U.S. patent application number 09/891823 was filed with the patent office on 2002-08-15 for human papilloma virus treatment.
Invention is credited to Boux, Leslie J., Goldstone, Stephen E., Neefe, John R., Siegel, Marvin, Winnett, Mark T..
Application Number | 20020110566 09/891823 |
Document ID | / |
Family ID | 22798190 |
Filed Date | 2002-08-15 |
United States Patent
Application |
20020110566 |
Kind Code |
A1 |
Neefe, John R. ; et
al. |
August 15, 2002 |
Human papilloma virus treatment
Abstract
Disclosed is a method of treating a wart in a subject by
administering to the subject a composition containing (1) a heat
shock protein or an immunostimulatory fragment thereof, and (2) a
protein of a human papilloma virus or an antigenic fragment
thereof. Also disclosed is a method of treating a human papilloma
virus infection in a subject infected or suspected of being
infected with a human papilloma virus of a first type by
administering to the subject a composition containing (1) a heat
shock protein or an antigenic fragment thereof, and (2) a protein
of a human papilloma virus of a second type or an antigenic
fragment thereof, where the first type and second type are
different.
Inventors: |
Neefe, John R.; (Devon,
PA) ; Goldstone, Stephen E.; (New York, NY) ;
Winnett, Mark T.; (Phoenixville, PA) ; Siegel,
Marvin; (Blue Bell, PA) ; Boux, Leslie J.;
(Victoria, CA) |
Correspondence
Address: |
LEE CREWS, PH. D.
Fish & Richardson P.C.
225 Franklin Street
Boston
MA
02110-2804
US
|
Family ID: |
22798190 |
Appl. No.: |
09/891823 |
Filed: |
June 26, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60214202 |
Jun 26, 2000 |
|
|
|
Current U.S.
Class: |
424/204.1 |
Current CPC
Class: |
A61K 38/162 20130101;
C12N 2710/20034 20130101; A61K 2039/55516 20130101; A61K 2039/6043
20130101; A61K 2039/53 20130101; A61P 31/20 20180101; A61K 39/39
20130101; A61K 38/164 20130101; A61K 2039/70 20130101; A61P 35/00
20180101; A61P 17/12 20180101; A61P 31/12 20180101; A61K 39/12
20130101 |
Class at
Publication: |
424/204.1 |
International
Class: |
A61K 039/12 |
Claims
What is claimed is:
1. A method of treating a wart in a subject, the method comprising
identifying a subject having or suspected of having a wart; and
administering to the subject a composition comprising a fusion
protein comprising (1) a heat shock protein (hsp) or an
immunostimulatory fragment thereof, and (2) a protein of a human
papilloma virus (HPV), or an antigenic fragment thereof, wherein
the composition is administered in an amount sufficient to treat
the wart.
2. The method of claim 1, wherein the hsp is a mycobacterial
hsp.
3. The method of claim 2, wherein the mycobacterial hsp is a
Mycobacterium bovis hsp.
4. The method of claim 3, wherein the hsp is Mycobacterium bovis
Hsp65.
5. The method of claim 1, wherein the hsp is a member of the Hsp 60
or Hsp 70 family of proteins.
6. The method of claim 1, wherein the HPV is a type 16 HPV.
7. The method of claim 1, wherein the protein of the HPV is an E7
protein.
8. The method of claim 1, wherein the composition contains about 50
to 5000 .mu.g of the fusion protein.
9. The method of claim 8, wherein the composition contains about
100 to 2000 .mu.g of the fusion protein.
10. The method of claim 1, wherein the composition is administered
free of adjuvant.
11. The method of claim 1, wherein the subject is a mammal.
12. The method of claim 11, wherein the mammal is a human.
13. The method of claim 1, wherein the fusion protein is
administered in an amount sufficient to reduce the size of the
wart.
14. A method of treating, in a subject, a disease or condition
associated with a human papilloma virus (HPV), the method
comprising administering to the subject a composition comprising a
fusion protein comprising (1) an hsp, or an immunostimulatory
fragment thereof, and (2) a protein of an HPV, or an antigenic
fragment thereof, wherein the subject is infected with an HPV type
that is different from the HPV type administered to the subject,
the composition being administered in an amount sufficient to treat
the disease or condition.
15. The method of claim 14, wherein the hsp is a mycobacterial
hsp.
16. The method of claim 15, wherein the mycobacterial hsp is a
Mycobacterium bovis hsp.
17. The method of claim 16, wherein the hsp is Mycobacterium bovis
Hsp65.
18. The method of claim 14, wherein the hsp is a member of the Hsp
60 or Hsp 70 family of proteins.
19. The method of claim 14, wherein the HPV type administered to
the subject is type 16.
20. The method of claim 19, wherein the subject has a disease or
condition associated with an HPV of type 5, 6, 11, 18, 31, 33, 35,
45, 54, 60, or 70.
21. The method of claim 20, wherein the subject has a disease or
condition associated with an HPV of type 6, 11, 33, 45, or 70.
22. The method of claim 21, wherein the subject has a disease or
condition associated with an HPV of type 6 or 11.
23. The method of claim 14, wherein the protein of the HPV is an E7
protein.
24. The method of claim 14, wherein the composition contains about
50 to 5000 .mu.g of the fusion protein.
25. The method of claim 24, wherein the composition contains about
100 to 2000 .mu.g of the fusion protein.
26. The method of claim 14, wherein the composition is free of
adjuvant.
27. The method of claim 14, wherein the subject is a mammal.
28. The method of claim 27, wherein the mammal is a human.
29. The method of claim 14, wherein the subject is not identified
as being infected with the type of HPV that is administered prior
to administration of the composition.
30. A method of treating a wart in a subject, the method comprising
identifying a subject having, or suspected of having, a wart;
administering to the subject a nucleic acid encoding a fusion
polypeptide comprising (1) an hsp, or an immunostimulatory fragment
thereof, and (2) a protein of an HPV or an antigenic fragment
thereof; and expressing the fusion polypeptide in the subject in an
amount sufficient to treat the wart.
31. The method of claim 30, wherein the nucleic acid is contained
within a viral vector.
32. A method of treating, in a subject, a disease or condition
associated with an HPV infection, the method comprising:
administering to the subject a nucleic acid encoding a fusion
protein comprising (1) an hsp, or an immunostimulatory fragment
thereof, and (2) a protein of an HPV, wherein the subject is
infected with an HPV type that is different from the HPV type
administered to the subject; and expressing the fusion protein in
the subject in an amount sufficient to treat the disease or
condition.
33. The method of claim 32, wherein the nucleic acid is contained
within a viral vector.
34. The method of claim 14, wherein the disease or condition is
anogenital warts, plantars warts, cervical cancer, cervical
dysplasia, anal cancer, anal dysplasia, or recurrent respiratory
papillomatosis.
35. The method of claim 32, wherein the disease or condition is
anogenital warts, plantars warts, cervical cancer, cervical
dysplasia, anal cancer, anal dysplasia, or recurrent respiratory
papillomatosis.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from U.S. Provisional
Application No. 60/214,202, filed Jun. 26, 2000, the content of
which is incorporated herein by reference in its entirety.
FIELD OF THE INVENTION
[0002] The invention relates to therapies for human papilloma virus
infections.
BACKGROUND OF THE INVENTION
[0003] Infection with human papilloma virus (HPV) is common. HPV
can be transmitted sexually, and it is estimated that 20-80% of
sexually active adults have been infected. While a majority of
infections are asymptomatic, infection can lead to the development
of genital warts (which have a prevalence of about 1-5% among
adults) and cancer of the anogenital tract. Another type of cancer,
cervical cancer, is strongly associated with HPV (Frazer,
Genitourin. Med. 72:398-403, 1996). HPV types 6, 11, 16, 18, 31,
and 33 are often associated with an increased risk of cancer, with
types 16 and/or 18 being detected in more than 90% of cervical
carcinomas (van Driel et al., Ann. Med. 28:471-477, 1996). Types 6
and 11 are also associated with anogenital warts. For reviews of
papilloma viruses and their associated pathologies, see Shah et
al., "Chapter 66: Papillomaviruses," In: Virology, 3rd Edition,
Fields et al., Eds., Raven Press, Philadelphia, pp 2077-2109, 1996,
and zur Hausen, J. Natl. Cancer Inst. 92:690-698, 2000.
[0004] There is currently no safe and effective way to treat or
prevent warts or the diseases described above by targeting the
immune system. Efforts to develop such therapies have been hampered
for several reasons, one of which is the dogma that antigens from a
single HPV type elicit a limited, type-specific immune response.
Consequently, it has been suggested that a cocktail containing
antigens from several different HPV types is necessary for a
broadly effective HPV therapy (Caine et al., Science 288:1753,
2000).
SUMMARY OF THE INVENTION
[0005] The present invention is based, in part, on the discovery
that a fusion protein containing a protein from one HPV type can be
used to treat a disease or condition that is caused by infection
with another HPV type. For example, an HPV type 16 antigen, fused
to a bacterial heat shock protein (hsp), was effective in treating
human anogenital warts caused by HPV types other than type 16
(e.g., HPV types 6 and 11). This result supports two contentions:
(1) that warts can be treated with an HPV protein and (2) that
therapeutic agents aimed at HPV need not contain protein antigens
from different HPV types in order to be broadly effective.
[0006] Accordingly, the invention features a method of treating a
wart in a subject by administering to the subject a composition
containing (1) an hsp, or an immunostimulatory fragment thereof,
and (2) an HPV protein (e.g., an antigenic protein such as the E7
protein of, e.g., HPV type 16) or an antigenic fragment thereof.
These components may be referred to herein as "component (1)" and
"component (2)," respectively. The hsp (or the immunostimulatory
fragment thereof) and the HPV protein (or the antigenic fragment
thereof) can be either simply combined in the same preparation or
more closely associated by chemical conjugation or fusion (i.e.,
one can administer a fusion protein having the components described
herein or a nucleic acid molecule that encodes it). When combined,
conjugated, or fused, component (1) and component (2) would be
administered simultaneously. Each component can, however, also be
administered separately (e.g., sequentially), and component (2) can
be administered without component (1). The method described above
can include a step in which a subject who has, or who is suspected
of having, a wart is identified (in the context of treating the
subject, identification would be made before administration of the
therapeutic agent begins). Physicians and others of ordinary skill
in the art are well able to identify such subjects.
[0007] The methods of the invention can also be used to prevent a
wart, in which case a subject who desires, or who would benefit
from, wart prevention (rather than a subject who already has a
wart) is identified.
[0008] The invention also features methods of treating a subject
who has a disease or condition caused by an infection with an HPV
of a first type (e.g, type 5, 6, 11, 18, 31, 33, 35, 45, 54, 60, or
70) by administering to the subject a composition containing (1) an
hsp, or an immunostimulatory fragment thereof, and (2) a protein of
an HPV of a second type (e.g., type 16) or an antigenic fragment
thereof. That is, the HPV of the "first type" and the HPV of the
"second type" are different from one another; they are of two
different HPV types. The hsp (or the immunostimulatory fragment
thereof) and the HPV protein (or the antigenic fragment thereof)
can be either simply combined in the same preparation or more
intimately associated by chemical conjugation or fusion (i.e., one
can administer a fusion protein having the components described
herein or a nucleic acid molecule that encodes it). When combined,
conjugated, or fused, component (1) and component (2) would be
administered simultaneously. Each component can, however, also be
administered separately (e.g., sequentially), and component (2) can
be administered without component (1). Here again, the method can
include a step in which a subject who has, or is suspected of
having, an HPV infection (or a disease or condition associated
therewith) is identified.
[0009] When a subject who is infected with a first HPV type is
given a composition that includes an HPV of a second type, the
method can be carried out before an HPV infection is typed, before
it is manifest, or before it has occurred (i.e., one need not know
the particular HPV type a subject has been infected with, or will
be infected with, before treatment or prophylaxis can begin). When
the methods are preventative, they can include a step in which a
subject who desires, or who would benefit from, prevention of an
HPV infection is identified.
[0010] The compositions described herein can be administered in
amounts that are sufficient to treat the wart (by, for example,
reducing the size or altering the shape of the wart, or by
ameliorating a symptom associated with a wart (e.g., the pain often
associated with a plantar wart); when a subject has more than one
wart, treatment can encompass reducing the number of warts).
Similarly, the compositions described herein can be administered in
amounts that are sufficient to treat the disease (e.g., cancer
(such as cervical cancer or anal cancer) or other condition (e.g.,
dysplasia (such as cervical or anal dysplasia)) that is caused by,
or associated with, an HPV infection. Although warts are mentioned
separately above, warts also constitute a condition caused by or
associated with HPV. Physicians and others of ordinary skill in the
art will recognize an effective "treatment" of a wart or an
HPV-associated disease or condition when there is a diminution in
an undesirable physiological affect associated with the wart or the
disease or condition. The clinical and physiological manifestations
of a wart, as well as those of a disease or condition associated
with HPV infection, are discussed in, for example, Fauci et al.,
Harrison's Principles of Internal Medicine, 14th Edition,
McGraw-Hill Press, New York, pp 302-303 and 1098-1100, 1998.
[0011] "Subjects" who can benefit from the methods described herein
are those who can be infected by papilloma viruses (e.g., mammals
such as humans, livestock (e.g., cows, horses, pigs, sheep, and
goats), and domestic animals (e.g. cats and dogs)). The wart can be
one that occurs on the subject's genitalia, skin, or internal
organs (such as the warts that appear on the vocal cords in
recurrent respiratory papillomatosis (RRP; also known as juvenile
laryngeal papillomatosis (JLP) or adult-onset RRP)).
[0012] The invention further includes the use of one or more of the
compositions described herein (including those that contain
proteins, protein conjugates or fusion proteins, or the nucleic
acid molecules that encode them) for the treatment of subject who
has warts or a disease or conditions associated with (or caused by)
an HPV infection, in accordance with the methods described herein.
The invention further includes the use of one or more of such
compositions in the manufacture of a medicament for the treatment
of subject who has warts or a disease or conditions associated with
(or caused by) an HPV infection, in accordance with the methods
described herein.
[0013] An "antigenic fragment" of a protein (e.g. an HPV protein)
is any portion of the protein that, when administered in accordance
with the methods described herein, elicits, in a subject, an immune
response that is either a fragment-specific or specific for the
protein from which the fragment was obtained. The immune response
can be either a humoral or a cell-mediated response. For example,
an antigenic fragment can be an HLA class I peptide antigen, such
as described below. One of ordinary skill in the art will recognize
that the immune response desired in the context of the present
invention can be generated not only by intact proteins and
fragments thereof, but also by mutant proteins (e.g., those that
contain one or more additions, substitutions (e.g. conservative
amino acid substitutions) or deletions in their amino acid
sequence). Mutant HPV antigens can be readily made and tested for
their ability to work in the context of the present invention.
[0014] An "immunostimulatory fragment" of a protein (e.g., an hsp)
is any portion of the protein that, when administered in accordance
with the methods described herein, facilitates an immune response
by an antigen. For example, if the immune response to an HPV
protein is facilitated when that HPV protein is administered with
(e.g., fused to) a fragment of an hsp, that fragment is an
immunostimulatory fragment of an hsp. One of ordinary skill in the
art will recognize that the immune response can also be facilitated
by mutant hsps (e.g., hsps that contain one or more additions,
substitutions (e.g., conservative amino acid substitutions) or
deletions in the amino acid sequence). Mutant hsps can be readily
made and tested for their ability to facilitate an immune response
to an HPV antigen.
[0015] The methods of the invention provide an efficient means of:
(1) treating or preventing warts and (2) treating or preventing a
disease or condition caused by (or associated with) an infection
with one HPV type with (i.e., using) a composition containing an
HPV of another type. Consequently, a composition containing an HPV
antigen of a single HPV type can be used in many, if not most,
subjects, regardless of the HPV type with which they are infected
(or with which they may become infected). It is surprising that HPV
compositions are effective in these circumstances (i.e.,
circumstances requiring cross-reactivity). It has been thought that
HPV antigens of one type cannot elicit an effective immune response
against another type. Other features or advantages of the present
invention will be apparent from the following detailed description,
and also from the claims.
DETAILED DESCRIPTION
[0016] The invention relates to broadly effective HPV-based
therapeutic agents containing an hsp and an HPV protein (e.g., a
protein antigen). Without limiting the invention to methods in
which HPV-based therapeutics exert their effect through a
particular mechanism, the agents are thought to produce an immune
response that improves warts and other conditions (e.g., dysplasia)
and diseases (e.g., cancer) associated with HPV infections.
Notably, while the compositions of the invention may contain an HPV
protein from more than one HPV type, they can contain an HPV
protein from only a single type. Moreover, compositions that
contain an HPV protein from a single HPV type are useful in
treating or preventing warts or other HPV-associated diseases or
conditions that are caused by an HPV infection of another (i.e., a
different) type. Various materials and procedures suitable for use
in connection with the invention are discussed below.
[0017] Preparation of Fusion Proteins
[0018] The nucleic acid sequences encoding hsps and HPV proteins
are known and available to those of ordinary skill in the art.
Thus, nucleic acid constructs encoding fusion polypeptides useful
in the methods of the invention can be readily prepared using
routine methods (similarly, such nucleic acid molecules can be used
to produce hsps and HPV proteins individually; the individual hsps
and HPV proteins can then be physically combined (e.g. simply mixed
together) or joined by chemical conjugation (see below) or via
disulfide bonds). Examples of nucleic acid sequences that encode an
hsp optionally fused to an antigen (e.g., an HPV antigen) can be
found in International Publication Nos. WO 89/12455, WO 94/29459,
WO 98/23735, and WO 99/07860 and the references cited therein.
Methods by which proteins, including fusion proteins, can be
expressed and purified are discussed further below.
[0019] Preparation of Protein Conjugates
[0020] Component (1) and component (2) can also be joined by
post-translational conjugation of individual hsps and individual
HPV antigens. Methods for chemically conjugating two proteins (or
portions thereof) are known in the art (see, e.g., the techniques
described in Hermanson, Bioconjugate Techniques, Academic Press,
San Diego, Calif., 1996; Lussow et al., Eur. J. Immun.
21:2297-2302, 1991; and Barrios et al., Eur. J Immun. 22:1365-1372,
1992). Conjugates can be prepared by methods that employ
cross-linking agents, such as glutaraldehyde (which becomes a part
of the resultant conjugate), or that join component (1) and
component (2) by disulfide bonds. One can use cysteine residues
that are either naturally present or recombinantly inserted in the
hsp, the HPV antigen, or both, to facilitate intermolecular
disulfide bond formation. Compositions containing hsps or
immunostimulatory fragments thereof (i.e. component (1)) that are
non-covalently associated with HPV antigens can be produced as
described in U.S. Pat. Nos. 6,048,530; 6,017,544; 6,017,540;
6,007,821; 5,985,270; 5,948,646; 5,935,576; 5,837,251; 5,830,464;
or 5,750,119. See also, U.S. Pat. Nos. 5,997,873; 5,961,979;
6,030,618; 6,139,841; 6,156,302; 6,168,793; and International
Publication No. WO 97/06821.
[0021] Regardless of the final configuration of the composition
administered, component (1) and component (2) can include the
following.
[0022] HPV Protein Antigens
[0023] Any HPV antigen is suitable for use in the compositions
(e.g., the mixtures, conjugates and fusion proteins described
herein) of the present invention. However, HPV antigens that
express recognizable epitopes on the surface of an HPV infected
cell should be especially useful. HPV expresses six or seven
non-structural proteins and two structural proteins, and each of
these can serve as a target in the immunoprophylactic or
immunotherapeutic approaches described herein.
[0024] The viral capsid proteins L1 and L2 are the late structural
proteins. L1 is the major capsid protein, the amino acid sequence
of which is highly conserved among different HPV types. There are
seven early non-structural proteins. Proteins E1, E2, and E4 play
an important role in virus replication. Protein E4 also plays a
role in virus maturation. The role of E5 is less well known.
Proteins E6 and E7 are oncoproteins that are critical for viral
replication, as well as for host cell immortalization and
transformation.
[0025] Hsps
[0026] A variety of hsps have been isolated, cloned, and
characterized from a diverse array of organisms (Mizzen, Biotherapy
10:173-189, 1998; as used herein, the term "heat shock protein(s)"
or its abbreviation (hsp(s)) is synonymous with, or encompasses,
the proteins referred to as "stress proteins"). Immunostimulatory
hsps, or immunostimulatory fragments thereof, are suitable for use
in the compositions described herein (e.g., as part of a fusion
polypeptide). Hsp70, hsp60, hsp20-30, and hsplO are among the major
determinants recognized by host immune responses to infection by
Mycobacterium tuberculosis and Mycobacterium leprae. In addition,
hsp65 of Bacille Calmette Guerin (BCG), a strain of Mycobacterium
bovis, was found to be an effective immunostimulatory agent, as
described in the example below.
[0027] Families of hsp genes and hsps, any of which can be used as
described herein for component (1), are well known in the art.
These include, for example, Hsp100-200, Hsp100, Hsp90, Lon, Hsp70,
Hsp60, TF55, Hsp40, FKBPs, cyclophilins, Hsp20-30, ClpP, GrpE,
Hsp10, ubiquitin, calnexin, and protein disulfide isomerases. See,
e.g., Macario, Cold Spring Harbor Laboratory Res. 25:59-70, 1995;
Parsell et al., Rev. Genet. 27:437-496, 1993; and U.S. Pat. No.
5,232,833. The hsp can be, but is not limited to, a mammalian,
bacterial, or mycobacterial hsp.
[0028] Grp170 (for glucose-regulated protein) is an example of an
hsp in the hsp100-200 family. Grp170 resides in the lumen of the
endoplasmic reticulum, in the pre-Golgi compartment, and may play a
role in immunoglobulin folding and assembly.
[0029] Examples of hsps in the hsp100 family include mammalian
Hsp110, yeast Hsp104, and the E. coli hsps CipA, ClpB, ClpC, ClpX
and CipY.
[0030] Examples of hsps in the hsp90 family includes HtpG in E.
coli , Hsp83 and Hsc83 in yeast, and Hsp90 alpha, Hsp90beta, and
Grp94 in humans. Hsp90 binds groups of proteins that are typically
cellular regulatory molecules, such as steroid hormone receptors
(e.g., glucocorticoid, estrogen, progesterone, and testosterone
receptors), transcription factors, and protein kinases that play a
role in signal transduction mechanisms. Hsp90 proteins also
participate in the formation of large, abundant protein complexes
that include other stress proteins.
[0031] Lon is a tetrameric ATP-dependent protease that degrades
non-native proteins in E. coli.
[0032] Examples of hsps in the hsp70 family include Hsp72 and Hsc73
from mammalian cells, DnaK from bacteria or mycobacteria such as
Mycobacterium leprae, Mycobacterium tuberculosis, and Mycobacterium
bovis (such as Bacille-Calmette Guerin; referred to herein as
hsp71), DnaK from E. coli , yeast, and other prokaryotes, and BiP
and Grp78. Hsp70 is capable of specifically binding ATP as well as
unfolded polypeptides and peptides; hsp70 participates in protein
folding and unfolding as well as in the assembly and disassembly of
protein complexes.
[0033] An example of an hsp from the Hsp 60 family is Hsp65 from
mycobacteria. Bacterial Hsp 60 is also commonly known as GroEL. Hsp
60 forms large homooligomeric complexes, and appears to play a key
role in protein folding. Hsp 60 homologues are present in
eukaryotic mitochondria and chloroplasts.
[0034] Examples of hsps in the TF55 family include Tcpl, TRiC, and
thermosome. These proteins typically occur in the cytoplasm of
eukaryotes and some archaebacteria, and they form multi-membered
rings, promoting protein folding. They are also weakly homologous
to Hsp 60.
[0035] Examples of hsps in the Hsp 40 family include DnaJ from
prokaryotes such as E. coli and mycobacteria and HSJ1, HDJ1, and
Hsp 40 . Hsp 40 plays a role as a molecular chaperone in protein
folding, thermotolerance and DNA replication, among other cellular
activities.
[0036] Examples of FKBPs include FKBP12, FKBP13, FKBP25, and
FKBP59, Fpr1 and Nep1. These proteins typically have
peptidyl-prolyl isomerase activity and interact with
immunosuppressants such as FK506 and rapamycin. The proteins are
typically found in the cytoplasm and the endoplasmic reticulum.
[0037] Examples of cyclophilins include cyclophilins A, B, and C.
These proteins have peptidyl-prolyl isomerase activity and interact
with the immunosuppressant cyclosporin A.
[0038] Hsp 20 -30 is also referred to as small Hsp. Hsp20-30 is
typically found in large homooligomeric complexes or possibly
heterooligomeric complexes. An organism or cell type can express
several different types of small Hsps. Hsp 20 -30 interacts with
cytoskeletal structures and may play a regulatory role in the
polymerization/depolymerization of actin. Hsp 20 -30 is rapidly
phosphorylated upon stress or exposure of resting cells to growth
factors. Hsp20-30 homologues include alpha-crystallin.
[0039] ClpP is an E. coli protease involved in degradation of
abnormal proteins. Homologues of ClpP are found in chloroplasts.
ClpP forms a heterooligomeric complex with ClpA.
[0040] GrpE is an E. coli protein of about 20 kDa that is involved
in the rescue of stress-damaged proteins as well as the degradation
of damaged proteins. GrpE plays a role in the regulation of stress
gene expression in E. coli.
[0041] Hsp10 examples include GroES and Cpn10. Hsp10 is found in E.
coli and in the mitochondria and chloroplasts of eukaryotic cells.
Hsp10 forms a seven-membered ring that associates with Hsp 60
oligomers. Hsp 10 is also involved in protein folding.
[0042] Ubiquitin has been found to bind proteins in coordination
with the proteolytic removal of the proteins by ATP-dependent
cytosolic proteases.
[0043] The stress proteins useful in the present invention can be
obtained from enterobacteria (e.g., E. coli), mycobacteria
(particularly M. leprae, M. tuberculosis, M. vaccae, M. smegmatis,
and M bovis), yeast, Drosophila, vertebrates (e.g., avians or
mammals such as rodents or primates, including humans).
[0044] Protein Expression and Purification
[0045] Proteins can be recombinantly produced. More specifically,
hsps (or fragments thereof) and HPV antigens (or fragments
thereof), which can be administered separately, in combination, or
after conjugation, as well as fusion proteins containing component
(1) and component (2) can be recombinantly produced in bacteria,
yeast, plants or plant cells, or animals or animal cells. For
example, hsps, HPV antigens, and fusion proteins containing them
can be produced by transformation (i.e., transfection,
transduction, or infection) of a host cell with a nucleic acid
sequence in a suitable expression vehicle. Suitable expression
vehicles include plasmids, viral particles, and phage. For insect
cells, baculovirus expression vectors are suitable. The entire
expression vehicle, or a part thereof, can be integrated into the
host cell genome. In some circumstances, it is desirable to employ
an inducible expression vector, for example, the LACSWITCH.RTM.
Inducible Expression System (Stratagene; La Jolla, Calif.).
[0046] Those skilled in the field of molecular biology will
understand that any of a wide variety of expression systems can be
used to provide recombinant proteins (e.g., fusion proteins) useful
in the methods described herein. The precise host cell and vector
used is not critical to the invention.
[0047] As noted above, component (1), component (2) and fusion
proteins containing them can be produced by plant cells. For plant
cells, viral expression vectors (e.g., cauliflower mosaic virus and
tobacco mosaic virus) and plasmid expression vectors (e.g., Ti
plasmid) are suitable. Such cells are available from a wide range
of sources (e.g., the American Type Culture Collection, Manassas,
Va.; see also, e.g., Ausubel et al., Current Protocols in Molecular
Biology, John Wiley & Sons, New York, 1994). The methods of
transformation and the choice of expression vehicle will depend on
the host system selected. Transformation methods are described in,
e.g., Ausubel (supra). Expression vehicles may be chosen from those
provided in, e.g., Pouwels et al., Cloning Vectors: A Laboratory
Manual, 1985, Supp. 1987.
[0048] The host cells harboring the expression vehicle can be
cultured in conventional nutrient media adapted as needed for
activation or repression of a chosen gene, selection of
transformants, or amplification of a chosen gene.
[0049] Where appropriate or beneficial, the nucleic acid encoding a
fusion protein can include a signal sequence for excretion of the
fusion protein to, e.g., facilitate isolation of the protein from a
cell culture. Specific initiation signals may also be required for
efficient translation of inserted nucleic acid sequences. These
signals include the ATG initiation codon and adjacent sequences. In
some cases, exogenous translational control signals, including,
perhaps, the ATG initiation codon, must be provided. Furthermore,
the initiation codon must be in phase with the reading frame of the
desired coding sequence to ensure translation of the entire insert.
These exogenous translational control signals and initiation codons
can be of a variety of origins, both natural and synthetic. The
efficiency of expression can be enhanced by the inclusion of
appropriate transcription or translation enhancer elements, (e.g.,
ones disclosed in Bittner et al., Methods in Enzymol. 153:516,
1987).
[0050] Component (1), component (2), and fusion proteins containing
them can be soluble under normal physiological conditions. In
addition, such fusion proteins can include one or more unrelated
(i.e. a non-hsp, non-HPV) proteins (in whole or in part) to create
an, at least, tripartite fusion protein. The "third" protein can be
one that facilitates purification, detection, or solubilization of
the fusion protein, or that provides some other function. For
example, the expression vector pUR278 (Ruther et al., EMBO J.
2:1791, 1983) can be used to create lacZ fusion proteins, and the
pGEX vectors can be used to express foreign polypeptides as fusion
proteins containing glutathione S-transferase (GST). In general,
such fusion proteins are soluble and can be easily purified from
lysed cells by adsorption to glutathione-agarose beads, followed by
elution in the presence of free glutathione. The pGEX vectors are
designed to include thrombin or factor Xa protease cleavage sites
so that the cloned target gene product can be released from the GST
moiety. The "third" protein can also be an immunoglobulin Fc
domain. Such a fusion protein can be readily purified using an
affinity column. Of course, the fusion proteins used in the methods
of the invention can include more than one component (1) and/or
more than one component (2), and components (1) and (2) may be
directly or indirectly linked (e.g., one or more amino acid
residues may be present between them).
[0051] A protein (e.g. an hsp, an HPV antigen or an hsp-containing
fusion protein) can be purified by utilizing an antibody to which
the protein specifically binds. One of ordinary skill in the art
can use affinity-based purification methods to purify proteins. For
example, see Janknecht et al., Proc. Natl. Acad. Sci. USA. 88:8972,
1981, for purification of non-denatured fusion proteins expressed
in human cell lines. In this system, the gene of interest is
subcloned into a vaccinia recombination plasmid such that the
gene's open reading frame is translationally fused to an
amino-terminal tag consisting of six histidine residues. Extracts
from cells infected with recombinant vaccinia virus are loaded onto
Ni.sup.2+ nitriloacetic acid-agarose columns, and histidine-tagged
proteins are selectively eluted with imidazole-containing buffers.
The same procedure can be used for a bacterial culture.
[0052] Proteins, including fusion proteins (particularly those
containing short antigenic fragments), can also be produced by
chemical synthesis (e.g., by the methods described in Solid Phase
Peptide Synthesis, 2nd ed., 1984 The Pierce Chemical Co., Rockford,
Ill.).
[0053] Once isolated, the proteins can, if desired, be further
purified and/or concentrated, so long as further processing does
not impair their ability to elicit an immune response sufficient to
be effective in the methods of the invention. A variety of methods
for purifying and concentrating proteins are well known in the art
(see, e.g., Fisher, Laboratory Techniques In Biochemistry And
Molecular Biology, Work and Burdon, Eds., Elsevier, 1980),
including ultracentrifugation and/or precipitation (e.g., with
ammonium sulfate), microfiltration (e.g., via 0.45 .mu.m cellulose
acetate filters), ultrafiltration (e.g., with the use of a sizing
membrane and recirculation filtration), gel filtration (e.g.,
columns filled with Sepharose CL-6B, CL-4B, CL-2B, 6B, 4B or 2B,
Sephacryl S-400 or S-300, Superose 6 or Ultrogel A2, A4, or A6; all
available from Pharmacia Corp.), fast protein liquid chromatography
(FPLC), and high performance liquid chromatography (HPLC).
[0054] Cross-reactive HPV Sequences
[0055] One of ordinary skill in the art can determine whether a
composition containing an HPV antigen of a first type can be used
to treat a subject who has been infected with a second type of HPV.
The assays upon which such a determination can be based include
predictive assays (e.g., those employing computer models) and
biological assays (in which one actually tests for
cross-reactivity). One or both types of assays can be used (not
surprisingly, one would expect the results obtained in a predictive
assay to be further tested in a biological assay). Examples of each
follow.
[0056] One can test for cross-reactivity (i.e., the ability of a
composition containing an HPV antigen of one type to effectively
treat a subject who is infected with an HPV of another type, or who
has a disease or condition associated with an HPV of another type)
using well-established immunological methods. For example,
bi-transgenic mice engineered to express the antigen binding region
of the human MHC class I molecule and the human CD8 gene
(Lustgarten et al., Human Immunol. 52:109, 1997; Vitiello et al.,
J. Exp. Med. 173:1007, 1991) can be used to demonstrate immune
cross-reactivity.
[0057] More specifically, the HLA-A2/CD8 bi-transgenic mouse
(Lustgarten et al., supra) can be used to demonstrate cross
reactivity of cytotoxic T lymphocytes (CTL) raised to HPV16 E7
against peptides derived from the E7 protein of HPV6 and 11 using
standard immunological techniques (see, e.g., Coligan et al. Eds.,
Current Protocols in Immunology, John Wiley & Sons, 1999).
Briefly, mice are immunized one to three times at intervals of
seven to 21 days with HspE7 fusion protein (based on the BCG Hsp65
and HPV16 E7 molecules). HspE7 is suspended in phosphate-buffered
saline (PBS) and administered subcutaneously at a dose ranging from
1 .mu.g to 1000 .mu.g per mouse. Seven days following the final
administration of HspE7, mice are sacrificed, their spleens
removed, and the tissue dissociated into a single cell suspension.
CTLs that are specific for HPV E7 are restimulated by the addition
of HLA-A2 binding peptides derived from HPV16 E7, HPV6 E7 and HPV11
E7 to the culture medium at a concentration of 1 .mu.M. The cells
can be restimulated in, for example, 6-well plates, having a
different peptide in each well. The peptides (e.g., the ten
peptides) with the highest predicted HLA-A2 binding affinity, as
defined by computer algorithm, can be used for each ofHPV16, HPV6,
and HPV11 (or any other HPV type; see Parker et al., J. Immunol.
152:163, 1994; the algorithm is also available on the internet
through the BIMAS (Bioinformatics & Molecular Analysis Section)
website of the National Institutes of Health (accessed on Jun. 26,
2001 at http://bimas.dcrt.nih.gov/). In addition, where different,
the corresponding peptides from the other two HPV genotypes would
also be used (i.e., HPV1 6 E7 peptide 11-20 and HPV6 and 11
peptides 11-20).
[0058] Following a period (e.g., one week) of restimulation in
vitro, CTL activity would be measured by the lysis of T2 target
cells pulsed with HLA-A2 binding peptides derived from HPV16 E7,
HPV6 E7 and HPV11E7. In addition, antigen-specific T lymphocytes,
which recognize HLA-A2 binding peptides derived from HPV16 E7, HPV6
E7 and HPV11 E7, can be measured by ELISPOT analysis of
IFN-.gamma.secreting cells using previously described methods (Asal
et al. Clin. Diagn. Lab. Immunol. 7:145, 2000). These analyses
could be performed in mice transgenic for other HLA alleles.
[0059] Alternately, one can measure the ability of CTL, which are
induced by immunization with HspE7, to cross-react with peptides
derived from HPV6 or 11 E7 proteins in human HLA-A2 positive
subjects undergoing therapy for genital warts using HspE7.
Peripheral blood mononuclear cells (PBMC) can be isolated from
subjects (e.g., human patients) prior to treatment and several days
(e.g., 7 days) following each treatment with HspE7. The cells can
be analyzed by fluorogenic MHC-peptide complexes (tetramers, Altman
et al., Science 274:94, 1996) or by ELISPOT analysis (Asal et al.,
Clin. Diagn. Lab. Immunol. 7:145, 2000). Cells can be assayed
directly from the peripheral blood and following in vitro
restimulation as described by Youde et al. (Cancer Res. 60:365,
2000). For in vitro restimulation, 2.times.10.sup.6/ml PBMC are
cultured in RPMI1640 with 10% human AB serum (RAB) and peptide at a
concentration of 10 .mu.g/ml. Restimulating peptides would be
derived from HPV16 E7 and would comprise the peptides (e.g., the
ten peptides) with the highest predicted HLA-A2 binding affinity,
as defined by computer algorithm (Parker et al., supra). On Day 4,
1 ml of RAB containing 25 units/ml of IL-2 is added to each well.
On Day 6, 1 ml of medium is replaced with 1 ml of medium containing
10 units/ml of IL-2. On Day 7, irradiated autologous PBMC (fresh or
frozen-then-thawed) are resuspended at 3.times.10.sup.6 cells/ml in
RAB containing 10 .mu.g/ml peptide and 3 .mu.g/ml
.beta..sub.2-microglobulin. Antigen presenting cells are allowed to
adhere for two hours and are then washed to remove non-adherent
cells before the addition of 1-2.times.10.sup.6 effector cells/ml.
On Day 9, one ml of RAB containing 25 units/ml of IL-2 is added to
each well. On Day 13, the contents of the wells are divided into
multiple plates and the medium (containing 10 units/ml of IL-2) is
restored to the original volume. The cells are used on Day 14. For
FACS analysis, tetramers are prepared as described previously
(Altman et al., Science 274:94, 1996). The peptides used for
loading the tetramers are HLA-A2 binding peptides derived from the
E7 molecule of HPV16, HPV6 and HPV11. The peptides (e.g., the ten
peptides) with the highest predicted HLA-A2 binding affinity, as
defined by computer algorithm (Parker et al., supra) are used for
each of HPV16, HPV6 and HPV11. In addition, where different, the
corresponding peptides from the other two HPV genotypes are also
used (i.e., HPV16 E7 peptide 11-20 and HPV 6 and 11 peptides
11-20). Fresh or restimulated PBMCs are stained with PE-labeled
HPV-E7peptide tetramers and FITC labeled anti-CD8 antibody and
analyzed by flow cytometry, as has been described. ELISPOT analysis
of antigen-specific T lymphocytes that recognize HLA-A2 binding
peptides derived from HPV16 E7, HPV6 E7 and HPV11 E7 present in
fresh and restimulated PBMC is performed using previously described
methods (Asal et al., Clin. Diagn. Lab. Immunol. 7:145, 2000).
Likewise, these techniques can be applied to subjects with other
HLA haplotypes.
[0060] In addition, it is possible to test the ability of human
PBMC derived from HLA-A2 positive healthy volunteers not previously
treated with HspE7, stimulated in vitro with HspE7 protein or
peptides derived from HPV type 16 E7, to cross-react with cells
pulsed with the corresponding peptides from the other two HPV
genotypes (6 and 11). Cells are stimulated and assayed using
procedures common to the art. Briefly, PBMC are isolated from
peripheral blood, adherent cells are separated from non-adherent
cells, and the adherent cells are cultured to generate dendritic
cells (DC) as described in Current Protocols in Immunology (Coligan
et al., Eds., John Wiley & Sons, pp 7.32.7-8, 1999). The
non-adherent cells are cryopreserved in 90% FCS/10% DMSO for use at
a later point in the assay.
[0061] For the stimulation, DC are pulsed with 50 .mu.g/ml HspE7 or
with 40 .mu.g/ml of the appropriate peptide and 3 ,.mu.g/ml
.beta..sub.2-microglobulin for 24 hours at 37.degree. C., 5%
CO.sub.2 (Kawashima et al., Human Immunol 59:1, 1998). The peptides
used are HLA-A2 binding peptides derived from the E7 molecule
ofHPV16, HPV6 and HPV11. The peptides (e.g., the ten peptides) with
the highest predicted HLA-A2 binding affinity, as defined by
computer algorithm (Parker etal., supra) are used for each ofHPV16,
HPV6 and HPV11. In addition, where different, the corresponding
peptides from the other two HPV genotypes would also be used (ie
HPV16 E7 peptide 11-20 and HPV 6 and 11 peptides 11-20). CD8.sup.+
cells are isolated from cryopreserved, autologous non-adherent
cells by positive selection using immunomagnetic beads (Miltenyi
Biotec). Peptide/protein-loaded DC are irradiated at 4200 rads and
mixed with autologous CD8.sup.+ cells at a ratio of 1:20 in, e.g.,
48-well plates containing 0.25.times.10.sup.5 DC and
5.times.10.sup.5 CD8.sup.+ cells and 10 ng/ml of IL-7 in 0.5 mls of
RAB. On days 7 and 14, the cells are restimulated with autologous
peptide-pulsed adherent APC (Kawashima et al, Human Immunol. 59:1,
1998). The cultures are fed every 2-3 days with 10 U/ml of hIL-2.
HPV E7 peptide-specific T lymphocytes are analyzed by fluorogenic
MHC-peptide complexes (tetramers, Altman et al., Science 274:94,
1996) or by ELISPOT analysis (Asal et al, Clin. Diagn. Lab.
Immunol. 7:145, 2000) following 7 and 14 days of in vitro
stimulation. For FACS analysis, tetramers are prepared as described
previously (Altman et al. Science 274:94, 1996). The peptides used
for loading the tetramers would be HLA-A2 binding peptides derived
from the E7 molecule of HPV16, HPV6 and HPV 11, as described above.
Peptide specific T lymphocytes are stained with PE-labeled HPV-E7
peptide tetramers and FITC labeled anti-CD8 antibody and analyzed
by flow cytometry (Youde et al. Cancer Res. 60:365, 2000). ELISPOT
analysis of antigen-specific T lymphocytes, which recognize HLA-A2
binding peptides derived from HPV16 E7, HPV6 E7 and HPV11 E7, is
performed using previously described methods (Asal et al. Clin.
Diagn. Lab. Immunol. 7:145, 2000). Likewise, these techniques could
be applied to subjects with other HLA haplotypes.
[0062] Administration of Compositions
[0063] The invention includes compositions containing at least one
HPV protein antigen (e.g. an HPV protein antigen (or an antigenic
fragment thereof), an HPV protein antigen mixed with or conjugated
to an hsp (or an immunostimulatory fragment thereof) or a fusion
protein containing an HPV protein antigen (or an antigenic fragment
thereof) and an hsp (or an immunostimulatory fragment thereof).
Optionally, these proteins can be suspended in a pharmaceutically
acceptable carrier, such as a diluent (e.g., PBS) or a bicarbonate
solution (e.g., 0.24 M NaHCO.sub.3). Useful carriers are selected
on the basis of the mode and route of administration and on
standard pharmaceutical practice. Suitable pharmaceutical carriers
and diluents, as well as pharmaceutical necessities for their use,
are described in Remington's Pharmaceutical Sciences. An adjuvant,
for example, a cholera toxin, Escherichia coli heat-labile
enterotoxin (LT), a liposome, or an immune-stimulating complex
(ISCOM), can also be included.
[0064] The protein(s) (e.g., the fusion protein) need not be
administered to the subject directly. Instead, a nucleic acid
sequence encoding the protein can be administered; the protein
being expressed in the subject in vivo. The nucleic acid can be a
part of a vector (such as a viral vector, for example, a part of a
viral vector genome), or encapsulated, for example, in liposomes.
Alternatively, the nucleic acid can be delivered as a naked nucleic
acid.
[0065] The compositions can be formulated as a solution,
suspension, suppository, tablet, granules, a powder, a capsule,
ointment, or cream. As noted above, in preparing these
compositions, one or more pharmaceutical carriers can be included.
Additional examples of pharmaceutically acceptable carriers or
other additives include solvents (e.g., water or physiological
saline), solubilizing agents (e.g., ethanol, polysorbates, or
Cremophor EL.RTM.), agents for rendering isotonicity,
preservatives, antioxidizing agents, excipients (e.g., lactose,
starch, crystalline cellulose, mannitol, maltose, calcium hydrogen
phosphate, light silicic acid anhydride, or calcium carbonate),
binders (e.g., starch, polyvinylpyrrolidone, hydroxypropyl
cellulose, ethyl cellulose, carboxy methyl cellulose, or gum
arabic), lubricants (e.g., magnesium stearate, talc, or hardened
oils), or stabilizers (e.g., lactose, mannitol, maltose,
polysorbates, macrogels, or polyoxyethylene-hardened castor oils).
If necessary (or desired), glycerin, dimethylacetamide, sodium
lactate, a surfactant, sodium hydroxide, ethylenediamine,
ethanolamine, sodium bicarbonate, arginine, meglumine, or
trisaminomethane can be added. Biodegradable polymers such as
poly-D,L-lactide-co-glycolide or polyglycolide can be used as a
bulk matrix if slow release of the composition is desired (see, for
example, U.S. Pat. Nos. 5,417,986, 4,675,381, and 4,450,150).
Pharmaceutical preparations such as solutions, tablets, granules or
capsules can be formed with these components. If the composition is
administered orally, flavorings and colors can be added.
[0066] The therapeutic compositions can be administered via any
appropriate route, for example, intravenously, intraarterially,
topically, intraperitoneally, intrapleurally, orally,
subcutaneously, intramuscularly, intradermally, sublingually,
intraepidermally, nasally, intrapulmonarily (e.g., by inhalation),
vaginally, or rectally.
[0067] The amount of the composition administered will depend, for
example, on the particular composition, whether an adjuvant is
co-administered with the composition, the type of adjuvant
co-administered, the mode and frequency of administration, and the
desired effect (e.g., protection or treatment). Dosages are
routinely determined by those of ordinary skill in the art in the
course of developing drugs or prophylactic agents. In general, the
compositions of the present invention are administered in amounts
ranging between 1 .mu.g and 100 mg per adult human dose. If
adjuvants are administered with the compositions, amounts ranging
between 1 ng and 1 mg per adult human dose can generally be used.
Administration is repeated as necessary, as can be determined by
one of ordinary skill in the art. For example, a priming dose can
be followed by three booster doses at weekly or monthly intervals.
A booster shot can be given at 3 to 12 weeks after the first
administration, and a second booster can be given 3 to 12 weeks
later, using the same formulation. Serum or T cells can be taken
from the subject for testing the immune response elicited by the
composition against the HPV antigen included in, for example, the
fusion protein or protein conjugate. Methods of assaying antibodies
or cytotoxic T cells against a specific antigen are well known in
the art. Additional boosters can be given as needed. By varying the
amount of, for example, fusion protein in the composition, the
immunization protocol can be optimized for eliciting a maximal
immune response.
[0068] Of course, the proteins described herein can also be
delivered by administering a nucleic acid, such as a viral vector
(e.g., a retroviral or adenoviral vector).
[0069] Without further elaboration, it is believed that one skilled
in the art can, based on the above disclosure and the example
below, utilize the present invention to its fullest extent. The
following example is to be construed as merely illustrative of how
one skilled in the art can isolate and use fusion polypeptides, and
is not limitative of the remainder of the disclosure in any way.
All publications, including U.S. patents and published
International applications, cited herein are hereby incorporated by
reference
EXAMPLE
[0070] A fusion polypeptide containing the M. bovis BCG Hsp65
coupled to the E7 protein of HPV type 16 was recombinantly produced
and formulated as described in WO 99/07860. Hsp65 is a member of
the Hsp 60 family of stress proteins. In the course of a human
clinical trial for testing the efficacy of this fusion polypeptide
in the treatment of anal high-grade squamous intraepithelial
lesions (HSIL), the following observation was made.
[0071] Twenty-two patients participated in a randomized,
double-blind, placebo-controlled, multicenter trial of HspE7 in the
treatment of anal HSIL. E1igible patients had biopsy-confirmed anal
HSIL and were negative for human immunodeficiency virus (HIV).
Patients were typed for HPV using cells obtained from an anal swab,
but were not required to have HPV-16. Individual lesions were not
typed for HPV. Patients received three subcutaneous injections of
either 100 .mu.g of HpsE7 or placebo at monthly intervals. They
were assessed for treatment response by anal Pap smears,
high-resolution anoscopy (HRA) with biopsy, and global physician
assessment. Non-responders (i.e., those with persistent anal HSIL)
after 12 or 24 weeks in the controlled trial were allowed to
crossover to an open-label trial where they received three
injections of 500 .mu.g of HspE7 at monthly intervals. The
treatment assignment was double-blinded in the placebo-controlled
trial, and the blind has not been broken.
[0072] To determine the HPV type(s) infecting patients, a Dacron
swab was used to collect specimens from the anus of patients at the
screening visit of the randomized, placebo-controlled trial, just
before biopsy. After transport in Sample Transport Medium (Digene),
DNA was isolated and used to determine HPV type. Briefly, the
consensus primer set MY09/MY11 was used to amplify HPV DNA by
polymerase chain reaction (PCR). Following the amplification step,
samples were blotted onto nylon membrane and probed with
biotin-labeled oligonucleotides specific for 29 different HPV types
(6, 11, 16, 18, 26, 31, 32, 33, 35, 39, 40, 45, 51, 52, 53, 54, 55,
56, 58, 59, 61, 66, 68, 69, 70, 73, AE2, Pap155, and Pap291), plus
a pooled probe containing primers for 10 HPV types (2, 13, 34, 42,
57, 62, 64, 67, 72, and W13B). Samples that produced a "dot blot"
were scored positive or negative for HPV type by comparison to
standardized controls using a 5-point scale; a score of 1 or
greater was positive.
[0073] To verify that the PCR was successful, a beta-globin control
amplification and probe detection was performed for each sample. If
the sample was not positive for the presence of beta-globin, the
PCR step was considered a technical failure. If the consensus probe
did not result in a score of 2 or more, the sample was considered
"HPV negative."
[0074] At the time of their entry into the open label trial, 14 of
the 22 patients (64%) had anogenital warts that had persisted
throughout the prior double-blind trial in which they received
three monthly injections of either 100 .mu.g of HspE7 or placebo.
Of these 14 patients, 8 patients (57%) had worsened, 4 patients
(29%) had no change, and 2 patients (14%) improved (one
dramatically and the other minimally) by the time they crossed over
to the open label trial. An additional patient had condyloma
present at the start of the double-blind trial that resolved before
the start of the open-label trial, and is omitted from this
analysis, as are the seven other patients who had no detectable
warts during either trial. Condylomata were present within the
anorectal canal in all 14 patients (100%) and on the perianal skin
as well in 6 of 14 patients (43%). Of the 14 patients with warts at
the beginning of the open label trial, the site investigator
determined that surgical ablation was needed for 11 (79%) patients,
local ablation (e.g., liquid nitrogen, electrocautery) was needed
for 2 patients (14%), and topical treatment (i.e., imiquimod) was
needed for 1 patient (7%). These patients elected to postpone the
site investigator's recommended treatment, consenting instead to
receive three injections of HspE7 500 .mu.g at monthly intervals in
the open label trial.
[0075] One month after the final treatment with 500 .mu.g of HspE7,
2 patients (14%) had no detectable warts, 1 1 patients (79%) had a
reduction in the size or number of warts as compared with their
status upon entry into the open-label trial, and 1 patient (7%)
experienced an increase in wart size (Table 1). By the time of the
primary evaluation point of the open label trial (4 months after
the final dose) one additional patient experienced an improvement
from partial to complete response (i.e., no visible warts), giving
a total of three (21%) complete responders (Table 1). None of these
responders relapsed during the six months of evaluation in the open
label trial. Ten patients (71%) continued to exhibit improvement in
partial response (i.e., warts reduced further in size significantly
with continued diminution of the extent of treatment needed to
remove the remaining warts). The one non-responder (7%) did not
improve by the end of the open-label trial.
1TABLE 1 Response Summary for Anogenital Warts After Treatment with
HspE7 Number (%) of Patients Week 12* Week 24.dagger. Outcome (n =
14) (n = 14) Complete responder 2 (14) 3 (21) Partial responder 11
(79) 10 (71) Non-responder 1 (7) 1 (7) *One month after the final
treatment with 500 .mu.g of HspE7. .dagger.Four months after the
final treatment with 500 .mu.g of HspE7.
[0076] At the end of the trial, the site investigator did not
recommend further treatment for the three complete responders. As
listed in Table 2, the site investigator's recommended treatment
for the partial responders was ablative therapy (6 of 14, 43%) or
treatment with a topical agent (4 of 14, 29%); additional surgery
was recommended for the non-responder (1 of 14, 7%). All 22
patients entered a registry protocol for long-term follow-up of
their response and they consented to postpone the investigator's
recommended treatment.
2TABLE 2 Anogenital Wart Response Assessments and
Clinician-Recommended Treatment Baseline* Week 12.dagger. Week
24.dagger-dbl. Recom- Recom- Recom- Patient mended Wart mended Wart
mended Number Treatment Response Treatment Response Treatment 003
Surgery CR Topical CR None 004 Surgery PR Ablation PR Ablation 005
Topical PR Topical CR None 006 Surgery PR Surgery PR Ablation 008
Ablation PR Topical PR Topical 009 Surgery PR Ablation PR Topical
010 Surgery PR Ablation PR Ablation 011 Surgery CR Topical CR None
014 Surgery PR Topical PR Topical 016 Surgery Worse Surgery Worse
Surgery 017 Ablation PR Topical PR Topical 020 Surgery PR Ablation
PR Ablation 021 Surgery PR Ablation PR Ablation 022 Surgery PR
Ablation PR Ablation *Baseline refers to the beginning of the
open-label trial. .dagger.One month after the final treatment with
500 .mu.g of HspE7. .dagger-dbl.Four months after the final
treatment with 500 .mu.g of HspE7. Abbreviations: CR = complete
response; PR = partial response
[0077] In all 14 patients diagnosed with anogenital warts, HPV DNA
of multiple HPV types was detected in anal swab specimens during
screening for the first, randomized, controlled trial (Table 3).
HPV-6 and/or 11 were present in 12 patients (86%). One patient had
only HPV-16 and related types and another patient could not be
typed. Three of the 14 patients (21%) were positive for HPV-16.
Most patients whose warts improved (11 of 13, 85%) did not have
HPV-16. The non-responder also did not have HPV-16 (see Table
3).
3TABLE 3 HPV Types in Patients with Anogenital Warts Patient HPV
Type in Anal Swab Specimens, Wart Response Number at Screen* at
Week 24.dagger. 003 6, 11, 16 CR 004 6, 54 PR 005 6, 70 CR 006 6,
11, 45 PR 008 16, 31, 55 PR 009 6, 11, 59 PR 010 6, 11, 45, 54 PR
011 HPV positive, type unknown CR 014 6, 11 PR 016 11, 61 Worse 017
HPV negative PR 020 6, 11, 16 PR 021 6, 31, 53, 58, 59, 61, 66 PR
022 6 PR *Screening visit of the randomized, placebo-controlled
clinical trial. .dagger.Four months after the final treatment with
500 .mu.g of HspE7. Abbreviations: HPV = human papillomavirus; CR =
complete response; PR = partial response
[0078] In this open-label, crossover trial of HspE7 (500 .mu.g at 3
monthly intervals) involving patients with persistent anal HSIL and
concomitant anogenital warts, 3 of the 14 patients (17%) who had
warts at baseline no longer had warts 4 months after the final
dose. Another 10 patients (71%) experienced improvement in their
symptoms (i.e., warts reduced in size significantly and continued
diminution of the extent of treatment needed to remove the
remaining warts). One patient (7%) did not improve over the course
of the trial and additional surgery was recommended by the site
investigator.
[0079] Before enrollment in the open-label trial, most patients at
this trial site would have undergone surgical intervention for the
removal of their warts (11 of 14, 79%). By the end of the trial,
surgical treatment was recommended for only one patient. Local
ablative therapy (e.g., liquid nitrogen, electrocautery) was
recommended for six patients (43%) and treatment with a topical
agent (e.g., imiquimod) was recommended for four patients (29%).
Three patients did not need further treatment.
[0080] Responses appear to be progressive over 6 months and no
responder relapsed over this period. Gradual and progressive
resolution of condyloma is in keeping with what one would expect
from an immunologic host response after induction of cell-mediated
immunity by HspE7.
[0081] Two patients in the double-blind trial had some improvement
in their condyloma before entering the open-label trial. To date,
we have not broken the blind and do not know whether these patients
received 100 .mu.g of HspE7 or placebo. However, based on the
response observed in the open-label trial of three monthly
injections of 500 .mu.g of HspE7, it appears that the higher dose
is more active than 100 .mu.g.
[0082] HPV-16 DNA was detected in anal swab specimens from only 3
of the 13 patients (23%) whose warts improved after treatment with
HspE7. DNA from HPV-6, HPV-11, or both, was detected in most of the
patients whose warts responded to treatment with HspE7. These data
suggest that there is immunologic cross-reactivity between these
HPV types in their response to HspE7.
[0083] In summary, the results presented here suggest that HspE7 is
broadly active in anogenital warts. This activity does not appear
to be limited to HPV-16 positive patients, but crosses multiple HPV
types. It is predicted that HspE7 will be active in the treatment
of HPV-induced diseases of the anogenital region and that this
activity will not be limited to HPV-16 positive patients.
[0084] The observations reported here suggest that therapeutic
treatment with HspE7 may constitute a new, simple, and non-surgical
treatment for anogenital warts that, at a minimum, would lessen
wart burden, thereby reducing the extent of treatment and resultant
morbidity. Internal anorectal disease often requires additional
treatment that can be quite painful and debilitating. Any treatment
that provides a even partial response that reduces or eliminates
the amount or extent of "surgical" or ablative therapy translates
into a reduction in morbidity, less loss of time from work, and
improved quality of life.
[0085] These results indicate that a heat shock protein/HPV type 16
antigen composition is effective in eliminating or reducing warts,
which are thought to be caused predominantly by HPV types 6 and 11.
Of significant import are the observations that (1) warts can be
treated at all with an HPV-based composition, and (2) a HPV type 16
composition was effective in treating a condition presumably caused
by a HPV other than type 16. The latter cross-reactive result was
wholly unexpected, given the generally held belief that a
type-specific composition could only elicit a type-specific immune
response.
[0086] To elucidate a possible mechanism for the observed
cross-reactivity of the fusion polypeptide, theoretic binding was
calculated for various HLA class I molecules and E7 peptides of HPV
types 16, 6, and 11. The T.sub.1/2 of dissociation was calculated
using the algorithm described in Parker et al., J. Immunol.
152:163, 1994 (see also the website described above). The data is
summarized in Table 4.
4TABLE 4 HLA HPV Type 16 HPV Type 6 HPV Type 11 Type start sequence
T.sub.1/2 start sequence T.sub.1/2 start sequence T.sub.1/2 A1 44
QAEPDRAHY 900 44 DSQPLKQHY 8 44 DAQPLTQHY 5 16 QPETTDLYCY 23 17
PPDPVGLHCY 6 17 PPDPVGLHCY 6 68 VVECTDGDIR 9 A_0201 11 YMLDLQPET
375 7 TLHEYMLDL 201 7 TLKDIVLDL 7 7 TLKDIVLDL 7 82 LLMGTLGIV 54 82
LLLGTLNIV 412 82 LLLGTLNIV 412 28 QLVDSSEDEV 140 28 QLEDSSEDEV 9 78
TLEDLLMGT 5 79 VQQLLLGTL 1 78 QLQDLLLGT 70 A_0205 7 TLHEYMLDL 50 7
TLKDIVLDL 4 7 TLKDIVLDL 4 11 YMLDLQPET 27 12 VLDLQPPDPV 1 12
VLDLQPPDPV 1 82 LLMGTLGIV 20 82 LLLGTLNIV 20 82 LLLGTLNIV 20 78
TLEDLLMGT 2 79 VQQLLLGTL 19 78 QLQDLLLGT 42 5 TPTLHEYML 0 5
HVTLKDIVL 14 5 LVTLKDIVL 24 A24 56 TFCCKCDSTL 20 51 HYNIVTFCC 11 51
HYQIVTCCC 11 51 HYQILTCCC 9 24 CYEQLNDSS 9 25 CYEQLVDSS 9 25
CYEQLEDSS 9 4 DTPTLHEYML 6 5 HVTLKDIVL 4 4 RLVTLKDIVL 12 39
EVDGQDSQPL 5 39 KVDKQDAQPL 10 A3 88 GIVCPICSQK 14 88 NIVCPICAPK 5
88 NIVCPICAPK 5 7 TLHEYMLDL 8 7 TLKDIVLDL 5 7 TLKDIVLDL 5 A68.1 68
CVQSTHVDIR 200 68 VVQCTETDIR 200 68 VVECTDGDIR 200 89 IVCPICSQK 180
89 IVCPICAPK 180 89 IVCPICAPK 180 A_1101 89 IVCPICSQK 2.0 89
IVCPICAPK 2 89 IVCPICAPK 2.0 68 CVQSTHVDIR 1.8 68 VVQCTETDIR 1 68
VVQCTETDIR 0.6 A_3101 69 VQSTHVDIR 4.0 69 VQCTETDIR 2 68 VVECTDGDIR
2.0 88 GIVCPICSQK 0.4 88 NIVCPICAPK 0 88 NIVCPICAPK 0.4 A_3302 68
CVQSTHVDIR 15 68 VVQCTETDIR 15 68 VVECTDGDIR 15 58 CCKCDSTLR 3 58
CCGCDSNVR 3 58 CCGCDSNVR 3 B14 65 LRLCVQSTHV 30 65 VRLVVQCTE 1 65
VRLVVECTD 1 4 DTPTLHEYML 18 3 GRHVTLKDI 12 3 GRLVTLKDI 60 5
TPTLHEYML 3 6 VTLKDIVLDL 10 6 VTLKDIVLDL 15 76 RTLEDLLMGT 1 76
IREVQQLLL 4 76 IRQLQDLLL 20 B40 36 DEIDGPAGQA 120 35 DEVDEVDGQ 2 35
DEVDKVDKQ 2 74 VDIRTLEDL 10 74 TDIREVQQL 10 74 GDIRQLQDL 20 77
RTLEDLLMGT 0 77 REVQQLLLGT 16 87 LGIVCPICS 0 87 LNIVCPICA 2 87
LNIVCPICA 2 B60 79 LEDLLMGTL 176 79 VQQLLLGTL 2 79 LQDLLLGTL 2 20
TDLYCYEQL 44 21 VGLHCYEQL 9 21 VGLHCYEQL 9 74 VDIRTLEDL 40 74
TDIREVQQL 44 74 GDIRQVQDL 44 40 VDGQDSQPL 20 40 VDKQDAQPL 20 B61 36
DEIDGPAGQA 40 35 DEVDEVDG 1 35 DEVDKVDKQ 1 34 EEDEIDGPA 20 33
SEDEVDEV 40 33 SEDEVDKV 40 72 TETDIREV 80 72 TDGDIRQL 1 29
NDSSEEEDEI 1 29 LEDSSEDEV 40 B62 15 LQPETTDLY 88 15 LQPPDPVGL 6 15
LQPPDPVGL 6 43 GQAEPDRAHY 44 44 DSQPLKQHY 1 44 DAQPLTQHY 5 7
TLHEYMLDL 3 7 TLKDIVLDL 16 7 TLKDIVLDL 16 82 LLMGTLGIV 2 83
LLGTLNIVC 11 83 LLGTLNIVC 11 B7 5 TPTLHEYML 80 5 HVTLKDIVL 20 5
LVTLKDIVL 20 75 DIRTLEDLL 40 75 DIREVQQLL 40 75 DIRQLQDLL 40 46
EPDRAHYNI 2 46 QPLKQHYQI 8 46 QPLTQHYQIL 80 B8 58 CCKCDSTLRL 16 58
CCGCDSNVRL 1 58 CCGCDSNVRL 1 75 DIRTLEDL 8 75 DIREVQQL 12 75
DIRQLQDLL 8 7 TLKDIVLDL 12 7 TLKDIVLDL 12 B_2702 48 DRAHYNIVTF 60
49 KQHYQIVTC 6 49 TQHYQILTC 2 76 IRTLEDLLM 20 76 IREVQQLLL 60 76
IRQLQDLLL 60 65 LRLCVQSTH 20 65 VRLVVQCTET 20 65 VRLVVECTD 2 2
HGDTPTLHEY 1 3 GRHVTLKDIV 20 3 GRLVTLKDIV 20 B_2705 76 IRTLEDLLM
600 76 IREVQQLLL 2000 76 IRQLQDLLL 2000 65 LRLCVQSTHV 600 65
VRLVVQCTET 200 65 VRLVVECTD 20 3 GRHVTLKDIV 600 3 GRLVTLKDIV 600
B_3501 5 TPTLHEYML 20 5 HVTLKDIVL 1 5 LVTLKDIVL 1 16 QPETTDLYCY 18
15 LQPPDPVGL 2 15 LQPPDPVGL 2 43 GQAEPDRAHY 6 44 DSQPLKQHY 10 44
DAQPLTQHY 6 46 EPDRAHYNIV 1 46 QPLKQHYQI 8 46 QPLTQHYQIL 20 B_3701
74 VDIRTLEDLL 200 74 TDIREVQQLL 300 74 GDIRQLQDLL 200 20 TDLYCYEQL
40 21 VGLHCYEQLV 1 21 VGLHCYEQL 1 40 VDGQDSQPL 40 40 VDKQDAQPL 40
80 EDLLMGTLGI 40 80 QQLLLGTLNI 1 80 QDLLLGTLNI 40 B_3801 78
TLEDLLLMGTL 8 78 EVQQLLLGTL 1 79 LQDLLLGTL 4 50 AHYNIVTFC 4 50
QHYQIVTCC 4 50 QHYQILTCC 4 5 TPTLHEYML 2 4 RHVTLKDIVL 30 4
RLVTLKDIVL 1 39 EVDGQDSQPL 6 39 KVDKQDAQPL 3 71 STHVDIRTL 1 71
CTETDIREV 1 71 CTDGDIRQL 6 B_3901 78 TLEDLLMGTL 27 79 VQQLLLGTL 5
79 LQDLLLGTL 14 73 HVDIRTLEDL 14 73 ETDIREVQQL 14 74 GDIRQLQDL 1 77
RTLEDLLMGT 1 76 IREVQQLLL 45 75 DIRQLQDLL 1 4 DTPTLHEYML 2 4
RHVTLKDIVL 90 3 GRLVTLKDI 15 B_3902 59 CKCDSTLRL 20 59 CGCDSNVRL 2
59 CGCDSNVRLV 3 7 TLHEYMLDL 2 7 TLKDIVLDL 1 6 VTLKDIVLDL 9 79
LEDLLMGTL 1 79 VQQLLLGTL 24 79 LQLQDLLLGTL 24 15 LQPETTDLY 1 15
LQPPDVGL 20 15 LQPPDPVGL 20 B_4403 36 DEIDGPAGQA 90 35 DEVDEVDGQ 7
35 DEVDKVDKQ 16 3 GDTPTLHEY 45 44 QAEPDRAHY 6 44 DSQPLKQHY 18 44
DAQPLTQHY 27 77 REVQQLLLGT 12 B_5101 46 EPDRAHYNI 880 46 QPLKQHYQI
440 46 QPLTQHYQI 400 84 MGTLGIVCPI 114 84 LGTLNIVCPI 114 84
LGTLNIVCPI 114 B_5102 46 EPDRAHYNI 220 46 QPLKQHYQI 1452 46
QPLTQHYQI 1452 84 MGTLGIVCPI 88 84 LGTLNIVCPI 88 84 LGTLNIVCPI 88
21 VGLHCYEQLV 145 21 VGLHCYEQL 73 B_5103 46 EPDRAHYNI 58 46
QPLKQHYQI 83 46 QPLTQHYQI 58 84 MGTLGIVCPI 44 84 LGTLNIVCPI 44 84
LGTLNIVCPI 44 21 VGLHCYEQLV 53 B_5201 46 EPDRAHYNIV 100 46
QPLKQHYQIV 132 46 QPLTQHYQIL 22 81 DLLMGTLGIV 33 82 LLLGTLNIV 50 82
LLLGTLNIV 50 60 GCDSNVRLVV 40 60 GCDSNVRLVV 40 B_5801 49 RAHYNIVTF
79.0 49 KQHYQIVTCC 0 48.0 LTQHYQILTC 3.0 77 RTLEDLLMGT 24.0 77
REVQQLLLGT 0 77.0 RQLQDLLLGT 0.1 6 PTLHEYMLDL 0.2 6 VTLKDIVLDL 8
6.0 VTLKDIVLDL 8.0 44 QAEPDRAHY 6.0 44 DSQPLKQHY 5 44.0 DAQPLTQHY
3.0 85 GTLGIVCPI 4.0 85 GTLNIVCPI 4 85.0 GTLNIVCPI 4.0 Cw_0301 20
TDLYCYEQL 100 21 VGLHCYEQL 100 21 VGLHCYEQL 100 74 VDIRTLEDL 30 74
TDIREVQQL 36 74 GDIRQLQDL 36 46 QPLKQHYQIV 6 46 QPLTQHYQIL 120
Cw_0401 56 TFCCKCDSTL 200 57 CCCGCDSNV 1 5 TPTLHEYML 88 73
HVDIRTLEDL 14 73 ETDIREVQQL 12 73 DGDIRQLQDL 12 46 EPDRAHYNI 17 46
QPLKQHYQIV 11 46 QPLTQHYQIL 88 Cw_0602 79 LEDLLMGTL 6 79 VQQLLLGTL
13 79 LQDLLLGTL 13 85 GTLGIVCPI 6 85 GTLNIVCPI 6 85 GTLNIVCPI 6 7
TLHEYMLDL 2 7 TLKDIVLDL 12 7 TLKDIVLDL 12 Cw_0702 3 GDTPTLHEY 27 3
GRHVTLKDI 1 3 GRLVTLKDI 1 15 LQPETTDLY 8 16 QPPDPVGLHC 3 16
QPPDPVGLHC 3 43 GQAEPDRAHY 2 43 QDSQPLKQHY 11 43 QDAQPLTQHY 32 7
TLHEYMLDL 1 7 TLKDIVLDL 4 7 TLKDIVLDL 4
[0087] The peptide sequences in bold indicate the top two binders
for each HLA molecule, and for each the E7 protein from each HPV
type.
[0088] The results in Table 4 suggest that, depending on the
specific HLA molecule examined, the HPV type 16 E7 antigen may
trigger a cell mediated immune response against the E7 antigen of
other HPV types. For example, for HLA B 2705, a high level of
binding was predicted for peptides starting from amino acid
position 76 of E7 for all three HPV types. Thus, it is possible
that, for patients expressing this HLA molecule, an HPV type 16 E7
composition would be cross-reactive and useful for treating or
preventing infection by HPV types 6 and 11. Each of the bolded
peptide fragments in Table 4 represents a possible antigenic
fragment that can be included in the compositions (e.g., the fusion
polypeptides described herein), as a substitute for the complete E7
viral antigen. Of course, two or more such putative HLA epitopes,
or a long fragment containing many putative HLA epitopes, can also
be used.
* * * * *
References