WO2021247789A1 - Immunomodulatory compounds - Google Patents

Immunomodulatory compounds Download PDF

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Publication number
WO2021247789A1
WO2021247789A1 PCT/US2021/035580 US2021035580W WO2021247789A1 WO 2021247789 A1 WO2021247789 A1 WO 2021247789A1 US 2021035580 W US2021035580 W US 2021035580W WO 2021247789 A1 WO2021247789 A1 WO 2021247789A1
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peptide
seq
amino acid
acid sequence
compound
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French (fr)
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Gabriel M. Gutierrez
James PANNUCCI
Vinayaka Kotraiah
Timothy W. Phares
Cecille D. BROWNE
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Leidos Inc
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Leidos Inc
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Priority to JP2022574459A priority Critical patent/JP7733020B2/ja
Priority to AU2021283353A priority patent/AU2021283353A1/en
Priority to CA3185657A priority patent/CA3185657A1/en
Priority to EP21736092.4A priority patent/EP4161952A1/en
Publication of WO2021247789A1 publication Critical patent/WO2021247789A1/en
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    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07KPEPTIDES
    • C07K14/00Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/705Receptors; Cell surface antigens; Cell surface determinants
    • C07K14/70596Molecules with a "CD"-designation not provided for elsewhere
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/62Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being a protein, peptide or polyamino acid
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00Medicinal preparations containing peptides
    • A61K38/04Peptides having up to 20 amino acids in a fully defined sequence; Derivatives thereof
    • A61K38/10Peptides having 12 to 20 amino acids
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K47/00Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient
    • A61K47/50Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates
    • A61K47/51Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent
    • A61K47/56Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule
    • A61K47/59Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes
    • A61K47/60Medicinal preparations characterised by the non-active ingredients used, e.g. carriers or inert additives; Targeting or modifying agents chemically bound to the active ingredient the non-active ingredient being chemically bound to the active ingredient, e.g. polymer-drug conjugates the non-active ingredient being a modifying agent the modifying agent being an organic macromolecular compound, e.g. an oligomeric, polymeric or dendrimeric molecule obtained otherwise than by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyureas or polyurethanes the organic macromolecular compound being a polyoxyalkylene oligomer, polymer or dendrimer, e.g. PEG, PPG, PEO or polyglycerol
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07KPEPTIDES
    • C07K14/00Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/46Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates
    • C07K14/47Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals
    • C07K14/4701Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans from vertebrates from mammals not used
    • C07K14/4747Apoptosis related proteins
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07KPEPTIDES
    • C07K14/00Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • C07K14/435Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • C07K14/705Receptors; Cell surface antigens; Cell surface determinants
    • C07K14/70503Immunoglobulin superfamily
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07KPEPTIDES
    • C07K7/00Peptides having 5 to 20 amino acids in a fully defined sequence; Derivatives thereof
    • C07K7/04Linear peptides containing only normal peptide links
    • C07K7/08Linear peptides containing only normal peptide links having 12 to 20 amino acids
    • CCHEMISTRY; METALLURGY
    • C07ORGANIC CHEMISTRY
    • C07KPEPTIDES
    • C07K2319/00Fusion polypeptide

Definitions

  • This disclosure relates generally to immunomodulatory peptides.
  • PD1 programmed cell death- 1
  • PD-L1 and PD-L2 are widely expressed and exert a number of immunoregulatory roles in T cell activation, including attenuation of immunity against tumor cells and infectious agents.
  • PD1 is therefore an attractive target for a variety of therapeutic applications.
  • Cytotoxic T-lymphocyte-associated antigen (CTLA-4) provides a negative signal to T cells and is also an attractive therapeutic target.
  • Lymphocyte activation gene 3 (LAG3, also known as LAG-3, LAG 3, Lag3, CD223, FDC protein) is a member of the immunoglobulin superfamily of receptors.
  • LAG3 is expressed on immune cells (activated T cells, Huard et ak, 1994; natural killer cells, Triebel et ak, 1990; B cells, Kisielow et ak, 2005; plasmacytoid dendritic cells, Workman et ak, 2009), where it binds to MHC class II (MHC-II) and serves as an immune checkpoint receptor.
  • MHC-II MHC class II
  • LAG3 also binds to fibrinogen-like protein (FGL1), and disrupting this binding can potentiate anti -tumor immunity (Wang et ak, 2019).
  • LAG3 is also expressed on neurons, where it serves as a receptor for the a-synuclein aggregates characteristic of synucleinopathies (Mao et ak, 2016).
  • Synucleinopathies are disorders characterized by the abnormal accumulation of aggregates of a-synuclein protein in neurons, nerve fibers, or glial cells.
  • Synucleinopathies include idiopathic and inherited forms of Parkinson’s disease (PD); Diffuse Lewy Body (DLB) disease, also known as Dementia with Lewy Bodies or Lewy body dementia; incidental Lewy body disease; Lewy body variant of Alzheimer’s disease (LBV); Combined Alzheimer's and Parkinson disease (CAPD); pure autonomic failure (PAF); multiple system atrophy (MSA), such as olivopontocerebellar atrophy, striatonigral degeneration, and Shy-Drager Syndrome; pantothenate kinase-associated neurodegeneration; Down’s Syndrome; Gaucher disease-related synucleinopathies; and neurodegeneration with brain iron accumulation.
  • PD Parkinson’s disease
  • LBV Lewy body variant of Alzheimer’s disease
  • CAPD Combined Alzheimer's and Parkinson disease
  • MSA multiple system atrophy
  • MSA multiple system atrophy
  • olivopontocerebellar atrophy striato
  • Figure 1 is a graph reporting the results of a TR-FRET assay testing the ability of peptide conjugates and individual peptides to affect the interaction between LAG3 and MHC-II. * indicates precipitation when diluted in assay buffer at ImM (100 mM final).
  • Figure 2A is a graph showing the results of a TR-FRET assay testing peptide LG42 (SEQ ID NO:6).
  • Figure 2B is a graph showing the results of a TR-FRET assay testing peptide LDlOda (SEQ ID NO: 8).
  • Figure 3 is a graph showing the results of a TR-FRET assay testing peptide LG11 (SEQ ID NO:3).
  • Figure 4A is a graph showing the results of a TR-FRET assay testing peptide conjugate BT1.
  • Figure 4B is a graph showing the results of a TR-FRET assay testing peptide conjugate BT2.
  • Figure 5 is a graph showing the results of a TR-FRET assay testing peptide conjugate BT3.
  • Figure 6A is a graph showing the results of a TR-FRET assay testing peptide conjugate BT4.
  • Figure 6B is a graph showing the results of a TR-FRET assay testing peptide conjugate BT5.
  • Figure 7A is a graph showing the results of a TR-FRET assay testing peptide conjugate BT6.
  • Figure 7B is a graph showing the results of a TR-FRET assay testing peptide conjugate [14]
  • Figure 8A is a graph showing the results of a TR-FRET assay testing peptide conjugate BT8.
  • Figure 8B is a graph showing the results of a TR-FRET assay testing peptide conjugate BT9.
  • Figure 9A is a graph showing the results of a TR-FRET assay testing peptide conjugate BT10.
  • Figure 9B is a graph showing the results of a TR-FRET assay testing peptide conjugate BT11.
  • Figure 10 is a graph showing the results of a PD1-PDL1 cell reporter assay testing various peptide conjugates and peptides.
  • This disclosure provides peptide conjugates that inhibit the function of PD 1 and/or block the interaction of LAG3 with MHC-II.
  • the disclosed peptide conjugates contain two peptides separated by a polyethylene glycol (PEG) linker.
  • PEG polyethylene glycol
  • Each of the peptide conjugates disclosed in this specification contains two of four peptides, with the sequences and orientations as shown in Table 1.
  • L10 (SEQ ID NO: 1) is a peptide that inhibits the function of the checkpoint receptor “programmed death 1” (PD1).
  • LG11 also known as “LAG3-11”) (SEQ ID NO:3) is a peptide that binds to LAG3 and blocks its interaction with MHC-II.
  • peptides of a peptide conjugate are modified using chemical or recombinant methods to enhance stability or other pharmacokinetic properties. See, e.g., US 2017/0020956. Modifications include, but are not limited to, replacement of one or more L-amino acid with its corresponding D-form, acetylation on a C- and/orN-terminal residue, and amidation on a C- and/or N-terminal residue.
  • a peptide conjugate inhibits the function of PD 1.
  • peptide conjugates are BT7, BT9, BT10, and BT11.
  • a peptide conjugate inhibits the interaction between LAG3 and MHC-II.
  • Examples of such peptide conjugates are BT1, BT2, BT3, BT4, BT5, BT6, and BT7.
  • a peptide conjugate inhibits the function of PD 1 and the interaction of LAG3 and MHC-II.
  • BT7 is an example of such a peptide conjugate.
  • Peptides of a peptide conjugate can be made by any method known in the art, including synthetic methods, recombinant methods, or both. Synthetic methods include solid-phase and solution methods, and may include the use of protective groups. See, e.g., Bodanszky et al. (1976), McOmie (1973), Merrifield (1963), Neurath et al. (1976), Stuart & Young (1984).
  • Recombinant production of the peptides used in peptide conjugates can be carried out using any nucleotide sequence(s) encoding the peptides in any suitable expression system.
  • Nucleic acid molecules encoding one or more of the disclosed peptides can be incorporated into an expression cassette that includes control elements operably linked to the coding sequences. Control elements include, but are not limited to, initiators, promoters (including inducible, repressible, and constitutive promoters), enhancers, and polyadenylation signals. Signal sequences can be included.
  • the expression cassette can be provided in a vector that can be introduced into an appropriate host cell for production of the peptide(s). Methods of constructing expression cassettes and expression vectors are well known. Expression vectors can include one or more expression cassettes encoding one or more peptides comprising, consisting essentially or, or consisting of any of SEQ ID NOS: 1-4.
  • the PEG linker can be incorporated by suitable methods known in the art.
  • the linker is incorporated using FMOC chemistry.
  • the 4-mer PEG linker of BT1-BT11 was incorporated using Fmoc-N-amido-dPEG® 4 -acid (Quanta BioDesign).
  • PEG linkers can vary in length (e.g., 2, 3, 4, 5, 6).
  • peptide conjugates can be labeled (e.g., with biotin or a fluorescent label) and used, for example, as diagnostic reagents.
  • peptide conjugates disclosed here have a number of therapeutic applications. “Treat,” as used herein, includes reducing or inhibiting the progression of one or more symptoms of the condition for which a peptide conjugate is administered.
  • Peptide conjugates that inhibit the interaction between PD1 and PDL1 can be used to treat hyperproliferative disorders, including cancer, to treat infectious diseases, to enhance a response to vaccination, to treat sepsis, to promote hair re -pigmentation, and to promote lightening of a pigmented skin lesion.
  • Peptide conjugates that inhibit the interaction between LAG3 and MHC-II also can be used to treat hyperproliferative disorders, including cancer, and can be useful for reducing one or more symptoms of or for treating synucleopathies, infectious diseases, and sepsis and for enhancing a response to vaccination.
  • administration is carried out in conjunction with one or more other therapies. “In conjunction with” includes administration together with, before, or after administration of the one or more other therapies.
  • One or more peptide conjugates are typically administered in a pharmaceutical composition comprising a pharmaceutically acceptable vehicle.
  • the “pharmaceutically acceptable vehicle” may comprise one or more substances which do not affect the biological activity of the peptides or modified versions thereof and, when administered to a patient, does not cause an adverse reaction.
  • Pharmaceutical compositions may be liquid or may be lyophilized. Lyophilized compositions may be provided in a kit with a suitable liquid, typically water for injection (WFI) for use in reconstituting the composition.
  • WFI water for injection
  • Other suitable forms of pharmaceutical compositions include suspensions, emulsions, and tablets.
  • a pharmaceutical composition comprises a plurality of only one type of peptide conjugate (e.g., BT1, BT2, BT4, BT5, BT6, BT7, BT9, BT10, BT11).
  • a pharmaceutical composition comprises pluralities of more than one type of peptide conjugate (e.g, any one of BT1, BT2, BT4, BT5, BT6, BT7, BT9, BT10, BT11 and one or more of BT1, BT2, BT4, BT5, BT6, BT7, BT9, BT10, BT11).
  • compositions can be administered by any suitable route, including, but not limited to, intravenous, intramuscular, intradermal, intraperitoneal, subcutaneous, epidural, intratumoral, transdermal (e.g., US 2017/0281672), mucosal (e.g., intranasal or oral), pulmonary, and topical (e.g., US 2017/0274010) routes. See, e.g., US 2017/0101474.
  • Administration can be systemic or local.
  • implants can be used to achieve a local administration.
  • suitable materials include, but are not limited to, sialastic membranes, polymers, fibrous matrices, and collagen matrices.
  • Topical administration can be by way of a cream, ointment, lotion, transdermal patch (such as a microneedle patch), or other suitable forms well known in the art.
  • Administration can also be by controlled release, for example, using a microneedle patch, pump and/or suitable polymeric materials.
  • suitable materials include, but are not limited to, poly(2 -hydroxy ethyl methacrylate), poly(methyl methacrylate), poly(acrylic acid), poly(ethylene-co-vinyl acetate), poly(methacrylic acid), polyglycolides (PLG), polyanhydrides, poly(N-vinyl pyrrolidone), poly(vinyl alcohol), polyacrylamide, polyethylene glycol), polylactides (PLA), poly(lactide-co-glycolides) (PLGA), and poly orthoesters.
  • Devices comprising any of the peptide conjugates described above include, but are not limited to, syringes, pumps, transdermal patches, spray devices, vaginal rings, and pessaries.
  • one or more of the peptide conjugates described above are administered to a patient to inhibit the progression of a hyperproliferative disorder, including cancer.
  • Such inhibition may include, for example, reducing proliferation of neoplastic or pre neoplastic cells; destroying neoplastic or pre-neoplastic cells; and inhibiting metastasis or decreasing the size of a tumor.
  • cancers include, but are not limited to, melanoma (including cutaneous or intraocular malignant melanoma), renal cancer, prostate cancer, breast cancer, colon cancer, lung cancer, bone cancer, pancreatic cancer, skin cancer, cancer of the head or neck, uterine cancer, ovarian cancer, rectal cancer, cancer of the anal region, stomach cancer, testicular cancer, carcinoma of the fallopian tubes, carcinoma of the endometrium, carcinoma of the cervix, carcinoma of the vagina, carcinoma of the vulva, Hodgkin’s Disease, non-Hodgkin’s lymphoma, cancer of the esophagus, cancer of the small intestine, cancer of the endocrine system, cancer of the thyroid gland, cancer of the parathyroid gland, cancer of the adrenal gland, sarcoma of soft tissue, cancer of the urethra, cancer of the penis, chronic or acute leukemias including acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblast
  • one or more of the peptide conjugates described above are administered in conjunction with one or more other cancer therapies or immunotherapies, such as those described below.
  • the second therapy comprises a second agent that reduces or blocks the activity of PD1 (e.g., nivolumab, pembrolizumab, durvalumab) or CTLA-4 (e.g., ipilimumab, tremelimumab).
  • PD1 e.g., nivolumab, pembrolizumab, durvalumab
  • CTLA-4 e.g., ipilimumab, tremelimumab.
  • the second therapy comprises an agent that reduces or blocks the activity of PD-L1 (e.g., atezolizumab).
  • the second therapy comprises another agent that reduces or blocks the activity of LAG3 or other inhibitory checkpoint molecules and/or molecules that suppress the immune system.
  • These molecules include, but are not limited to:
  • V-domain Immunoglobulin Suppressor of T cell Activation (VISTA, also known as cl0orf54, PD1H, DDla, Gi24, Diesl, and SISP1; see US 2017/0334990, US 2017/0112929, Gao et ak, 2017, Wang et ak, 2011; Uiu et ak, 2015);
  • T-cell Immunoglobulin domain and Mucin domain 3 (TIM-3; see US 2017/0198041, US 2017/0029485, US 2014/0348842, Sakuishi et ak, 2010);
  • killer immunoglobulin-like receptors see US 2015/0290316
  • B and T Uymphocyte Attenuator see US 2016/09222114
  • A2A adenosine receptor see Beavis et ak, 2015; US 2013/0267515; US 2017/0166878; Ueone et ak, 2015; Mediavilla-Varela et ak, 2017; Young et ak, 2016).
  • Agents that reduce or block the activity of UAG3 include, but are not limited to, BMS- 986016, IMP321, and GSK2831781 (He et ak, 2016).
  • Agents that reduce or block the activity of VISTA include, but are not limited to, small molecules, such as CA-170, and antibodies (e.g., Ue Mercier et ak, 2014).
  • Agents that reduce or block the activity of TIM-3 include, but are not limited to, antibodies such as MBG453 and TSR-022; see Dempke et ak, 2017.
  • Agents that reduce or block the activity of KIRs include, but are not limited to, monoclonal antibodies such as IPH2101 and Lirilumab (BMS-986015, formerly IPH2102); see Benson & Caligiuri, 2014.
  • Agents that reduce or block the activity of IDO include, but are not limited to, epacadostat and agents disclosed in US 2017/0037125.
  • Agents that reduce or block the activity of BTLA include, but are not limited to, peptides (e.g., Spodzieja et ak, 2017).
  • Agents that reduce or block the activity of A2AR include, but are not limited to, small molecules such as CPI -444 and vipadenant.
  • the second therapy comprises a cytokine (e.g. , interleukin 7).
  • a cytokine e.g. , interleukin 7
  • the second therapy comprises an agonist of a stimulatory checkpoint molecule.
  • a stimulatory checkpoint molecule include, but are not limited to:
  • GITR glucocorticoid-induced tumor necrosis factor-related protein
  • Agonists of CD40 include, but are not limited to, CD40 agonist monoclonal antibodies such as cp-870,893, ChiLob7/4, dacetuzumab, and lucatumumab. See, e.g., Vonderheide et ak, 2007; Khubchandani et ak, 2009; Johnson et ak, 2010; Bensinger et ak, 2012; Vonderheide and Glennie, 2013; Johnson et ak, 2015.
  • Agonists of 0X40 include, but are not limited to, 0X40 agonist antibodies such as MOXR0916, MED 16469, MED10562, PF-045618600, GSK3174998, and INCCAGN01949, and OX40L-Fc fusion proteins, such as MEDI6383. See, e.g., Huseni et ak, 2014; Linch et ak, 2015; Messenheimer et ak, 2017. See also Schmali et ak, 2017. [58] Agonists of GITR include, but are not limited to, MEDI1873. See, e.g., Schaer et al., 2012; Tigue et al., 2017.
  • Agonists of ICOS include, but are not limited to, ICOS agonist antibodies JTX-2011 and GSK3359609. See, e.g., Harvey et al., 2015; Michaelson et al., 2016.
  • the second therapy comprises a 4-1BB agonist (Shindo et al., 2015), such as urelumab; a 4-1BB antagonist (see US 2017/0174773); an inhibitor of anaplastic lymphoma kinase (ALK; Wang et al., 2014; US 2017/0274074), such as crizotinib, ceritinib, alectinib, PF-06463922, NVP-TAE684, AP26113, TSR-011, X-396, CEP-37440, RXDX-101; an inhibitor of histone deacetylase (HDAC; see US 2017/0327582); a VEGFR inhibitor, such as axitinib, sunitinib, sorafenib, tivozanib, bevacizumab; and/or an anti-CD27 antibody, such as varlilumab.
  • a 4-1BB agonist such as urelumab
  • the second therapy comprises a cancer vaccine (e.g. , Duraiswamy et al., 2013).
  • a “cancer vaccine” is an immunogenic composition intended to elicit an immune response against a particular antigen in the individual to which the cancer vaccine is administered.
  • a cancer vaccine typically contains a tumor antigen which is able to induce or stimulate an immune response against the tumor antigen.
  • a “tumor antigen” is an antigen that is present on the surface of a target tumor.
  • a tumor antigen may be a molecule which is not expressed by a non-tumor cell or may be, for example, an altered version of a molecule expressed by a non-tumor cell (e.g. , a protein that is misfolded, truncated, or otherwise mutated).
  • the second therapy comprises a chimeric antigen receptor (CAR)
  • T cell therapy See, e.g., John et al., 2013; Chong et al., 2016.
  • one or more of the peptide conjugates described above are administered in conjunction with a CAR-T cell cancer therapy to increase the efficacy of the CAR-T cell cancer therapy.
  • one or more of the peptide conjugates described above are administered in conjunction with an oncolytic virus as disclosed, for example, in US 2017/0143780.
  • oncolytic viruses are described above. Additional Therapeutic Uses
  • one or more of the peptide conjugates described above may be useful to reduce a symptom of a synucleinopathy, either alone or in combination with other therapeutic interventions such as L-DOPA, dopamine agonists (e.g., ropinirole, pramipexole), dopamine reuptake inhibitors (e.g., amantadine), and cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine).
  • dopamine agonists e.g., ropinirole, pramipexole
  • dopamine reuptake inhibitors e.g., amantadine
  • cholinesterase inhibitors e.g., donepezil, rivastigmine, galantamine
  • synucleinopathies include idiopathic and inherited forms of Parkinson’s disease (PD); Diffuse Lewy Body (DLB) disease, also known as Dementia with Lewy Bodies or Lewy body dementia; incidental Lewy body disease; Lewy body variant of Alzheimer’s disease (LBV); Combined Alzheimer's and Parkinson disease (CAPD); pure autonomic failure (PAP); multiple system atrophy (MSA), such as olivopontocerebellar atrophy, striatonigral degeneration, and Shy- Drager Syndrome; pantothenate kinase-associated neurodegeneration; Down’s Syndrome; Gaucher disease-related synucleinopathies; and neurodegeneration with brain iron accumulation.
  • PD Parkinson’s disease
  • LBV Lewy body variant of Alzheimer’s disease
  • LBV Lewy body variant of Alzheimer’s disease
  • CAPD Combined Alzheimer's and Parkinson disease
  • MSA multiple system atrophy
  • MSA multiple system atrophy
  • LAG3 expression is up-regulated in sepsis (Patil et ak, 2017). Accordingly, one or more of the peptide conjugates described above (e.g., BT1, BT2, BT4, BT5, BT6, BT7) may be useful to treat sepsis, either alone or in combination with other therapeutic interventions such as antibiotics, intravenous fluids, and vasopressors.
  • BT1, BT2, BT4, BT5, BT6, BT7 may be useful to treat sepsis, either alone or in combination with other therapeutic interventions such as antibiotics, intravenous fluids, and vasopressors.
  • one or more of the peptide conjugates described above can be administered to treat infectious diseases, including chronic infections, caused, e.g., by viruses, fungi, bacteria, and protozoa, and helminths, either alone or in combination with other therapeutic interventions.
  • viral agents include human immunodeficiency virus (HIV), Epstein Barr Virus (EBV), Herpes simplex (HSV, including HSV1 and HSV2), Human Papillomavirus (HPV), Varicella zoster (VSV) Cytomegalovirus (CMV), and hepatitis A, B, and C viruses.
  • HSV human immunodeficiency virus
  • EBV Epstein Barr Virus
  • HSV Herpes simplex
  • HPV Human Papillomavirus
  • VSV Varicella zoster
  • CMV Cytomegalovirus
  • hepatitis A, B, and C viruses hepatitis A, B, and C viruses.
  • fungal agents include Aspergillus, Candida, Coccidioides, Cryptococcus, and Histoplasma capsulatum.
  • bacterial agents include Streptococcal bacteria (e.g. , pyogenes, agalactiae, pneumoniae), Chlamydia pneumoniae, Listeria monocytogenes, and Mycobacterium tuberculosis .
  • protozoa examples include Sarcodina (e.g. , Entamoeba), Mastigophora (e.g. ,
  • Giardia Ciliophora (e.g., Balantidium), and Sporozoa (e.g., Plasmodium falciparum, Cryptosporidium).
  • helminths examples include Platyhelminths (e.g., trematodes, cestodes), Acanthocephalins, and Nematodes .
  • one or more of the peptide conjugates can be administered as a vaccine adjuvant in conjunction with a vaccine to enhance a response to vaccination (e.g., by increasing effector T cells and/or reducing T cell exhaustion).
  • the vaccine can be, for example, an RNA vaccine (e.g., US 2016/0130345, US 2017/0182150), a DNA vaccine, a recombinant vector, a protein vaccine, or a peptide vaccine.
  • RNA vaccine e.g., US 2016/0130345, US 2017/0182150
  • DNA vaccine e.g., a recombinant vector, a protein vaccine, or a peptide vaccine.
  • Such vaccines can be delivered, for example, using virus-like particles, as is well known in the art.
  • HTRF Time-resolved Fluorescence
  • BT9 contains two LD10 (SEQ ID NO: 1) peptides yet behaved in this assay like a LAG3 agonist. BT3 had similar agonistic response.
  • the IC50 for BT5 is an estimate due to the nature of the dose curve.
  • Peptide conjugates BT1-BT11 were tested at three concentrations: 3.6 mM, 10.8 pM, 32.5 pM in triplicate wells peptide conjugates were dissolved in DMSO and serially diluted in assay buffer. The highest concentration that can be tested in this assay was 32.5 pM peptide conjugate (1% DMSO).
  • Peptides LD12 (SEQ ID NO:9), LD10 (SEQ ID NO:l), and LD16 (SEQ ID NO: 10) were tested at three concentrations: 11 pM, 33 pM, 100 pM in triplicate.
  • LD peptides were dissolved in water and serially diluted in assay buffer. RLUs were measured at the end of the assay, and % Inhibition (%Efficiency) was calculated using the formula above.
  • AUNP-12 A Novel Peptide Therapeutic Targeting PD1 Immune Checkpoint Pathway for Cancer Immunotherapy - Structure Activity Relationships & Peptide/Peptidomimetic Analogs,” available at differding.com/data/AUNP_12_A_novel_peptide_therapeutic_targeting_PD_l_immune_ checkpoint_pathway_for_cancer_immunotherapy.pdf, February 26, 2014
  • VISTA is an inhibitory immune checkpoint that is increased after ipilimumab therapy in patients with prostate cancer.”
  • VCAM-1 specific PEGylated SAINT-based lipoplexes deliver siRNA to activated endothelium in vivo but do not attenuate target gene expression,” Int. J. Pharm. 469, 121-31, 2014
  • VSV strains with defects in their ability to shutdown innate immunity are potent systemic anti-cancer agents
  • LAG3 a novel lymphocyte activation gene closely related to CD4

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