WO2024102157A1 - Methods and compositions for treating diabetes and diabetic complications - Google Patents

Abstract

A method of treating or preventing the onset of diabetes or diabetic complications comprises administering to a subject a composition comprising an anti-AGE antibody. A composition for treating or preventing the onset of diabetes or diabetic complications comprises a first anti-AGE antibody, a second anti-AGE antibody and a pharmaceutically acceptable carrier. The first anti-AGE antibody is different from the second anti-AGE antibody. A method of treating or preventing the onset of diabetes or diabetic complications comprises immunizing a subject in need thereof against AGE-modified proteins or peptides of a cell.

Description

METHODS AND COMPOSITIONS FOR TREATING DIABETES AND DIABETIC COMPLICATIONS

BACKGROUND

[01] Diabetes mellitus, commonly referred to as diabetes or DM, is the general term for diseases and disorders that are characterized by recurrent or persistent elevated levels of blood glucose. Diabetes occurs when beta cells in the pancreas do not produce sufficient insulin and/or when the body cannot effectively use the insulin produced by beta cells. The most common forms of diabetes are Type 1 diabetes (also known as juvenile diabetes, juvenile-onset diabetes or insulindependent diabetes) and Type 2 diabetes (also known as adult-onset diabetes or non-insulin-dependent diabetes). Type 1 diabetes is an autoimmune disease in which the body attacks insulin-producing beta cells in the pancreas. Type 2 diabetes is a progressive metabolic disease in which the body becomes unable to properly regulate insulin and beta cells become unable to produce sufficient insulin.

[02] Diabetes is a significant public health problem. The World Health

Organization estimates that 422 million adults worldwide have diabetes (“Global Report on Diabetes”, World Health Organization, 2016). The United States Centers for Disease Control and Prevention (CDC) estimates that 29.1 million people in the U.S. currently have diabetes, which is 9.3% of the total population (“National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014”, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2014). Diabetes is currently the seventh leading cause of death in the U.S. and the estimated total costs of diabetes in the U.S. is $245 billion. The prevalence of diabetes is increasing and the CDC projects that one in three adults in the U.S. will have diabetes by 2050.

[03] Diabetes is associated with a number of complications, including heart disease such as cardiomyopathy, stroke, diabetic retinopathy, cataracts, glaucoma, kidney disease such as nephropathy, hypoglycemia, hyperglycemic crisis, high blood pressure, high blood LDL cholesterol, nerve disease, diabetic neuropathy (peripheral and autonomic neuropathy), neuropathic pain, cognitive impairment, non-alcoholic fatty liver disease, periodontal (gum) disease, hearing loss, erectile dysfunction, depression, complications with pregnancy, diabetic ketoacidosis, hyperosmolar hyperglycemic state and diabetic coma. These complications can result in severe consequences such as blindness, kidney failure, amputations, infections and even death.

[04] Diabetic complications may be studied in the mouse strain BTBR with the ob/ob leptin-deficiency mutation, a recently developed animal model of type 2 diabetes. The BTBR mouse has been recognized as a good animal model of diabetic neuropathy (O’Brien, P.D. et al., “BTBR ob/ob mice as a novel diabetic neuropathy model: Neurological characterization and gene expression analyses”, Neurobiology of Disease, Vol. 73, pp. 348-355 (2015)). The BTBR mouse also serves as an animal model of nephropathy and cardiomyopathy (Alpers, C.E. et al., “Mouse models of diabetic nephropathy”, Current Opinion in Nephrology and Hypertension, Vol. 20, No. 3, pp. 278-284 (2011); O’Brien, K.D. etal., “Divergent effects of vasodilators on cardiac hypertrophy and inflammation in a murine model of diabetic cardiomyopathy”, Journal of the American College of Cardiology, Vol. 57, Issue 17, p. E193 (2011)). The BTBR mouse has the potential to advance the development of treatments for diabetes and diabetic complications.

[05] Current treatments for diabetes and diabetic complications focus on maintaining blood glucose at normal levels. Type 1 diabetes is not preventable and blood glucose must be managed with insulin therapy, such as insulin injections or an implantable insulin pump. Type 2 diabetes may be prevented, treated or reversed with lifestyle changes, such as maintaining a healthy weight, eating a healthy diet, being physically active and avoiding tobacco use. If lifestyle changes are insufficient, Type 2 diabetics may manage their blood glucose by consuming oral glucose or regulating insulin levels through insulin injections or an implantable insulin pump. Bariatric surgery is a radical treatment option, but has been shown to prevent or even reverse Type 2 diabetes. Pharmacotherapies for treating and/or preventing diabetes and diabetic complications are limited. [06] Senescent cells are cells that are partially-functional or non-functional and are in a state of proliferative arrest. Senescence is a distinct state of a cell, and is associated with biomarkers, such as activation of the biomarker p16^lnk4a, and expression of ^-galactosidase. Senescence begins with damage or stress (such as overstimulation by growth factors) of cells.

[07] Advanced glycation end-products (AGEs; also referred to as AGE-modified proteins or peptides, or glycation end-products) arise from a non-enzymatic reaction of sugars with protein side-chains (Ando, K. et al., Membrane Proteins of Human Erythrocytes Are Modified by Advanced Glycation End Products during Aging in the Circulation, Biochem Biophys Res Commun., Vol. 258, 123, 125 (1999)). This process begins with a reversible reaction between the reducing sugar and the amino group to form a Schiff base, which proceeds to form a covalently-bonded Amadori rearrangement product. Once formed, the Amadori product undergoes further rearrangement to produce AGEs. Hyperglycemia and oxidative stress promote this post-translational modification of membrane proteins (Lindsey JB, et al., “Receptor For Advanced Glycation End-Products (RAGE) and soluble RAGE (sRAGE): Cardiovascular Implications," Diabetes Vascular Disease Research, Vol. 6(1), 7-14, (2009)). AGEs may also be formed from other processes. For example, the advanced glycation end product, N^e-(carboxymethyl)lysine, is a product of both lipid peroxidation and glycoxidation reactions. AGEs have been associated with several pathological conditions including inflammation, atherosclerosis, stroke, endothelial cell dysfunction, and neurodegenerative disorders (Bierhaus A, “AGEs and their interaction with AGE-receptors in vascular disease and diabetes mellitus. I. The AGE concept," Cardiovasc Res, Vol. 37(3), 586-600 (1998)).

[08] AGE-modified proteins are also a marker of senescent cells. This association between AGEs and senescence is well known in the art. See, for example, Gruber, L. (WO 2009/143411 , 26 Nov. 2009), Ando, K. et al. (Membrane Proteins of Human Erythrocytes Are Modified by Advanced Glycation End Products during Aging in the Circulation, Biochem Biophys Res Commun., Vol. 258, 123, 125 (1999)), Ahmed, E.K. etal. (“Protein Modification and Replicative Senescence of WI-38 Human Embryonic Fibroblasts” Aging Cells, vol. 9, 252, 260 (2010)), Vlassara, H. et al. (Advanced Glycosylation Endproducts on Erythrocyte Cell Surface Induce Receptor- Mediated Phagocytosis by Macrophages, J. Exp. Med., Vol. 166, 539, 545 (1987)) and Vlassara etal. (“High-affinity-receptor-mediated Uptake and Degradation of Glucose-modified Proteins: A Potential Mechanism for the Removal of Senescent Macromolecules” Proc. Natl. Acad. Sci. USAI, Vol. 82, 5588, 5591 (1985)). Furthermore, Ahmed, E.K. et al. indicates that glycation end-products are “one of the major causes of spontaneous damage to cellular and extracellular proteins" (Ahmed, E.K. et al., see above, page 353). Accordingly, the accumulation of glycation endproducts is associated with senescence and lack of function.

[09] The damage or stress that causes cellular senescence also negatively impacts mitochondrial DNA in the cells to cause them to produce free radicals which react with sugars in the cell to form methyl glyoxal (MG). MG in turn reacts with proteins or lipids to generate advanced glycation end products. In the case of the protein component lysine, MG reacts to form carboxymethyllysine, which is an AGE.

[10] Damage or stress to mitochondrial DNA also sets off a DNA damage response which induces the cell to produce cell cycle blocking proteins. These blocking proteins prevent the cell from dividing. Continued damage or stress causes mTOR production, which in turn activates protein synthesis and inactivates protein breakdown. Further stimulation of the cells leads to programmed cell death (apoptosis).

[11] p16 is a protein involved in regulation of the cell cycle, by inhibiting the S phase (synthesis phase). It can be activated during ageing or in response to various stresses, such as DNA damage, oxidative stress or exposure to drugs. p16 is typically considered a tumor suppressor protein, causing a cell to become senescent in response to DNA damage and irreversibly preventing the cell from entering a hyperproliferative state. However, there has been some ambiguity in this regard, as some tumors show overexpression of p16, while others show downregulated expression. Evidence suggests that overexpression of p16 is some tumors results from a defective retinoblastoma protein (“Rb”). p16 acts on Rb to inhibit the S phase, and Rb downregulates p16, creating negative feedback. Defective Rb fails to both inhibit the S phase and downregulate p16, thus resulting in overexpression of p16 in hyperproliferating cells (Romagosa, C. et al., p16^lnk4a overexpression in cancer: a tumor suppressor gene associated with senescence and high-grade tumors, Oncogene, Vol. 30, 2087-2097 (2011 )).

[12] Senescent cells are associated with secretion of many factors involved in intercellular signaling, including pro-inflammatory factors; secretion of these factors has been termed the senescence-associated secretory phenotype, or SASP (Freund, A. “Inflammatory networks during cellular senescence: causes and consequences” Trends Mol Med. 2010 May;16(5):238-46). Autoimmune diseases, such as Crohn’s disease and rheumatoid arthritis, are associated with chronic inflammation (Ferraccioli, G. et al. “Interleukin-1 and lnterleukin-6 in Arthritis Animal Models: Roles in the Early Phase of Transition from Acute to Chronic Inflammation and Relevance for Human Rheumatoid Arthritis” Mol Med. 2010 Nov-Dec; 16(11-12): 552-557). Chronic inflammation may be characterized by the presence of pro- inflammatory factors at levels higher than baseline near the site of pathology, but lower than those found in acute inflammation. Examples of these factors include TNF, IL-1a, IL-1 p, IL-5, IL-6, IL-8, IL-12, IL-23, CD2, CD3, CD20, CD22, CD52, CD80, CD86, C5 complement protein, BAFF, APRIL, IgE, a4pi integrin and a4p7 integrin. Senescent cells also upregulate genes with roles in inflammation including IL-1 p, IL-8, ICAM1, TNFAP3, ESM1 and CCL2 (Burton, D.G.A. et al., “Microarray analysis of senescent vascular smooth muscle cells: a link to atherosclerosis and vascular calcification”, Experimental Gerontology, Vol. 44, No. 10, pp. 659-665 (October 2009)). Because senescent cells produce pro-inflammatory factors, removal of these cells alone produces a profound reduction in inflammation as well as the amount and concentration of pro-inflammatory factors.

[13] Senescent cells secrete reactive oxygen species (“ROS”) as part of the SASP. ROS are believed to play an important role in maintaining senescence of cells. The secretion of ROS creates a bystander effect, where senescent cells induce senescence in neighboring cells: ROS create the very cellular damage known to activate p16 expression, leading to senescence (Nelson, G., A senescent cell bystander effect: senescence-induced senescence, Aging Cell, Vo. 11 , 345-349 (2012)). The p16/Rb pathway leads to the induction of ROS, which in turn activates the protein kinase C delta creating a positive feedback loop that further enhance ROS, helping maintain the irreversible cell cycle arrest; it has even been suggested that exposing cancer cells to ROS might be effective to treat cancer by inducing cell phase arrest in hyperproliferating cells (Rayess, H. et al., Cellular senescence and tumor suppressor gene p16, Int J Cancer, Vol. 130, 1715-1725 (2012)).

[14] Recent research demonstrates the therapeutic benefits of removing senescent cells. In vivo animal studies at the Mayo Clinic in Rochester, Minnesota, found that elimination of senescent cells in transgenic mice carrying a biomarker for elimination delayed age-related disorders associated with cellular senescence. Eliminating senescent cells in fat and muscle tissues substantially delayed the onset of sarcopenia and cataracts and reduced senescence indicators in skeletal muscle and the eye (Baker, D. J. et al., “Clearance of p16^lnk4a-positive senescent cells delays ageing-associated disorders”, Nature, Vol. 479, pp. 232-236, (2011)). Mice that were treated to induce senescent cell elimination were found to have larger diameters of muscle fibers as compared to untreated mice. Treadmill exercise tests indicated that treatment also preserved muscle function. Continuous treatment of transgenic mice for removal of senescent cells had no negative side effects and selectively delayed age-related phenotypes that depend on cells. This data demonstrates that removal of senescent cells produces beneficial therapeutic effects and shows that these benefits may be achieved without adverse effects.

[15] Additional In vivo animal studies in mice found that removing senescent cells using senolytic agents treats aging-related disorders and atherosclerosis. Shortterm treatment with senolytic drugs in chronologically aged or progeroid mice alleviated several aging-related phenotypes (Zhu, Y. et al., “The Achilles’ heel of senescent cells: from transcriptome to senolytic drugs”, Aging Cell, vol. 14, pp. 644- 658 (2015)). Long-term treatment with senolytic drugs improved vasomotor function in mice with established atherosclerosis and reduced intimal plaque calcification (Roos, C.M. et al., “Chronic senolytic treatment alleviates established vasomotor dysfunction in aged or atherosclerotic mice”, Aging Cell (2016)). This data further demonstrates the benefits of removing senescent cells. [16] Another in vivo animal study in mice found that a treatment for removing senescent cells improved glucose tolerance and insulin sensitivity in obese mice (Johmura, Y. et al., “Senolysis by glutaminolysis inhibition ameliorates various age- associated disorders”, Science, vol. 371 , pp. 265-270, (2021)). Bis-2-(5- phenylacetamido-1,3,4-thiadiazol-2-yl)ethyl sulfide (BPTES) was administered to aged mice, which inhibited kidney-type glutaminase (KGA) production. The inhibition of KGA-dependent glutaminase in aged mice eliminated senescent cells.

[17] Vaccines have been widely used since their introduction by Edward Jenner in the 1770s to confer immunity against a wide range of diseases and afflictions. Vaccine preparations contain a selected immunogenic agent capable of stimulating immunity to an antigen. Typically, antigens are used as the immunogenic agent in vaccines, such as, for example, viruses, either killed or attenuated, and purified viral components. Antigens used in the production of cancer vaccines include, for example, tumor-associated carbohydrate antigens (TACAs), dendritic cells, whole cells and viral vectors. Different techniques are employed to produce the desired amount and type of antigen being sought. For example, pathogenic viruses are grown either in eggs or cells. Recombinant DNA technology is often utilized to generate attenuated viruses for vaccines.

[18] Vaccines may therefore be used to stimulate the production of antibodies in the body and provide immunity against antigens. When an antigen is introduced to a subject that has been vaccinated and developed immunity to that antigen, the immune system may destroy or remove cells that express the antigen.

SUMMARY

[19] In a first aspect, the invention is a method of treating or preventing the onset of diabetes or diabetic complications, including administering to a subject a composition comprising an anti-AGE antibody.

[20] In a second aspect, the invention is a method of treating or preventing the onset diabetes or diabetic complications, including administering to a subject a composition comprising a first anti-AGE antibody and a second anti-AGE antibody; wherein the second anti-AGE antibody is different from the first anti-AGE antibody.

[21] In a third aspect, the invention is a method of treating a subject with diabetes or diabetic complications, including a first administering of an anti-AGE antibody; followed by testing the subject for effectiveness of the first administration at treating diabetes or diabetic complications; followed by a second administering of the anti- AGE antibody

[22] In a fourth aspect, the invention is a method of treating or preventing the onset of diabetes or diabetic complications, including immunizing a subject in need thereof against AGE-modified proteins or peptides of a cell.

[23] DEFINITIONS

[24] The term “diabetes” means a disease or disorder characterized by persistent elevated levels of blood glucose in which a subject has an A1C level greater than 5.7% when measured on two separate occasions. Diabetes includes Type 1 diabetes, Type 2 diabetes, gestational diabetes, prediabetes, latent autoimmune diabetes of adults, congenital diabetes, monogenic diabetes, maturity-onset diabetes of the young (MODY), cystic fibrosis-related diabetes and idiopathic diabetes.

[25] The term “peptide” means a molecule composed of 2-50 amino acids.

[26] The term “protein” means a molecule composed of more than 50 amino acids.

[27] The terms “advanced glycation end-product” , “AGE”, “AGE-modified protein”, “AGE-modified peptide” and “glycation end-product’ refer to modified proteins or peptides that are formed as the result of the reaction of sugars with protein side chains that further rearrange and form irreversible cross-links. This process begins with a reversible reaction between a reducing sugar and an amino group to form a Schiff base, which proceeds to form a covalently-bonded Amadori rearrangement product. Once formed, the Amadori product undergoes further rearrangement to produce AGEs. AGE-modified proteins and antibodies to AGE-modified proteins are described in U.S. 5,702,704 to Bucala {“Bucala”) and U.S. 6,380,165 to Al-Abed et al. (“Al-Abed”). Glycated proteins or peptides that have not undergone the necessary rearrangement to form AGEs, such as N-deoxyfructosyllysine found on glycated albumin, are not AGEs. AGEs may be identified by the presence of AGE modifications (also referred to as AGE epitopes or AGE moieties) such as 2-(2- furoyl)-4(5)-(2-furanyl)-1 H-imidazole ("FFI"); 5-hydroxymethyl-1-alkylpyrrole-2- carbaldehyde ("Pyrraline"); 1-alkyl-2-formyl-3,4-diglycosyl pyrrole ("AFGP"), a non- fluorescent model AGE; carboxymethyllysine; carboxyethyllysine; and pentosidine. ALI, another AGE, is described in Al-Abed.

[28] The term “AGE antigen” means a substance that elicits an immune response against an AGE-modified protein or peptide of a cell. The immune response against an AGE-modified protein or peptide of a cell does not include the production of antibodies to the non-AGE-modified protein or peptide.

[29] “An antibody that binds to an AGE-modified protein on a cell", “anti-AGE antibody" or “AGE antibody” means an antibody, antibody fragment or other protein or peptide that binds to an AGE-modified protein or peptide which preferably includes a constant region of an antibody, where the protein or peptide which has been AGE-modified is a protein or peptide normally found bound on the surface of a cell, preferably a mammalian cell, more preferably a human, cat, dog, horse, camelid (for example, camel or alpaca), cattle, sheep, or goat cell. “An antibody that binds to an AGE-modified protein on a cell”, “anti-AGE antibody” or “AGE antibody” does not include an antibody or other protein which binds with the same specificity and selectivity to both the AGE-modified protein or peptide, and the same non-AGE- modified protein or peptide (that is, the presence of the AGE modification does not increase binding). AGE-modified albumin is not an AGE-modified protein on a cell, because albumin is not a protein normally found bound on the surface of cells. “An antibody that binds to an AGE-modified protein on a cell”, “anti-AGE antibody” or “AGE antibody" only includes those antibodies which lead to removal, destruction, or death of the cell. Also included are antibodies which are conjugated, for example to a toxin, drug, or other chemical or particle. Preferably, the antibodies are monoclonal antibodies, but polyclonal antibodies are also possible. [30] The term “senescent cell” means a cell which is in a state of proliferative arrest and expresses one or more biomarkers of senescence, such as activation of p1gink4a or expression of senescence-associated p-galactosidase. Also included are cells which express one or more biomarkers of senescence, do not proliferate in vivo, but may proliferate in vitro under certain conditions, such as some satellite cells found in the muscles of ALS patients.

[31] The term “variant” means a nucleotide, protein or amino acid sequence different from the specifically identified sequences, wherein one or more nucleotides, proteins or amino acid residues is deleted, substituted or added. Variants may be naturally-occurring allelic variants, or non-naturally-occurring variants. Variants of the identified sequences may retain some or all of the functional characteristics of the identified sequences.

[32] The term "percent (%) sequence identity" is defined as the percentage of amino acid residues in a candidate sequence that are identical to the amino acid residues in a reference polypeptide sequence, after aligning the sequences and introducing gaps, if necessary, to achieve the maximum percent sequence identity, and not considering any conservative substitutions as part of the sequence identity. Alignment for purposes of determining percent amino acid sequence identity can be achieved in various ways using publicly available computer software such as BLAST, BLAST-2, ALIGN or Megalign (DNASTAR) software. Preferably, % sequence identity values are generated using the sequence comparison computer program ALIGN-2. The ALIGN-2 sequence comparison computer program is publicly available from Genentech, Inc. (South San Francisco, GA), or may be compiled from the source code, which has been filed with user documentation in the U.S. Copyright Office and is registered under U.S. Copyright Registration No. TXU510087. The ALIGN-2 program should be compiled for use on a UNIX operating system, including digital UNIX V4.0D. All sequence comparison parameters are set by the ALIGN-2 program and do not vary.

[33] In situations where ALIGN-2 is employed for amino acid sequence comparisons, the % sequence identity of a given amino acid sequence A to, with, or against a given amino acid sequence B (which can alternatively be phrased as a given amino acid sequence A that has or comprises a certain % amino acid sequence identity to, with, or against a given amino acid sequence B) is calculated as follows: 100 times the fraction X/Y where X is the number of amino acid residues scored as identical matches by the sequence alignment program ALIGN-2 in that program’s alignment of A and B, and where Y is the total number of amino acid residues in B. Where the length of amino acid sequence A is not equal to the length of amino acid sequence B, the % amino acid sequence identity of A to B will not equal the % amino acid sequence identity of B to A. Unless specifically stated otherwise, all % amino acid sequence identity values used herein are obtained using the ALIGN-2 computer program.

BRIEF DESCRIPTION OF THE DRAWING

[34] FIG. 1 is a graph of the response versus time in an antibody binding experiment.

DETAILED DESCRIPTION

[35] Elevated blood glucose has long been considered to be the primary cause of diabetes. Recent research into the pathogenesis of diabetes and diabetic complications has revealed that the mechanism is more complex. A number of studies have indicated that cellular senescence is the main proponent in the development and progression of diabetes and diabetic complications.

[36] Senescent cells have been identified as a contributing factor to the onset and progression of both Type 1 and Type 2 diabetes through the secretion of reactive oxygen species. Reactive oxygen species contribute to Type 1 diabetes by activating inflammatory and apoptotic processes involved in beta cell dysfunction (Radoi, V. et al., “Advanced glycation end-products in diabetes mellitus: mechanism of action and focused treatment” , Proceedings of the Romanian Academy, Series B, No. 1 , p. 9-19 (2012)). In Type 2 diabetes, reactive oxygen species disrupt transmission pathways between the insulin receptor and the glucose transport system, which causes insulin resistance and inactivation of anti-atherosclerotic enzymes. The interaction of toxic AGEs, a marker of senescent cells, with their receptors (RAGE) in endothelial and inflammatory cells also leads to intracellular generation of reactive oxygen species.

[37] Senescent cells have been linked specifically with Type 2 diabetes. Elevated glucose is known to promote premature senescence in vitro in endothelial cells, renal mesangial cells, adipose-derived stem cells and fibroblasts (Palmer, A.K. et al., “Cellular senescence in Type 2 diabetes: a therapeutic opportunity”, Diabetes, Vol 64, pp. 2289-2298 (2015)). Other metabolic and signaling changes seen in diabetes such as altered lipid metabolism and growth hormone axis perturbations also promote senescent cell formation. Inflammatory factors are part of the senescence- associated secretory phenotype (SASP) and are thought to be a major contributor to the development of insulin resistance. The association between inflammation and proinflammatory factors and cellular senescence is described in more detail in WO 2016/044252 and in Application No. 62/443,557. Cellular senescence may directly contribute to Type 2 diabetes through beta cell senescence. Senescent cells may be both a cause and a consequence of Type 2 diabetes as part of a pathogenic feedback loop (Palmer et al.). In addition, a high proportion of senescent islets of Langerhans, which decreases the beta cell number and islet mass to pathological levels, was found in a mouse model of Friedreich’s ataxia, a disorder characterized by diabetes (Mol , B. et al., “Two different pathogenic mechanisms, dying-back axonal neuropathy and pancreatic senescence, are present in the YG8R mouse model of Friedreich’s ataxia”, Disease Models & Mechanisms, Vol. 9, pp. 647-657 (2016)).

[38] The relationship between AGEs and diabetes and diabetic complications also implicates cellular senescence. Carboxy methyl lysine (CML), the most well-known AGE, induced cell death in human pancreatic beta cells in vitro and was accompanied by an increase in intracellular oxidative stress (Boesten, D.M.P.H.J. et al., “Effect of Ns-carboxymethyllysine on oxidative stress and the glutathione system in beta cells”, Toxicology Reports, Vol. 1, pp. 973-980 (2014)). AGEs have been associated with diabetic complications including diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic cardiomyopathy, thrombogenesis, atherosclerosis, stroke, osteoporosis and erectile dysfunction. While the specific mechanism varies depending on the diabetic complication, many diabetic complications result from an increase in proinflammatory factors such as NF-KB, TNF-a and IL-6 or an increase in fibrosis by promoting profibrotic proteins such as TGF-P, both of which are promoted by AGEs and the AGE-RAGE interaction (Radoi etal.). AGEs have also been indirectly implicated in diabetic complications though methylglyoxal, a known cause of AGEs. For example, methylglyoxal increases the chronic extremity soreness in diabetic neuropathy (“Methylglyoxal”, available online at en.wikipedia.org/wiki/Methylglyoxal (June 5, 2017)). The presence of AGEs in skin, serum, saliva and urine has been correlated with diabetes and diabetic complications (Garay-Sevilla, M.E. et al., “Advanced glycosylation end products in skin, serum, saliva and urine and its association with complications of patients with Type 2 diabetes mellitus”, Journal of Endocrinological Investigation, Vol. 28, No. 5, pp. 223-230 (2005); Yoon, M-S. et al., “Characterisation of advanced glycation endproducts in saliva from patients with diabetes mellitus", Biochemical and Biophysical Research Communications, Vol. 323, Issue 2, pp. 377-381 (2004)).

[39] AGEs have also been associated with the development of diabetic complications through matrix metalloproteinases (MMPs). MMPs have been implicated in a number of diabetic microvascular complications including diabetic nephropathy, diabetic cardiomyopathy, diabetic peripheral arterial disease, cerebral circulation and stroke volume in diabetes and poor diabetic wound healing (Tsioufis, C. et al., “The role of matrix metalloproteinases in diabetes mellitus”, Current Topics in Medicinal Chemistry, Vol.12, No.10, Pages 1159 - 1165 (2012)). Expression of the MMP macrophage metalloelastase (MMP12) is correlated positively and significantly with insulin resistance, TNF-a expression and the number of CD14+ CD206+ macrophages in adipose tissue (Lee, J-T. et al., “Macrophage metalloelastase (MMP12) regulates adipose tissue expansion, insulin sensitivity, and expression of inducible nitric oxide synthase”, Endocrinology, Vol. 155, No. 9, p. 3409-3420 (2014)). AGEs can be one of the major factors influencing the progression of diabetic nephropathy by modulating the expression of MMPs (Xu, X. et al., “A glimpse of matrix metalloproteinases in diabetic nephropathy”, Current Medicinal Chemistry, Vol. 21 , No. 28, p. 3244-3260 (2014)).

[40] The recognition of a link between AGEs and diabetes has resulted in research into therapies that target AGEs for treating diabetic complications. Therapies that have been investigated for treating diabetic complications include aminoguanidine, pyridoxamine, benfotiamine, LR-90, soluble AGE receptor molecules, angiotensinconverting-enzyme (ACE) inhibitors, angiotensin II receptor antagonists, superoxide dismutase (SOD)Zcatalase mimetics, bisphosphonates, minodronate, statins, AGE- breakers, pyridinium (TRC4186), alagebrium (ALT-711) and Janus kinase (JAK) inhibitors (Radoi eta/.; Xu, M. et a/., “Targeting senescent cells enhances adipogenesis and metabolic function in old age”, eLife (2015)). However, none of these therapies targets senescent cells, the root cause of diabetes and diabetic complications.

[41] The therapeutic benefits of removing senescent cells has been demonstrated in atherosclerosis and in age-related diseases, such as sarcopenia. The identification of a link between cellular senescence, either directly or through AGEs, and diabetes and diabetic complications allows for similar treatment possibilities. The present invention uses enhanced clearance of cells expressing AGE-modified proteins or peptides (AGE-modified cells) to treat, ameliorate or prevent the onset of diabetes and diabetic complications by removing or killing senescent cells. This may be accomplished by administering anti-AGE antibodies to a subject.

[42] Vaccination against AGE-modified proteins or peptides of a cell may also be used to control the presence of AGE-modified cells in a subject. The continuous and virtually ubiquitous surveillance exercised by the immune system in the body in response to a vaccination allows maintaining low levels of AGE-modified cells in the body. Vaccination against AGE-modified proteins or peptides of a cell removes or kills senescent cells. The process of senescent cell removal or destruction allows vaccination against AGE-modified proteins or peptides of a cell to be used to treat or prevent the onset of diabetes and diabetic complications. [43] An antibody that binds to an AGE-modified protein on a cell (“anti-AGE antibody” or “AGE antibody”) is known in the art. Examples include those described in U.S. 5,702,704 (Bucala) and U.S. 6,380,165 (Al-Abed etal.). The antibody may bind to one or more AGE-modified proteins or peptides having an AGE modification such as FFI, pyrraline, AFGP, ALI, carboxymethyllysine, carboxyethyl lysine and pentosidine, and mixtures of such antibodies. Preferably, the antibody binds carboxymethyllysine-modified or carboxyethyllysine-modified proteins. Preferably, the antibody is non-immunogenic to the animal in which it will be used, such as non- immunogenic to humans; companion animals including cats, dogs and horses; and commercially important animals, such camels (or alpaca), cattle (bovine), sheep, and goats. More preferably, the antibody has the same species constant region as antibodies of the animal to reduce the immune response against the antibody, such as being humanized (for humans), felinized (for cats), caninized (for dogs), equuinized (for horses), camelized (for camels or alpaca), bovinized (for cattle), ovinized (for sheep), or caperized (for goats). Most preferably, the antibody is identical to that of the animal in which it will be used (except for the variable region), such as a human antibody, a cat antibody, a dog antibody, a horse antibody, a camel antibody, a bovine antibody, a sheep antibody or a goat antibody. Details of the constant regions and other parts of antibodies for these animals are described below. The antibody may be monoclonal or polyclonal. Preferably, the antibody is a monoclonal antibody.

[44] Preferred anti-AGE antibodies include those which bind to proteins or peptides that exhibit a carboxymethyllysine or carboxyethyllysine AGE modification. Carboxymethyllysine (also known as N(epsilon)-(carboxymethyl)lysine, N(6)- carboxymethyllysine, or 2-Amino-6-(carboxymethylamino)hexanoic acid) and carboxyethyllysine (also known as N-epsilon-(carboxyethyl)lysine) are found on proteins or peptides and lipids as a result of oxidative stress and chemical glycation. CML- and CEL-modified proteins or peptides are recognized by the receptor RAGE which is expressed on a variety of cells. CML and CEL have been well-studied and CML- and CEL-related products are commercially available. For example, Cell Biolabs, Inc. sells CML-BSA antigens, CML polyclonal antibodies, CML immunoblot kits, and CML competitive ELISA kits (www.cellbiolabs.com/cml-assays) as well as CEL-BSA antigens and CEL competitive ELISA kits (www.cellbiolabs.com/cel-n- epsilon-carboxyethyl-lysine-assays-and-reagents). A particularly preferred antibody includes the variable region of the commercially available mouse anti-glycation endproduct antibody raised against carboxymethyl lysine conjugated with keyhole limpet hemocyanin, the carboxymethyl lysine MAb (Clone 318003) available from R&D Systems, Inc. (Minneapolis, MN; catalog no. MAB3247), modified to have a human constant region (or the constant region of the animal into which it will be administered). Commercially-available antibodies, such as the carboxymethyl lysine antibody corresponding to catalog no. MAB3247 from R&D Systems, Inc., may be intended for diagnostic purposes and may contain material that is not suited for use in animals or humans. Preferably, commercially-available antibodies are purified and/or isolated prior to use in animals or humans to remove toxins or other potentially-harmful material.

[45] The anti-AGE antibody has low rate of dissociation from the antibody-antigen complex, or kd (also referred to as kback or off-rate), preferably at most 9 x 10’³, 8 x

10’³, 7 x 10’³ or 6 x 10’³ (sec’¹). The anti-AGE antibody has a high affinity for the AGE-modified protein of a cell, which may be expressed as a low dissociation constant KD of at most 9 x 10'⁶, 8 x 10’⁶, 7 x 10’⁶, 6 x 10'⁶, 5 x 10*⁶, 4 x 10^-6 or 3 x 10’⁶ (M). Preferably, the binding properties of the anti-AGE antibody are similar to, the same as, or superior to the carboxymethyl lysine MAb (Clone 318003) available from R&D Systems, Inc. (Minneapolis, MN; catalog no. MAB3247), illustrated in FIG. 1.

[46] The anti-AGE antibody may destroy AGE-modified cells through antibodydependent cell-mediated cytotoxicity (ADCC). ADCC is a mechanism of cell- mediated immune defense in which an effector cell of the immune system actively lyses a target cell whose membrane-surface antigens have been bound by specific antibodies. ADCC may be mediated by natural killer (NK) cells, macrophages, neutrophils or eosinophils. The effector cells bind to the Fc portion of the bound antibody. The anti-AGE antibody may also destroy AGE-modified cells through complement-dependent cytotoxicity (CDC). In CDC, the complement cascade of the immune system is triggered by an antibody binding to a target antigen. [47] The anti-AGE antibody may be conjugated to an agent that causes the destruction of AGE-modified cells. Such agents may be a toxin, a cytotoxic agent, magnetic nanoparticles, and magnetic spin-vortex discs.

[48] A toxin, such as pore-forming toxins (PFT) (Aroian R. et al., “Pore-Forming Toxins and Cellular Non-lmmune Defenses (CNIDs),” Current Opinion in Microbiology, 10:57-61 (2007)), conjugated to an anti-AGE antibody may be injected into a patient to selectively target and remove AGE-modified cells. The anti-AGE antibody recognizes and binds to AGE-modified cells. Then, the toxin causes pore formation at the cell surface and subsequent cell removal through osmotic lysis.

[49] Magnetic nanoparticles conjugated to the anti-AGE antibody may be injected into a patient to target and remove AGE-modified cells. The magnetic nanoparticles can be heated by applying a magnetic field in order to selectively remove the AGE- modified cells.

[50] As an alternative, magnetic spin-vortex discs, which are magnetized only when a magnetic field is applied to avoid self-aggregation that can block blood vessels, begin to spin when a magnetic field is applied, causing membrane disruption of target cells. Magnetic spin-vortex discs, conjugated to anti-AGE antibodies specifically target AGE-modified cell types, without removing other cells.

[51] Antibodies are Y-shaped proteins composed of two heavy chains and two light chains. The two arms of the Y shape form the fragment antigen-binding (Fab) region while the base or tail of the Y shape forms the fragment crystallizable (Fc) region of the antibody. Antigen binding occurs at the terminal portion of the fragment antigen-binding region (the tips of the arms of the Y shape) at a location referred to as the paratope, which is a set of complementarity determining regions (also known as CDRs or the hypervariable region). The complementarity determining regions vary among different antibodies and gives a given antibody its specificity for binding to a given antigen. The fragment crystallizable region of the antibody determines the result of antigen binding and may interact with the immune system, such as by triggering the complement cascade or initiating antibody-dependent cell-mediated cytotoxicity (ADCC). When antibodies are prepared recombinantly, it is also possible to have a single antibody with variable regions (or complementary determining regions) that bind to two different antigens, with each tip of the Y shape being specific to one of the antigens; these are referred to as bi-specific antibodies.

[52] A humanized anti-AGE antibody according to the present invention may have the human constant region sequence of amino acids shown in SEQ ID NO: 22. The heavy chain complementarity determining regions of the humanized anti-AGE antibody may have one or more of the protein sequences shown in SEQ ID NO: 23 (CDR1 H), SEQ ID NO: 24 (CDR2H) and SEQ ID NO: 25 (CDR3H). The light chain complementarity determining regions of the humanized anti-AGE antibody may have one or more of the protein sequences shown in SEQ ID NO: 26 (CDR1L), SEQ ID NO: 27 (CDR2L) and SEQ ID NO: 28 (CDR3L).

[53] The heavy chain of a humanized anti-AGE antibody may have or may include the protein sequence of SEQ ID NO: 1. The variable domain of the heavy chain may have or may include the protein sequence of SEQ ID NO: 2. The complementarity determining regions of the variable domain of the heavy chain (SEQ ID NO: 2) are shown in SEQ ID NO: 41, SEQ ID NO: 42 and SEQ ID NO: 43. The kappa light chain of a humanized anti-AGE antibody may have or may include the protein sequence of SEQ ID NO: 3. The variable domain of the kappa light chain may have or may include the protein sequence of SEQ ID NO: 4. Optionally, the arginine (Arg or R) residue at position 128 of SEQ ID NO: 4 may be omitted. The complementarity determining regions of the variable domain of the light chain (SEQ ID NO: 4) are shown in SEQ ID NO: 44, SEQ ID NO: 45 and SEQ ID NO: 46. The variable regions may be codon-optimized, synthesized and cloned into expression vectors containing human immunoglobulin G1 constant regions. In addition, the variable regions may be used in the preparation of non-human anti-AGE antibodies.

[54] The antibody heavy chain may be encoded by the DNA sequence of SEQ ID NO: 12, a murine anti-AGE immunoglobulin G2b heavy chain. The protein sequence of the murine anti-AGE immunoglobulin G2b heavy chain encoded by SEQ ID NO: 12 is shown in SEQ ID NO: 16. The variable region of the murine antibody is shown in SEQ ID NO: 20, which corresponds to positions 25-142 of SEQ ID NO: 16. The antibody heavy chain may alternatively be encoded by the DNA sequence of SEQ ID NO: 13, a chimeric anti-AGE human immunoglobulin G1 heavy chain. The protein sequence of the chimeric anti-AGE human immunoglobulin G1 heavy chain encoded by SEQ ID NO: 13 is shown in SEQ ID NO: 17. The chimeric anti-AGE human immunoglobulin includes the murine variable region of SEQ ID NO: 20 in positions 25-142. The antibody light chain may be encoded by the DNA sequence of SEQ ID NO: 14, a murine anti-AGE kappa light chain. The protein sequence of the murine anti-AGE kappa light chain encoded by SEQ ID NO: 14 is shown in SEQ ID NO: 18. The variable region of the murine antibody is shown in SEQ ID NO: 21, which corresponds to positions 21-132 of SEQ ID NO: 18. The antibody light chain may alternatively be encoded by the DNA sequence of SEQ ID NO: 15, a chimeric anti- AGE human kappa light chain. The protein sequence of the chimeric anti-AGE human kappa light chain encoded by SEQ ID NO: 15 is shown in SEQ ID NO: 19. The chimeric anti-AGE human immunoglobulin includes the murine variable region of SEQ ID NO: 21 in positions 21-132.

[55] A humanized anti-AGE antibody according to the present invention may have or may include one or more humanized heavy chains or humanized light chains. A humanized heavy chain may be encoded by the DNA sequence of SEQ ID NO: 30, 32 or 34. The protein sequences of the humanized heavy chains encoded by SEQ ID NOs: 30, 32 and 34 are shown in SEQ ID NOs: 29, 31 and 33, respectively. A humanized light chain may be encoded by the DNA sequence of SEQ ID NO: 36, 38 or 40. The protein sequences of the humanized light chains encoded by SEQ ID NOs: 36, 38 and 40 are shown in SEQ ID NOs: 35, 37 and 39, respectively. Preferably, the humanized anti-AGE antibody maximizes the amount of human sequence while retaining the original antibody specificity. A complete humanized antibody may be constructed that contains a heavy chain having a protein sequence chosen from SEQ ID NOs: 29, 31 and 33 and a light chain having a protein sequence chosen from SEQ ID NOs: 35, 37 and 39.

[56] Particularly preferred anti-AGE antibodies may be obtained by humanizing murine monoclonal anti-AGE antibodies. Murine monoclonal anti-AGE antibodies have the heavy chain protein sequence shown in SEQ ID NO: 47 (the protein sequence of the variable domain is shown in SEQ ID NO: 52) and the light chain protein sequence shown in SEQ ID NO: 57 (the protein sequence of the variable domain is shown in SEQ ID NO: 62). A preferred humanized heavy chain may have the protein sequence shown in SEQ ID NO: 48, SEQ ID NO: 49, SEQ ID NO: 50 or SEQ ID NO: 51 (the protein sequences of the variable domains of the humanized heavy chains are shown in SEQ ID NO: 53, SEQ ID NO: 54, SEQ ID NO: 55 and SEQ ID NO: 56, respectively). A preferred humanized light chain may have the protein sequence shown in SEQ ID NO: 58, SEQ ID NO: 59, SEQ ID NO: 60 or SEQ ID NO: 61 (the protein sequences of the variable domains of the humanized light chains are shown in SEQ ID NO: 63, SEQ ID NO: 64, SEQ ID NO: 65 and SEQ ID NO: 66, respectively). Preferably, a humanized anti-AGE monoclonal antibody is composed a heavy chain having a protein sequence selected from the group consisting of SEQ ID NO: 48, SEQ ID NO: 49, SEQ ID NO: 50 and SEQ ID NO: 51 and a light chain having a protein sequence selected from the group consisting of SEQ ID NO: 58, SEQ ID NO: 59, SEQ ID NO: 60 and SEQ ID NO: 61. Humanized monoclonal anti-AGE antibodies composed of these protein sequences may have better binding and/or improved activation of the immune system, resulting in greater efficacy.

[57] The protein sequence of an antibody from a non-human species may be modified to include the variable domain of the heavy chain having the sequence shown in SEQ ID NO: 2 or the kappa light chain having the sequence shown in SEQ ID NO: 4. The non-human species may be a companion animal, such as the domestic cat or domestic dog, or livestock, such as cattle, the horse or the camel. Preferably, the non-human species is not the mouse. The heavy chain of the horse (Equus caballus) antibody immunoglobulin gamma 4 may have or may include the protein sequence of SEQ ID NO: 5 (EMBL/GenBank accession number AY445518). The heavy chain of the horse (Equus caballus) antibody immunoglobulin delta may have or may include the protein sequence of SEQ ID NO: 6 (EMBL/GenBank accession number AY631942). The heavy chain of the dog (Canis familiaris) antibody immunoglobulin A may have or may include the protein sequence of SEQ ID NO: 7 (GenBank accession number L36871). The heavy chain of the dog (Canis familiaris) antibody immunoglobulin E may have or may include the protein sequence of SEQ ID NO: 8 (GenBank accession number L36872). The heavy chain of the cat (Fe/zs catus) antibody immunoglobulin G2 may have or may include the protein sequence of SEQ ID NO: 9 (DDBJ/EMBL/GenBank accession number KF811175).

[58] Animals of the camelid family, such as camels (Camelus dromedarius and Camelus bactrianus), llamas (Lama glama, Lama pacos and Lama vicugna), alpacas (Vicugna pacos) and guanacos (Lama guanicoe), have a unique antibody that is not found in other mammals. In addition to conventional immunoglobulin G antibodies composed of heavy and light chain tetramers, camelids also have heavy chain immunoglobulin G antibodies that do not contain light chains and exist as heavy chain dimers. These antibodies are known as heavy chain antibodies, HCAbs, single-domain antibodies or sdAbs, and the variable domain of a camelid heavy chain antibody is known as the VHH. The camelid heavy chain antibodies lack the heavy chain CH1 domain and have a hinge region that is not found in other species. The variable region of the Arabian camel (Camelus dromedarius) single-domain antibody may have or may include the protein sequence of SEQ ID NO: 10 (GenBank accession number AJ245148). The variable region of the heavy chain of the Arabian camel (Camelus dromedarius) tetrameric immunoglobulin may have or may include the protein sequence of SEQ ID NO: 11 (GenBank accession number AJ245184).

[59] In addition to camelids, heavy chain antibodies are also found in cartilaginous fishes, such as sharks, skates and rays. This type of antibody is known as an immunoglobulin new antigen receptor or IgNAR, and the variable domain of an IgNAR is known as the VNAR. The IgNAR exists as two identical heavy chain dimers composed of one variable domain and five constant domains each. Like camelids, there is no light chain.

[60] The protein sequences of additional non-human species may be readily found in online databases, such as the International ImMunoGeneTics Information System (www.imgt.org), the European Bioinformatics Institute (www.ebi.ac.uk), the DNA Databank of Japan (ddbj.nig.ac.jp/arsa) or the National Center for Biotechnology Information (www.ncbi.nlm.nih.gov).

[61] An anti-AGE antibody or a variant thereof may include a heavy chain having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to the amino acid sequence of SEQ ID NO: 1, SEQ ID NO: 16, SEQ ID NO: 17, SEQ ID NO: 29, SEQ ID NO: 31 , SEQ ID NO: 33, SEQ ID NO: 47, SEQ ID NO: 48, SEQ ID NO: 49, SEQ ID NO: 50 or SEQ ID NO: 51, including post-translational modifications thereof. A heavy chain having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity may contain substitutions (e.g., conservative substitutions), insertions, or deletions relative to the reference sequence, but an anti-AGE antibody including that sequence retains the ability to bind to AGE.

[62] An anti-AGE antibody or a variant thereof may include a heavy chain variable region having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to the amino acid sequence of SEQ ID NO: 2, SEQ ID NO: 20, SEQ ID NO: 23, SEQ ID NO: 24, SEQ ID NO: 25, SEQ ID NO: 41 , SEQ ID NO: 42, SEQ ID NO: 43, SEQ ID NO: 52, SEQ ID NO: 53, SEQ ID NO: 54, SEQ ID NO: 55, or SEQ ID NO: 56, including post-translational modifications thereof. A variable region having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity may contain substitutions (e.g., conservative substitutions), insertions, or deletions relative to the reference sequence, but an anti-AGE antibody including that sequence retains the ability to bind to AGE. The substitutions, insertions, or deletions may occur in regions outside the variable region.

[63] An anti-AGE antibody or a variant thereof may include a light chain having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to the amino acid sequence of SEQ ID NO: 3, SEQ ID NO: 18, SEQ ID NO: 19, SEQ ID NO: 35, SEQ ID NO: 37, SEQ ID NO: 39, SEQ ID NO: 57, SEQ ID NO: 58, SEQ ID NO: 59, SEQ ID NO: 60 or SEQ ID NO: 61, including post-translational modifications thereof. A light chain having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity may contain substitutions (e.g., conservative substitutions), insertions, or deletions relative to the reference sequence, but an anti-AGE antibody including that sequence retains the ability to bind to AGE. The substitutions, insertions, or deletions may occur in regions outside the variable region.

[64] An anti-AGE antibody or a variant thereof may include a light chain variable region having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to the amino acid sequence of SEQ ID NO: 4, SEQ ID NO: 21, SEQ ID NO: 26, SEQ ID NO: 27, SEQ ID NO: 28, SEQ ID NO: 44, SEQ ID NO: 45, SEQ ID NO: 46, SEQ ID NO: 62, SEQ ID NO: 63, SEQ ID NO: 64, SEQ ID NO: 65 or SEQ ID NO: 66, including post-translational modifications thereof. A variable region having at least 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity may contain substitutions (e.g., conservative substitutions), insertions, or deletions relative to the reference sequence, but an anti-AGE antibody including that sequence retains the ability to bind to AGE. The substitutions, insertions, or deletions may occur in regions outside the variable region.

[65] Alternatively, the antibody may have the complementarity determining regions of commercially available mouse anti-glycation end-product antibody raised against carboxymethyl lysine conjugated with keyhole limpet hemocyanin (CML-KLH), the carboxymethyl lysine MAb (Clone 318003) available from R&D Systems, Inc. (Minneapolis, MN; catalog no. MAB3247).

[66] The antibody may have or may include constant regions which permit destruction of targeted cells by a subject’s immune system.

[67] Mixtures of antibodies that bind to more than one type AGE of AGE-modified proteins may also be used.

[68] Bi-specific antibodies, which are anti-AGE antibodies directed to two different epitopes, may also be used. Such antibodies will have a variable region (or complementary determining region) from those of one anti-AGE antibody, and a variable region (or complementary determining region) from a different antibody. [69] Antibody fragments may be used in place of whole antibodies. For example, immunoglobulin G may be broken down into smaller fragments by digestion with enzymes. Papain digestion cleaves the N-terminal side of inter-heavy chain disulfide bridges to produce Fab fragments. Fab fragments include the light chain and one of the two N-terminal domains of the heavy chain (also known as the Fd fragment). Pepsin digestion cleaves the C-terminal side of the inter-heavy chain disulfide bridges to produce F(ab’)2 fragments. F(ab’)2 fragments include both light chains and the two N-terminal domains linked by disulfide bridges. Pepsin digestion may also form the Fv (fragment variable) and Fc (fragment crystallizable) fragments. The Fv fragment contains the two N-terminal variable domains. The Fc fragment contains the domains which interact with immunoglobulin receptors on cells and with the initial elements of the complement cascade. Pepsin may also cleave immunoglobulin G before the third constant domain of the heavy chain (CH3) to produce a large fragment F(abc) and a small fragment pFc’. Antibody fragments may alternatively be produced recombinantly. Preferably, such antibody fragments are conjugated to an agent that causes the destruction of AGE-modified cells.

[70] If additional antibodies are desired, they can be produced using well-known methods. For example, polyclonal antibodies (pAbs) can be raised in a mammalian host by one or more injections of an immunogen, and if desired, an adjuvant. Typically, the immunogen (and adjuvant) is injected in a mammal by a subcutaneous or intraperitoneal injection. The immunogen may be an AGE-modified protein of a cell, such as AGE-antithrombin III, AGE-calmodulin, AGE-insulin, AGE- ceruloplasmin, AGE-collagen, AGE-cathepsin B, AGE-albumin such as AGE-bovine serum albumin (AGE-BSA), AGE-human serum albumin and ovalbumin, AGE- crystallin, AGE-plasminogen activator, AGE-endothelial plasma membrane protein, AGE-aldehyde reductase, AGE-transferrin, AGE-fibrin, AGE-copper/zinc SOD, AGE- apo B, AGE-fibronectin, AGE-pancreatic ribose, AGE-apo A-l and II, AGE- hemoglobin, AGE-Na7K⁺-ATPase, AGE-plasminogen, AGE-myelin, AGE-lysozyme, AGE-immunoglobulin, AGE-red cell Glu transport protein, AGE- -N-acetyl hexominase, AGE-apo E, AGE-red cell membrane protein, AGE-aldose reductase, AGE-ferritin, AGE-red cell spectrin, AGE-alcohol dehydrogenase, AGE-haptoglobin, AGE-tubulin, AGE-thyroid hormone, AGE-fibrinogen, AGE-Pa-microglobulin, AGE- sorbitol dehydrogenase, AGE-ai-antitrypsin, AGE-carbonate dehydratase, AGE- RNAse, AGE-low density lipoprotein, AGE-hexokinase, AGE-apo C-l, AGE-RNAse, AGE-hemoglobin such as AGE-human hemoglobin, AGE-low density lipoprotein (AGE-LDL) and AGE-collagen IV. AGE-modified cells, such as AGE-modified erythrocytes, whole, lysed, or partially digested, may also be used as AGE antigens. Examples of adjuvants include Freund’s complete, monophosphoryl Lipid A synthetic-trehalose dicorynomycolate, aluminum hydroxide (alum), heat shock proteins HSP 70 or HSP96, squalene emulsion containing monophosphoryl lipid A, a2-macroglobulin and surface active substances, including oil emulsions, pleuronic polyols, polyanions and dinitrophenol. To improve the immune response, an immunogen may be conjugated to a polypeptide that is immunogenic in the host, such as keyhole limpet hemocyanin (KLH), serum albumin, bovine thyroglobulin, cholera toxin, labile enterotoxin, silica particles or soybean trypsin inhibitor. A preferred immunogen conjugate is AGE-KLH. Alternatively, pAbs may be made in chickens, producing IgY molecules.

[71] Monoclonal antibodies (mAbs) may also be made by immunizing a host or lymphocytes from a host, harvesting the mAb-secreting (or potentially secreting) lymphocytes, fusing those lymphocytes to immortalized cells (for example, myeloma cells), and selecting those cells that secrete the desired mAb. Other techniques may be used, such as the EBV-hybridoma technique. Techniques for the generation of chimeric antibodies by splicing genes encoding the variable domains of antibodies to genes of the constant domains of human (or other animal) immunoglobulin result in "chimeric antibodies" that are substantially human (humanized) or substantially “ized” to another animal (such as cat, dog, horse, camel or alpaca, cattle, sheep, or goat) at the amino acid level. If desired, the mAbs may be purified from the culture medium or ascites fluid by conventional procedures, such as protein A-sepharose, hydroxyapatite chromatography, gel electrophoresis, dialysis, ammonium sulfate precipitation or affinity chromatography. Additionally, human monoclonal antibodies can be generated by immunization of transgenic mice containing a third copy IgG human trans-loci and silenced endogenous mouse Ig loci or using human-transgenic mice. Production of humanized monoclonal antibodies and fragments thereof can also be generated through phage display technologies.

[72] A "pharmaceutically acceptable carrier" includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agents, isotonic and absorption delaying agents, and the like, compatible with pharmaceutical administration. Preferred examples of such carriers or diluents include water, saline, Ringer’s solutions and dextrose solution. Supplementary active compounds can also be incorporated into the compositions. Solutions and suspensions used for parenteral administration can include a sterile diluent, such as water for injection, saline solution, polyethylene glycols, glycerin, propylene glycol or other synthetic solvents; antibacterial agents such as benzyl alcohol or methyl parabens; antioxidants such as ascorbic acid or sodium bisulfite; buffers such as acetates, citrates or phosphates, and agents for the adjustment of tonicity such as sodium chloride or dextrose. The pH can be adjusted with acids or bases, such as hydrochloric acid or sodium hydroxide. The parenteral preparation can be enclosed in ampoules, disposable syringes or multiple dose vials made of glass or plastic.

[73] The antibodies may be administered by injection, such as by intravenous injection or locally, such as by intra-articular injection into a joint. Pharmaceutical compositions suitable for injection include sterile aqueous solutions or dispersions for the extemporaneous preparation of sterile injectable solutions or dispersion. Various excipients may be included in pharmaceutical compositions of antibodies suitable for injection. Suitable carriers include physiological saline, bacteriostatic water, CREMOPHOR EL® (BASF; Parsippany, NJ) or phosphate buffered saline (PBS). In all cases, the composition must be sterile and should be fluid so as to be administered using a syringe. Such compositions should be stable during manufacture and storage and must be preserved against contamination from microorganisms such as bacteria and fungi. Various antibacterial and anti-fungal agents, for example, parabens, chlorobutanol, phenol, ascorbic acid, and thimerosal, can contain microorganism contamination. Isotonic agents such as sugars, polyalcohols, such as manitol, sorbitol, and sodium chloride can be included in the composition. Compositions that can delay absorption include agents such as aluminum monostearate and gelatin. Sterile injectable solutions can be prepared by incorporating antibodies, and optionally other therapeutic components, in the required amount in an appropriate solvent with one or a combination of ingredients as required, followed by sterilization. Methods of preparation of sterile solids for the preparation of sterile injectable solutions include vacuum drying and freeze-drying to yield a solid.

[74] For administration by inhalation, the antibodies may be delivered as an aerosol spray from a nebulizer or a pressurized container that contains a suitable propellant, for example, a gas such as carbon dioxide. Antibodies may also be delivered via inhalation as a dry powder, for example using the iSPERSE™ inhaled drug delivery platform (PULMATRIX, Lexington, Mass.). The use of anti-AGE antibodies which are chicken antibodies (IgY) may be non-immunogenic in a variety of animals, including humans, when administered by inhalation.

[75] An appropriate dosage level of each type of antibody will generally be about 0.01 to 500 mg per kg patient body weight. Preferably, the dosage level will be about 0.1 to about 250 mg/kg; more preferably about 0.5 to about 100 mg/kg. A suitable dosage level may be about 0.01 to 250 mg/kg, about 0.05 to 100 mg/kg, or about 0.1 to 50 mg/kg. Within this range the dosage may be 0.05 to 0.5, 0.5 to 5 or 5 to 50 mg/kg. Although each type of antibody may be administered on a regimen of 1 to 4 times per day, such as once or twice per day, antibodies typically have a long half-life in vivo. Accordingly, each type of antibody may be administered once a day, once a week, once every two or three weeks, once a month, or once every 60 to 90 days.

[76] A subject that receives administration of an anti-AGE antibody may be tested to determine if the administration has been effective to treat diabetes or diabetic complications. Diabetes may be monitored with a blood test that measures blood glucose such as the fasting plasma glucose (FPG) test, the A1C test (also known as the hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test), the random plasma glucose (RPG) test, the glucose challenge test or the oral glucose tolerance test (OGTT). A subject may be considered to have received an effective antibody treatment if he or she demonstrates a reduction in blood glucose between subsequent measurements or over time. Diabetic complications may be monitored with a diagnostic test that is suitable for evaluating a given diabetic complication. For example, a reduction in blood pressure, a reduction in the development of cataracts, a reduction in neuropathic pain, reduced albumin in urine (diabetic nephropathy) or improved ventricular diastolic function (cardiomyopathy). Alternatively, the concentration and/or number of senescent cells may be measured over time. Administration of antibody and subsequent testing may be repeated until the desired therapeutic result is achieved.

[77] Unit dosage forms can be created to facilitate administration and dosage uniformity. Unit dosage form refers to physically discrete units suited as single dosages for the subject to be treated, containing a therapeutically effective quantity of one or more types of antibodies in association with the required pharmaceutical carrier. Preferably, the unit dosage form is in a sealed container and is sterile.

[78] Vaccines against AGE-modified proteins or peptides contain an AGE antigen, an adjuvant, optional preservatives and optional excipients. Examples of AGE antigens include AGE-modified proteins or peptides such as AGE-antithrombin III, AGE-calmodulin, AGE-insulin, AGE-ceruloplasmin, AGE-collagen, AGE-cathepsin B, AGE-albumin such as AGE-bovine serum albumin (AGE-BSA), AGE-human serum albumin and ovalbumin, AGE-crystallin, AGE-plasminogen activator, AGE- endothelial plasma membrane protein, AGE-aldehyde reductase, AGE-transferrin, AGE-fibrin, AGE-copper/zinc SOD, AGE-apo B, AGE-fibronectin, AGE-pancreatic ribose, AGE-apo A-l and II, AGE-hemoglobin, AGE-Na7K⁺-ATPase, AGE- plasminogen, AGE-myelin, AGE-lysozyme, AGE-immunoglobulin, AGE-red cell Glu transport protein, AGE-p-N-acetyl hexominase, AGE-apo E, AGE-red cell membrane protein, AGE-aldose reductase, AGE-ferritin, AGE-red cell spectrin, AGE-alcohol dehydrogenase, AGE-haptoglobin, AGE-tubulin, AGE-thyroid hormone, AGE- fibrinogen, AGE-Pa-microglobulin, AGE-sorbitol dehydrogenase, AGE-ai-antitrypsin, AGE-carbonate dehydratase, AGE-RNAse, AGE-low density lipoprotein, AGE- hexokinase, AGE-apo C-l, AGE-RNAse, AGE-hemoglobin such as AGE-human hemoglobin, AGE-low density lipoprotein (AGE-LDL) and AGE-collagen IV. AGE- modified cells, such as AGE-modified erythrocytes, whole, lysed, or partially digested, may also be used as AGE antigens. Suitable AGE antigens also include proteins or peptides that exhibit AGE modifications (also referred to as AGE epitopes or AGE moieties) such as carboxymethyllysine (CML), carboxyethyllysine (CEL), pentosidine, pyrraline, FFI, AFGP and ALI. The AGE antigen may be an AGE- protein conjugate, such as AGE conjugated to keyhole limpet hemocyanin (AGE- KLH). Further details of some of these AGE-modified proteins or peptides and their preparation are described in Bucala.

[79] Particularly preferred AGE antigens include proteins or peptides that exhibit a carboxymethyllysine or carboxyethyllysine AGE modification. Carboxymethyllysine (also known as N(epsilon)-(carboxymethyl)lysine, N(6)-carboxymethyllysine, or 2- Amino-6-(carboxymethylamino)hexanoic acid) and carboxyethyllysine (also known as N-epsilon-(carboxyethyl)lysine) are found on proteins or peptides and lipids as a result of oxidative stress and chemical glycation, and have been correlated with juvenile genetic disorders. CML- and CEL-modified proteins or peptides are recognized by the receptor RAGE which is expressed on a variety of cells. CML and CEL have been well-studied and CML- and CEL-related products are commercially available. For example, Cell Biolabs, Inc. sells CML-BSA antigens, CML polyclonal antibodies, CML immunoblot kits, and CML competitive ELISA kits (www.cellbiolabs.com/cml-assays) as well as CEL-BSA antigens and CEL competitive ELISA kits (www.cellbiolabs.com/cel-n-epsilon-carboxyethyl-lysine- assays-and-reagents).

[80] AGE antigens may be conjugated to carrier proteins to enhance antibody production in a subject. Antigens that are not sufficiently immunogenic alone may require a suitable carrier protein to stimulate a response from the immune system. Examples of suitable carrier proteins include keyhole limpet hemocyanin (KLH), serum albumin, bovine thyroglobulin, cholera toxin, labile enterotoxin, silica particles and soybean trypsin inhibitor. Preferably, the carrier protein is KLH (AGE-KLH). KLH has been extensively studied and has been identified as an effective carrier protein in experimental cancer vaccines. Preferred AGE antigen-carrier protein conjugates include CML-KLH and CEL-KLH. [81] The administration of an AGE antigen allows the immune system to develop immunity to the antigen. Immunity is a long-term immune response, either cellular or humoral. A cellular immune response is activated when an antigen is presented, preferably with a co-stimulator to a T-cell which causes it to differentiate and produce cytokines. The cells involved in the generation of the cellular immune response are two classes of T-helper (Th) cells, Th1 and Th2. Th1 cells stimulate B cells to produce predominantly antibodies of the lgG2A isotype, which activates the complement cascade and binds the Fc receptors of macrophages, while Th2 cells stimulate B cells to produce lgG1 isotype antibodies in mice, lgG4 isotype antibodies in humans, and IgE isotype antibodies. The human body also contains “professional” antigen-presenting cells such as dendritic cells, macrophages, and B cells.

[82] A humoral immune response is triggered when a B cell selectively binds to an antigen and begins to proliferate, leading to the production of a clonal population of cells that produce antibodies that specifically recognize that antigen and which may differentiate into antibody-secreting cells, referred to as plasma-cells or memory-B cells. Antibodies are molecules produced by B-cells that bind a specific antigen. The antigen-antibody complex triggers several responses, either cell-mediated, for example by natural killers (NK) or macrophages, or serum-mediated, for example by activating the complement system, a complex of several serum proteins that act sequentially in a cascade that result in the lysis of the target cell.

[83] Immunological adjuvants (also referred to simply as “adjuvants”) are the component(s) of a vaccine which augment the immune response to the immunogenic agent. Adjuvants function by attracting macrophages to the immunogenic agent and then presenting the agent to the regional lymph nodes to initiate an effective antigenic response. Adjuvants may also act as carriers themselves for the immunogenic agent. Adjuvants may induce an inflammatory response, which may play an important role in initiating the immune response.

[84] Adjuvants include mineral compounds such as aluminum salts, oil emulsions, bacterial products, liposomes, immunostimulating complexes and squalene. Aluminum compounds are the most widely used adjuvants in human and veterinary vaccines. These aluminum compounds include aluminum salts such as aluminum phosphate (AIPO4) and aluminum hydroxide (AI(OH)3) compounds, typically in the form of gels, and are generically referred to in the field of vaccine immunological adjuvants as "alum." Aluminum hydroxide is a poorly crystalline aluminum oxyhydroxide having the structure of the mineral boehmite. Aluminum phosphate is an amorphous aluminum hydroxyphosphate. Negatively charged species (for example, negatively charged antigens) can absorb onto aluminum hydroxide gels at neutral pH, whereas positively charged species (for example, positively charged antigens) can absorb onto aluminum phosphate gels at neutral pH. It is believed that these aluminum compounds provide a depot of antigen at the site of administration, thereby providing a gradual and continuous release of antigen to stimulate antibody production. Aluminum compounds tend to more effectively stimulate a cellular response mediated by Th2, rather than Th1 cells.

[85] Emulsion adjuvants include water-in-oil emulsions (for example, Freund's adjuvants, such as killed mycobacteria in oil emulsion) and oil-in-water emulsions (for example, MF-59). Emulsion adjuvants include an immunogenic component, for example squalene (MF-59) or mannide oleate (Incomplete Freund's Adjuvants), which can induce an elevated humoral response, increased T cell proliferation, cytotoxic lymphocytes and cell-mediated immunity.

[86] Liposomal or vesicular adjuvants (including paucilamellar lipid vesicles) have lipophilic bilayer domains and an aqueous milieu which can be used to encapsulate and transport a variety of materials, for example an antigen. Paucilamellar vesicles (for example, those described in U.S. Pat. No. 6,387,373) can be prepared by mixing, under high pressure or shear conditions, a lipid phase comprising a nonphospholipid material (for example, an amphiphile surfactant; see U.S. Pat. Nos. 4,217,344; 4,917,951; and 4,911,928), optionally a sterol, and any water-immiscible oily material to be encapsulated in the vesicles (for example, an oil such as squalene oil and an oil-soluble or oil-suspended antigen); and an aqueous phase such as water, saline, buffer or any other aqueous solution used to hydrate the lipids.

Liposomal or vesicular adjuvants are believed to promote contact of the antigen with immune cells, for example by fusion of the vesicle to the immune cell membrane, and preferentially stimulate the Th1 sub-population of T-helper cells.

[87] Other types of adjuvants include Mycobacterium bovis bacillus Calmette- Guerin (BCG), quill-saponin and unmethylated CpG dinucleotides (CpG motifs). Additional adjuvants are described in U.S. Patent Application Publication Pub. No. US 2010/0226932 (September 9, 2010) and Jiang, Z-H. et al. “Synthetic vaccines: the role of adjuvants in immune targeting”, Current Medicinal Chemistry, Vol. 10(15), pp. 1423-39 (2003). Preferable adjuvants include Freund’s complete adjuvant and Freund’s incomplete adjuvant.

[88] The vaccine may optionally include one or more preservatives, such as antioxidants, antibacterial and antimicrobial agents, as well as combinations thereof. Examples include benzethonium chloride, ethylenediamine-tetraacetic acid sodium (EDTA), thimerosal, phenol, 2-phenoxyethanol, formaldehyde and formalin; antibacterial agents such as amphotericin B, chlortetracycline, gentamicin, neomycin, polymyxin B and streptomycin; antimicrobial surfactants such as polyoxyethylene-9, 10-nonyl phenol (Triton N-101 , octoxynol-9), sodium deoxycholate and polyoxyethylated octyl phenol (Triton X-I00). The production and packaging of the vaccine may eliminate the need for a preservative. For example, a vaccine that has been sterilized and stored in a sealed container may not require a preservative.

[89] Other components of vaccines include pharmaceutically acceptable excipients, such as stabilizers, thickening agents, toxin detoxifiers, diluents, pH adjusters, tonicity adjustors, surfactants, antifoaming agents, protein stabilizers, dyes and solvents. Examples of such excipients include hydrochloric acid, phosphate buffers, sodium acetate, sodium bicarbonate, sodium borate, sodium citrate, sodium hydroxide, potassium chloride, potassium chloride, sodium chloride, polydimethylsilozone, brilliant green, phenol red (phenolsulfon-phthalein), glycine, glycerin, sorbitol, histidine, monosodium glutamate, potassium glutamate, sucrose, urea, lactose, gelatin, sorbitol, polysorbate 20, polysorbate 80 and glutaraldehyde. A variety of these components of vaccines, as well as adjuvants, are described in www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf and Vogel, F. R. et al., “A compendium of vaccine adjuvants and excipients”, Pharmaceutical Biotechnology, Vol. 6, pp. 141-228 (1995).

[90] The vaccine may contain from 1 pg to 100 mg of at least one AGE antigen, including 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 200, 400, 800 or 1000 pg, or 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80 or 90 mg. The amount used for a single injection corresponds to a unit dosage.

[91] The vaccine may be provided in unit dosage form or in multidosage form, such as 2-100 or 2-10 doses. The unit dosages may be provided in a vial with a septum, or in a syringe with or without a needle. The vaccine may be administered intravenously, subdermally or intraperitoneally. Preferably, the vaccine is sterile.

[92] The vaccine may be administered one or more times, such as 1 to 10 times, including 2, 3, 4, 5, 6, 7, 8 or 9 times, and may be administered over a period of time ranging from 1 week to 1 year, 2-10 weeks or 2-10 months. Furthermore, booster vaccinations may be desirable, over the course of 1 year to 20 years, including 2, 5, 10 and 15 years.

[93] A subject that receives a vaccine for AGE-modified proteins or peptides of a cell may be tested to determine if he or she has developed an immunity to the AGE- modified proteins or peptides. Suitable tests may include blood tests for detecting the presence of an antibody, such as immunoassays or antibody titers. An immunity to AGE-modified proteins or peptides may also be determined by monitoring the concentration and/or number of senescent cells over time. In addition to testing for the development of an immunity to AGE-modified proteins or peptides, a subject may also be tested to determine if the vaccination has been effective to treat diabetes or diabetic complications. A subject may be considered to have received an effective vaccination if he or she demonstrates a reduction in blood glucose or an improvement in diabetic complications between subsequent measurements or over time, or by measuring the concentration and/or number of senescent cells. Vaccination and subsequent testing may be repeated until the desired therapeutic result is achieved.

[94] The vaccination process may be designed to provide immunity against multiple AGE moieties. A single AGE antigen may induce the production of AGE antibodies which are capable of binding to multiple AGE moieties. Alternatively, the vaccine may contain multiple AGE antigens. In addition, a subject may receive multiple vaccines, where each vaccine contains a different AGE antigen.

[95] Any mammal that could develop diabetes or diabetic complications may be treated by the methods herein described. Humans are a preferred mammal for treatment. Other mammals that may be treated include mice, rats, goats, sheep, cows, horses and companion animals, such as dogs or cats. Alternatively, any of the mammals or subjects identified above may be excluded from the patient population in need of treatment for diabetes or diabetic complications.

[96] A subject may be identified as in need of treatment based on a diagnosis of diabetes. Diabetes may be diagnosed with a blood test that measures blood glucose such as the fasting plasma glucose (FPG) test, the A1C test (also known as the hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test), the random plasma glucose (RPG) test, the glucose challenge test or the oral glucose tolerance test (OGTT). For example, a subject may be diagnosed with diabetes if he or she has an A1C level greater than 5.7% when measured on two separate occasions.

[97] A subject may be identified as in need of treatment based on a diagnosis of one or more diabetic complications. Examples of diabetic complications include heart disease such as cardiomyopathy, stroke, diabetic retinopathy, cataracts, glaucoma, kidney disease such as nephropathy, hypoglycemia, hyperglycemic crisis, high blood pressure, high blood LDL cholesterol, nerve disease, diabetic neuropathy (peripheral and autonomic neuropathy), neuropathic pain, cognitive impairment, nonalcoholic fatty liver disease, periodontal (gum) disease, hearing loss, erectile dysfunction, depression, complications with pregnancy, diabetic ketoacidosis, hyperosmolar hyperglycemic state and diabetic coma. Diabetic complications may be diagnosed with any suitable diagnostic test for a given diabetic complication. For example, measuring blood pressure, examining the eye for cataracts, a liver ultrasound indicating steatosis (non-alcoholic fatty liver disease), urinalysis measuring albumin in urine (diabetic nephropathy) or echocardiography to measure ventricular diastolic function (cardiomyopathy).

[98] Subjects may also be identified as in need of treatment based on detection of advanced glycation end products in a sample obtained from the subject. Suitable samples include blood, skin, serum, saliva and urine. The diagnostic use of anti- AGE antibodies is discussed in more detail in Application No. 62/501,424.

[99] The one-letter amino acid sequence that corresponds to SEQ ID NO: 1 is shown below:

10 20 30 40 50

MNLLLILTFV AAAVAQVQLL QPGAELVKPG ASVKLACKAS GYLFTTYWMH

60 70 80 90

WLKQRPGQGL EWIGEISPTN GRAYYNARFK SEATLTVDKS 100 110 120 130

SNTAYMQLSS LTSEASAVYY CARAYGNYEF AYWGQGTLVT 140 150 160 170

VSVASTKGPS VFPLAPSSKS TSGGTAALGC LVKDYFPEPV

180 190 200 210 220

TVSWNSGALT SGVHTFPAVL QSSGLYSLSS WTVPSSSLG TQTYICNVNH 230 240 250 260

KPSNTKVDKK VEPKSCDKTH TCPPCPAPEL LGGPSVFLFP 270 280 290 300

PKPKDTLMIS RTPEVTCWV DVSHEDPEVK FNWYVDGVEV

310 320 330 340

HNAKTKPREE QYNSTYRWS VLTVLHQDWL NGKEYKCKVS

350 360 370 380 390 NKALPAPIEK TISKAKGQPR EPQVYTLPPS REEMTKNQVS LTCLVKGFYP

400 410 420 430

SDIAVEWESN GQPENNYKTT PPVLDSDGSF FLYSKLTVDK 440 450 460

SRWQQGNVFS CSVMHEALHN HYTQKSLSLS PGK

[100] Positions 16-133 of the above amino acid sequence correspond to SEQ ID NO: 2. Positions 46-50 of the above amino acid sequence correspond to SEQ ID NO: 41. Positions 65-81 of the above amino acid sequence correspond to SEQ ID NO: 42. Positions 114-122 of the above amino acid sequence correspond to SEQ ID NO: 43.

[101] The one-letter amino acid sequence that corresponds to SEQ ID NO: 3 is shown below:

10 20 30 40 50

MNLLLILTFV AAAVADWMT QTPLSLPVSL GDQASISCRS RQSLVNSNGN

60 70 80 90 100

TFLQWYLQKP GQSPKLLIYK VSLRFSGVPD RFSGSGSGTD FTLKISRVEA

110 120 130 140 150

EDLGLYFCSQ STHVPPTFGG GTKLEIKRTV AAPSVFIFPP SDEQLKSGTA

160 170 180 190

SWCLLNNFY PREAKVQWKV DNALQSGNSQ ESVTEQDSKD 200 210 220 230

STYSLSSTLT LSKADYEKHK VYACEVTHQG LSSPVTKSFN RGEC ll 02] Positions 16-128 of the above amino acid sequence correspond to SEQ ID

NO: 4. Optionally, the arginine (Arg or R) residue at position 128 of SEQ ID NO: 4 may be omitted. Positions 39-54 of the above amino acid sequence correspond to

SEQ ID NO: 44. Positions 70-76 of the above amino acid sequence correspond to

SEQ ID NO: 45. Positions 109-117 of the above amino acid sequence correspond to

SEQ ID NO: 46.

- se [103] The DNA sequence that corresponds to SEQ ID NO: 12 is shown below:

ATGGACCCCAAGGGCAGCCTGAGCTGGAGAATCCTGCTGTTCCTGAGCCTGGC

CTTCGAGCTGAGCTACGGCCAGGTGCAGCTGCTGCAGCCAGGTGCCGAGCTC

GTGAAACCTGGCGCCTCTGTGAAGCTGGCCTGCAAGGCTTCCGGCTACCTGTT

CACCACCTACTGGATGCACTGGCTGAAGCAGAGGCCAGGCCAGGGCCTGGAA

TGGATCGGCGAGATCTCCCCCACCAACGGCAGAGCCTACTACAACGCCCGGTT

CAAGTCCGAGGCCACCCTGACCGTGGACAAGTCCTCCAACACCGCCTACATGC

AGCTGTCCTCCCTGACCTCTGAGGCCTCCGCCGTGTACTACTGCGCCAGAGCT

TACGGCAACTACGAGTTCGCCTACTGGGGCCAGGGCACCCTCGTGACAGTGTC

TGTGGCTAAGACCACCCCTCCCTCCGTGTACCCTCTGGCTCCTGGCTGTGGCG

ACACCACCGGATCCTCTGTGACCCTGGGCTGCCTCGTGAAGGGCTACTTCCCT

GAGTCCGTGACCGTGACCTGGAACTCCGGCTCCCTGTCCTCCTCCGTGCACAC

CTTTCCAGCCCTGCTGCAGTCCGGCCTGTACACCATGTCCTCCAGCGTGACAG

TGCCCTCCTCCACCTGGCCTTCCCAGACCGTGACATGCTCTGTGGCCCACCCT

GCCTCTTCCACCACCGTGGACAAGAAGCTGGAACCCTCCGGCCCCATCTCCAC

CATCAACCCTTGCCCTCCCTGCAAAGAATGCCACAAGTGCCCTGCCCCCAACC

TGGAAGGCGGCCCTTCCGTGTTCATCTTCCCACCCAACATCAAGGACGTGCTG

ATGATCTCCCTGACCCCCAAAGTGACCTGCGTGGTGGTGGACGTGTCCGAGGA

CGACCCTGACGTGCAGATCAGTTGGTTCGTGAACAACGTGGAAGTGCACACCG

CCCAGACCCAGACACACAGAGAGGACTACAACAGCACCATCAGAGTGGTGTCT

ACCCTGCCCATCCAGCACCAGGACTGGATGTCCGGCAAAGAATTCAAGTGCAA

AGTGAACAACAAGGACCTGCCCAGCCCCATCGAGCGGACCATCTCCAAGATCA

AGGGCCTCGTGCGGGCTCCCCAGGTGTACATTCTGCCTCCACCAGCCGAGCA

GCTGTCCCGGAAGGATGTGTCTCTGACATGTCTGGTCGTGGGCTTCAACCCCG

GCGACATCTCCGTGGAATGGACCTCCAACGGCCACACCGAGGAAAACTACAAG

GACACCGCCCCTGTGCTGGACTCCGACGGCTCCTACTTCATCTACTCCAAGCT

GAACATGAAGACCTCCAAGTGGGAAAAGACCGACTCCTTCTCCTGCAACGTGC

GGCACGAGGGCCTGAAGAACTACTACCTGAAGAAAACCATCTCCCGGTCCCCC GGCTAG

[104] The DNA sequence that corresponds to SEQ ID NO: 13 is shown below: ATGGACCCCAAGGGCAGCCTGAGCTGGAGAATCCTGCTGTTCCTGAGCCTGGC CTTCGAGCTGAGCTACGGCCAGGTGCAGCTGCTGCAGCCAGGTGCCGAGCTC GTGAAACCTGGCGCCTCTGTGAAGCTGGCCTGCAAGGCTTCCGGCTACCTGTT CACCACCTACTGGATGCACTGGCTGAAGCAGAGGCCAGGCCAGGGCCTGGAA TGGATCGGCGAGATCTCCCCCACCAACGGCAGAGCCTACTACAACGCCCGGTT CAAGTCCGAGGCCACCCTGACCGTGGACAAGTCCTCCAACACCGCCTACATGC AGCTGTCCTCCCTGACCTCTGAGGCCTCCGCCGTGTACTACTGCGCCAGAGCT TACGGCAACTACGAGTTCGCCTACTGGGGCCAGGGCACCCTCGTGACAGTGTC TGTGGCTAGCACCAAGGGCCCCAGCGTGTTCCCTCTGGCCCCCAGCAGCAAG AGCACCAGCGGCGGAACCGCCGCCCTGGGCTGCCTGGTGAAGGACTACTTCC CCGAGCCCGTGACCGTGTCCTGGAACAGCGGCGCTCTGACCAGCGGAGTGCA CACCTTCCCTGCCGTGCTGCAGAGCAGCGGCCTGTACTCCCTGAGCAGCGTG GTGACCGTGCCCAGCAGCAGCCTGGGCACCCAGACCTACATCTGCAACGTGAA CCACAAGCCCTCCAACACCAAGGTGGACAAGAAGGTGGAGCCTAAGAGCTGC GACAAGACCCACACCTGCCCTCCCTGCCCCGCCCCCGAGCTGCTGGGCGGAC CCAGCGTGTTCCTGTTCCCTCCCAAGCCCAAGGACACCCTGATGATCAGCCGC ACCCCCGAGGTGACCTGCGTGGTGGTGGACGTGAGCCACGAGGACCCCGAGG TGAAGTTCAACTGGTACGTGGACGGCGTGGAGGTGCACAACGCCAAGACCAAG CCTCGGGAGGAGCAGTACAACTCCACCTACCGCGTGGTGAGCGTGCTGACCG TGCTGCACCAGGACTGGCTGAACGGCAAGGAGTACAAGTGCAAGGTGAGCAA CAAGGCCCTGCCCGCTCCCATCGAGAAGACCATCAGCAAGGCCAAGGGCCAG CCCCGGGAGCCTCAGGTGTACACCCTGCCCCCCAGCCGCGACGAGCTGACCA AGAACCAGGTGAGCCTGACCTGCCTGGTGAAGGGCTTCTACCCCTCCGACATC GCCGTGGAGTGGGAGAGCAACGGCCAGCCTGAGAACAACTACAAGACCACCC CTCCCGTGCTGGACAGCGACGGCAGCTTCTTCCTGTACAGCAAGCTGACCGTG GACAAGTCCCGGTGGCAGCAGGGCAACGTGTTCAGCTGCAGCGTGATGCACG AGGCCCTGCACAACCACTACACCCAGAAGAGCCTGAGCCTGAGCCCCGGATA G

[1051 The DNA sequence that corresponds to SEQ ID NO: 14 is shown below:

ATGGAGACCGACACCCTGCTGCTCTGGGTGCTGCTGCTCTGGGTGCCCGGCT

CCACCGGAGACGTCGTGATGACCCAGACCCCTCTGTCCCTGCCTGTGTCTCTG GGCGACCAGGCCTCCATCTCCTGCCGGTCTAGACAGTCCCTCGTGAACTCCAA CGGCAACACCTTCCTGCAGTGGTATCTGCAGAAGCCCGGCCAGTCCCCCAAGC TGCTGATCTACAAGGTGTCCCTGCGGTTCTCCGGCGTGCCCGACAGATTTTCC GGCTCTGGCTCTGGCACCGACTTCACCCTGAAGATCTCCCGGGTGGAAGCCGA GGACCTGGGCCTGTACTTCTGCAGCCAGTCCACCCACGTGCCCCCTACATTTG GCGGAGGCACCAAGCTGGAAATCAAACGGGCAGATGCTGCACCAACTGTATCC ATCTTCCCACCATCCAGTGAGCAGTTAACATCTGGAGGTGCCTCAGTCGTGTGC TTCTTGAACAACTTCTACCCCAAAGACATCAATGTCAAGTGGAAGATTGATGGC AGTGAACGACAAAATGGCGTCCTGAACAGTTGGACTGATCAGGACAGCAAAGA CAGCACCTACAGCATGAGCAGCACCCTCACGTTGACCAAGGACGAGTATGAAC GACATAACAGCTATACCTGTGAGGCCACTCACAAGACATCAACTTCACCCATTG TCAAGAGCTTCAACAGGAATGAGTGTTGA

[106] The DNA sequence that corresponds to SEQ ID NO: 15 is shown below:

ATGGAGACCGACACCCTGCTGCTCTGGGTGCTGCTGCTCTGGGTGCCCGGCT CCACCGGAGACGTCGTGATGACCCAGACCCCTCTGTCCCTGCCTGTGTCTCTG GGCGACCAGGCCTCCATCTCCTGCCGGTCTAGACAGTCCCTCGTGAACTCCAA CGGCAACACCTTCCTGCAGTGGTATCTGCAGAAGCCCGGCCAGTCCCCCAAGC TGCTGATCTACAAGGTGTCCCTGCGGTTCTCCGGCGTGCCCGACAGATTTTCC GGCTCTGGCTCTGGCACCGACTTCACCCTGAAGATCTCCCGGGTGGAAGCCGA GGACCTGGGCCTGTACTTCTGCAGCCAGTCCACCCACGTGCCCCCTACATTTG GCGGAGGCACCAAGCTGGAAATCAAGCGGACCGTGGCCGCCCCCAGCGTGTT

CATCTTCCCTCCCAGCGACGAGCAGCTGAAGTCTGGCACCGCCAGCGTGGTGT GCCTGCTGAACAACTTCTACCCCCGCGAGGCCAAGGTGCAGTGGAAGGTGGA CAACGCCCTGCAGAGCGGCAACAGCCAGGAGAGCGTGACCGAGCAGGACTCC AAGGACAGCACCTACAGCCTGAGCAGCACCCTGACCCTGAGCAAGGCCGACTA CGAGAAGCACAAGGTGTACGCCTGCGAGGTGACCCACCAGGGACTGTCTAGC CCCGTGACCAAGAGCTTCAACCGGGGCGAGTGCTAA

[107] The one-letter amino acid sequence that corresponds to SEQ ID NO: 16 is shown below: MDPKGSLSWRILLFLSLAFELSYGQVQLLQPGAELVKPGASVKLACKASGYLFTTY WMHWLKQRPGQGLEWIGEISPTNGRAYYNARFKSEATLTVDKSSNTAYMQLSSLT SEASAVYYCARAYGNYEFAYWGQGTLVTVSVAKTTPPSVYPLAPGCGDTTGSSVT LGCLVKGYFPESVTVTWNSGSLSSSVHTFPALLQSGLYTMSSSVTVPSSTWPSQT VTCSVAHPASSTTVDKKLEPSGPISTINPCPPCKECHKCPAPNLEGGPSVFIFPPNIK DVLMISLTPKVTCVWDVSEDDPDVQISWFVNNVEVHTAQTQTHREDYNSTIRWS TLPIQHQDWMSGKEFKCKVNNKDLPSPIERTISKIKGLVRAPQVYILPPPAEQLSRK DVSLTCLWGFNPGDISVEWTSNGHTEENYKDTAPVLDSDGSYFIYSKLNMKTSKW EKTDSFSCNVRHEGLKNYYLKKTISRSPG*

[108] The alanine residue at position 123 of the above amino acid sequence may optionally be replaced with a serine residue. The tyrosine residue at position 124 of the above amino acid sequence may optionally be replaced with a phenylalanine residue. Positions 25-142 of the above amino acid sequence correspond to SEQ ID NO: 20. SEQ ID NO: 20 may optionally include the substitutions at positions 123 and 124. SEQ ID NO: 20 may optionally contain one additional lysine residue after the terminal valine residue.

[109] The one-letter amino acid sequence that corresponds to SEQ ID NO: 17 is shown below:

MDPKGSLSWRILLFLSLAFELSYGQVQLLQPGAELVKPGASVKLACKASGYLFTTY WMHWLKQRPGQGLEWIGEISPTNGRAYYNARFKSEATLTVDKSSNTAYMQLSSLT SEASAVYYCARAYGNYEFAYWGQGTLVTVSVASTKGPSVFPLAPSSKSTSGGTAA LGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQT YICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMIS RTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVL HQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSL TCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQG NVFSCSVMHEALHNHYTQKSLSLSPG*

[110] The one-letter amino acid sequence that corresponds to SEQ ID NO: 18 is shown below: METDTLLLVWLLLVWPGSTGDWMTQTPLSLPVSLGDQASISCRSRQSLVNSNGN TFLQWYLQKPGQSPKLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGLYF CSQSTHVPPTFGGGTKLEIKRADAAPTVSIFPPSSEQLTSGGASWCFLNNFYPKDI NVKWKIDGSERQNGVLNSWTDQDSKDSTYSMSSTLTLTKDEYERHNSYTCEATHK TSTSPIVKSFNRNEC*

[111] Positions 21-132 of the above amino acid sequence correspond to SEQ ID NO: 21.

[112] The one-letter amino acid sequence that corresponds to SEQ ID NO: 19 is shown below:

METDTLLLWVLLLWVPGSTGDWMTQTPLSLPVSLGDQASISCRSRQSLVNSNGN TFLQWYLQKPGQSPKLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGLYF CSQSTHVPPTFGGGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC*

[113] The one-letter amino acid sequence that corresponds to SEQ ID NO: 22 is shown below:

10 20 30 40 50

ASTKGPSVFP LAPCSRSTSE STAALGCLVK DYFPEPVTVS WNSGALTSGV

60 70 80 90 100

HTFPAVLQSS GLYSLSSWT VPSSNFGTQT YTCNVDHKPS NTKVDKTVER

110 120 130 140 150

KCCVECPPCP APPVAGPSVF LFPPKPKDTL MISRTPEVTC VWDVSHEDP 160 170 180 190

EVQFNWYVDG VEVHNAKTKP REEQFNSTFR WSVLTWHQ

200 210 220 230 240

DWLNGKEYKC KVSNKGLPAP IEKTISKTKG QPREPQVYTL PPSREEMTKN 250 260 270 280 290

QVSLTCLVKG FYPSDISVEW ESNGQPENNY KTTPPMLDSD GSFFLYSKLT 300 310 320

VDKSRWQQGN VFSCSVMHEA LHNHYTQKSL SLSPGK

[114] The one-letter amino acid sequence that corresponds to SEQ ID NO: 23 is SYTMGVS.

[115] The one-letter amino acid sequence that corresponds to SEQ ID NO: 24 is TISSGGGSTYYPDSVKG.

[116] The one-letter amino acid sequence that corresponds to SEQ ID NO: 25 is QGGWLPPFAX, where X may be any naturally occurring amino acid.

[117] The one-letter amino acid sequence that corresponds to SEQ ID NO: 26 is RASKSVSTSSRGYSYMH.

[118] The one-letter amino acid sequence that corresponds to SEQ ID NO: 27 is LVSNLES.

[119] The one-letter amino acid sequence that corresponds to SEQ ID NO: 28 is QHIRELTRS.

[120] The one-letter amino acid sequence that corresponds to SEQ ID NO: 29 is MDPKGSLSWRILLFLSLAFELSYGQVQLVQSGAEVKKPGASVKVSCKASGYLFTTY WMHWVRQAPGQGLEWMGEISPTNGRAYYNQKFQGRVTMTVDKSTNTVYMELSS LRSEDTAVYYCARAYGNYFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTA ALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQ TYICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPPELLGGPSVFLFPPKPKDTLMIS RTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVL HQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELKNQVSLT CLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGN VFSCSVMHEALHNHYTQKSLSLSPG.

[121] The DNA sequence that corresponds to SEQ ID NO: 30 is ATGGACCCCAAGGGCAGCCTGAGCTGGAGAATCCTGCTGTTCCTGAGCCTGGC CTTCGAGCTGAGCTACGGCCAGGTGCAGCTGGTGCAGTCTGGCGCCGAAGTG AAGAAACCTGGCGCCTCCGTGAGGTGTCCTGCAAGGCTTCCGGCTACCTGTTC ACCACCTACTGGATGCACTGGGTGCGACAGGCCCCTGGACAGGGCCTGGAAT GGATGGGCGAGATCTCCCCTACCAACGGCAGAGCCTACTACAACAGAAATTCC AGGGCAGAGTGACCATGACCGTGGACAAGTCCACCAACACCGTGTACATGGAA CTGTCCTCCCTGCGGAGCGAGGACACCGCCGTGTACTACTGCGCTAGAGCCTA CGGCAACTACGATTCGCCTACTGGGGCCAGGGCACCCTCGTGACAGTGTCCTC TGCTAGCACCAAGGGCCCCAGCGTGTTCCCTCTGGCCCCCAGCAGCAAGAGC ACCAGCGGCGGAACCGCCGCCCTGGGCTGCCTGGGAAGGACTACTTCCCCGA GCCCGTGACCGTGTCCTGGAACAGCGGCGCTCTGACCAGCGGAGTGCACACC TTCCCTGCCGTGCTGCAGAGCAGCGGCCTGTACTCCCTGAGCAGCGTGGTGA CCGTGCCAGCAGCAGCCTGGGCACCCAGACCTACATCTGCAACGTGAACCACA AGCCCTCCAACACCAAGGTGGACAAGAAGGTGGAGCCTAAGAGCTGCGACAA GACCCACACCTGCCCTCCCTGCCCCGCCCCGAGCTGCTGGGCGGACCCAGCG TGTTCCTGTTCCCTCCCAAGCCCAAGGACACCCTGATGATCAGCCGCACCCCC GAGGTGACCTGCGTGGTGGTGGACGTGAGCCACGAGGACCCCGAGGTGAGTT CAACTGGTACGTGGACGGCGTGGAGGTGCACAACGCCAAGACCAAGCCTCGG GAGGAGCAGTACAACTCCACCTACCGCGTGGTGAGCGTGCTGACCGTGCTGC ACCAGGACTGGCTGAACGGCAGGAGTACAAGTGCAAGGTGAGCAACAAGGCC CTGCCCGCTCCCATCGAGAAGACCATCAGCAAGGCCAAGGGCCAGCCCCGGG AGCCTCAGGTGTACACCCTGCCCCCCAGCCGCGACGAGCTGACAAGAACCAG GTGAGCCTGACCTGCCTGGTGAAGGGCTTCTACCCCTCCGACATCGCCGTGGA GTGGGAGAGCAACGGCCAGCCTGAGAACAACTACAAGACCACCCCTCCCGTG CTGGACAGCGACGCAGCTTCTTCCTGTACAGCAAGCTGACCGTGGACAAGTCC CGGTGGCAGCAGGGCAACGTGTTCAGCTGCAGCGTGATGCACGAGGCCCTGC ACAACCACTACACCCAGAAGAGCCTGAGCCTGAGCCCGGATAGTAA.

[122] The one-letter amino acid sequence that corresponds to SEQ ID NO: 31 is

MDPKGSLSWRILLFLSLAFELSYGQVQLVQSGAEVKKPGASVKVSCKASGYLFTTY WMHVWRQAPGQGLEWMGEISPTNGRAYYNAKFQGRVTMTVDKSTNTAYMELSS LRSEDTAVYYCARAYGNYFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTA ALGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQ TYICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPPELLGGPSVFLFPPKPKDTLMIS RTPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVL HQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELKNQVSLT CLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGN VFSCSVMHEALHNHYTQKSLSLSPG.

[123] The DNA sequence that corresponds to SEQ ID NO: 32 is ATGGACCCCAAGGGCAGCCTGAGCTGGAGAATCCTGCTGTTCCTGAGCCTGGC CTTCGAGCTGAGCTACGGCCAGGTGCAGCTGGTGCAGTCTGGCGCCGAAGTG AAGAAACCTGGCGCCTCCGTGAGGTGTCCTGCAAGGCTTCCGGCTACCTGTTC ACCACCTACTGGATGCACTGGGTGCGACAGGCCCCTGGACAGGGCCTGGAAT GGATGGGCGAGATCTCCCCTACCAACGGCAGAGCCTACTACAACCAAAATTCC AGGGCAGAGTGACCATGACCGTGGACAAGTCCACCAACACCGCTTACATGGAA CTGTCCTCCCTGCGGAGCGAGGACACCGCCGTGTACTACTGCGCTAGAGCCTA CGGCAACTACGATTCGCCTACTGGGGCCAGGGCACCCTCGTGACAGTGTCCTC TGCTAGCACCAAGGGCCCCAGCGTGTTCCCTCTGGCCCCCAGCAGCAAGAGC ACCAGCGGCGGAACCGCCGCCCTGGGCTGCCTGGGAAGGACTACTTCCCCGA GCCCGTGACCGTGTCCTGGAACAGCGGCGCTCTGACCAGCGGAGTGCACACC TTCCCTGCCGTGCTGCAGAGCAGCGGCCTGTACTCCCTGAGCAGCGTGGTGA CCGTGCCAGCAGCAGCCTGGGCACCCAGACCTACATCTGCAACGTGAACCACA AGCCCTCCAACACCAAGGTGGACAAGAAGGTGGAGCCTAAGAGCTGCGACAA GACCCACACCTGCCCTCCCTGCCCCGCCCCGAGCTGCTGGGCGGACCCAGCG TGTTCCTGTTCCCTCCCAAGCCCAAGGACACCCTGATGATCAGCCGCACCCCC GAGGTGACCTGCGTGGTGGTGGACGTGAGCCACGAGGACCCCGAGGTGAGTT CAACTGGTACGTGGACGGCGTGGAGGTGCACAACGCCAAGACCAAGCCTCGG GAGGAGCAGTACAACTCCACCTACCGCGTGGTGAGCGTGCTGACCGTGCTGC ACCAGGACTGGCTGAACGGCAGGAGTACAAGTGCAAGGTGAGCAACAAGGCC CTGCCCGCTCCCATCGAGAAGACCATCAGCAAGGCCAAGGGCCAGCCCCGGG AGCCTCAGGTGTACACCCTGCCCCCCAGCCGCGACGAGCTGACAAGAACCAG GTGAGCCTGACCTGCCTGGTGAAGGGCTTCTACCCCTCCGACATCGCCGTGGA GTGGGAGAGCAACGGCCAGCCTGAGAACAACTACAAGACCACCCCTCCCGTG CTGGACAGCGACGCAGCTTCTTCCTGTACAGCAAGCTGACCGTGGACAAGTCC CGGTGGCAGCAGGGCAACGTGTTCAGCTGCAGCGTGATGCACGAGGCCCTGC

ACAACCACTACACCCAGAAGAGCCTGAGCCTGAGCCCGGATAGTAA.

[124] The one-leter amino acid sequence that corresponds to SEQ ID NO: 33 is MDPKGSLSWRILLFLSLAFELSYGQVQLVQSGAEVKKPGASVKVSCKASGYLFTTY WMHVWRQAPGQGLEWMGEISPTNGRAYYNAKFQGRVTMTVDKSINTAYMELSRL RSDDTAVYYCARAYGNYFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAA LGCLVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQT YICNVNHKPSNTKVDKKVEPKSCDKTHTCPPCPPELLGGPSVFLFPPKPKDTLMISR TPEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLH QDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELKNQVSLTC LVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNV FSCSVMHEALHNHYTQKSLSLSPG.

[125] The DNA sequence that corresponds to SEQ ID NO: 34 is ATGGACCCCAAGGGCAGCCTGAGCTGGAGAATCCTGCTGTTCCTGAGCCTGGC CTTCGAGCTGAGCTACGGCCAGGTGCAGCTGGTGCAGTCTGGCGCCGAAGTG AAGAAACCTGGCGCCTCCGTGAGGTGTCCTGCAAGGCTTCCGGCTACCTGTTC ACCACCTACTGGATGCACTGGGTGCGACAGGCCCCTGGACAGGGCCTGGAAT GGATGGGCGAGATCTCCCCTACCAACGGCAGAGCCTACTACAACCAAAATTCC AGGGCAGAGTGACCATGACCGTGGACAAGTCCATCAACACCGCTTACATGGAA CTGTCCAGACTGCGGAGCGATGACACCGCCGTGTACTACTGCGCTAGAGCCTA CGGCAACTACGATTCGCCTACTGGGGCCAGGGCACCCTCGTGACAGTGTCCTC TGCTAGCACCAAGGGCCCCAGCGTGTTCCCTCTGGCCCCCAGCAGCAAGAGC ACCAGCGGCGGAACCGCCGCCCTGGGCTGCCTGGGAAGGACTACTTCCCCGA GCCCGTGACCGTGTCCTGGAACAGCGGCGCTCTGACCAGCGGAGTGCACACC TTCCCTGCCGTGCTGCAGAGCAGCGGCCTGTACTCCCTGAGCAGCGTGGTGA CCGTGCCAGCAGCAGCCTGGGCACCCAGACCTACATCTGCAACGTGAACCACA AGCCCTCCAACACCAAGGTGGACAAGAAGGTGGAGCCTAAGAGCTGCGACAA GACCCACACCTGCCCTCCCTGCCCCGCCCCGAGCTGCTGGGCGGACCCAGCG TGTTCCTGTTCCCTCCCAAGCCCAAGGACACCCTGATGATCAGCCGCACCCCC GAGGTGACCTGCGTGGTGGTGGACGTGAGCCACGAGGACCCCGAGGTGAGTT CAACTGGTACGTGGACGGCGTGGAGGTGCACAACGCCAAGACCAAGCCTCGG GAGGAGCAGTACAACTCCACCTACCGCGTGGTGAGCGTGCTGACCGTGCTGC ACCAGGACTGGCTGAACGGCAGGAGTACAAGTGCAAGGTGAGCAACAAGGCC CTGCCCGCTCCCATCGAGAAGACCATCAGCAAGGCCAAGGGCCAGCCCCGGG AGCCTCAGGTGTACACCCTGCCCCCCAGCCGCGACGAGCTGACAAGAACCAG GTGAGCCTGACCTGCCTGGTGAAGGGCTTCTACCCCTCCGACATCGCCGTGGA GTGGGAGAGCAACGGCCAGCCTGAGAACAACTACAAGACCACCCCTCCCGTG CTGGACAGCGACGCAGCTTCTTCCTGTACAGCAAGCTGACCGTGGACAAGTCC CGGTGGCAGCAGGGCAACGTGTTCAGCTGCAGCGTGATGCACGAGGCCCTGC ACAACCACTACACCCAGAAGAGCCTGAGCCTGAGCCCGGATAGTAA.

[126] The one-leter amino acid sequence that corresponds to SEQ ID NO: 35 is METDTLLLWVLLLWVPGSTGDWMTQSPLSLPVTLGQPASISCRSSQSLVNSNGNT FLQWYQQRPGQSPRLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVYY CSQSTHVPPTFGGGTVEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREAK VQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQG LSSPVTKSFNRGEC.

[127] The DNA sequence that corresponds to SEQ ID NO: 36 is ATGGAGACCGACACCCTGCTGCTCTGGGTGCTGCTGCTCTGGGTGCCCGGCT CCACCGGAGACGTCGTGATGACCCAGTCCCCTCTGTCCCTGCCTGTGACCCTG GGACAGCCTGCCTCCATCTCCTCAGATCCTCCCAGTCCCTCGTGAACTCCAAC GGCAACACCTTCCTGCAGTGGTATCAGCAGCGGCCTGGCCAGAGCCCCAGAC TGCTGATCTACAAGGTGTCCCTGCGGTTCTCCGGCGTGCCCGACGATTTTCCG GCTCTGGCTCTGGCACCGACTTCACCCTGAAGATCTCCCGGGTGGAAGCCGAG GACGTGGGCGTGTACTACTGCTCCCAGAGCACCCACGTGCCCCCTACATTTGG CGGAGGCACCAAGTGGAAATCAAGCGGACCGTGGCCGCCCCCAGCGTGTTCA TCTTCCCTCCCAGCGACGAGCAGCTGAAGTCTGGCACCGCCAGCGTGGTGTG CCTGCTGAACAACTTCTACCCCCGCGAGGCCAAGGGCAGTGGAAGGTGGACA ACGCCCTGCAGAGCGGCAACAGCCAGGAGAGCGTGACCGAGCAGGACTCCAA GGACAGCACCTACAGCCTGAGCAGCACCCTGACCCTGAGCAAGGCCGACTAC GAGAAGACAAGGTGTACGCCTGCGAGGTGACCCACCAGGGACTGTCTAGCCC CGTGACCAAGAGCTTCAACCGGGGCGAGTGCTAA. [128] The one-letter amino acid sequence that corresponds to SEQ ID NO: 37 is METDTLLLWVLLLWVPGSTGDWMTQSPLSLPVTLGQPASISCRSRQSLVNSNGN TFLQWYQQRPGQSPRLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEAEDVGVY YCSQSTHVPPTFGGGTVEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC.

[129] The DNA sequence that corresponds to SEQ ID NO: 38 is ATGGAGACCGACACCCTGCTGCTCTGGGTGCTGCTGCTCTGGGTGCCCGGCT CCACCGGAGACGTCGTGATGACCCAGTCCCCTCTGTCCCTGCCTGTGACCCTG GGACAGCCTGCCTCCATCTCCTCAGATCCAGGCAGTCCCTCGTGAACTCCAAC GGCAACACCTTCCTGCAGTGGTATCAGCAGCGGCCTGGCCAGAGCCCCAGAC TGCTGATCTACAAGGTGTCCCTGCGGTTCTCCGGCGTGCCCGACGATTTTCCG GCTCTGGCTCTGGCACCGACTTCACCCTGAAGATCTCCCGGGTGGAAGCCGAG GACGTGGGCGTGTACTACTGCTCCCAGAGCACCCACGTGCCCCCTACATTTGG CGGAGGCACCAAGTGGAAATCAAGCGGACCGTGGCCGCCCCCAGCGTGTTCA TCTTCCCTCCCAGCGACGAGCAGCTGAAGTCTGGCACCGCCAGCGTGGTGTG CCTGCTGAACAACTTCTACCCCCGCGAGGCCAAGGGCAGTGGAAGGTGGACA ACGCCCTGCAGAGCGGCAACAGCCAGGAGAGCGTGACCGAGCAGGACTCCAA GGACAGCACCTACAGCCTGAGCAGCACCCTGACCCTGAGCAAGGCCGACTAC GAGAAGACAAGGTGTACGCCTGCGAGGTGACCCACCAGGGACTGTCTAGCCC CGTGACCAAGAGCTTCAACCGGGGCGAGTGCTAA.

[130] The one-letter amino acid sequence that corresponds to SEQ ID NO: 39 is METDTLLLVWLLLWVPGSTGDWMTQSPLSSPVTLGQPASISCRSSQSLVNSNGN TFLQWYHQRPGQPPRLLIYKVSLRFSGVPDRFSGSGAGKDFTLKISRVEAEDVGVY YCSQSTHVPPTFGQGTLEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC.

[131] The DNA sequence that corresponds to SEQ ID NO: 40 is ATGGAGACCGACACCCTGCTGCTCTGGGTGCTGCTGCTCTGGGTGCCCGGCT CCACCGGAGACGTCGTGATGACCCAGTCCCCTCTGTCCAGTCCTGTGACCCTG GGACAGCCTGCCTCCATCTCCTCAGATCCTCCCAGTCCCTCGTGAACTCCAAC GGCAACACCTTCCTGCAGTGGTATCACCAGCGGCCTGGCCAGCCTCCCAGACT GCTGATCTACAAGGTGTCCCTGCGGTTCTCCGGCGTGCCCGACGATTTTCCGG CTCTGGCGCTGGCAAGGACTTCACCCTGAAGATCTCCCGGGTGGAAGCCGAG GACGTGGGCGTGTACTACTGCTCCCAGAGCACCCACGTGCCCCCTACATTTGG CCAGGGCACCAACTGGAAATCAAGCGGACCGTGGCCGCCCCCAGCGTGTTCA TCTTCCCTCCCAGCGACGAGCAGCTGAAGTCTGGCACCGCCAGCGTGGTGTG CCTGCTGAACAACTTCTACCCCCGCGAGGCCAAGGGCAGTGGAAGGTGGACA ACGCCCTGCAGAGCGGCAACAGCCAGGAGAGCGTGACCGAGCAGGACTCCAA GGACAGCACCTACAGCCTGAGCAGCACCCTGACCCTGAGCAAGGCCGACTAC GAGAAGACAAGGTGTACGCCTGCGAGGTGACCCACCAGGGACTGTCTAGCCC CGTGACCAAGAGCTTCAACCGGGGCGAGTGCTAA.

[132] The one-letter amino acid sequence that corresponds to SEQ ID NO: 47 is MGWTLVFLFLLSVTAGVHSQVQLLQPGAELVKPGASVKLACKASGYLFTTYWMHW LKQRPGQGLEWIGEISPTNGRAYYNARFKSEATLTVDKSSNTAYMQLSSLTSEASA VYYCARSFGNYEFAYWGQGTLVTVSVASTKGPSVFPLAPSSKSTSGGTAALGCLV KDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQTYICNV NHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPE VTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQD WLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCL VKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF SCSVMHEALHNHYTQKSLSLSPGK.

[133] The one-letter amino acid sequence that corresponds to SEQ ID NO: 48 is MGWTLVFLFLLSVTAGVHSEVQLLESGAEAKKPGASVKLSCKASGYLFTTYWMHW VHQAPGQRLEWMGEISPTNGRAYYNARFKSRVTITVDKSASTAYMELSSLRSEDT AVYYCARSFGNYEFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCL VKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQTYICN VNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTP EVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQD WLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCL VKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF

SCSVMHEALHNHYTQKSLSLSPGK.

[134] The one-letter amino acid sequence that corresponds to SEQ ID NO: 49 is MGWTLVFLFLLSVTAGVHSQVQLVQSGAEVKKPGASVKVSCKASGYLFTTYWMH WVRQAPGQRLEWIGEISPTNGRAYYNARFKSRVTITRDTSASTAYMELSSLRSEDT AVYYCARSFGNYEFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGCL VKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQTYICN VNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTP EVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQD WLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTCL VKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVF SCSVMHEALHNHYTQKSLSLSPGK.

[135] The one-letter amino acid sequence that corresponds to SEQ ID NO: 50 is MGWTLVFLFLLSVTAGVHSQVQLVQSGAEVKKPGSSVKVSCKASGYLFTTYWMH WVRQAPGQGLEWMGEISPTNGRAYYNARFKSRVTITADKSTSTAYMELSSLRSED TAVYYCARSFGNYEFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGC LVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQTYIC NVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRT PEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQ DWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTC LVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNV FSCSVMHEALHNHYTQKSLSLSPGK.

[136] The one-letter amino acid sequence that corresponds to SEQ ID NO: 51 is MGWTLVFLFLLSVTAGVHSQVQLVQSGAEVKKPGASVKVSCEASGYLFTTYWMH WVRQAPGQGLEWMGEISPTNGRAYYNARFKSRVTITRDTSINTAYMELSRLRSDD TAVYYCARSFGNYEFAYWGQGTLVTVSSASTKGPSVFPLAPSSKSTSGGTAALGC LVKDYFPEPVTVSWNSGALTSGVHTFPAVLQSSGLYSLSSWTVPSSSLGTQTYIC NVNHKPSNTKVDKKVEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRT PEVTCVWDVSHEDPEVKFNWYVDGVEVHNAKTKPREEQYNSTYRWSVLTVLHQ DWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSRDELTKNQVSLTC LVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNV

FSCSVMHEALHNHYTQKSLSLSPGK.

[137] The one-leter amino acid sequence that corresponds to SEQ ID NO: 52 is QVQLLQPGAELVKPGASVKLACKASGYLFTTYWMHWLKQRPGQGLEWIGEISPTN GRAYYNARFKSEATLTVDKSSNTAYMQLSSLTSEASAVYYCARSFGNYEFAYWGQ GTLVTVSV.

[138] The one-leter amino acid sequence that corresponds to SEQ ID NO: 53 is EVQLLESGAEAKKPGASVKLSCKASGYLFTTYWMHWVHQAPGQRLEWMGEISPT NGRAYYNARFKSRVTITVDKSASTAYMELSSLRSEDTAVYYCARSFGNYEFAYWG QGTLVTVSS.

[139] The one-leter amino acid sequence that corresponds to SEQ ID NO: 54 is QVQLVQSGAEVKKPGASVKVSCKASGYLFTTYWMHWVRQAPGQRLEWIGEISPT NGRAYYNARFKSRVTITRDTSASTAYMELSSLRSEDTAVYYCARSFGNYEFAYWG QGTLVTVSS.

[140] The one-leter amino acid sequence that corresponds to SEQ ID NO: 55 is QVQLVQSGAEVKKPGSSVKVSCKASGYLFTTYWMHWVRQAPGQGLEWMGEISP TNGRAYYNARFKSRVTITADKSTSTAYMELSSLRSEDTAVYYCARSFGNYEFAYW GQGTLVTVSS.

[141] The one-leter amino acid sequence that corresponds to SEQ ID NO: 56 is QVQLVQSGAEVKKPGASVKVSCEASGYLFTTYWMHWVRQAPGQGLEWMGEISP TNGRAYYNARFKSRVTITRDTSINTAYMELSRLRSDDTAVYYCARSFGNYEFAYWG QGTLVTVSS.

[142] The one-leter amino acid sequence that corresponds to SEQ ID NO: 57 is MVSSAQFLGLLLLCFQGTRCDWMTQTPLSLPVSLGDQASISCRSRQSLVNSNGNT FLQWYLQKPGQSPKLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGLYF CSQSTHVPPTFGGGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC. [143] The one-leter amino acid sequence that corresponds to SEQ ID NO: 58 is MVSSAQFLGLLLLCFQGTRCDIVMTQTPLSLPVTLGQPASISCRSRQSLVNSNGNT FLQWLQQRPGQPPRLLIYKVSLRFSGVPDRFSGSGAGTDFTLTISRVEAEDVGIYF CSQSTHVPPTFGQGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC.

[144] The one-leter amino acid sequence that corresponds to SEQ ID NO: 59 is MVSSAQFLGLLLLCFQGTRCDIVMTQTPLSLSVTPGQPASISCRSRQSLVNSNGNT FLQWYLQKPGQSPQLLIYKVSLRFSGVPDRFSGSGSGTDFTLKISRVEPEDVGVYY CSQSTHVPPTFGGGTKVEVKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPRE AKVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTH QGLSSPVTKSFNRGEC.

[145] The one-leter amino acid sequence that corresponds to SEQ ID NO: 60 is MVSSAQFLGLLLLCFQGTRCDWMTQSPLSLPVTLGQPASISCRSRQSLVNSNGNT FLQWFQQRPGQSPRRLIYKVSLRFSGVPDRFSGSGSDTDFTLRISRVEAEDVGLYY CSQSTHVPPTFGQGTKLEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC.

[146] The one-leter amino acid sequence that corresponds to SEQ ID NO: 61 is MVSSAQFLGLLLLCFQGTRCDIVMTQTPLSLSVTPGQPASISCRSRQSLVNSNGNT FLQWLLQKPGQPPQLLIYKVSLRFSGVPNRFSGSGSGTDFTLKISRVEAEDVGLYY CSQSTHVPPTFGGGTKVEIKRTVAAPSVFIFPPSDEQLKSGTASWCLLNNFYPREA KVQWKVDNALQSGNSQESVTEQDSKDSTYSLSSTLTLSKADYEKHKVYACEVTHQ GLSSPVTKSFNRGEC.

[147] The one-leter amino acid sequence that corresponds to SEQ ID NO: 62 is DWMTQTPLSLPVSLGDQASISCRSRQSLVNSNGNTFLQWYLQKPGQSPKLLIYKV SLRFSGVPDRFSGSGSGTDFTLKISRVEAEDLGLYFCSQSTHVPPTFGGGTKLEIK. [148] The one-leter amino acid sequence that corresponds to SEQ ID NO: 63 is DIVMTQTPLSLPVTLGQPASISCRSRQSLVNSNGNTFLQWLQQRPGQPPRLLIYKV SLRFSGVPDRFSGSGAGTDFTLTISRVEAEDVGIYFCSQSTHVPPTFGQGTKVEIK.

[149] The one-leter amino acid sequence that corresponds to SEQ ID NO: 64 is DIVMTQTPLSLSVTPGQPASISCRSRQSLVNSNGNTFLQWYLQKPGQSPQLLIYKV SLRFSGVPDRFSGSGSGTDFTLKISRVEPEDVGVYYCSQSTHVPPTFGGGTKVEV K.

[150] The one-leter amino acid sequence that corresponds to SEQ ID NO: 65 is DWMTQSPLSLPVTLGQPASISCRSRQSLVNSNGNTFLQWFQQRPGQSPRRLIYK VSLRFSGVPDRFSGSGSDTDFTLRISRVEAEDVGLYYCSQSTHVPPTFGQGTKLEI K.

[151] The one-leter amino acid sequence that corresponds to SEQ ID NO: 66 is DIVMTQTPLSLSVTPGQPASISCRSRQSLVNSNGNTFLQWLLQKPGQPPQLLIYKV SLRFSGVPNRFSGSGSGTDFTLKISRVEAEDVGLYYCSQSTHVPPTFGGGTKVEIK.

[152] EXAMPLES

[153] Example 1 : In vivo study of the administration of anti-glycation end-product antibody

[154] To examine the effects of an anti-glycation end-product antibody, the antibody was administered to the aged CD1 (ICR) mouse (Charles River Laboratories), twice daily by intravenous injection, once a week, for three weeks (Days 1, 8 and 15), followed by a 10 week treatment-free period. The test antibody was a commercially available mouse anti-glycation end-product antibody raised against carboxymethyl lysine conjugated with keyhole limpet hemocyanin, the carboxymethyl lysine MAb (Clone 318003) available from R&D Systems, Inc. (Minneapolis, MN; catalog no. MAB3247). A control reference of physiological saline was used in the control animals. [155] Mice referred to as “young” were 8 weeks old, while mice referred to as “old” were 88 weeks (±2 days) old. No adverse events were noted from the administration of the antibody. The different groups of animals used in the study are shown in Table 1.

[156] Table 1: The different groups of animals used in the study

- = Not Applicable, Pre = Subset of animals euthanized prior to treatment start for collection of adipose tissue.

[157] pigiNK4a _mRNA, a marker for senescent cells, was quantified in adipose tissue of the groups by Real Time-qPCR. The results are shown in Table 2. In the table AACt = ACt mean control Group (2) - ACt mean experimental Group (1 or 3 or 5); Fold Expression= 2 ~^AACt.

[158] Table 2: pi6^INK4a mRNA quantified in adipose tissue

[159] The table above indicates that untreated old mice (Control Group 2) express 2.55-fold more p16^lnk4a mRNA than the untreated young mice (Control Group 1), as expected. This was observed when comparing Group 2 untreated old mice euthanized at end of recovery Day 85 to Group 1 untreated young mice euthanized at end of treatment Day 22. When results from Group 2 untreated old mice were compared to results from Group 3 treated old mice euthanized Day 85, it was observed that p 16^lnk4a mRNA was 1.23-fold higher in Group 2 than in Group 3. Therefore, the level of p16^lnk4a mRNA expression was lower when the old mice were treated with 2.5 pg/gram/BID/week of antibody.

[160] When results from Group 2 (Control) untreated old mice were compared to results from Group 5 (5 pg/gram) treated old mice euthanized Day 22, it was observed that p16^lnk4a mRNA was 3.03-fold higher in Group 2 (controls) than in Group 5 (5 pg/gram). This comparison indicated that the Group 5 animals had lower levels of p16^lnk4a mRNA expression when they were treated with 5.0 pg/gram/BID/week, providing p16^lnk4a mRNA expression levels comparable to that of the young untreated mice (i.e. Group 1). Unlike Group 3 (2.5 pg/gram) mice that were euthanized at end of recovery Day 85, Group 5 mice were euthanized at end of treatment Day 22.

[161] These results indicate the antibody administration resulted in the killing of senescent cells.

[162] The mass of the gastrocnemius muscle was also measured, to determine the effect of antibody administration on sarcopenia. The results are provided in Table 3. The results indicate that administration of the antibody increased muscle mass as compared to controls, but only at the higher dosage of 5.0 pg/gm/BID/ week.

[163] Table 3: Effect of antibody administration on mass of the gastrocnemius muscle

Summary Absolute weight of Weight relative to body mass of

Group Information Gastrocnemius Muscle (g) Gastrocnemius Muscle (%)

1 Mean 0.3291 1.1037

SD 0.0412 0.1473

N 20 20

2 Mean 0.3304 0.7671

SD 0.0371 0.1246

N 20 20

3 Mean 0.3410 0.7706

SD 0.0439 0.0971

N 19 19

5 Mean 0.4074 0.9480

SD 0.0508 0.2049

N 9 9

[164] These results demonstrate that administration of antibodies that bind to AGEs of a cell resulted in a reduction of cells expressing p16^lnk4a, a biomarker of senescence. The data show that reducing senescent cells leads directly to an increase in muscle mass in aged mice. These results indicate that the loss of muscle mass, a classic sign of sarcopenia, can be treated by administration of antibodies that bind to AGEs of a cell. The results suggest that administration of the antibodies would be effective in treating or preventing the onset of diabetes and diabetic complications by removing senescent cells.

[165] Example 2: Affinity and kinetics of test antibody

[166] The affinity and kinetics of the test antibody used in Example 1 were analyzed using Na,Na-bis(carboxymethyl)-L-lysine trifluoroacetate salt (Sigma-Aldrich, St. Louis, MO) as a model substrate for an AGE-modified protein of a cell. Label-free interaction analysis was carried out on a BIACORE™ T200 (GE Healthcare, Pittsburgh, PA), using a Series S sensor chip CM5 (GE Healthcare, Pittsburgh, PA), with Fc1 set as blank, and Fc2 immodilized with the test antibody (molecular weigh of 150,000 Da). The running buffer was a HBS-EP buffer (10 mM HEPES, 150 mM NaCI, 3 mM EDTA and 0.05% P-20, pH of 7.4), at a temperature of 25 °C. Software was BIACORE™ T200 evaluation software, version 2.0. A double reference (Fc2-1 and only buffer injection), was used in the analysis, and the data was fitted to a Langmuir 1 :1 binding model.

[167] Table 4: Experimental set-up of affinity and kinetics analysis

[168] A graph of the response versus time is illustrated in FIG. 1. The following values were determined from the analysis: k_a (1/Ms) = 1.857 x 10³; kd (1/s) = 6.781 x IO'³; KD (M) = 3.651 x 10‘⁶; Rmax (RU) = 19.52; and Chi² = 0.114. Because the Chi² value of the fitting is less than 10% of Rmax, the fit is reliable.

[169] Example 3: Construction and production of murine anti-AGE lgG2b antibody and chimeric anti-AGE lgG1 antibody

[170] Murine and chimeric human anti-AGE antibodies were prepared. The DNA sequence of murine anti-AGE antibody lgG2b heavy chain is shown in SEQ ID NO: 12. The DNA sequence of chimeric human anti-AGE antibody lgG1 heavy chain is shown in SEQ ID NO: 13. The DNA sequence of murine anti-AGE antibody kappa light chain is shown in SEQ ID NO: 14. The DNA sequence of chimeric human anti- AGE antibody kappa light chain is shown in SEQ ID NO: 15. The gene sequences were synthesized and cloned into high expression mammalian vectors. The sequences were codon optimized. Completed constructs were sequence confirmed before proceeding to transfection.

[1711 HEK293 cells were seeded in a shake flask one day before transfection, and were grown using serum-free chemically defined media. The DNA expression constructs were transiently transfected into 0.03 liters of suspension HEK293 cells. After 20 hours, cells were sampled to obtain the viabilities and viable cell counts, and titers were measured (Octet QKe, ForteBio). Additional readings were taken throughout the transient transfection production runs. The cultures were harvested on day 5, and an additional sample for each was measured for cell density, viability and titer.

[172] The conditioned media for murine and chimeric anti-AGE antibodies were harvested and clarified from the transient transfection production runs by centrifugation and filtration. The supernatants were run over a Protein A column and eluted with a low pH buffer. Filtration using a 0.2 pm membrane filter was performed before aliquoting. After purification and filtration, the protein concentrations were calculated from the OD280 and the extinction coefficient. A summary of yields and aliquots is shown in Table 5:

[173] Table 5: Yields and aliquots

[174] Antibody purity was evaluated by capillary electrophoresis sodium-dodecyl sulfate (CE-SDS) analysis using LabChip® GXII, (PerkinElmer).

[ 75] Example 4: Binding of murine (parental) and chimeric anti-AGE antibodies

[176] The binding of the murine (parental) and chimeric anti-AGE antibodies described in Example 3 was investigated by a direct binding ELISA. An anti- carboxymethyl lysine (CML) antibody (R&D Systems, MAB3247) was used as a control. CML was conjugated to KLH (CML-KLH) and both CML and CML-KLH were coated overnight onto an ELISA plate. HRP-goat anti-mouse Fc was used to detect the control and murine (parental) anti-AGE antibodies. HRP-goat anti-human Fc was used to detect the chimeric anti-AGE antibody.

[177] The antigens were diluted to 1 pg/mL in 1x phosphate buffer at pH 6.5. A 96- well microtiter ELISA plate was coated with 100 pL/well of the diluted antigen and let sit at 4°C overnight. The plate was blocked with 1x PBS, 2.5% BSA and allowed to sit for 1-2 hours the next morning at room temperature. The antibody samples were prepared in serial dilutions with 1x PBS, 1% BSA with the starting concentration of 50 pg/mL. Secondary antibodies were diluted 1 :5,000. 100 pL of the antibody dilutions was applied to each well. The plate was incubated at room temperature for 0.5-1 hour on a microplate shaker. The plate was washed 3 times with 1x PBS. 100 pL/well diluted HRP-conjugated goat anti-human Fc secondary antibody was applied to the wells. The plate was incubated for 1 hour on a microplate shaker. The plate was then washed 3 times with 1x PBS. 100 pL HRP substrate TMB was added to each well to develop the plate. After 3-5 minutes elapsed, the reaction was terminated by adding 100 pL of 1 N HCL A second direct binding ELISA was performed with only CML coating. The absorbance at OD450 was read using a microplate reader.

[178] The OD450 absorbance raw data for the CML and CML-KLH ELISA is shown in the plate map below. 48 of the 96 wells in the well plate were used. Blank wells in the plate map indicate unused wells.

[179] Plate map of CML and CML-KLH ELISA: Cone.

(pg/mL) 1 2 3 4 5 6 7

[180] The OD450 absorbance raw data for the CML-only ELISA is shown in the plate map below. 24 of the 96 wells in the well plate were used. Blank wells in the plate map indicate unused wells.

[181] Plate map of CML-only ELISA:

Cone.

(pg/mL) 1 2 3 4 5 6 7

[182] The control and chimeric anti-AGE antibodies showed binding to both CML and CML-KLH. The murine (parental) anti-AGE antibody showed very weak to no binding to either CML or CML-KLH. Data from repeated ELISA confirms binding of the control and chimeric anti-AGE to CML. All buffer control showed negative signal.

[183] Example 5: Humanized antibodies

[184] Humanized antibodies were designed by creating multiple hybrid sequences that fuse select parts of the parental (mouse) antibody sequence with the human framework sequences. Acceptor frameworks were identified based on the overall sequence identity across the framework, matching interface position, similarly classed CDR canonical positions, and presence of N-glycosylation sites that would have to be removed. Three humanized light chains and three humanized heavy chains were designed based on two different heavy and light chain human acceptor frameworks. The amino acid sequences of the heavy chains are shown in SEQ ID NO: 29, 31 and 33, which are encoded by the DNA sequences shown in SEQ ID NO: 30, 32 and 34, respectively. The amino acid sequences of the light chains are shown in SEQ ID NO: 35, 37 and 39, which are encoded by the DNA sequences shown in SEQ ID NO: 36, 38 and 40, respectively. The humanized sequences were methodically analyzed by eye and computer modeling to isolate the sequences that would most likely retain antigen binding. The goal was to maximize the amount of human sequence in the final humanized antibodies while retaining the original antibody specificity. The light and heavy humanized chains could be combined to create nine variant fully humanized antibodies.

[185] The three heavy chains and three light chains were analyzed to determine their humanness. Antibody humanness scores were calculated according to the method described in Gao, S. H., et al., “Monoclonal antibody humanness score and its applications”, BMC Biotechnology, 13:55 (July 5, 2013). The humanness score represents how human-like an antibody variable region sequence looks. For heavy chains a score of 79 or above is indicative of looking human-like; for light chains a score of 86 or above is indicative of looking human-like. The humanness of the three heavy chains, three light chains, a parental (mouse) heavy chain and a parental (mouse) light chain are shown below in Table 6:

[186] Table 6: Antibody humanness

[187] Full-length antibody genes were constructed by first synthesizing the variable region sequences. The sequences were optimized for expression in mammalian cells. These variable region sequences were then cloned into expression vectors that already contain human Fc domains; for the heavy chain, the lgG1 was used.

[188] Small scale production of humanized antibodies was carried out by transfecting plasmids for the heavy and light chains into suspension HEK293 cells using chemically defined media in the absence of serum. Whole antibodies in the conditioned media were purified using MabSelect SuRe Protein A medium (GE Healthcare).

[189] Nine humanized antibodies were produced from each combination of the three heavy chains having the amino acid sequences shown in SEQ ID NO: 29, 31 and 33 and three light chains having the amino acid sequences shown in SEQ ID NO: 35, 37 and 39. A comparative chimeric parental antibody was also prepared.

The antibodies and their respective titers are shown below in Table 7:

[190] Table 7: Antibody titers

[191] The binding of the humanized antibodies may be evaluated, for example, by dose-dependent binding ELISA or cell-based binding assay. [192] Example 6 (Prophetic): An AGE-RNAse containing vaccine in a human subject

[193] AGE-RNAse is prepared by incubating RNAse in a phosphate buffer solution containing 0.1-3 M glucose, glucose-6-phosphate, fructose or ribose for 10-100 days. The AGE-RNAse solution is dialyzed and the protein content is measured. Aluminum hydroxide or aluminum phosphate, as an adjuvant, is added to 100 pg of the AGE-RNAse. Formaldehyde or formalin is added as a preservative to the preparation. Ascorbic acid is added as an antioxidant. The vaccine also includes phosphate buffer to adjust the pH and glycine as a protein stabilizer. The composition is injected intravenously into a subject with diabetes.

[194] Example 7 (Prophetic): Injection regimen for an AGE-RNAse containing vaccine in a human subject.

[195] The same vaccine as described in Example 6 is injected intra-articularly into a subject with diabetic neuropathy. The titer of antibodies to AGE-RNAse is determined by ELISA after two weeks. Additional injections are performed after three weeks and six weeks, respectively. Further titer determination is performed two weeks after each injection.

[196] Example 8 (Prophetic): An AG E-hemoglobin containing vaccine in a human subject.

[197] AGE-hemoglobin is prepared by incubating human hemoglobin in a phosphate buffer solution containing 0.1-3 M glucose, glucose-6-phosphate, fructose or ribose for 10-100 days. The AGE-hemoglobin solution is dialyzed and the protein content is measured. All vaccine components are the same as in Example 6, except AGE-hemoglobin is substituted for AGE-RNAse. Administration is carried out as in Example 6, or as in Example 7.

[198] Example 9 (Prophetic): An AGE-human serum albumin containing vaccine in a human subject. [199] AGE-human serum albumin is prepared by incubating human serum albumin in a phosphate buffer solution containing 0.1-3 M glucose, glucose-6-phosphate, fructose or ribose for 10-100 days. The AGE-human serum albumin solution is dialyzed and the protein content is measured. All vaccine components are the same as in Example 6, except AGE-human serum albumin is substituted for AGE-RNAse. Administration is carried out as in Example 6, or as in Example 7.

[200] Example 10: Carboxymethyllysine-modified protein vaccine for a human subject (prophetic)

[201] A vaccine is prepared by combining a carboxymethyllysine-modified protein as an AGE antigen, aluminum hydroxide as an adjuvant, formaldehyde as a preservative, ascorbic acid as an antioxidant, a phosphate buffer to adjust the pH of the vaccine and glycine as a protein stabilizer. The vaccine is injected subcutaneously into a subject with diabetic cardiomyopathy.

[202] Example 11 : Carboxyethyllysine-modified peptide vaccine for a human subject (prophetic)

[203] A vaccine is prepared by combining a carboxyethyllysine-modified peptide conjugated to KLH as an AGE antigen, aluminum hydroxide as an adjuvant, formaldehyde as a preservative, ascorbic acid as an antioxidant, a phosphate buffer to adjust the pH of the vaccine and glycine as a protein stabilizer. The vaccine is injected subcutaneously into a subject with diabetic nephropathy.

[204] Example 12: In vivo study of the administration of a carboxymethyl lysine monoclonal antibody

[205] The effect of a carboxymethyl lysine antibody on tumor growth, metastatic potential and cachexia was investigated. In vivo studies were carried out in mice using a murine breast cancer tumor model. Female BALB/c mice (BALB/cAnNCrl, Charles River) were eleven weeks old on Day 1 of the study. [206] 4T1 murine breast tumor cells (ATCC CRL-2539) were cultured in RPM1 1640 medium containing 10% fetal bovine serum, 2 mM glutamine, 25 g/mL gentamicin, 100 units/mL penicillin G Na and 100 pg/mL streptomycin sulfate. Tumor cells were maintained in tissue culture flasks in a humidified incubator at 37 °C in an atmosphere of 5% CO2 and 95% air.

[207] The cultured breast cancer cells were then implanted in the mice. 4T1 cells were harvested during log phase growth and re-suspended in phosphate buffered saline (PBS) at a concentration of 1 x 10⁶ cells/mL on the day of implant. Tumors were initiated by subcutaneously implanting 1 x 10⁵4T1 cells (0.1 mL suspension) into the right flank of each test animal. Tumors were monitored as their volumes approached a target range of 80-120 mm³. Tumor volume was determined using the formula: tumor volume = (tumor width)²(tumor length)/2. Tumor weight was approximated using the assumption that 1 mm³ of tumor volume has a weight of 1 mg. Thirteen days after implantation, designated as Day 1 of the study, mice were sorted into four groups (n=15/group) with individual tumor volumes ranging from 108 to 126 mm³ and a group mean tumor volume of 112 mm³. The four treatment groups are shown in Table 8 below:

[208] Table 8: Treatment groups

[209] An anti-carboxymethyl lysine monoclonal antibody was used as a therapeutic agent. 250 mg of carboxymethyl lysine monoclonal antibody was obtained from R&D Systems (Minneapolis, MN). Dosing solutions of the carboxymethyl lysine monoclonal antibody were prepared at 1 and 0.5 mg/mL in a vehicle (PBS) to provide the active dosages of 10 and 5 pg/g, respectively, in a dosing volume of 10 mL/kg. Dosing solutions were stored at 4 °C protected from light.

[210] All treatments were administered intravenously (i.v.) twice daily for 21 days, except on Day 1 of the study where the mice were administered one dose. On Day 19 of the study, i.v. dosing was changed to intraperitoneal (i.p.) dosing for those animals that could not be dosed i.v. due to tail vein degradation. The dosing volume was 0.200 mL per 20 grams of body weight (10 mL/kg), and was scaled to the body weight of each individual animal.

[211] The study continued for 23 days. Tumors were measured using calipers twice per week. Animals were weighed daily on Days 1-5, then twice per week until the completion of the study. Mice were also observed for any side effects. Acceptable toxicity was defined as a group mean body weight loss of less than 20% during the study and not more than 10% treatment-related deaths. Treatment efficacy was determined using data from the final day of the study (Day 23).

[212] The ability of the anti-carboxymethyl lysine antibody to inhibit tumor growth was determined by comparing the median tumor volume (MTV) for Groups 1-3. Tumor volume was measured as described above. Percent tumor growth inhibition (%TGI) was defined as the difference between the MTV of the control group (Group 1) and the MTV of the drug-treated group, expressed as a percentage of the MTV of the control group. %TGI may be calculated according to the formula: %TGI = (1- MTVtreated/MTVcontrol) X 100.

[213] The ability of the anti-carboxymethyl lysine antibody to inhibit cancer metastasis was determined by comparing lung cancer foci for Groups 1-3. Percent inhibition (%lnhibition) was defined as the difference between the mean count of metastatic foci of the control group and the mean count of metastatic foci of a drug- treated group, expressed as a percentage of the mean count of metastatic foci of the control group. %lnhibition may be calculated according to the following formula: %lnhibition = (1-Mean Count of Focitreated/Mean Count of Focicontroi) x 100.

[214] The ability of the anti-carboxymethyl lysine antibody to inhibit cachexia was determined by comparing the weights of the lungs and gastrocnemius muscles for Groups 1-3. Tissue weights were also normalized to 100 g body weight.

[215] Treatment efficacy was also evaluated by the incidence and magnitude of regression responses observed during the study. Treatment may cause partial regression (PR) or complete regression (CR) of the tumor in an animal. In a PR response, the tumor volume was 50% or less of its Day 1 volume for three consecutive measurements during the course of the study, and equal to or greater than 13.5 mm³ for one or more of these three measurements. In a CR response, the tumor volume was less than 13.5 mm³ for three consecutive measurements during the course of the study.

[216] Statistical analysis was carried out using Prism (GraphPad) for Windows 6.07. Statistical analyses of the differences between Day 23 mean tumor volumes (MTVs) of two groups were accomplished using the Mann-Whitney l/test. Comparisons of metastatic foci were assessed by ANOVA-Dunnett. Normalized tissue weights were compared by ANOVA. Two-tailed statistical analyses were conducted at significance level P = 0.05. Results were classified as statistically significant or not statistically significant.

[217] The results of the study are shown below in Table 9:

[218] Table 9: Results

[219] All treatment regimens were acceptably tolerated with no treatment-related deaths. The only animal deaths were non-treatment-related deaths due to metastasis. The %TGI trended towards significance (P > 0.05, Mann-Whitney) for the 5 pg/g (Group 2) or 10 pg/g treatment group (Group 3). The %lnhibition trended towards significance (P > 0.05, ANOVA-Dunnett) for the 5 pg/g treatment group. The %lnhibition was statistically significant (P < 0.01, ANOVA-Dunnett) for the 10 pg/g treatment group. The ability of the carboxymethyl lysine antibody to treat cachexia trended towards significance (P > 0.05, ANOVA) based on a comparison of the organ weights of the lung and gastrocnemius between treatment groups and the control group. The results indicate that administration of an anti-carboxymethyl lysine monoclonal antibody is able to reduce cancer metastases. This data provides additional evidence that in vivo administration of anti-AGE antibodies can provide therapeutic benefits safely and effectively.

[220] Example 13: In vivo diabetic complication study (prophetic)

[221] In vivo studies are carried out in mice to study the effect of treatment with anti- AGE antibodies on diabetic complications including diabetic neuropathy and diabetic cardiomyopathy. Male and female BTBR ob/ob mice are used for the study. The male mice are primarily intended for studying diabetic neuropathy while the female mice are primarily intended for studying diabetic cardiomyopathy. All mice are 6-8 weeks old on Day 1 of the study. The mice are separated into four treatment groups of 10-15 mice each: (1) male - control; (2) female - control; (3) male - anti-AGE antibody; and (4) female - anti-AGE antibody.

[222] Dosing begins on Day 1 of the study. Groups 1 and 2 receive phosphate- buffered saline (PBS) delivered intravenously. Groups 3 and 4 receive 10 pg/g of an anti-AGE antibody twice daily for 21 days delivered intravenously. The dosing volume is 0.200 ml_ per 20 grams of body weight (10 mL/kg), and is scaled to the body weight of each individual animal.

[223] All Groups are monitored daily for morbidity/mortality. Diabetic neuropathy is measured by tail flick thermal testing. Blood is drawn and percent of glycosylated hemoglobin (A1C) is measured 1 day before Day 1 of the study, at 12 weeks, at 16 weeks and at 24 weeks. Treatment will end at 9-11 weeks (21 days after treatment commences).

[224] Half of the animals are sacrificed at 16 weeks. The remaining animals are sacrificed at 24 weeks. The sacrificed animals are analyzed for p16INK4a qRT PCR measured in inguinal adipose tissue. The p16INK4a qRT PCR is preserved for qRT PCR analysis. Diabetic cardiomyopathy is studied by analyzing the left ventricle including measuring myocardial cross-sectional area, myocyte size, fibrosis and macrophage content. Diabetic nephropathy is studied by histologically examining the kidneys for loss of podocytes and by measuring the glomerular basement membrane thickness, the amount of mesangial matrix and the presence/absence of mesangial sclerosis. Diabetic neuropathy is studied by determining the epidermal nerve fiber density.

[225] The anti-AGE antibody will specifically bind to cells expressing cell-surface AGEs, such as senescent beta cells, and allow the immune system to destroy those cells. Killing and removing senescent cells will prevent the onset of diabetes and the development of diabetic complications.

[226] Example 14: Expression of AGE antigen in human renal tissue

[227] Renal tissue samples of 4 diabetic subjects, 1 near end-stage chronic kidney disease subject, and 1 control subject were examined. The tissue samples were stained to detect the presence of AGE antigens on the cells in the tissue samples. The cell types that showed staining were the same for all tissue samples. The 4 diabetic samples and the 1 end-stage chronic kidney disease sample showed more intense staining compared to the control, and they also showed a higher percentage of structures and cells that were stained. [228] Example 15: Renal tissue immunostaining

[229] Samples of renal tissue from 4 diabetic subjects and 3 non-diabetic subjects were stained and examined. A monoclonal antibody that binds to AGE antigens was used to stain the tissue samples.

[230] Staining results for diabetic tissue: In tubule tissue, more than 50% of tubules positive (maybe distal > proximal), with brush border accentuation. Staining of tubules is all cells within a tubule or none of the cells within a tubule. Cellular staining is diffuse cytoplasmic, with minimal vesicular prominence (unlike nondiabetic renal tissue). There was minimal to no staining of atrophic tubules. The percentage of tubules positive for the anti-AGE antibody was greater (approaching 100%) in the more advanced DM tissues. In interstitium tissue, there was not staining of interstitial matrix or periglomerular fibrosis; there was some cytoplasmic staining of infiltrating cells. In globerular tissue, there was weak glomerular staining, with staining most prominently of endothelial cells and of parietal epithelial cells (i.e. , epithelial cells lining inside of Bowman's capsule), but very weak staining if any of visceral epithelial cells (podocytes), and no mesangial matrix staining. Periodic acid- Schiff (PAS) staining showed diabetic changes ranging from early pathology (focal mesangial expansion, without clear nodularity) to late advanced pathology (clear nodularity, i.e., Kimmelstein-Wilson lesions).

[231] Staining results for non-diabetic tissue: The staining in non-diabetic tissue showed a similar general pattern of staining as in diabetic, but fewer tubules (<25%), the tubular epithelial cell staining is more vesicular than diffuse cytoplasmic, and there was much less (i.e., minimal) glomerular staining. PAS staining showed no tubular dropout and normal glomeruli.

[232] Measurements of Cytokeratin 8/18 (epithelial cell marker) showed similar results for diabetic and non-diabetic tissue samples. Measurement of Pan- cytokeratin (expression of additional cytokeratins beyond CK8/18 is a marker of epithelial cell stress) was also similar in diabetic and non-diabetic tissue samples. These results show that AGE antigens are present on the cells of kidney tissue in diabetic patients at a higher rate compared to the kidney tissue of non-diabetic subjects.

[233] Example 16: determine presence of AGEs in renal tissues from patients with a variety of renal diseases, including cancer (prophetic)

[234] A study is conducted in human renal tissue samples from patients with a variety of kidney disease states and conditions to determine the presence or absence of the AGEs on diseased cells of interest. The antibody assay is optimized on frozen and paraffin-embedded tissues. "Normal" renal tissue is used as a positive control to determine optimal staining conditions by varying antibody dilutions, incubation times, and antigen retrieval methods. Once optimal conditions have been determined, a variety of renal tissues are stained to determine their reactivity with 318H mAb (“318H"). The 318H antibody includes the heavy chain of SEQ ID NO: 50 and the light chain of SEQ ID NO: 59. The stained tissue will include kidney biopsies from individuals with: (a) diabetic nephropathy of varying severity; (b) all WHO classes of lupus nephritis; (c) renal cell carcinomas, of clear cell, papillary (cortical tubular epithelial origin), and chromophobe types, as well as oncocytomas (collecting duct origin): tissue microarrays constructed with multiple tumor specimens will be used for this purpose and will also contain cases of other on-renal tumors such as breast, pancreas, and colon adenocarcinomas; (d) acute kidney injury (AKI) from acute tubular necrosis (ATN); (e) COVID-associated renal disease; (f) kidney transplants, experiencing antibody-mediated rejection, cell-mediated rejection, transplant glomerulopathy, or polyoma virus nephropathy. Fetal kidney products are stained for a range of ages from conception where the age of gestation is precisely known. This may show an interesting transition in the pattern and level of expression at some point in development. The disease states and conditions with the highest levels of 318H marker would be selected as candidates for further development.

[235] Example 17: In vivo efficacy of 318H on diabetic mice models for modeling chronic kidney disease (CKD) (prophetic) [236] The study will use two humanized mouse models of diabetes. The streptozotocin model entails destruction of the pancreas, with consequent absence of insulin, and most closely mimics type I diabetes mellitus, with autoimmune destruction of the pancreas. The second model involves feeding mice a calorie-rich, lipid-laden diet, typical of an American "unhealthy" diet, and leads to the insulin resistance characteristic of type 2 diabetes mellitus. The AGE antibody, 318H, is administered to the mice and the effect of the 318H antibody is measured. The mice are randomly assigned to one of three cohorts: isotype control, 318H high dose, and 318H low dose. The isotype control cohort receives a control antibody, which is an IgG antibody that does not bind to AGEs. The 318H low dose and 318H high dose cohorts receives the 318H antibody is dosages according to the schedule shown in Table 5 below. The isotype control dosage is the same as the dosage of the 318H high dose cohort.

[237] Table 10: dosages administered every 3 days

[238] The dosages from Table 10 are administered every 3 days for 6 treatments.

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Claims

WHAT IS CLAIMED IS:

1. A method of treating or preventing the onset of diabetes or diabetic complications, comprising administering to a subject a composition comprising an anti-AGE antibody.

2. A method of treating or preventing the onset diabetes or diabetic complications, comprising administering to a subject a composition comprising a first anti-AGE antibody and a second anti-AGE antibody; wherein the second anti-AGE antibody is different from the first anti-AGE antibody.

3. A method of treating a subject with diabetes or diabetic complications, comprising: a first administering of an anti-AGE antibody; followed by testing the subject for effectiveness of the first administration at treating diabetes or diabetic complications; followed by a second administering of the anti-AGE antibody.

4. Use of an anti-AGE antibody for the manufacture of a medicament for treating or preventing the onset of diabetes or diabetic complications.

5. A composition comprising an anti-AGE antibody for use in treating or preventing the onset of diabetes or diabetic complications.

6. A composition for treating or preventing the onset of diabetes or diabetic complications, comprising

(a) a first anti-AGE antibody,

(b) a second anti-AGE antibody, and

(c) a pharmaceutically acceptable carrier, wherein the first anti-AGE antibody is different from the second anti-AGE antibody.

7. A method of treating or preventing the onset of diabetes or diabetic complications, comprising immunizing a subject in need thereof against AGE- modified proteins or peptides of a cell.

8. The method, use or composition of any of the preceding claims, wherein the composition further comprises a pharmaceutically acceptable carrier.

9. The method, use or composition of any of the preceding claims, wherein the subject is selected from the group consisting of humans, mice, rats, goats, sheep, cows, horses, dogs and cats.

10. The method, use or composition of any of the preceding claims, wherein the subject is a human.

11. The method, use or composition of any of the preceding claims, wherein the anti-AGE antibody is non-immunogenic to a species selected from the group consisting of humans, cats, dogs, horses, camels, alpaca, cattle, sheep, and goats.

12. The method, use or composition of any of the preceding claims, wherein the anti-AGE antibody is administered intravenously.

13. The method, use or composition of any of the preceding claims, wherein the anti-AGE antibody binds an AGE antigen comprises at least one protein or peptide that exhibits AGE modifications selected from the group consisting of FFI, pyrraline, AFGP, ALI, carboxymethyllysine, carboxyethyllysine and pentosidine.

14. The method, use or composition of any of the preceding claims, wherein the composition is in unit dosage form.

15. The method, use or composition of any of the preceding claims, wherein the composition is in multidosage form

16. The method, use or composition of any of the preceding claims, wherein the composition is sterile.

17. The method, use or composition of any of the preceding claims, wherein the vaccine comprises

(a) the AGE antigen,

(b) an adjuvant,

(c) optionally, a preservative, and

(d) optionally, an excipient.

18. The method, use or composition of any of the preceding claims, wherein the vaccine is administered in an amount effective to cause the immune system to produce antibodies to cells having AGE-modified proteins or peptides.

19. The method, use or composition of any of the preceding claims, wherein the AGE antigen is an AGE-modified protein or peptide selected from the group consisting of AGE-RNAse, AGE-human hemoglobin, AGE-albumin, AGE-BSA, AGE-human serum albumin, AGE-ovalbumin, AGE-low density lipoprotein, AGE- collagen IV, AGE-antithrombin III, AGE-calmodulin, AGE-insulin, AGE- ceruloplasmin, AGE-collagen, AGE-cathepsin B, AGE-albumin, AGE-crystallin, AGE- plasminogen activator, AGE-endothelial plasma membrane protein, AGE-aldehyde reductase, AGE-transferrin, AGE-fibrin, AGE-copper/zinc SOD, AGE-apo B, AGE- fibronectin, AGE-pancreatic ribose, AGE-apo A-l and II, AGE-hemoglobin, AGE- Na⁺/K⁺-ATPase, AGE-plasminogen, AGE-myelin, AGE-lysozyme, AGE- immunoglobulin, AGE-red cell Glu transport protein, AGE-P-N-acetyl hexominase, AGE-apo E, AGE-red cell membrane protein, AGE-aldose reductase, AGE-ferritin, AGE-red cell spectrin, AGE-alcohol dehydrogenase, AGE-haptoglobin, AGE-tubulin, AGE-thyroid hormone, AGE-fibrinogen, AGE-p2-microglobulin, AGE-sorbitol dehydrogenase, AGE-ai-antitrypsin, AGE-carbonate dehydratase, AGE-RNAse, AGE-low density lipoprotein, AGE-hexokinase, AGE-apo C-l, AGE-KLH and mixtures thereof.

20. The method, use or composition of any of the preceding claims, wherein the AGE antigen comprises at least one protein or peptide that exhibits AGE modifications selected from the group consisting of carboxymethyllysine, carboxyethyllysine, pentosidine, pyrraline, FFI, AFGP, and ALL

21. The use of any of the preceding claims, wherein the medicament comprises

(a) the AGE antigen,

(b) an adjuvant,

(c) optionally, a preservative, and

(d) optionally, an excipient.

22. The method, use or composition of any of the preceding claims, wherein the composition comprises a vaccine.

23. The method, use or composition of any of the preceding claims, further comprising testing the patient to determine if diabetes or diabetic complications have been ameliorated, and repeating the immunizing, if necessary.

24. The method, use or composition of any of the previous claims, wherein the antibody comprises a heavy chain, and a light chain, wherein the heavy chain comprises an amino acid sequence having at least 90% sequence identity, preferably at least 95% sequence identity, more preferably at least 98% sequence identity, with an amino acid sequence selected from the group consisting of SEQ ID NO: 1, SEQ ID NO: 17, SEQ ID NO: 29, SEQ ID NO: 31, SEQ ID NO: 33, SEQ ID NO: 48, SEQ ID NO: 49, SEQ ID NO: 50, and SEQ ID NO: 51, or the light chain comprises an amino acid sequence having at least 90% sequence identity, preferably at least 95% sequence identity, more preferably at least 98% sequence identity, with an amino acid sequence selected from the group consisting of SEQ ID NO: 3, SEQ ID NO: 19, SEQ ID NO: 35, SEQ ID NO: 37, SEQ ID NO: 39, SEQ ID NO: 58, SEQ ID NO: 59, SEQ ID NO: 60, and SEQ ID NO: 61.

25. The method, use or composition of any of the previous claims, wherein the antibody is conjugated to an agent that causes the destruction of AGE-modified cells.

26. The method, use or composition of any of the preceding claims, wherein the antibody is substantially non-immunogenic to humans.

27. The method, use or composition of any of the preceding claims, wherein the antibody has a rate of dissociation (ka) of at most 9 x 10‘³ sec¹.

28. The method, use or composition of any of the preceding claims, wherein the diabetic complication comprises at least one disease or disorder selected from the group consisting of heart disease, stroke, diabetic retinopathy, cataracts, glaucoma, kidney disease, hypoglycemia, hyperglycemic crisis, high blood pressure, high blood LDL cholesterol, nerve disease, diabetic neuropathy, neuropathic pain, cognitive impairment, non-alcoholic fatty liver disease, periodontal disease, hearing loss, erectile dysfunction, depression, complications with pregnancy, diabetic ketoacidosis, hyperosmolar hyperglycemic state and diabetic coma.