily.
  • PD-1 is an important type of immunosuppressive molecule, which functions as a "closed switch" to inhibit T cells from attacking other cells in the body.
  • PD-1 ligand PD-L1 programmed death ligand-1
  • Tumor cells use this mechanism to escape the immune attack of T cells. They express a large amount of PD-L1 to combine with PD-1 on the surface of T cells to inhibit their cell killing effect.
  • Inhibitors against PD-1 or PD-L1 immune checkpoints can block the combination of PD-1 and PD-L1 and inhibit its downstream signal transduction, thereby enhancing the immune killing effect of T cells on tumor cells.
  • PD-1 antibody drugs According to current clinical research and preclinical research, PD-1 antibody drugs have shown significant effects in the treatment of a variety of cancers, including a variety of gastrointestinal cancers, melanoma, non-small cell lung cancer, kidney cancer, etc.
  • immune signal pathway regulators represented by PD-1/PD-L1 inhibitors also have many problems in cancer treatment, among which the low response rate is the most prominent. Studies have shown that the response rate of patients with drug therapy targeting PD-1/PD-L1 is usually no more than 40%, while the response rate of patients treated with CTLA-4 monoclonal antibody drug-ipilimumab is only about 15%, and part of it The patient only responded locally.
  • this type of treatment also has the following problems: slow onset, with a median onset time of 12 weeks, which may delay the treatment time of patients; some patients have poor treatment effects; and cause side effects in patients, such as colitis, diarrhea, Immune-related adverse events (irAEs), such as dermatitis, hepatitis, and endocrine diseases, may lead to early termination of treatment; and are expensive, which makes it difficult for ordinary patients to bear.
  • slow onset with a median onset time of 12 weeks, which may delay the treatment time of patients; some patients have poor treatment effects; and cause side effects in patients, such as colitis, diarrhea, Immune-related adverse events (irAEs), such as dermatitis, hepatitis, and endocrine diseases, may lead to early termination of treatment; and are expensive, which makes it difficult for ordinary patients to bear.
  • irAEs Immune-related adverse events
  • the purpose of the present disclosure is to provide a bacterial solution of healthy human intestinal flora and its combination with an immune signal pathway regulator for treating tumor patients, so as to improve the tumor's response to immunotherapy.
  • the present disclosure provides a method for preparing a whole bacterial composition of healthy human intestinal flora, which is characterized in that the method includes the following steps:
  • the method is carried out under anaerobic conditions.
  • the above preparation method wherein the first centrifugation conditions are 50g-200g, centrifugation for 1-15 minutes; the second centrifugation conditions are 4000g-5500g, centrifugation for 1-15 minutes.
  • the above preparation method wherein the method includes the following steps:
  • the homogenized liquid is filtered step by step, preferably, the step by step filtration is 1 mm-2 mm, 400-600 ⁇ m, 20-80 ⁇ m;
  • the first centrifuge conditions are 50g-200g for 5-7 minutes, and the second centrifuge conditions are 4000g-5500g for 5-7 minutes to collect bacterial pellets.
  • the temperature for the first and second centrifugation is preferably 0-25°C, or 0-15°C, or 1-10°C, or 2-8°C, most preferably 4°C
  • the above preparation method wherein the method further comprises the following steps:
  • the quality control step of the stool source includes selecting healthy people aged 18-40, passing health screening and clinical examination, and the health screening and clinical examination include: blood examination without HIV, hepatitis B virus, Epstein-Barr virus, etc. Infection; the body has no digestive tract diseases and other diseases that affect the intestinal flora, such as metabolic syndrome, etc.; no rotavirus, norovirus, salmonella, Shigella, carbapenem resistant intestinal rods in stool examination Bacteria, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase-producing Enterococcus bacteria, Candida albicans, Cryptosporidium and Cyclospora infection; three meals regularity, The routine of work and rest; the quality control steps of the human intestinal flora whole bacterial composition include: in the bacterial liquid obtained by resuspending in sterile deoxygenated normal saline, the count of viable bacteria rate>5x10 10 /ml is
  • the present disclosure also provides a whole bacterial composition of human intestinal flora prepared by any of the above-mentioned preparation methods.
  • the present disclosure also provides a pharmaceutical composition
  • a pharmaceutical composition comprising a whole human intestinal flora composition prepared by any of the above-mentioned preparation methods, and a pharmaceutically acceptable carrier.
  • kits for treating cancer which includes the above-mentioned human intestinal flora whole bacterial composition or pharmaceutical composition, and PD-1 antibody.
  • the present disclosure also provides the use of the above-mentioned whole human intestinal flora composition in the preparation of drugs or kits for the treatment of cancer; preferably, the cancer is a tumor of the digestive tract; more preferably, the cancer is a tumor Rectal cancer.
  • the above-mentioned use is characterized in that the drug or kit further includes one or more immune signal pathway modulators; preferably, the immune signal pathway modulator includes inhibiting PD1/PDL1, PD1/PDL2, and CD28 /B7-1(CD80), CD28/B7-2(CD86), CTLA4/B7-1(CD80), CILA4/B7-2(CD86), 4-1BB(CD137)/4-1BBL(CD137L), ICOS /B7RP1, CD40/CD40L, Herpesvirus entry mediator (HVEM)/B-and T-lymphocyteattenuator (BTLA), OX40/OX40L, CD27/CD70, GITR/ GITRL, KIR/MHC, lymphocyte activation gene 3 (LAG3 or CD223)/MHC, mucin domain of TIM3/TIM3 ligand, T cell immune receptor with Ig and ITIM domain (TIGIT)/CD96, and One or more of TIGIT/CD226
  • the drug can improve the patient's therapeutic response to PD-1 inhibitors.
  • the method of the present disclosure to prepare the bacterial liquid of the intestinal flora of healthy people has the characteristics of simple operation method, high rate of viable bacteria, low toxic and side effects, and low risk of virus infection.
  • the present disclosure uses whole bacteria from the intestinal flora of healthy people for tumor treatment, which can improve tumor immunotherapy response, and can be used in combination with PD-1 inhibitors to have a synergistic effect, enhance tumor suppression effects, and prolong survival of tumor patients Expect.
  • Figure 1 The administration method of mouse colon cancer CT26 model
  • Intestinal microbiota (formerly known as intestinal flora or microbial community) means a group of microorganisms in the intestines of any organism (human, animal, insect, etc.) belonging to the animal kingdom. Although each individual has a unique microbiota composition (in a total of 400-500 different bacterial species/individuals, 60 to 80 bacterial species are shared by more than 50% of the sampled population), it always achieves similarity
  • the development of the gut microbiota begins at birth.
  • the sterile inside of the uterus and the digestive tract of the newborn baby are rapidly colonized by microorganisms from the mother (vagina, skin, breast, etc.), the environment in which the delivery occurs, the air, etc.
  • the composition of the gut microbiota directly depends on how the baby is fed: Compared to infants fed with infant formula, the gut microbiota of breast-fed infants is dominated by, for example, Bifidobacterium.
  • the composition of the gut microbiota has evolved throughout life, from birth to old age, and is the result of different environmental influences.
  • the balance of the gut microbiota can be affected during the aging process, therefore, the elderly have a microbiota significantly different from that of young adults.
  • the general composition of the dominant gut microbiota is similar in most healthy people (the 4 main phyla, namely Firmicutes, Bacteroides, Actinobacteria, and Proteobacteria), the species level
  • the composition is highly personalized and is mainly determined by the individual's genetics, environment, and diet.
  • the composition of the gut microbiota can become accustomed to dietary components (temporarily or permanently).
  • the Japanese can digest seaweed (a part of their daily diet) because of the special enzymes their microbiota has obtained from marine bacteria.
  • an imbalance in the composition of the gut microbiota can occur under certain circumstances. This is called “ecological dysbiosis", an imbalance between potentially “harmful” bacteria in the intestines and known “good” bacteria or considered “healthy” microorganisms in terms of the composition and diversity of the main flora Any deviation of the microbiota of the population.
  • Ecological disorders can be associated with health problems such as functional bowel disease, inflammatory bowel disease, allergies, obesity, and diabetes. It can also be the result of treatment (such as cytotoxic treatment or antibiotic treatment).
  • gut microbial dysbiosis involves the enrichment of bacterial species from the genus Bacteroides and the reduction of species belonging to Faecalibacterium and Roseburia (Sobhani et al., 2011; Wu et al. People, 2013). Specifically, it was found that Fusobacterium and Campylobacter were consistently increased in both feces and mucous membranes of CRC patients.
  • the "beneficial” or “favorable” bacteria are basically Lactobacillus and Bifidobacterium, while the “harmful” or “unfavorable” bacteria are basically the following species: And the following genera: Jimmyria, Alitipes.
  • microbiota and “flora” refer to microorganisms (including eukaryotes, archaea, Communities of bacteria, and viruses, including bacterial viruses (ie, bacteriophages).
  • colony forming units refers to an estimate of the number of viable microbial cells in a given sample.
  • isolated or purified refers to bacteria or other entities or substances that have (1) with which they were originally produced (whether natural or In a laboratory environment) at least some of the combined components are separated, and/or (2) produced, prepared, purified, and/or manufactured by human hands.
  • the isolated or purified bacteria can be at least about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, and other components with which it was originally combined. About 90% or more separated.
  • Immune cell information transmission pathways can be regulated by one or more of the following exemplary receptor/ligand pairs on the cell: PD1/PDL1, PD1/PDL2, CD28/B7-1 (CD80), CD28/B7-2 (CD86) , CTLA4/B7-1 (CD80), CILA4/B7-2 (CD86), 4-1BB (CD137)/4-1BBL (CD137L), ICOS/B7RP1, CD40/CD40L, Herpesvirus entry mediator ,HVEM)/B-and T-lymphocyteattenuator (BTLA); OX40/OX40L, CD27/CD70, GITR/GITRL, KIR/MHC, lymphocyte activation gene 3 (LAG3 or CD223) /MHC, Hepatitis A virus cellular receptor 2 (Hepatitis A virus cellular receptor 2, HAVCR2; also known as T cell immunoglobulin and mucin domain containing -3 (TIM3))/TIM3 ligand, with Ig T cell immune
  • Immune cell information pathways can also be regulated by one or more of the following exemplary cytokines/chemactivins and their homologous cell surface receptors: interleukin 2 (IL-2)/CD122, adenosine/adenosine A2A receptor (adenosine A2A receptor, A2AR), interleukin 6 (IL-6)/IL6R (CD126), interleukin 10 (IL-10)/IL-10R, interleukin 15 (IL-15)/IL-15R, transforming growth factor ⁇ (TGF ⁇ ) /TGF ⁇ R, and macrophage community stimulating factor 1 (CSF-1)/CSF-1R.
  • IL-2 interleukin 2
  • A2A receptor adenosine A2A receptor
  • A2AR adenosine A2A receptor
  • IL-6 interleukin 6
  • CD126 interleukin 10
  • IL-15 interleukin 15
  • TGF ⁇ transforming growth factor ⁇
  • CSF-1R macrophage
  • immune molecules include, but are not limited to, KIR2DL, VISTA, HLLA2, TLIA, DNAM-1, CEACAM1, CD155, and indoleamine 2,3-dioxygenase (IDO), such as IDO1. Any of the above-mentioned immune molecules can be the target of anti-cancer therapy as described in this disclosure.
  • an "immune signaling pathway modulator” refers to an agent that changes the activity of an immune molecule (for example, any one as described in the present disclosure) relative to a control carrier.
  • modulator is used in the broadest sense in this disclosure and includes any molecule that partially or completely changes the information pathway regulated by one or more immune molecules, including information regulated by the molecule as described in this disclosure Conduction pathway.
  • the immune signal pathway modulator is an inhibitor of an immune checkpoint molecule, which can reduce, slow down, stop, and/or prevent the activity regulated by the checkpoint molecule.
  • the term "inhibitor” is used in the broadest sense in this disclosure, and includes any molecule that partially or completely blocks, inhibits, or neutralizes the information pathway regulated by one or more immune checkpoint molecules, including The regulatory pathways of molecular regulation described in the present disclosure. Suitable inhibitory molecules specifically include natural polypeptides, peptides, antisense oligonucleotides, small organic molecules, recombinant proteins or peptides, such as antagonist antibodies or antibody fragments, fragments, or amino acid sequence variants.
  • the immune signal pathway modulator is an activator of an immune molecule, which enhances and improves the activity regulated by the immune molecule.
  • activator is used in the broadest sense in this disclosure and includes any molecule that enhances an information pathway regulated by one or more immune molecules, including an information transmission pathway regulated by a molecule as described in this disclosure. Suitable activators include agonistic antibodies or antibody fragments, small organic molecules, recombinant proteins or peptides and the like. In some cases, the activator may be an agonist antibody of an immune molecule, such as MEDI0562 (humanized OX40 agonist antibody), MEDI6469 (mouse OX4 agonist); and MEDI6383 (OX40 agonist).
  • the candidate modulator can be brought into contact with a suitable immune molecule target, and the intensity of the information transmission regulated by the immune molecule can be measured by a conventional assay.
  • the detectable change in information transmission relative to the blank control indicates that the candidate modulator has the regulatory activity of immune molecules.
  • the bacterial liquid of healthy human intestinal flora described in the present disclosure can be put into pharmaceutical compositions, unit dosages or dosage forms.
  • the pharmaceutical composition can be in a solid dosage form (such as powder, granules, pellets, coated or uncoated tablets or filled capsules) or liquid dosage forms (such as solutions, suspensions, emulsions, or filled capsules). Capsules) or semi-solid dosage forms (such as gels, creams and ointments).
  • the dissolution and release characteristics of one or more active ingredients of the pharmaceutical dosage form can vary from a few seconds to several months.
  • the "drug” or “pharmaceutical composition” is designed for use in animals and humans and can be administered via all routes of administration. Preferred routes of administration are oral route, pulmonary route, nasal route, rectal route, parenteral route.
  • the pharmaceutical composition and its unit dosage form may contain conventional or new ingredients in conventional or special ratios, with or without additional active compounds or ingredients, and such unit dosage forms may contain the intended daily dosage range commensurate with the intended use Any suitable and effective amount of active ingredient.
  • carrier applied to the pharmaceutical composition of the present disclosure relates to a diluent, adjuvant or excipient to be administered with the active compound.
  • the medicament or pharmaceutical composition of the present disclosure can be formulated orally, topically, parenterally, or mucosally (e.g., orally, by inhalation, or rectal) in a dosage unit containing a conventional non-toxic pharmaceutically acceptable carrier Apply. It is usually desirable to use the oral route.
  • the active agent can be administered orally in the form of capsules, tablets, etc. (see Remington: The Science and Practice of Pharmacy, 20th Edition).
  • the active drug component can be combined with non-toxic, pharmaceutically acceptable excipients such as binders (for example, pregelatinized corn starch, polyvinylpyrrolidone or hydroxypropyl methyl Base cellulose); fillers (e.g., lactose, sucrose, glucose, mannitol, sorbitol and other reducing and non-reducing sugars, microcrystalline cellulose, calcium sulfate or dibasic calcium phosphate); lubricants (e.g.
  • disintegrants for example, potato starch or hydroxy Sodium starch acetate
  • wetting agents for example, sodium lauryl sulfate
  • coloring and flavoring agents for example, gelatin, sweeteners, natural and synthetic gums (such as gum arabic, tragacanth or alginate), Buffer salt, carboxymethyl cellulose, polyethylene glycol, wax, etc.
  • the pharmaceutical component can be combined with non-toxic, pharmaceutically acceptable inert carriers (e.g., ethanol, glycerol, water), anti-settling agents (e.g., sorbitol syrup, cellulose-derived Or hydrogenated edible fats), emulsifiers (for example, lecithin or gum arabic), non-aqueous carriers (for example, almond oil, oil esters, ethanol or fractionated vegetable oil), preservatives (for example, p- Methyl hydroxybenzoate or propyl p-hydroxybenzoate or sorbic acid) and other combinations.
  • Stabilizers such as antioxidants (BHA, BHT, propyl citrate, sodium ascorbate, citric acid) can also be added to stabilize the dosage form.
  • the tablets containing the active compound may be coated by methods well known in the art.
  • the composition of the present disclosure containing the compound of formula I as the active compound may also be incorporated into beads, microspheres or microcapsules, for example, constructed of polyglycolic acid/lactic acid (PGLA).
  • PGLA polyglycolic acid/lactic acid
  • Liquid preparations for oral administration can take the form of, for example, solutions, syrups, emulsions or suspensions or they can be presented as dry products that are reconstituted with water or other suitable excipients before use.
  • Preparations for oral administration can be suitably formulated so that the active compound is released in a controlled or delayed manner.
  • the medicament or pharmaceutical composition of the present disclosure can be delivered parenterally, that is, via intravenous (iv), intracerebroventricular (icv), subcutaneous (sc), intraperitoneal (ip), intramuscular (im), subcutaneous (sd) Or intradermal (id) administration, by direct injection, via, for example, bolus injection or continuous infusion.
  • Formulations for injection can be presented in unit dosage form, for example in ampoules or multi-dose containers with added preservatives.
  • the composition may take the form of an excipient, a suspension, solution or emulsion in an oil or aqueous carrier, and may contain formulation agents such as anti-settling agents, stabilizers and/or dispersants.
  • the active ingredient may be reconstituted in powder form with a suitable carrier (for example, sterile pyrogen-free water) before use.
  • the medicament or pharmaceutical composition of the present disclosure can also be formulated for rectal administration, for example as a suppository or retention enema (for example, containing a conventional suppository base such as cocoa butter or other glycerides).
  • a suppository or retention enema for example, containing a conventional suppository base such as cocoa butter or other glycerides.
  • the present disclosure provides a combined cancer therapy using the immune signal pathway modulator as described in the present disclosure and the bacterial fluid of healthy human intestinal flora.
  • the term "combination therapy" as used in the present disclosure includes the administration of these agents in a sequential manner (for example, an immune signaling pathway modulator and a bacterial solution of healthy human intestinal flora), that is, where each therapeutic agent is administered at different times, and administration These therapeutic agents, or at least two agents, are performed substantially simultaneously.
  • the order, or substantially simultaneous administration of each agent may be affected by any appropriate route, including, but not limited to, oral route, intravenous route, intramuscular route, subcutaneous route, and direct absorption through mucosal tissue.
  • the agents can be administered by the same route or different routes.
  • the first agent may be administered orally (for example, a bacterial solution of the intestinal flora of a healthy person), and the second agent may be administered intravenously (for example, an anti-checkpoint antibody such as an anti-PD1 antibody).
  • the selected combination agent may be administered by intravenous injection, while the other agents of the combination may be administered orally.
  • two or more agents may be administered by intravenous or subcutaneous injection.
  • Combination therapy may also include the agents described in the present disclosure (e.g., immune signaling pathway modulators and fermented compositions) further with other biologically active ingredients (e.g., different anti-tumor agents) and non-drug treatments (e.g., surgery or Radiation therapy) combined administration.
  • the combination therapy further includes radiotherapy
  • the radiotherapy can be performed at any suitable time, as long as a beneficial effect is obtained from the combination of the therapeutic agent and the combined action of the radiotherapy. For example, under appropriate circumstances, when radiotherapy is temporarily removed from the administration of the therapeutic agent, it may reach several days or even weeks, and the beneficial effect can still be achieved.
  • any combination of the immune signal pathway modulator and the bacterial liquid as described in the present disclosure can be used in any order for the treatment of cancer.
  • the combination described in the present disclosure can be selected based on many factors, including, but not limited to, the effectiveness of inhibiting or preventing cancer progression, the effectiveness of reducing the side effects of another drug of the combination, or the effectiveness of alleviating cancer-related symptoms sex.
  • a combination therapy as described in this disclosure can reduce any side effects associated with each individual member of the combination.
  • Some examples are provided in the following table.
  • the bacterial liquid of the healthy human intestinal flora can be used every day in the course of treatment involving immune signal pathway modulators (for example, anti-PD1 antibodies).
  • the combination of the immune signal pathway modulator described in the present disclosure and the bacterial liquid described in the present disclosure is provided in the form of a kit.
  • the kit includes an immune signal pathway regulator, and the bacterial liquid described in the present disclosure.
  • the kit of the present disclosure may also include other necessary reagents. It should be understood that the various components in the kits of the present disclosure can be used in any order for the treatment of cancer.
  • cancer any combination of the immune signal pathway modulator as described in the present disclosure and the bacterial fluid of healthy human intestinal flora can be used to treat cancer.
  • cancer refers to a medical condition regulated by tumors or malignant cell populations, proliferation or metastasis, including solid cancers and non-solid cancers.
  • cancer examples include, but are not limited to, lung cancer, kidney cancer, stomach cancer, breast cancer, brain cancer, prostate cancer, hepatocellular cancer, pancreatic cancer, cervical cancer, ovarian cancer, liver cancer, bladder cancer, urethral cancer, thyroid cancer, Melanoma, head and neck cancer, colon cancer, leukemia, lymphoma, skin cancer, stomach cancer, esophageal cancer, myeloma, rectal cancer, bone cancer, uterine cancer, prostate cancer, and hematological malignancies.
  • the terms “individual,” “individual,” and “patient” are used interchangeably in this disclosure and refer to a mammal that is evaluated for treatment and/or being treated.
  • the individual may be a human, but also includes other mammals, especially those mammals that can be used as laboratory models for human diseases, such as mice, rats, rabbits, dogs, and the like.
  • an effective amount refers to the amount of each active agent (for example, immune signal pathway modulator, for example, anti-PD1 antibody or bacterial fluid of healthy human intestinal flora) required to impart a therapeutic effect to an individual , Whether alone or in combination with one or more other active agents.
  • the therapeutic effect is to inhibit the growth of cancer cells and/or reduce tumor burden.
  • the amount of the bacterial liquid of the intestinal flora of healthy people is effective to enhance the anti-cancer effect of the immune signal pathway modulator.
  • the amount of the bacterial liquid of the intestinal flora of a healthy person is effective in enhancing the individual's immunity to cancer cells.
  • the therapeutic effect is prevention or inhibition of tumor growth.
  • the therapeutic effect is the reduction of side effects associated with one or more drugs/drugs.
  • it may be caused by inhibiting the PD-1 pathway (e.g., fatigue, peripheral edema, chills, fever, diarrhea, nausea, abdominal pain, cough, dyspnea, rash, itching, vitiligo, arthralgia, myalgia, back pain, headache , Dizziness, and/or increased side effects of aspartate aminotransferase (AST) can be achieved by combining with another agent (for example, immune signaling pathway modulators and healthy human intestinal flora as described in the present disclosure). ⁇ ) to alleviate the joint treatment.
  • a PD-1 pathway e.g., fatigue, peripheral edema, chills, fever, diarrhea, nausea, abdominal pain, cough, dyspnea, rash, itching, vitiligo, arthralgia, myalgia, back pain, headache , Dizziness,
  • treatment refers to the application or administration of a composition comprising one or more active agents to an individual suffering from the target disease or disorder, symptoms of the disease/disorder, or the disease/ The tendency of the disease, and its purpose is to cure, treat, alleviate, alleviate, change, remedy, improve, enhance, or affect the disease, disease symptoms, or tendency to the disease or disease.
  • Alleviating the target disease/condition includes delaying the development or progression of the disease, or reducing the severity of the disease. Relief of the disease does not necessarily require treatment results.
  • "delaying" the development of the target disease or condition means delaying, preventing, slowing, hindering, stabilizing, and/or delaying the progression of the disease. Such delays can be of different lengths of time, depending on the history of the disease and/or the individual being treated.
  • a method of "delaying" or alleviating the development of a disease, or delaying the onset of a disease, in order to reduce the possibility of developing one or more disease symptoms within a given time frame, and/or reducing the degree of symptoms within a given time frame Method compare with those who have not used the method. This comparison is usually based on clinical studies, using multiple individuals sufficient to give statistically significant results.
  • development or “progress” of a disease means the initial manifestation and/or subsequent progression of the disease. Standard clinical techniques well known in the art can be used to detect and assess the development of the disease. However, development also refers to progress that may not be detected. For the purposes of the present invention, development or progression refers to the biological process of the symptom.
  • Development includes occurrence, recurrence and disease. As used in the present disclosure, the "onset” or “occurrence” of the target disease or condition includes initial onset and/or recurrence.
  • the combination of the immune signal pathway modulator described in the present disclosure and the bacterial fluid of healthy human intestinal flora is sufficient to inhibit the activity of one or more target information transmission pathways in vivo by at least 20% (for example, an amount of 30%, 40%, 50%, 60%, 70%, 80%, 90% or more) is administered to the individual in need of treatment.
  • the combination reduces the activity of one or more target antigens by at least 20% (for example, 30%, 40%, 50%, 60%, 70%, 80%, 90% or more). An effective amount is applied.
  • the bacterial fluid of the healthy human intestinal flora as described in the present disclosure is administered to an individual (e.g., , Human cancer patients), as described in this disclosure.
  • compositions can also be administered by other conventional routes, for example, oral, parenteral, by inhalation spray, topical, rectal, nasal, oral, vagina, or via implanted reservoirs.
  • parenteral as used in the present disclosure includes subcutaneous, intradermal, intravenous, intramuscular, intraarticular, intraarterial, intrasynovial, intrasternal, intrathecal, intracerebral, and intracranial injection or infusion techniques.
  • injectable depot route for example, using a 1, 3, or 6-month storage tank for injection or biodegradable materials and methods.
  • the pharmaceutical composition is administered intraocularly or intravitreously.
  • the active ingredient of formula I of the present disclosure or with one or more pharmaceutically-acceptable excipients, carriers Or diluents, especially and preferably in the form of their pharmaceutical compositions are administered to a subject in need thereof in an effective amount, such as living animals (including humans), for the treatment, reduction or improvement, alleviation or elimination of the Sensitive indications or conditions or indications or conditions described elsewhere in this application.
  • An object of the present disclosure is to provide a method for preparing a whole bacterial composition of healthy human intestinal flora, characterized in that the method comprises the following steps:
  • the filtrate was centrifuged twice and resuspended, and the resulting suspension was the whole bacterial composition of the human intestinal flora;
  • the method is carried out under anaerobic conditions.
  • the first centrifugation conditions are 0-25°C, 50g-200g, centrifugation 1-15 minutes; the second centrifugation conditions are 0-25°C, 4000g-5500g, centrifugation 1-15 minute;
  • the temperature of the first and second centrifugation is preferably 0-15°C, or 1-10°C, or 2-9°C, or 3-8°C, or 4-7°C, or 5-6°C, most preferably Is 4°C;
  • the rotation speed of the first centrifugation is preferably 100-200g, or 150-200g, most preferably 200g;
  • the rotation speed of the second centrifugation is preferably 4500-5000g, most preferably 4500g;
  • the centrifugation time for the first and second centrifugation is preferably 3-10 minutes, more preferably 5-7 minutes, and most preferably 7 minutes.
  • the particle size of the stepwise filtration is selected to be 1 mm-2 mm, 400-600 ⁇ m, and 20-80 ⁇ m.
  • the preparation method further includes the following steps:
  • the homogenized liquid is filtered step by step, preferably, the step by step filtration is 1 mm-2 mm, 400-600 ⁇ m, 20-80 ⁇ m;
  • the first centrifugation conditions are 1-10°C, 50g-200g, centrifugation for 5-7 minutes, and the second centrifugation conditions are 1-10°C, 4000g-5500g, centrifugation 5- 7 minutes, collect the bacterial pellet;
  • the method further includes the following steps:
  • the quality control step of the stool source includes: selecting healthy people aged 18-40 and passing health screening and clinical examination.
  • the health screening and clinical examination include: blood tests without HIV, hepatitis B virus, Epstein-Barr virus and other infections; the body has no digestive tract diseases and other diseases that affect the intestinal flora, such as metabolic synthesis Symptoms; stool examination without rotavirus, norovirus, Salmonella, Shigella, carbapenem-resistant enterobacteria, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, production Extended-spectrum beta-lactamase enterobacteria, Candida albicans, Cryptosporidium and Cyclosporidium infection; regular meals, regular schedules and rest.
  • diseases and other diseases that affect the intestinal flora such as metabolic synthesis Symptoms
  • stool examination without rotavirus, norovirus Salmonella, Shigella, carbapenem-resistant enterobacteria, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, production Extended-spectrum beta-lactamase enterobacter
  • the quality control step of the human intestinal flora whole bacterial composition includes: in the bacterial liquid obtained by resuspension in sterile deoxygenated physiological saline, the count of viable bacteria rate> 5x10 10 cells/ml is regarded as qualified.
  • An objective of the present disclosure is also to provide a whole bacterial composition of human intestinal flora prepared by any of the above-mentioned preparation methods.
  • An objective of the present disclosure is also to provide a pharmaceutical composition
  • a pharmaceutical composition comprising a whole human intestinal flora composition prepared by any of the above-mentioned preparation methods, and a pharmaceutically acceptable carrier.
  • An object of the present disclosure is also to provide a kit for treating cancer, which includes the above-mentioned whole human intestinal flora composition or pharmaceutical composition, and PD-1 antibody.
  • An object of the present disclosure is also to provide the use of the above-mentioned human intestinal flora whole bacterial composition in the preparation of medicines or kits for the treatment of cancer.
  • the cancer is a tumor of the digestive tract.
  • the cancer is colorectal cancer.
  • the above-mentioned use in the preparation of a drug or kit for treating cancer is characterized in that the drug or kit further includes one or more immune signal pathway modulators.
  • the immune signaling pathway modulator includes optional immune signaling pathway modulators known in the art, including but not limited to PD1/PDL1, PD1/PDL2, CD28/B7-1 (CD80 ), CD28/B7-2(CD86), CTLA4/B7-1(CD80), CILA4/B7-2(CD86), 4-1BB(CD137)/4-1BBL(CD137L), ICOS/B7RP1, CD40/CD40L ⁇ Herpesvirus entry mediator (HVEM)/B-and T-lymphocyteattenuator (BTLA), OX40/OX40L, CD27/CD70, GITR/GITRL, KIR/MHC, Lymphocyte activation gene 3 (LAG3 or CD223)/MHC, mucin domain of TIM3/TIM3 ligand, T cell immune receptor with Ig and ITIM domain (TIGIT)/CD96, and one of TIGIT/CD226
  • One or more reagents preferably, the immune signal pathway modulators known in the
  • the above-mentioned use in the preparation of a medicine or a kit for treating cancer which can improve a patient's therapeutic response to a PD-1 inhibitor.
  • the above-mentioned use in the preparation of a medicine or a kit for treating cancer which can improve the response of PD-1 inhibitors.
  • Example 1 Preparation of a whole bacterial composition of healthy human intestinal fecal flora
  • the weighed sample mass pour 5 times the volume of sterile deoxygenated normal saline. For example, if the stool mass is 100g, pour 500mL; stir the sample to ensure that the stool does not excessively stick to the sampling box; pour the entire sample into a sealed bag to homogenize the sample stool; then perform step-by-step filtration,
  • the particle size of the step-by-step filtration is selected as 1mm-2mm, 400-600 ⁇ m and 20-80 ⁇ m; then use an electric pipette and pipette to transfer the last filtrate to a 50mL centrifuge tube, and fill each tube with 50mL; proceed Two-step centrifugation, the first step: 4°C, 200g centrifugation for 7 minutes; the second step: 4°C, 4500g centrifugation for 7 minutes, discard the supernatant, and collect the bacterial pellet; the bacterial cells are resuspended in 50mL sterile deoxygenated physiological saline. At this time, the suspension is
  • a flow cytometer to detect the staining dilution, adjust the FITC channel gain to 150, the PC5.5 channel gain to 200, the main threshold to FSC, manual, 400, and the second threshold to SSC, manual, 4500, all other parameters are set to default, and the acquisition volume is fixed.
  • Set up the flow cytometer acquisition chart take the log of FITC-A as the abscissa, and the log of PC5.5-A as the ordinate to quantitatively collect data.
  • the quality inspection standard is that the rate of viable bacteria>5x10 10 /ml, if it reaches this standard, it is deemed qualified.
  • the viable bacteria rate of the product prepared this time is 1.21x 10 11 /mL. Qualified.
  • Example 2 Whole bacteria of healthy human intestinal flora combined with PD-1 immunosuppressant for the treatment of gastrointestinal tumors
  • Day-8 to Day-4 The formula includes Ampicillin 1mg/ml, Neomycin 1mg/ml, Metronidazole 1mg/ml and Vancomycin 0.5mg/ml .
  • the antibiotics were added proportionally to sterile water for the mice to drink.
  • the antibiotic treatment time was 4 days, and the water bottles containing antibiotics were replaced every three days.
  • Day-3 to Day 7 The formula includes Ampicillin 1mg/ml, Neomycin 10mg/ml, Metronidazole 10mg/ml, Vancomycin 5mg/ml and both sexes Amphotericin B (Amphotericin B) 0.1 mg/ml. Ampicillin was added to sterile water for the mice to drink, and the other antibiotics were mixed and gavage the mice twice a day, each time 200 ⁇ l.
  • the antibiotic treatment was interrupted and the mice were transferred to a new cage to prevent the mice from eating feces containing antibiotics.
  • mice On Day 8 before the first microbial treatment, the mice were again transferred to a new cage to prevent the mice from eating feces that still contain antibiotics.
  • CT26 cells (SIBS: Shanghai Institutes for Biological Sciences, CAT#: TCM37) were cultured in RPMI-1640 medium containing 10% fetal bovine serum. CT26 cells in the exponential growth phase were collected and resuspended in PBS to a suitable concentration for subcutaneous tumor inoculation in mice.
  • mice belonging to the same group in different cages were randomly exchanged.
  • mice were divided into 4 groups: control group (sterile saline + isotype control), FMT single treatment group (FMT + isotype control), PD-1 single treatment group (sterile saline + PD-1) and FMT combined treatment Group (FMT+PD-1), 10 mice in each group.
  • control group sterile saline + isotype control
  • FMT single treatment group FMT + isotype control
  • PD-1 single treatment group sterile saline + PD-1
  • FMT+PD-1 FMT combined treatment Group
  • mice After the adaptive feeding, the mice were treated with antibiotics by gavage, and the treatment time was 16 days (from Day-8 to Day7), and the mice were gavage once a day.
  • the cultured CT26 cells were injected into mice on Day0 for modeling. 256 female mice were subcutaneously inoculated with 5 ⁇ 10 5 CT26 cells on the right side. The day of vaccination was defined as Day 0 (Day 0).
  • the FMT bacterial solution prepared in Example 1 was resuspended to 2.5 ⁇ 10 10 cells/ml with sterile physiological saline.
  • mice in the FMT single treatment group and the FMT combined treatment group were treated by gavage. Each mouse was gavaged once a day.
  • the gavage volume was 200 ⁇ l, that is, the dose was 5x10 9 One/only/time; the control group and the PD-1 single treatment group were infused with equal volume of normal saline.
  • Antibody injections were carried out on Day9, Day12, Day15 and Day18, and the dosage was 200ug/head/time.
  • the PD-1 single treatment group and the combination treatment group were injected with PD-1 antibody, while the control group and the single treatment group were injected with the same type control.
  • mice On Day 24, the mice were sacrificed, tumors were collected, weighed and the tumor area was measured, the tumor tissues were ground, and the spleens were collected for flow cytometry analysis.
  • Tumor volume (mm 3 ) 1/2 ⁇ (a ⁇ b 2 ) (where a represents the long diameter and b represents the short diameter).
  • the monitoring time points are: 5th, 8, 11, 14, 17, 21 and 24 days; monitoring of mouse body weight after tumor inoculation.
  • Relative tumor proliferation rate is the percentage value of the treatment group and the control group relative to the tumor volume or tumor weight at a certain point in time. Calculated as follows:
  • T/C% T TW /C TW ⁇ 100% (T TW : average tumor weight at the end of the experiment in the treatment group; C TW : average tumor weight at the end of the experiment in the vehicle control group).
  • TGI tumor inhibition rate
  • TGI% (1-T/C) ⁇ 100%
  • T and C are the relative tumor volume (RTV) or tumor weight (TW) at a specific time point in the treatment group and the control group, respectively).
  • mice in all groups of CT26 model are on the 13th day after the administration (the 21st day after cell inoculation, namely Day 21). From the growth status of the mice in each group (Table 1), it can be seen that:
  • the average tumor volume of sterile normal saline + isotype control mice was 1916.88mm 3 ;
  • the average tumor volume of the FMT+ isotype control group was 1,790.40 mm 3 , which was statistically insignificant compared with the control group, with a p value of 0.679 and a relative tumor inhibition rate TGI (%) of 6%;
  • the average tumor volume of the sterile saline + aPD-1 group was 1402.64 mm 3 , which was statistically insignificant compared with the control group, with a p value of 0.159 and a relative tumor inhibition rate TGI (%) of 26%;
  • the average tumor volume of the FMT+aPD-1 group was 1206.56 mm 3 , which was statistically significantly different from the control group, with a p value of 0.003 and a relative tumor inhibition rate TGI (%) of 37% (Table 1).
  • mice in all groups of CT26 model were subjected to survival analysis on the 15th day after administration (Day 24 after cell inoculation) (Table 2), Kaplan-Meier method was used to analyze the survival curve of each treatment group ( Figure 2), FMT
  • the +aPD-1 treatment group can significantly promote the survival of mice, which is statistically significantly different compared with the control group (p value is 0.002).
  • the FMT+aPD-1 and treatment groups can further promote the survival of mice compared with the sterile saline+aPD-1 treatment group (p value is 0.039).

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Abstract

一种健康人肠道菌群全菌组合物及其制备方法和质量控制步骤。包含健康人肠道菌群全菌组合物以及PD-1抗体的试剂盒。健康人肠道菌群全菌组合物在制备用于治疗癌症的药物或试剂盒中的用途，所述药物或试剂盒中还包括一种或多种免疫信号通路调节剂。能够提高患者对PD-1抑制剂的治疗应答和/或延长肿瘤病人的生存期。

Description

人体共生菌群在提高肿瘤免疫治疗应答中的作用 技术领域
本公开涉及生物医药领域，更具体地，它涉及使用人体肠道微生物组来提高肿瘤免疫治疗应答。
背景技术
近年来，全球癌症患者激增，最新数据表明：2017年，全球新发癌症病例2450万，癌症死亡病例960万。结直肠癌(colorectal cancer,CRC)，又称为大肠癌、直肠癌、大肠直肠癌、结肠直肠癌、或肠癌，为源自结肠或直肠(为大肠的一部分)的癌症。因为细胞不正常的生长，可能侵犯或转移至身体其他部分，结直肠癌是全球最常见的恶性肿瘤之一。
人体微生物被称为“人类的第二基因组”。肠道是人体内最大的微生态环境，参与人体的营养吸收、能量代谢、组织器官发育、免疫防御及内分泌调控等多种重要的生理过程。近十几年来肠道微生态学取得了飞跃式的发展，人类对其认识不断加深，肠道微生态被认为是人体的“第二大脑”和“第二基因组”，与人类健康息息相关。
粪菌移植(fecal microbiota transplantation,FMT)，其定义是将健康人粪便中的功能菌群，移植到患者胃肠道内，重建新的肠道菌群，实现肠道及肠道外疾病的治疗。2013年，菌群移植治疗复发性艰难梭菌感染被列入美国医学指南，并入选2013年美国时代杂志“世界十大医学突破”和美国克利夫兰医学中心“影响2014年的十大医学创新”榜单。
PD-1(programmed death 1,程序性死亡受体1)是由T细胞表达的一类免疫检查点(immune checkpoint)分子，为CD28超家族成员。PD-1是一类重要的免疫抑制分子，其作为“关闭的开关”发挥功能，抑制T细胞攻击体内的其它细胞。当T细胞表面的PD-1与体内正常细胞上表达的PD-1配体PD-L1(programmed death ligand-1,程序性死亡配体1)时，T细胞的细胞杀伤效果受到抑制。肿瘤细胞利用这一机制逃避T细胞的免疫攻击，其表达大量PD-L1，以与T细胞表面的PD-1联合，抑制其细胞杀伤效果。针对PD-1或PD-L1免疫检查点的抑制剂，例如单克隆抗体药物能够阻断PD-1与PD-L1联合，抑制其下游信号传导，从而增强T细胞对肿瘤细胞的免疫杀伤作用。根据目前的临床研究和临床前研究，PD-1抗体药物在多种癌症的治疗中表现出显著的效果，包括多种消化道癌症、黑色素瘤、非小细胞肺癌、肾癌等。
然而，以PD-1/PD-L1抑制剂为代表的免疫信号通路调节剂在癌症治疗方面也存在诸多问题，其中以响应率低最为突出。研究表明，靶向PD-1/PD-L1的药物治疗的患者响应率通常不超过40％，而采用CTLA-4单抗药物-ipilimumab治疗的患者其响应率仅约为15％，并且其中一部分患者仅为局部应答。此外，此类治疗还存在以下问题：起效慢，其中位起效时间为12周，可能会耽误患者的救治时间；部分患者治疗效果较差；在患者体内引起副作用，诸如结肠炎、腹泻、皮炎、肝炎、内分泌疾病等免疫相关不良反应(immune-related adverse events,irAEs)，可能导致治疗提前终止；以及价格昂贵，令普通患者难以承担。
发明内容
本公开的目的在于提供一种健康人肠道菌群的菌液，及其与免疫信号通路调节剂联合，用于治疗肿瘤患者，以提高肿瘤对免疫治疗的应答。
具体来讲，本公开提供了一种健康人肠道菌群全菌组合物的制备方法，其特征在于，所述方法包括以下步骤：
将健康人粪便按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌；
对样本进行均质化；
对均质化的液体进行逐级过滤；
将滤液离心后重悬，所得悬液即人肠道菌群全菌组合物；
所述方法在厌氧条件下进行。
优选地，上述制备方法，其中，所述第一次离心条件为50g-200g，离心1-15分钟；第二次离心条件为4000g-5500g，离心1-15分钟。
优选地，上述制备方法，其中，所述方法包括以下步骤：
使用无菌粪便采集盒收集新鲜粪便样本，取样后盖上盖子，送至实验室进行称量，并记录质量；
将采样盒放入在厌氧操作台的传递窗内，打开盒盖确保气体交换，盖上传递窗盖，启动去氧程序；5分钟后，将采样盒转移至操作台内部；
按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌，确保粪便不过分粘在采样盒上；
对样本粪便进行均质化；
对进行均质化的液体进行逐级过滤，优选地，所述逐级过滤为1mm-2mm、400-600μm、20-80μm；
将滤液转移至离心管内，离心2次，第一次离心条件为，50g-200g，离心5-7分钟，第二次离心条件为，4000g-5500g，离心5-7分钟，收集菌体沉淀。
用50mL无菌去氧生理盐水重悬，所得悬液即人肠道菌群全菌组合物。
优选地，上述制备方法，所述第一次、第二次离心温度优选为0-25℃，或0-15℃，或1-10℃，或2-8℃，最优选为4℃
优选地，上述制备方法，其中，所述方法还包括以下步骤：
粪便来源的质量控制步骤；和/或，
人肠道菌群全菌组合物的质量控制步骤。
更优选地，所述粪便来源的质量控制步骤包括选择18-40岁健康人，通过健康筛查和临床检查，所述健康筛查和临床检查包括：血液检查无HIV、乙肝病毒、EB病毒等感染；身体无消化道疾病及其他会影响肠道菌群的疾病如代谢综合征等；粪便检查无轮状病毒，诺如病毒、沙门氏菌、志贺菌属、耐碳青霉烯类抗生素肠杆科细菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、产超广谱beta-内酰胺酶肠杆科细菌、白色念珠菌、隐孢子虫及环孢子虫感染；三餐规律，作息规律；所述人肠道菌群全菌组合物的质量控制步骤包括：无菌去氧生理盐水重悬所得菌液中，计数活菌率>5x10 10个/ml视为合格。
本公开还提供上述任一种制备方法制得的人肠道菌群全菌组合物。
本公开还提供包含上述任一种制备方法制得的人肠道菌群全菌组合物，以及药学上可接受的载体的药物组合物。
特别地，本公开提供一种治疗癌症的试剂盒，其包上述的人肠道菌群全菌组合物或药物组合物，以及PD-1抗体。
本公开还提供上述的人肠道菌群全菌组合物在制备用于治疗癌症的药物或试剂盒中的用途；优选地，所述癌症为消化道肿瘤；更优选地，所述癌症为结直肠癌。
优选地，上述用途，其特征在于所述药物或试剂盒中还包括一种或多种免疫信号通路调节剂；优选地，所述免疫信号通路调节剂包括抑制PD1/PDL1、PD1/PDL2、CD28/B7-1(CD80)、CD28/B7-2(CD86)、CTLA4/B7-1(CD80)、CILA4/B7-2(CD86)、4-1BB(CD137)/4-1BBL(CD137L)、ICOS/B7RP1、CD40/CD40L、疱疹病毒进入调控因子(Herpesvirus entry mediator，HVEM)/B-及T-淋巴细胞衰减因子(B-and T-lymphocyteattenuator,BTLA)、OX40/OX40L、CD27/CD70、GITR/GITRL、KIR/MHC、淋巴细胞活化基因3(LAG3或CD223)/MHC、TIM3/TIM3配体的黏蛋白结构域、带有Ig与ITIM结构域(TIGIT)/CD96的T细胞免疫受体，以及TIGIT/CD226中的一种或多种的试剂；更优选地，所述免疫信号通路调节剂为PD-1抑制剂， 最优选为PD-1抗体。
优选地，上述用途，所述药物能够提高患者对PD-1抑制剂的治疗应答。
本公开的方法制备健康人肠道菌群的菌液具有操作方法简单，活菌率高，毒副作用低，病毒病菌感染风险低的特点。本公开人将来自健康人肠道菌群的全菌用于肿瘤治疗，可以提高肿瘤免疫治疗应答情况，同时可以与PD-1抑制剂联合使用具有协同效果，增强肿瘤抑制效果，延长肿瘤患者生存期。
附图说明
图1小鼠结肠癌CT26模型的给药方法
图2小鼠结肠癌CT26模型中，各给药组肿瘤生长情况
图3小鼠结肠癌CT26模型中，各给药组小鼠的Kaplan-Meier生存曲线
具体实施方式
根据本公开的上述内容，按照本领域的普通技术知识和惯用手段，在不脱离本公开上述基本技术思想前提下，还可以做出其它多种形式的修改、替换或变更。
I.定义
肠道微生物群
“肠道微生物群”(以前称为肠道菌群或微生物群落)表示属于动物界的任何生物(人、动物、昆虫等)的肠中的微生物的群体。虽然每一个个体具有独特的微生物群组成(在总共400-500个不同的细菌种/个体中，60至80个细菌种由超过50％的采样人群所共有)，但它总是实现相似的主要生理功能并且对个体的健康具有直接影响：促成胃和小肠不能消化的某些食物(主要是不可消化的纤维)的消化；促成一些维生素(B和K)的产生；保护免受来自其它微生物的侵害，维持小肠粘膜的完整性；在适当的免疫系统的发育中起着重要作用；健康、多种多样和平衡的肠道微生物群是确保肠发挥恰当功能的关键。
考虑到肠道微生物群在身体的正常功能中所起的主要作用和其实现的不同功能，它现今被当作“器官”。然而，因为婴儿生来无菌，因此它是“获得性”器官；也就是说，肠道定殖在出生后立即启动，并在之后演化。
肠道微生物群的发展始于出生。子宫内部的无菌、新生儿的消化道被来自母亲(阴道、皮肤、乳房等)、其中发生递送的环境、空气等的微生物迅速定殖。从第3天开始，肠道微生物 群的组成直接取决于婴儿如果被喂养：相较于用婴儿配方奶哺育的婴儿，以母乳喂养的婴儿的肠道微生物群例如主要由双歧杆菌属主导。
肠道微生物群组成的演化遍及整个生命，从出生至老年，并且是不同环境影响的结果。肠道微生物群的平衡可在老化过程中受到影响，因此，老年人具有与年轻成人显著不同的微生物群。
虽然主导肠道微生物群的一般组成在大多数健康人中是相似的(4个主要的门，即厚壁菌门、拟杆菌门、放线菌门和变形菌门)，但种水平上的组成是高度个性化的，并且主要由个体的遗传、环境和饮食决定。肠道微生物群的组成可变得习惯于饮食成分(暂时地或永久地)。例如，日本人可因他们的微生物群已从海洋细菌获得的特殊酶而能消化海藻类(他们日常饮食的一部分)。
生态失调
虽然它可适应变化并具有高弹性容量，但肠道微生物群组成失去平衡可在某些特定情况下出现。这被称为“生态失调”，肠道中潜在地“有害”细菌与已知的“有益”细菌之间的不平衡或对就主要菌群的组成和多样性而言被认为是“健康”微生物群的微生物群的任何偏差。生态失调可与健康问题诸如功能性肠病、炎性肠病、变态反应、肥胖和糖尿病相关。它也可以是治疗(诸如细胞毒性治疗或抗生素治疗)的结果。
在结直肠癌(CRC)患者中，肠道微生物生态失调涉及来自拟杆菌属的细菌种的富集和属于Faecalibacterium和罗斯氏菌属(Roseburia)的种的减少(Sobhani等人，2011；Wu等人，2013)。具体而言，发现梭杆菌属(Fusobacterium)和弯曲杆菌属(Campylobacter)在CRC患者的粪便和粘膜二者中一致增加。
在癌症的情况下，“有益的”或“有利的”细菌基本上是乳杆菌属和双歧杆菌属，而“有害的”或“不利的”细菌基本上是以下种：吉氏副拟杆菌和以下属：吉米菌属、Alistipes。
如本文中所使用的，“微生物群”和“菌群(flora)”是指持续地和短暂地生活于受试对象身体中或受试对象身体上的微生物(包括真核生物、古细菌、细菌、和病毒(包括细菌病毒(即，噬菌体))的群落。
如本文中所使用的，“集落形成单位(colony forming units,cfu)”是指对给定样本中活微生物细胞数量的估计值。
如本文中所使用的，“活的(viable)”表示具备增殖的能力。
如本文中所使用的，“经分离的(isolated)”或“经纯化的(purified)”是指这样的细菌或者其他实体或物质，其已经(1)与其在初始产生(无论是天然地或在实验室环境中)时结合的组分中的 至少一些组分分离，和/或(2)通过人类的手所生产、制备、纯化和/或制造。经分离的或经纯化的细菌可以与其初始结合的其他组分的至少约10％、约20％、约30％、约40％、约50％、约60％、约70％、约80％、约90％或更多分离。
免疫信号通路调节剂
免疫细胞信息传递途径可由细胞上的一或多个以下示例性的受体/配体对调节：PD1/PDL1、PD1/PDL2、CD28/B7-1(CD80)、CD28/B7-2(CD86)、CTLA4/B7-1(CD80)、CILA4/B7-2(CD86)、4-1BB(CD137)/4-1BBL(CD137L)、ICOS/B7RP1、CD40/CD40L、疱疹病毒进入调控因子(Herpesvirus entry mediator,HVEM)/B-及T-淋巴细胞衰减因子(B-and T-lymphocyteattenuator,BTLA)；OX40/OX40L、CD27/CD70、GITR/GITRL、KIR/MHC、淋巴细胞活化基因3(LAG3或CD223)/MHC、A型肝炎病毒细胞受体2(Hepatitis A virus cellular receptor 2,HAVCR2；也称为T细胞免疫球蛋白与含有-3(TIM3))/TIM3配体的黏蛋白结构域、带有Ig与ITIM结构域(TIGIT)/CD96的T细胞免疫受体，以及TIGIT/CD226。免疫细胞信息途径也可由一或多种以下示例性的细胞激素/化学激活素及其同源细胞表面受体调节：白介素2(IL-2)/CD122、腺苷/腺苷A2A受体(adenosine A2A receptor,A2AR)、白介素6(IL-6)/IL6R(CD126)、白介素10(IL-10)/IL-10R、白介素15(IL-15)/IL-15R、转化生长因子β(TGFβ)/TGFβR，以及巨噬细胞群落刺激因子1(CSF-1)/CSF-1R。其他免疫分子包括，但不限于，KIR2DL、VISTA、HLLA2、TLIA、DNAM-1、CEACAM1、CD155，以及吲哚胺2，3-二氧酶(IDO)，如IDO1。上述任何免疫分子可作为如本公开所述的抗癌疗法的目标。
如本公开所用，“免疫信号通路调节剂”是指相对于对照载剂，改变免疫分子(例如，如本公开所述的任何一种)的活性的试剂。“调节剂”一词在本公开中以最广泛的含义使用，且包括部分或完全改变由一或多种免疫分子调节的信息途径的任何分子，包括由如本公开所述的分子调节的信息传导途径。
于一些情况下，免疫信号通路调节剂为一种免疫检查点分子的抑制剂，其可以减少、减缓、停止，及/或阻止由该检查点分子调节的活性。“抑制剂”一词在本公开中以最广泛的含义使用，并且包括部分或完全阻断、抑制，或中和由一或多种免疫检查点分子调节的信息途径的任何分子，包括由如本公开所述的分子调节的调节途径。合适的抑制分子具体包括天然多胜肽、胜肽、反义寡核苷酸、小的有机分子、重组蛋白或胜肽等的拮抗剂抗体或抗体片段、片段或胺基酸序列变体。
在其他情况下，免疫信号通路调节剂为免疫分子的活化剂，其增强及改善由该免疫分子调节的活性。“活化剂”一词在本公开中以最广泛的含义使用，且包括增强由一或多种免疫分子 调节的信息途径的任何分子，包括由如本公开所述的分子调节的信息传导途径。合适的活化剂包括激动性抗体或抗体片段、小的有机分子、重组蛋白质或胜肽等。于一些情况下，活化剂可为免疫分子的激动性抗体，例如MEDI0562(人源化OX40激动性抗体)、MEDI6469(小鼠OX4激动剂)；以及MEDI6383(OX40激动剂)。
识别这种调节剂的方法为本领域公知的。例如，可以使候选调节剂与合适的免疫分子目标接触，且可通过常规测定法测量由该免疫分子调节的信息传导的强度。在候选调节剂存在下，相对于空白对照的信息传导的可检测的变化表明，候选调节剂具有免疫分子的调节活性。
药物或药物组合物
本公开所述的健康人肠道菌群的菌液，与一种或多种辅料如佐剂、载体或稀释剂一起，可以置入药物组合物、单位剂量(unit dosages)或剂型(dosage forms)的形式中。所述药物组合物可以固体剂型(如粉剂、颗粒剂、丸粒剂、包衣或未包衣的片剂或经填充的胶囊)或液体的剂型(如溶液、混悬液、乳液或填充其的胶囊)或半固体剂型(如凝胶、霜剂和软膏)采用。药物剂型的一种或多种活性成分的溶解和释放特性可以在数秒至数月的范围内变化。
所述“药物”或“药物组合物”被设计用于在动物和人中的用途并可以经所有给药途径施用。优选的给药途径是口服途径、肺途径、鼻途径、直肠途径、肠胃外途径。此种药物组合物及其单位剂型可以常规或特别的比例包含常规的或新的成分，具有或不具有另外的活性化合物或成分，并且此种单位剂型可包含与目的日剂量范围相称的待采用的任何适宜有效量的活性成分。
应用于本公开的药物组合物的术语“载体”涉及与活性化合物一起施用的稀释剂、辅料或赋形剂。
本公开的药物或药物组合物可以经口地、局部地、肠胃外地或粘膜地(例如，含服地、通过吸入或直肠地)以包含常规的非-毒性药学可接受的载体的剂量单位配制剂施用。通常希望使用口服途径。所述活性试剂可以经口地以胶囊、片剂等形式(参见Remington：The Science and Practice of Pharmacy，20th Edition)施用。
对于以片剂或胶囊形式的口服给药，活性药物组分可以与非-毒性的、药学可接受的辅料如粘结剂(例如，预胶化的玉米淀粉、聚乙烯吡咯烷酮或羟丙基甲基纤维素)；填料(例如，乳糖、蔗糖、葡萄糖、甘露糖醇、山梨糖醇和其它还原性和非-还原性糖类、微晶纤维素、硫酸钙或磷酸氢钙)；润滑剂(例如，硬脂酸镁、滑石粉或硅土、硬脂酸、硬脂基富马酸酯钠、甘油二十二烷酸酯、硬脂酸钙等)；崩解剂(例如，马铃薯淀粉或羟乙酸淀粉钠)；或润湿剂(例如，月桂基硫酸钠)、着色剂和调味剂、明胶、甜味剂、天然和合成的胶(如阿拉伯胶、黄蓍 胶或藻朊酸盐)、缓冲盐、羧甲纤维素、聚乙二醇、蜡、等。对于以液体形式的口服给药，所述药物组分可以与非-毒性、药学可接受的惰性载体(例如，乙醇、甘油、水)、防沉降剂(例如，山梨糖醇糖浆、纤维素衍生物或氢化的可食用脂肪)、乳化剂(例如，卵磷脂或阿拉伯胶)、非-水性载体(例如，扁桃油、油酯类、乙醇或经分馏的植物油)、保藏剂(例如，p-羟基苯甲酸甲酯或p-羟基苯甲酸丙酯或山梨酸)等组合。还可以加入稳定剂如抗氧化剂(BHA、BHT、桔酸丙酯、抗坏血酸钠、柠檬酸)以稳定所述剂型。
包含作为活性化合物的片剂可以通过本领域熟知的方法包衣。包含作为活性化合物的式I化合物的本公开的所述组合物还可以引入小珠、微球或微胶囊，例如由聚乙醇酸/乳酸(PGLA)构建的。用于口服给药的液体的制剂可以采取例如溶液，糖浆剂，乳液或混悬液的形式或者它们可以呈现为在使用前用水或其它适宜的辅料重构的干产品。用于口服给药的制剂可以适宜地配制以使活性化合物受控或延迟地释放。
本公开的药物或药物组合物可以经肠胃外递送，即，通过静脉内(i.v.)、脑室内(i.c.v.)、皮下(s.c.)、腹膜内(i.p.)、肌内(i.m.)、皮下(s.d.)或皮内(i.d.)施用，通过直接注射，经例如快速浓注或连续输液。用于注射的配制剂可以单位剂型呈现，例如在具有添加的保藏剂的安瓿瓶或多-剂量容器中。所述组合物可以采用赋形剂(excipient)的形状，在油或水性载体中的混悬液、溶液或乳液的形式，并可以包含配制试剂如防沉降剂、稳定剂和/或分散剂。备选地，所述活性成分可以以粉末形式在使用前用适宜的载体(例如无菌无热原水)重构。
本公开的药物或药物组合物还可以配制用于直肠给药，例如呈栓剂或保留灌肠(例如，包含常规栓剂基质如可可油或其它甘油酯)。
联合治疗方法
本公开提供了使用如本公开所述的免疫信号通路调节剂与健康人肠道菌群的菌液的联合癌症疗法。本公开所用的“联合疗法”一词包括以顺序方式施用这些药剂(例如，免疫信号通路调节剂与健康人肠道菌群的菌液)，即其中每种治疗剂在不同时间施用，以及施用这些治疗剂，或至少二种药剂，基本上同时进行。每种试剂的顺序，或基本上同时给药，可受任何适当途径的影响，包括，但不限于，口服途径、静脉内途径、肌肉内、皮下途径，以及通过黏膜组织的直接吸收。药剂可以通过相同的途径或不同的途径来施用。例如，可以口服给予第一药剂(例如，健康人肠道菌群的菌液)，而以静脉内施用第二药剂(例如，抗PD1抗体等抗检查点抗体)。此外，选择的组合剂可通过静脉内注射施用，而组合的其它药剂可以口服给药。或者，例如，可以通过静脉内或皮下注射施用二种或更多种药剂。
联合疗法还可包括如本公开所述的药剂(例如，免疫信号通路调节剂与发酵的组合物)进 一步与其它生物活性成分(例如，不同的抗肿瘤剂)以及非药物治疗(例如，手术或放射治疗)组合的施用。在联合疗法进一步包含放射治疗的情况下，放射治疗可以在任何合适的时间进行，只要从治疗剂的组合与放射治疗的共同作用获得有益的效果即可。例如，在适当的情况下，当放射治疗暂时从治疗剂的给药中除去时，可能达到几天甚至数周，仍可达到该有益效果。
应当理解的是，免疫信号通路调节剂与如本公开所述的菌液的任何组合可以治疗癌症的任何顺序使用。可基于许多因素来选择本公开所述的组合，该因素包括，但不限于，抑制或预防癌症进展的有效性、减轻组合的另一种药物的副作用的有效性，或缓解癌症相关症状的有效性。例如，如本公开所述的联合疗法可减少与组合的每个单独成员相关联的任何副作用。下列表格中提供了一些示例。例如，该健康人肠道菌群的菌液可以在涉及免疫信号通路调节剂(例如，抗PD1抗体)的治疗过程中每天使用。
在一些实施方案中，本公开所述的免疫信号通路调节剂与如本公开所述的菌液的组合是以试剂盒的形式提供。所述试剂盒包含免疫信号通路调节剂，以及本公开所述的菌液。在一些情况下，本公开的试剂盒还可以包含其他必要的试剂。应当理解的是，本公开的试剂盒中的各种组分可以治疗癌症的任何顺序使用。
如本公开所述的免疫信号通路调节剂与健康人肠道菌群的菌液的任何组合可用于治疗癌症。本公开所用的“癌症”一词是指由肿瘤或恶性细胞群、增殖或转移调节的医学病症，包括固体癌症及非固体癌症。癌症的实例包括，但不限于，肺癌、肾癌、胃癌、乳腺癌、脑癌、前列腺癌、肝细胞癌、胰腺癌、子宫颈癌、卵巢癌、肝癌、膀胱癌、尿道癌、甲状腺癌、黑素瘤、头颈癌、结肠癌、白血病、淋巴瘤、皮肤癌、胃癌、食管癌、骨髓瘤、直肠癌、骨癌、子宫癌、前列腺癌，以及血液恶性肿瘤。
“个体”、“个人”以及“患者”等词在本公开中可互换使用，而且是指被评估用于治疗及/或被治疗的哺乳动物。个体可为人类，但亦包括其他哺乳动物，特别是可用作人类疾病实验室模型的那些哺乳动物，例如，小鼠、大鼠、兔、狗等。
如本公开所用，“有效量”是指对个体赋予治疗效果所需的每种活性剂(例如，免疫信号通路调节剂，例如，抗PD1抗体或健康人肠道菌群的菌液)的量，不论是单独或组合地与一或多种其它活性剂施用。于一些具体实施例中，治疗效果为抑制癌细胞生长及/或减少肿瘤负担。于一些具体实施例中，健康人肠道菌群的菌液的量对增强免疫信号通路调节剂的抗癌作用是有效的。在其它具体实施例中，健康人肠道菌群的菌液的量对增强个体对癌细胞的免疫力是有效的。于一些具体实施例中，治疗效果为预防或抑制肿瘤生长。于一些具体实施例中，治疗效果为与一种或多种药物/药物相关的副作用的降低。例如，可能由抑制PD-1途径(例如，疲 劳、末梢水肿、发冷、发热、腹泻、恶心、腹痛、咳嗽、呼吸困难、皮疹、瘙痒、白斑病、关节痛、肌痛、背痛、头痛、头晕，及/或增加的天门冬胺酸胺基转移酶(AST))的副作用可通过与另一种药剂(例如，免疫信号通路调节剂与如本公开所述的健康人肠道菌群的菌液)的共同治疗而减轻。
如本公开所用，“治疗”一词是指将包括一或多种活性剂的组合物应用或施用于一个体，该个体患有目标疾病或病症、疾病/病症的症状，或对该疾病/病症的倾向，且其目的为治愈、治疗、缓解、减轻、改变、补救、改善、增进，或影响疾病、疾病症状，或对该疾病或病症的倾向。
缓解目标疾病/病症包括推迟疾病的发展或进展，或降低疾病严重程度。缓解疾病并不一定需要治疗结果。如其中所使用的，“延迟”目标疾病或病症的发展意指推迟、阻止、缓慢、妨碍、稳定，及/或推迟疾病进展。这样的延迟可为不同的时间长度，这取决于疾病的历史及/或被治疗的个体。一种“延迟”或减轻疾病发展，或推迟疾病发病的方法，为减少在给定时间框架内发展一或多种疾病症状的可能性，及/或在给定的时间框架内减少症状程度的方法，与未使用该方法者进行比较。这种比较通常基于临床研究，使用足以给出统计学显著结果的多个个体。
疾病的“发展”或“进展”意指疾病的初始表现及/或随后的进展。可使用本领域熟知的标准临床技术检测并评估疾病的发展。然而，发展亦指可能无法检测的进展。为了本发明的目的，发展或进展是指该症状的生物学过程。“发展”包括发生、复发及发病。如本公开所用，目标疾病或病症的“发作”或“发生”包括初始发作及/或复发。
于一些具体实施例中，如本公开所述的免疫信号通路调节剂与健康人肠道菌群的菌液的组合，以足以将一或多种目标信息传导途径的活性体内抑制至少20％(例如，30％、40％、50％、60％、70％、80％、90％或更高)的量，施用于需要治疗的个体。在其它具体实施例中，该组合以将一或多种目标抗原的活性程度降低至少20％(例如30％、40％、50％、60％、70％、80％、90％或以上)的有效量施用。
于一些具体实施例中，将如本公开所述的健康人肠道菌群的菌液给予已经接受或正在接受涉及使用免疫信号通路调节剂(例如，抑制剂)的抗癌疗法的个体(例如，人类癌症患者)，如本公开所述者。
医学领域的普通技术人员已知的常规方法，可用于根据待治疗的疾病的类型或疾病的部位，而向个体施用医药组合物。该组合物亦可通过其它常规途径施用，例如，口服、肠胃外、通过吸入喷雾、局部性、直肠、鼻腔、口腔、阴道，或经由植入的储库给药。本公开所用的“肠 胃外”一词包括皮下、皮内、静脉内、肌内、关节内、动脉内、滑膜内、胸骨内、鞘内、脑内，以及颅内注射或输注技术。此外，其可通过可注射的贮库途径施用于个体，例如使用1、3或6个月储存罐注射或可生物降解的材料及方法。于一些实例中，该医药组合物在眼内或玻璃体内施用。
无论通过口服、直肠或肠胃外(包括静脉内的和皮下)或在某些情况下甚至局部途径，可以将本公开的式I活性成分或与一种或多种药物-可接受的辅料、载体或稀释剂，特别是和优选地以它们的药物组合物的形式，以有效量施用给需要其的对象，例如活动物(包括人)体，用于治疗、减轻或改善、缓解或消除对其敏感的适应症或病症或者阐述于本申请其它处的适应症或病症。
II.具体实施方式
下面参照实施例进一步阐释本公开。对本公开的具体示例性实施方案的描述是为了说明和例证的目的。这些描述并非想将本公开限定为所公开的精确形式，并且很显然，根据本申请说明书的教导，可以进行很多改变和变化。对示例性实施例进行选择和描述的目的在于解释本公开的特定原理及其实际应用，从而使得本领域的技术人员能够实现并利用本公开的各种不同的示例性实施方案以及各种不同的选择和改变。
本公开的一个目的在于提供了一种健康人肠道菌群全菌组合物的制备方法，其特征在于，所述方法包括以下步骤：
将健康人粪便按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌；对样本进行均质化；
对均质化的液体进行逐级过滤；
滤液离心2次，重悬，所得悬液即人肠道菌群全菌组合物；
所述方法在厌氧条件下进行。
在一个优选的实施方案中，所述第一次离心条件为0-25℃，50g-200g，离心1-15分钟；第二次离心条件为0-25℃，4000g-5500g，离心1-15分钟；
所述第一次、第二次离心温度优选为0-15℃，或1-10℃，或2-9℃，或3-8℃，或4-7℃，或5-6℃，最优选为4℃；
所述第一次离心转速优选为100-200g，或150-200g，最优选为200g；
所述第二次离心转速优选为4500-5000g，最优选为4500g；
所述第一次、第二次离心时间优选为3-10分钟，更优选5-7分钟，最优选为7分钟。
在一个优选的实施方案中，所述逐级过滤的粒径选择为1mm-2mm、400-600μm和20-80μm。
在一个优选的实施方案中，所述制备方法还包括以下步骤：
使用无菌粪便采集盒收集新鲜粪便样本，取样后盖上盖子，送至实验室进行称量，并记录质量；
将采样盒放入在厌氧操作台的传递窗内，打开盒盖确保气体交换，盖上传递窗盖，启动去氧程序；5分钟后，将采样盒转移至操作台内部；
按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌，确保粪便不过分粘在采样盒上；
对样本粪便进行均质化；
对进行均质化的液体进行逐级过滤，优选地，所述逐级过滤为1mm-2mm、400-600μm、20-80μm；
将滤液转移至离心管内，离心2次，第一次离心条件为1-10℃，50g-200g，离心5-7分钟，第二次离心条件为1-10℃，4000g-5500g，离心5-7分钟，收集菌体沉淀；
用50mL无菌去氧生理盐水重悬，所得悬液即人肠道菌群全菌组合物。
在一个优选地实施方案中，所述方法还包括以下步骤：
粪便来源的质量控制步骤；和/或
人肠道菌群全菌组合物的质量控制步骤。
在一个优选地实施方案中，所述粪便来源的质量控制步骤包括：选择18-40岁健康人，通过健康筛查和临床检查。
在一个更加优选地实施方案中，所述健康筛查和临床检查包括：血液检查无HIV、乙肝病毒、EB病毒等感染；身体无消化道疾病及其他会影响肠道菌群的疾病如代谢综合征等；粪便检查无轮状病毒，诺如病毒、沙门氏菌、志贺菌属、耐碳青霉烯类抗生素肠杆科细菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、产超广谱beta-内酰胺酶肠杆科细菌、白色念珠菌、隐孢子虫及环孢子虫感染；三餐规律，作息规律。
在一个优选地实施方案中，所述人肠道菌群全菌组合物的质量控制步骤包括：无菌去氧生理盐水重悬所得菌液中，计数活菌率>5x10 10个/ml视为合格。
本公开的一个目的还在于提供上述任一种制备方法制得的人肠道菌群全菌组合物。
本公开的一个目的还在于提供包含上述任一种制备方法制得的人肠道菌群全菌组合物，以及药学上可接受的载体的药物组合物。
本公开的一个目的还在于提供一种治疗癌症的试剂盒，其包上述的人肠道菌群全菌组合物 或药物组合物，以及PD-1抗体。
本公开的一个目的还在于提供上述的人肠道菌群全菌组合物在制备用于治疗癌症的药物或试剂盒中的用途。
在一个优选地实施方案中，所述癌症为消化道肿瘤。
在一个更加优选地实施方案中，所述癌症为结直肠癌。
在一个优选地实施方案中，上述制备用于治疗癌症的药物或试剂盒中的用途，其特征在于所述药物或试剂盒中还包括一种或多种免疫信号通路调节剂。
在一个更加优选地实施方案中，所述免疫信号通路调节剂包括本领域已知的任选地免疫信号通路调节剂，包括但不限于PD1/PDL1、PD1/PDL2、CD28/B7-1(CD80)、CD28/B7-2(CD86)、CTLA4/B7-1(CD80)、CILA4/B7-2(CD86)、4-1BB(CD137)/4-1BBL(CD137L)、ICOS/B7RP1、CD40/CD40L、疱疹病毒进入调控因子(Herpesvirus entry mediator，HVEM)/B-及T-淋巴细胞衰减因子(B-and T-lymphocyteattenuator,BTLA)、OX40/OX40L、CD27/CD70、GITR/GITRL、KIR/MHC、淋巴细胞活化基因3(LAG3或CD223)/MHC、TIM3/TIM3配体的黏蛋白结构域、带有Ig与ITIM结构域(TIGIT)/CD96的T细胞免疫受体，以及TIGIT/CD226中的一种或多种的试剂；优选地，所述免疫信号通路调节剂为PD-1抑制剂，最优选为PD-1抗体。
优选地，上述制备用于治疗癌症的药物或试剂盒中的用途，所述药物能够提高患者对PD-1抑制剂的治疗应答。
优选地，上述制备用于治疗癌症的药物或试剂盒中的用途，所述药物能够提高PD-1抑制剂的响应。
实施例1：健康人肠道粪便菌群全菌组合物的制备
选择32岁健康人，通过健康筛查和临床检查：血液检查HIV，乙肝，EB病毒(epstein-barr virus，EBV)等感染；身体无消化道疾病及其他会影响肠道菌群的疾病如代谢综合征等；粪便检查无轮状病毒，诺如病毒、沙门氏菌、志贺菌属、耐碳青霉烯类抗生素肠杆科细菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、产超广谱beta-内酰胺酶肠杆科细菌、白色念珠菌、隐孢子虫及环孢子虫感染；三餐规律，作息规律。
使用特定的无菌粪便采集盒收集新鲜粪便样本，取样后盖上盖子，送至实验室进行称量，并记录质量；将采样盒放入在厌氧操作台的传递窗内，打开盒盖确保气体交换。盖上传递窗盖，启动去氧程序；5分钟后，将采样盒转移至操作台内部，开始实验流程。
根据称量的样本质量，倒入5倍体积的无菌去氧生理盐水。例如粪便质量为100g，则倒 入500mL；对样本进行搅拌，确保粪便不过分粘在采样盒上；将样本整体倒入到密封袋中，对样本粪便进行均质化；然后进行逐级过滤，所述逐级过滤的粒径选择为1mm-2mm、400-600μm和20-80μm；之后使用电动移液器和移液管将最后一次的滤液转移至50mL离心管内，每管装入50mL；进行两步离心，第一步：4℃，200g离心7分钟；第二步：4℃，4500g离心7分钟，弃上清，收集菌体沉淀；菌体用50mL无菌去氧生理盐水重悬，此时悬液为包含全菌的微生物溶液，即FMT菌液，可用于后续治疗。
取1ul菌液样本进行质检，将其稀释在1ml的无菌生理盐水中，并向其中加入ThermoFisher LIVE/DEAD TM BacLight TM Bacterial Viability Kit试剂盒中的SYTO 9染色剂和PI染色剂各1μl。震荡混匀后在黑暗中静置15分钟。15分钟后取2μl该溶液，将其稀释在1ml的无菌生理盐水中，震荡混匀。使用流式细胞仪检测该染色稀释液，将FITC通道增益调整为150，将PC5.5通道增益调整为200，将主阈值设为FSC，手动，400，将第二阈值设为SSC，手动，4500，其余所有参数设为默认，固定采集体积。设置流式细胞仪采集图，以FITC-A的log值为横坐标，以PC5.5-A的log值为纵坐标，定量采集数据。采集完成的散点图中，圈出图中右下部分聚集的散点，即为活菌。统计其数量，根据实验过程的稀释倍数，计算原始菌液中的活菌率。
该质检标准为，活菌率>5x10 10个/ml，如达到这个标准则视为合格。
经流式细胞仪检测，本次菌液制备产品活菌率为1.21x 10 11/mL。检验合格。
实施例2：健康人肠道菌群全菌联合PD-1免疫抑制剂，用于治疗消化道肿瘤
受试药Rat IgG2a
供货商：中美冠科生物技术有限公司
货号：CVP039
批号：0119L220
包装：2.8mg/ml,96mg
储存温度：
Figure PCTCN2021087593-appb-000001
受试药aPD-1抗体(RMP1-14)
供货商：中美冠科生物技术有限公司
货号：CVP033
批号：0119L225
包装：4.1mg/ml,96mg
储存温度：
Figure PCTCN2021087593-appb-000002
抗生素
Day-8到Day-4：配方包括氨苄青霉素(Ampicillin)1mg/ml，新霉素(Neomycin)1mg/ml，甲硝哒唑(Metronidazole)1mg/ml和万古霉素(Vancomycin)0.5mg/ml。将抗生素按比例添加到无菌水中供小鼠饮用，抗生素处理时间为4天，含抗生素的水瓶每三天更换一次。
Day-3到Day 7：配方包括氨苄青霉素(Ampicillin)1mg/ml，新霉素(Neomycin)10mg/ml，甲硝哒唑(Metronidazole)10mg/ml，万古霉素(Vancomycin)5mg/ml和两性霉素B(Amphotericin B)0.1mg/ml。将氨苄青霉素添加到无菌水中供小鼠饮用，其他抗生素混合后给小鼠灌胃，每天两次，每次200μl。
在接收微生物治疗前24h(Day 7)，中断抗生素处理，并将小鼠转入到新的笼子中，以防止老鼠食用含有抗生素的粪便。
Day 8在第一次微生物治疗前再一次将小鼠转移到新的笼子中，以防止老鼠食用还残留有抗生素的粪便。
细胞培养
CT26细胞(SIBS：上海生命科学研究院，CAT#：TCM37)培养在含10％胎牛血清的RPMI-1640培养液中。收集指数生长期的CT26细胞，PBS重悬至适合浓度用于小鼠皮下肿瘤接种。
动物造模和随机分组
小鼠结肠癌CT26模型的给药方法如图所示。具体而言，购买SPF级6-8周龄雌性Balb/c小鼠。适应性饲养一周。实验期间将饲养在不同笼子里的属于同一组别的小鼠进行随机交换。
将小鼠分为4组：对照组(无菌生理盐水+同型对照)，FMT单独治疗组(FMT+同型对照)，PD-1单独治疗组(无菌生理盐水+PD-1)和FMT联合治疗组(FMT+PD-1)，每组10只小鼠。
适应性饲养结束后，采用灌胃的方式对小鼠进行抗生素处理，处理时间为16天(从Day-8到Day7)，每天灌胃1次。
在抗生素处理过程中，选择在Day0将培养好的CT26细胞注射到小鼠体内，进行造模。256只雌性小鼠右侧皮下接种5×10 5CT26细胞。接种当天定义为第0天(Day 0)。
接种8天后根据肿瘤体积进行随机分组，各组肿瘤平均体积为87mm 3。
Day7灌胃结束后中断抗生素处理，将小鼠转移到新的笼子中，以防小鼠食用含抗生素的粪便。
Day9在第一次微生物治疗前再一次将小鼠转移到新的笼子中。
实施例1制备的FMT菌液，用无菌生理盐水重悬至2.5x10 10个/ml。
在Day8，Day11，Day14及Day17分别给予FMT单独治疗组和FMT联合治疗组小鼠以灌胃的形式进行治疗，每只小鼠每天灌胃1次，灌胃体积为200μl，即剂量为5x10 9个/只/次；对照组和PD-1单独治疗组灌入等体积生理盐水。
在Day9，Day12，Day15及Day18分别进行抗体注射，用量为200ug/只/次。其中PD-1单独治疗组和联合治疗组注射PD-1抗体，而对照组和单独治疗组注射同型对照。
Day24处死小鼠，收集肿瘤，进行称重并测量肿瘤面积后将肿瘤组织磨碎，同时收集脾脏，用于流式细胞分析。
在实验过程中，定期监控肿瘤细胞接种后小鼠肿瘤的生长状况：用游标卡尺直接测量肿瘤体积，肿瘤体积计算公式：
肿瘤体积(mm 3)＝1/2×(a×b 2)(其中a表示长径，b表示短径)。
监测时间点为：第5，8，11，14，17，21及24天；接种肿瘤后小鼠体重的监测。
相对肿瘤增殖率，T/C％，即在某一时间点，治疗组和对照组相对肿瘤体积或瘤重的百分比值。计算公式如下：
T/C％＝T RTV/C RTV×100％(T RTV：治疗组平均RTV；C RTV：溶媒对照组平均RTV；RTV＝V t/V 0，V 0为分组时该动物的瘤体积，V t为治疗后该动物的瘤体积)；或，
T/C％＝T TW/C TW×100％(T TW：治疗组实验终结时平均瘤重；C TW：溶媒对照组实验终结时平均瘤重)。
相对肿瘤抑制率，TGI(％)，计算公式如下：
TGI％＝(1-T/C)×100％(T和C分别为治疗组和对照组在某一特定时间点的相对肿瘤体积(RTV)或瘤重(TW))。
结论
CT26模型所有组小鼠在给药后第13天(细胞接种后第21天即Day21)，由各组小鼠生长情况(表1)可知：
无菌生理盐水+同型对照对照组小鼠的平均瘤体积为1916.88mm 3；
FMT+同型对照组的平均肿瘤体积为1790.40mm 3，相较对照组统计学上均无显著性差异，p值为0.679，相对肿瘤抑制率TGI(％)为6％；
无菌生理盐水+aPD-1组的平均肿瘤体积为1402.64mm 3，相较对照组统计学上均无显著性差异，p值为0.159，相对肿瘤抑制率TGI(％)为26％；
FMT+aPD-1组的平均肿瘤体积为1206.56mm 3，相较对照组统计学上有显著性差异，p值为0.003，相对肿瘤抑制率TGI(％)为37％(表1)。
表1、在鼠结肠癌CT26模型中各组药效分析表
Figure PCTCN2021087593-appb-000003
CT26模型所有组小鼠在给药后第15天(细胞接种后第24天即Day24)，进行生存分析(表2)，用Kaplan-Meier方法分析各治疗组的生存曲线(图2)，FMT+aPD-1治疗组能够显著促进小鼠的生存期，相较对照组统计学上均有显著性差异(p值为0.002)。并且FMT+aPD-1和治疗组相较于无菌生理盐水+aPD-1治疗组能进一步促进小鼠的生存期(p值为0.039)。
表2.在鼠结肠癌CT26模型中的生存分析
Figure PCTCN2021087593-appb-000004
*MST：中位生存期(Median Survival Time)
**ILS：生存期延长率(Increase of Life Span)

Claims (10)

  1. 一种健康人肠道菌群全菌组合物的制备方法，其特征在于，所述方法包括以下步骤：
    将健康人粪便按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌；
    对样本进行均质化；
    对均质化的液体进行逐级过滤；
    将滤液离心后重悬，所得悬液即人肠道菌群全菌组合物；
    所述方法在厌氧条件下进行。
  2. 根据权利要求1所述的制备方法，其中，离心2次，第一次离心条件为50g-200g，离心1-15分钟；第二次离心条件为4000g-5500g，离心1-15分钟。
  3. 根据权利要求1或2所述的制备方法，其中，所述方法包括以下步骤：
    使用无菌粪便采集盒收集新鲜粪便样本，取样后盖上盖子，送至实验室进行称量，并记录质量；
    将采样盒放入在厌氧操作台的传递窗内，打开盒盖确保气体交换，盖上传递窗盖，启动去氧程序；5分钟后，将采样盒转移至操作台内部；
    按照1:3-5的质量体积比加入的无菌去氧生理盐水，对样本进行搅拌，确保粪便不过分粘在采样盒上；
    对样本粪便进行均质化；
    对进行均质化的液体进行逐级过滤，优选地，所述逐级过滤为1mm-2mm、400-600μm、20-80μm；
    将滤液转移至离心管内，离心2次，第一次离心条件为50g-200g，离心5-7分钟，第二次离心条件为4000g-5500g，离心5-7分钟，收集菌体沉淀；
    用50mL无菌去氧生理盐水重悬，所得悬液即人肠道菌群全菌组合物。
  4. 根据前述任一项权利要求所述的制备方法，其中，所述方法还包括以下步骤：
    粪便来源的质量控制步骤；和/或，
    人肠道菌群全菌组合物的质量控制步骤。
  5. 根据权利要求4所述的制备方法，其中，所述粪便来源的质量控制步骤包括选择18-40岁健康人，通过健康筛查和临床检查，所述健康筛查和临床检查包括：血液检查无HIV(human imunodeficiency virus、乙肝病毒、EB病毒(epstein-barr virus,EBV)等感染；身体无消化道疾病及其他会影响肠道菌群的疾病如代谢综合征等；粪便检查无轮状病毒、诺如病毒、沙门氏菌、志贺菌属、耐碳青霉烯类抗生素肠杆科细菌、耐甲氧西林金黄色葡萄球菌、耐万古霉素肠球菌、产超广谱beta-内酰胺酶肠杆科细菌、白色念珠菌、隐孢子虫及环孢子虫感染；三餐规律，作息 规律；
    所述人肠道菌群全菌组合物的质量控制步骤包括：无菌去氧生理盐水重悬所得菌液中，计数活菌率>5x10 10个/ml视为合格。
  6. 根据前述任一项权利要求所述的制备方法制得的人肠道菌群全菌组合物，或包含前述任一项权利要求所述的制备方法制得的人肠道菌群全菌组合物以及药学上可接受的载体的药物组合物。
  7. 治疗癌症的试剂盒，其包含权利要求6的人肠道菌群全菌组合物或药物组合物，以及PD-1抗体。
  8. 根据权利要求6所述的人肠道菌群全菌组合物或药物组合物在制备用于治疗癌症的药物或试剂盒中的用途；优选地，所述癌症为消化道肿瘤；更优选地，所述癌症为结直肠癌。
  9. 根据权利要求8所述的用途，其特征在于所述药物或试剂盒中还包括一种或多种免疫信号通路调节剂；优选地，所述免疫信号通路调节剂包括调节PD1/PDL1、PD1/PDL2、CD28/B7-1(CD80)、CD28/B7-2(CD86)、CTLA4/B7-1(CD80)、CILA4/B7-2(CD86)、4-1BB(CD137)/4-1BBL(CD137L)、ICOS/B7RP1、CD40/CD40L、疱疹病毒进入调控因子(Herpesvirus entry mediator，HVEM)/B-及T-淋巴细胞衰减因子(B-and T-lymphocyteattenuator,BTLA)、OX40/OX40L、CD27/CD70、GITR/GITRL、KIR/MHC、淋巴细胞活化基因3(LAG3或CD223)/MHC、TIM3/TIM3配体的黏蛋白结构域、带有Ig与ITIM结构域(TIGIT)/CD96的T细胞免疫受体，以及TIGIT/CD226中的一种或多种的试剂；更优选地，所述免疫信号通路调节剂为PD-1抑制剂，最优选为PD-1抗体。
  10. 根据前述任一项权利要求所述的用途，所述药物能够提高患者对PD-1抑制剂的治疗应答和/或延长肿瘤病人的生存期。
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