U.S. patent application number 13/922060 was filed with the patent office on 2014-03-06 for use of cytokine expression to predict skin inflammation; methods of treatment.
The applicant listed for this patent is MERCK SHARP & DOHME CORP.. Invention is credited to JASON R. CHAN, ROBERT A. KASTELEIN, TERRILL K. MCCLANAHAN, ERIN MURPHY.
Application Number | 20140065147 13/922060 |
Document ID | / |
Family ID | 46123921 |
Filed Date | 2014-03-06 |
United States Patent
Application |
20140065147 |
Kind Code |
A1 |
KASTELEIN; ROBERT A. ; et
al. |
March 6, 2014 |
Use of Cytokine Expression to Predict Skin Inflammation; Methods of
Treatment
Abstract
Provided are methods for diagnosing the propensity of a subject
to develop skin inflammation, in particular, psoriasis. Also
provided are methods of treatment with antagonists of IL-17, IL-19,
and/or IL-23.
Inventors: |
KASTELEIN; ROBERT A.;
(PORTOLA VALLEY, CA) ; MCCLANAHAN; TERRILL K.;
(SUNNYVALE, CA) ; MURPHY; ERIN; (MENLO PARK,
CA) ; CHAN; JASON R.; (PALO ALTO, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
MERCK SHARP & DOHME CORP. |
RAHWAY |
NJ |
US |
|
|
Family ID: |
46123921 |
Appl. No.: |
13/922060 |
Filed: |
June 19, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13471250 |
May 14, 2012 |
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13922060 |
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12817432 |
Jun 17, 2010 |
8178095 |
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13471250 |
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12202962 |
Sep 2, 2008 |
7740848 |
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12817432 |
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11635960 |
Dec 8, 2006 |
7427402 |
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12202962 |
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11218446 |
Sep 2, 2005 |
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11635960 |
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11120518 |
May 2, 2005 |
7501247 |
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11218446 |
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60567747 |
May 3, 2004 |
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Current U.S.
Class: |
424/136.1 ;
424/133.1; 424/145.1; 424/158.1; 435/6.12; 514/44A |
Current CPC
Class: |
C12Q 1/6883 20130101;
A61P 29/00 20180101; A61P 17/06 20180101; C12Q 2600/106 20130101;
C12Q 1/6881 20130101; C12Q 2600/158 20130101; A61P 17/00 20180101;
A61K 39/3955 20130101; A61K 31/713 20130101 |
Class at
Publication: |
424/136.1 ;
435/6.12; 424/158.1; 514/44.A; 424/133.1; 424/145.1 |
International
Class: |
C12Q 1/68 20060101
C12Q001/68; A61K 31/713 20060101 A61K031/713; A61K 39/395 20060101
A61K039/395 |
Claims
1. A method of evaluating the propensity of a subject to develop an
inflammatory skin disorder comprising: a) obtaining a sample of
skin from the subject; and b) quantifying the level of IL-17 or
IL-19 expression in the sample.
2. The method of claim 1, wherein the IL-17 or IL-19 expression is
mRNA expression.
3. The method of claim 1, wherein the level of IL-17 or IL-19
expression is quantified by real-time PCR.
4. The method of claim 1, wherein the inflammatory skin disorder is
cutaneous inflammation.
5. The method of claim 4, wherein the cutaneous inflammation is
psoriasis.
6. The method of claim 1, wherein the skin sample is from both
lesional and non-lesional psoriatic skin.
7. The method of claim 6, wherein the level of IL-17 expression in
the skin sample is an average value between 5 and 20 fold higher
than normal skin.
8. The method of claim 6, wherein the level of IL-19 expression in
the skin sample is an average value of between 5 and 130 fold
higher than normal skin.
9. The method of claim 1, wherein the subject has: a) a family
history of psoriasis; or b) previously presented psoriatic
symptoms.
10. The method of claim 1, wherein the subject is a human.
11. A method of preventing skin inflammation comprising
administering to a subject exhibiting a propensity to develop skin
inflammation: a) an antagonist of IL-17; b) an antagonist of IL-23;
c) an antagonist of IL-19; or c) an antagonist of at least two
cytokines selected from the group consisting of IL-17, IL-19, and
IL-23.
12. The method of claim 11, wherein the skin inflammation is
cutaneous inflammation.
13. The method of claim 11, wherein the cutaneous inflammation is
psoriasis.
14. The method of claim 11, wherein the subject expresses an
average value of at least 5 fold higher IL-17 expression in a
non-lesional psoriatic skin sample compared to a normal skin
sample, as quantified by real-time PCR.
15. The method of claim 11, wherein the subject expresses an
average value of at least 20 fold higher IL-19 expression in a
non-lesional psoriatic skin sample compared to a normal skin sample
as quantified by real-time PCR.
16. The method of claim 11, wherein the antagonist of IL-17, IL-19,
and/or IL-23 is an: a) antibody or binding fragment thereof; b)
siRNA; or c) a small molecule inhibitor.
17. The method of claim 16, wherein the antibody is: a) a
polyclonal antibody; b) a monoclonal antibody; c) a humanized
antibody; d) a bi-specific antibody.
Description
[0001] This application is a Continuation of U.S. patent
application Ser. No. 13/471,250, filed May 14, 2012, which is a
Continuation of U.S. patent application Ser. No. 12/817,432, filed
Jun. 17, 2010, now U.S. Pat. No. 8,178,095, which is a Continuation
of U.S. patent application Ser. No. 12/202,962, filed Sep. 2, 2008,
now U.S. Pat. No. 7,740,848, which is a Divisional of U.S. patent
application Ser. No. 11/635,960, filed Dec. 8, 2006, now U.S. Pat.
No. 7,427,402, which is a Continuation of U.S. patent application
Ser. No. 11/218,446, filed Sep. 2, 2005, now abandoned, which is a
Continuation-In-Part of U.S. patent application Ser. No.
11/120,518, filed May 2, 2005, now U.S. Pat. No. 7,501,247, which
claims benefit from U.S. Provisional Patent Application No.
60/567,747, filed May 3, 2004, each of which is incorporated herein
by reference.
[0002] The Sequence Listing filed electronically herewith is also
hereby incorporated by reference in its entirety (File Name:
DX06165-US-CNT-5_SeqListing.txt; Date Created: Jun. 19, 2013; File
Size: 1.79 KB.)
FIELD OF THE INVENTION
[0003] The present invention relates to methods of analysis the
propensity to develop skin inflammatory disorders, in particular,
psoriasis. Also provided is a method of treatment to prevent such
skin inflammatory disorders using antagonists of IL-17A, IL-17F,
IL-19, and/or IL-23.
BACKGROUND OF THE INVENTION
[0004] The skin serves as an important boundary between the
internal milieu and the environment, preventing contact with
potentially harmful antigens. In the case of antigen/pathogen
penetration, an inflammatory response is induced to eliminate the
antigen. This response leads to a dermal infiltrate that consists
predominantly of T cells, polymophonuclear cells, and macrophages
(see, e.g., Williams and Kupper (1996) Life Sci., 58:1485-1507.)
Normally, this inflammatory response, triggered by the pathogen, is
under tight control and will be halted upon elimination of the
pathogen.
[0005] In certain cases, this inflammatory response occurs without
external stimuli and without proper controls, leading to cutaneous
inflammation. Cutaneous inflammation, the result of the cellular
infiltrate noted above as well as the secreted cytokines from these
cells, encompasses several inflammatory disorders such as
cicatricial pemphigoid, scleroderma, hidradenitis suppurativa,
toxic epidermal necrolysis, acne, osteitis, graft vs. host disease
(GvHD), pyroderma gangrenosum, and Behcet's Syndrome (see, e.g.,
Willams and Griffiths (2002) Clin. Exp. Dermatol., 27:585-590). The
most common form of cutaneous inflammation is psoriasis.
[0006] Psoriasis is characterized by T cell mediated
hyperproliferation of keratinocytes coupled with an inflammatory
infiltrate. The disease has certain distinct overlapping clinical
phenotypes including chronic plaque lesions, skin eruptions, and
pustular lesions (see, e.g., Gudjonsson, et al. (2004) Clin Exp.
Immunol. 135:1-8). Approximately 10% of psoriasis patients develop
arthritis. The disease has a strong but complex genetic
predisposition, with 60% concordance in monozygotic twins.
[0007] The typical psoriatic lesion is a well defined erythematous
plaque covered by thick, silvery scales. The inflammation and
hyperproliferation of psoriatic tissue is associated with a
different histological, antigenic, and cytokine profile than normal
skin. Among the cytokines associated with psoriasis are:
TNF.alpha., IL-19, IL-18, IL-15, IL-12, IL-7, IFN.gamma., IL-17A
and IL-23 (see, Gudjonsson, et al., supra). IL-17A has been
detected in psoriatic skin.
[0008] To date, prediction of psoriasis flare-ups has been hampered
by lack of knowledge of the cytokine changes between nonlesional
and lesional psoriatic tissue. The present invention fills this
unmet need by providing a method of comparing IL-17A, IL-17F, and
IL-19 expression in nonlesional psoriatic skin relative to normal
skin, thus affording the ability to assess probability of the
formation of lesional psoriasis.
SUMMARY OF THE INVENTION
[0009] The invention is based, in part, upon the discovery that
IL-17A, IL-17F (collectively, "IL-17"), and IL-19 mRNA levels are
comparably elevated in non-lesional psoriatic tissue as compared to
normal or non-psoriatic skin tissue.
[0010] The present invention provides a method of a method of
evaluating the propensity of a subject to develop an inflammatory
skin disorder comprising: a) obtaining a sample of skin from the
subject; and b) quantifying the level of IL-17 or IL-19 expression
in the sample. In one embodiment, the IL-17 or IL-19 expression is
mRNA expression, and level of IL-17 or IL-19 expression is
quantified by real-time PCR.
[0011] The invention further provides that the inflammatory skin
disorder is cutaneous inflammation, in particular, psoriasis. The
skin sample can be from lesional or non-lesional psoriatic skin. In
certain embodiments, the level of IL-17 expression in the skin
sample is an average value between 5 and 20 fold higher in than
normal skin. The average value for IL-19 expression can be between
5 and 130 fold higher than normal skin.
[0012] In a further embodiment, the skin sample is from
non-lesional psoriatic skin. Also encompassed is that the
non-lesional psoriatic skin sample is from a subject having: a) a
family history of psoriasis; or b) previously presented psoriatic
symptoms. In a further embodiment, subject is a human.
[0013] The present invention also provides a method of preventing
skin inflammation comprising administering to a subject exhibiting
a propensity to develop skin inflammation: a) an antagonist of
IL-17; b) an antagonist of IL-23; c) an antagonist of IL-19; or d)
an antagonist of at least two cytokines selected from the group
consisting of IL-17, IL-19, or IL-23. In one embodiment the skin
inflammation is cutaneous inflammation, in particular, psoriasis.
In this method of preventing skin inflammation, subject expresses
an average value of at least 5 fold higher IL-17 expression in a
non-lesional psoriatic skin sample compared to a normal skin
sample, as quantified by real-time PCR. The average value of IL-19
expression is at least 20 fold higher.
[0014] The invention further provides that the antagonist of IL-17,
IL-19, and/or IL-23 is an: a) antibody or binding fragment thereof;
b) siRNA; or c) a small molecule inhibitor. In a further
embodiment, the antibody is: a) a polyclonal antibody; b) a
monoclonal antibody; c) a humanized antibody; d) a bi-specific
antibody.
DETAILED DESCRIPTION
[0015] As used herein, including the appended claims, the singular
forms of words such as "a," "an," and "the" include their
corresponding plural references unless the context clearly dictates
otherwise. All references cited herein are incorporated by
reference to the same extent as if each individual publication,
patent application, or patent, was specifically and individually
indicated to be incorporated by reference.
I. DEFINITIONS
[0016] "Activity" of a molecule may describe or refer to binding of
the molecule to a ligand or to a receptor, to catalytic activity,
to the ability to stimulate gene expression, to antigenic activity,
to the modulation of activities of other molecules, and the like.
"Activity" of a molecule may also refer to activity in modulating
or maintaining cell-to-cell interactions, e.g., adhesion, or
activity in maintaining a structure of a cell, e.g., cell membranes
or cytoskeleton. "Activity" may also mean specific activity, e.g.,
[catalytic activity]/[mg protein], or [immunological activity]/[mg
protein], or the like.
[0017] "Administration" and "treatment," as it applies to an
animal, human, experimental subject, cell, tissue, organ, or
biological fluid, refers to contact of an exogenous pharmaceutical,
therapeutic, diagnostic agent, or composition to the animal, human,
subject, cell, tissue, organ, or biological fluid. "Administration"
and "treatment" can refer, e.g., to therapeutic, pharmacokinetic,
diagnostic, research, and experimental methods. Treatment of a cell
encompasses contact of a reagent to the cell, as well as contact of
a reagent to a fluid, where the fluid is in contact with the cell.
"Administration" and "treatment" also means in vitro and ex vivo
treatments, e.g., of a cell, by a reagent, diagnostic, binding
composition, or by another cell. Treatment encompasses methods
using a purified immune cell, e.g., in a mixed cell reactions or
for administration to a research, animal, or human subject. The
invention contemplates treatment with a cell, a purified cell, a
stimulated cell, a cell population enriched in a particular cell,
and a purified cell. Treatment further encompasses situations where
an administered reagent or administered cell is modified by
metabolism, degradation, or by conditions of storage.
[0018] "Amino acid" refers to naturally occurring and synthetic
amino acids, as well as amino acid analogs and amino acid mimetics
that function in a manner similar to the naturally occurring amino
acids. Naturally occurring amino acids are those encoded by the
genetic code, including selenomethionine, as well as those amino
acids that are modified after incorporation into a polypeptide,
e.g., hydroxyproline, O-phosphoserine, O-phosphotyrosine,
gamma-carboxyglutamate, and cystine. Amino acid analogs refers to
compounds that have the same basic chemical structure as a
naturally occurring amino acid, i.e., an .alpha.-carbon that is
bound to a hydrogen, a carboxyl group, an amino group, and an R
group, e.g., homoserine, norleucine, methionine sulfoxide,
methionine methyl sulfonium. Such analogs have modified R groups
(e.g., norleucine) or modified peptide backbones, but retain the
same basic chemical structure as a naturally occurring amino acid.
Amino acid mimetic refers to a chemical compound that has a
structure that is different from the general chemical structure of
an amino acid, but that functions in a manner similar to a
naturally occurring amino acid. Amino acids may be referred to
herein by either their commonly known three letter symbols or by
their one-letter symbols.
[0019] "Binding composition" refers to a molecule, small molecule,
macromolecule, antibody, a fragment or analogue thereof, or soluble
receptor, capable of binding to a target. "Binding composition"
also may refer to a complex of molecules, e.g., a non-covalent
complex, to an ionized molecule, and to a covalently or
non-covalently modified molecule, e.g., modified by
phosphorylation, acylation, cross-linking, cyclization, or limited
cleavage, which is capable of binding to a target. "Binding
composition" may also refer to a molecule in combination with a
stabilizer, excipient, salt, buffer, solvent, or additive, capable
of binding to a target. "Binding" may be defined as an association
of the binding composition with a target where the association
results in reduction in the normal Brownian motion of the binding
composition, in cases where the binding composition can be
dissolved or suspended in solution.
[0020] "Bispecific antibody" generally refers to a covalent
complex, but may refer to a stable non-covalent complex of binding
fragments from two different antibodies, humanized binding
fragments from two different antibodies, or peptide mimetics
derived from binding fragments from two different antibodies. Each
binding fragment recognizes a different target or epitope, e.g., a
different receptor, e.g., an inhibiting receptor and an activating
receptor. Bispecific antibodies normally exhibit specific binding
to two different antigens.
[0021] "Cutaneous Inflammation" refers to improper regulation of
the immune response in the skin or dermis, leading to an infiltrate
of inflammatory cells and release of various inflammatory factors,
including cytokines Cutaneous inflammation includes psoriasis,
atopic dermatitis, scleroderma, and the like.
[0022] Endpoints in activation or inhibition can be monitored as
follows. Activation, inhibition, and response to treatment, e.g.,
of a cell, skin tissue, keratinocyte, physiological fluid, tissue,
organ, and animal or human subject, can be monitored by an
endpoint. The endpoint may comprise a predetermined quantity or
percentage of, e.g., an indicia of inflammation, oncogenicity, or
cell degranulation or secretion, such as the release of a cytokine,
toxic oxygen, or a protease. The endpoint may comprise, e.g., a
predetermined quantity of ion flux or transport; cell migration;
cell adhesion; cell proliferation; potential for metastasis; cell
differentiation; and change in phenotype, e.g., change in
expression of gene relating to inflammation, apoptosis,
transformation, cell cycle, or metastasis (see, e.g., Knight (2000)
Ann. Clin. Lab. Sci. 30:145-158; Hood and Cheresh (2002) Nature
Rev. Cancer 2:91-100; Timme, et al. (2003) Curr. Drug Targets
4:251-261; Robbins and Itzkowitz (2002) Med. Clin. North Am.
86:1467-1495; Grady and Markowitz (2002) Annu. Rev. Genomics Hum.
Genet. 3:101-128; Bauer, et al. (2001) Glia 36:235-243;
Stanimirovic and Satoh (2000) Brain Pathol. 10:113-126).
[0023] To examine the extent of inhibition, for example, samples or
assays comprising a given, e.g., protein, gene, cell, or organism,
are treated with a potential activator or inhibitor and are
compared to control samples without the inhibitor. Control samples,
i.e., not treated with antagonist, are assigned a relative activity
value of 100% Inhibition is achieved when the activity value
relative to the control is about 90% or less, typically 85% or
less, more typically 80% or less, most typically 75% or less,
generally 70% or less, more generally 65% or less, most generally
60% or less, typically 55% or less, usually 50% or less, more
usually 45% or less, most usually 40% or less, preferably 35% or
less, more preferably 30% or less, still more preferably 25% or
less, and most preferably less than 25%. Activation is achieved
when the activity value relative to the control is about 110%,
generally at least 120%, more generally at least 140%, more
generally at least 160%, often at least 180%, more often at least
2-fold, most often at least 2.5-fold, usually at least 5-fold, more
usually at least 10-fold, preferably at least 20-fold, more
preferably at least 40-fold, and most preferably over 40-fold
higher.
[0024] "Exogenous" refers to substances that are produced outside
an organism, cell, or human body, depending on the context.
"Endogenous" refers to substances that are produced within a cell,
organism, or human body, depending on the context.
[0025] "IL-17" as used herein, unless specifically stated
otherwise, can mean IL-17A and/or IL-17F.
[0026] The "level of IL-17 expression" or "level of IL-19
expression" refers to real-time PCR values that are normalized to
ubiquitin. Kruskal-Wallis statistical analysis is performed on log
transformed data (median method). Typically the calculated average
level of IL-17 mRNA expression in non-lesional psoriatic tissues is
between 2 and 50 fold higher than normal tissues. Preferably the
level is between 5 and 20 fold higher.
[0027] A "marker" relates to the phenotype of a cell, tissue,
organ, animal, or human subject. Markers are used to detect cells,
e.g., during cell purification, quantitation, migration,
activation, maturation, or development, and may be used for both in
vitro and in vivo studies. An activation marker is a marker that is
associated with cell activation.
[0028] "Monofunctional reagent" refers, e.g., to an antibody,
binding composition derived from the binding site of an antibody,
an antibody mimetic, a soluble receptor, engineered, recombinant,
or chemically modified derivatives thereof, that specifically bind
to a single type of target. For example, a monofunctional reagent
may contain one or more functioning binding sites for an IL-17,
IL-19, or IL-23 ligand or receptor. "Monofunctional reagent" also
refers to a polypeptide, antibody, or other reagent that contains
one or more functioning binding sites for, e.g., IL-17, IL-19, or
IL-23 ligand or receptor and one or more non-functioning binding
sites for another type of receptor. For example, a monofunctional
reagent may comprise an antibody binding site for IL-17, IL-19, or
IL-23 ligand or receptor plus an Fc fragment that has been
engineered so that the Fc fragment does not specifically bind to Fc
receptor.
[0029] "Nucleic acid" refers to deoxyribonucleotides or
ribonucleotides and polymers thereof in either single stranded or
double-stranded form. The term nucleic acid may be used
interchangeably with gene, cDNA, mRNA, oligonucleotide, and
polynucleotide. A particular nucleic acid sequence also implicitly
encompasses "allelic variants" and "splice variants."
[0030] "Condition" of skin encompasses disorders but also states
that are not necessarily classified as disorders, e.g., cosmetic
conditions or states of normal physiology. Disorders of a the skin
encompass disorders of a cell, where the cell is in the same
genetic lineage of the skin, e.g., a precursor cell of dermal
keratinocytes where the precursor is committed to becoming a
keratinocyte.
[0031] "Sample" refers to a sample from a human, animal, or to a
research sample, e.g., a cell, tissue, organ, fluid, gas, aerosol,
slurry, colloid, or coagulated material. The "sample" may be tested
in vivo, e.g., without removal from the human or animal, or it may
be tested in vitro. The sample may be tested after processing,
e.g., by histological methods. "Sample" also refers, e.g., to a
cell comprising a fluid or tissue sample or a cell separated from a
fluid or tissue sample. "Sample" may also refer to a cell, tissue,
organ, or fluid that is freshly taken from a human or animal, or to
a cell, tissue, organ, or fluid that is processed or stored.
[0032] Small molecules are provided for the treatment of physiology
and disorders of the skin, e.g., cutaneous inflammation. "Small
molecule" is defined as a molecule with a molecular weight that is
less than 10 kD, typically less than 2 kD, and preferably less than
1 kD. Small molecules include, but are not limited to, inorganic
molecules, organic molecules, organic molecules containing an
inorganic component, molecules comprising a radioactive atom,
synthetic molecules, peptide mimetics, and antibody mimetics. As a
therapeutic, a small molecule may be more permeable to cells, less
susceptible to degradation, and less apt to elicit an immune
response than large molecules. Small molecule toxins are described
(see, e.g., U.S. Pat. No. 6,326,482 issued to Stewart, et al).
[0033] "Specifically" or "selectively" binds, when referring to a
ligand/receptor, antibody/antigen, or other binding pair, indicates
a binding reaction which is determinative of the presence of the
protein in a heterogeneous population of proteins and other
biologics. Under designated conditions, a specified ligand binds to
a particular receptor and does not bind in a significant amount to
other proteins present in the sample. The antibody, or binding
composition derived from the antigen-binding site of an antibody,
of the contemplated method binds to its antigen, or a variant or
mutein thereof, with an affinity or binding constant that is at
least two fold greater, preferably at least ten times greater, more
preferably at least 20-times greater, and most preferably at least
100-times greater than the affinity with any other antibody, or
binding composition derived thereof. In a preferred embodiment the
antibody will have an affinity that is greater than about 10.sup.9
liters/mol, as determined, e.g., by Scatchard analysis (Munsen, et
al. (1980) Analyt. Biochem. 107:220-239).
[0034] "Treatment," as it applies to a human, veterinary, or
research subject, refers to therapeutic treatment, prophylactic or
preventative measures, to research and diagnostic applications.
"Treatment" as it applies to a human, veterinary, or research
subject, or cell, tissue, or organ, encompasses contact of a IL-17
or IL-23 antagonist to a human or animal subject, or to a cell,
tissue, physiological compartment, or physiological fluid.
"Treatment of a cell, tissue, organ, or subject" encompasses
situations where it has not been demonstrated that the antagonist
of IL-17 or IL-23 has contacted their respective receptors, or a
cell expressing these receptors.
[0035] "Therapeutically effective amount" of a therapeutic agent is
defined as an amount of each active component of the pharmaceutical
formulation that is sufficient to show a meaningful patient
benefit, i.e., to cause a decrease in, amelioration of, or
prevention of the symptoms of the condition being treated. When the
pharmaceutical formulation comprises a diagnostic agent, "a
therapeutically effective amount" is defined as an amount that is
sufficient to produce a signal, image, or other diagnostic
parameter that facilitates diagnosis. Effective amounts of the
pharmaceutical formulation will vary according to factors such as
the degree of susceptibility of the individual, the age, gender,
and weight of the individual, and idiosyncratic responses of the
individual (see, e.g., U.S. Pat. No. 5,888,530).
II. GENERAL
[0036] Mammalian skin consists of dermal (inner) and epidermal
(outer) layers. The epidermis is made almost entirely of
keratinocytes (95%) with other cell types including Langerhans
cells and melanocytes. The epidermis is rapidly growing, turning
over every seven days in the mouse. In psoriasis, this turnover is
shortened to 3-5 days as a result of keratinocyte
hyperproliferation.
[0037] The present invention is based, in part, upon the discovery
that non-lesional psoriatic tissues expresses IL-17A mRNA at
significantly elevated levels when compared to normal or
non-psoriatic tissue. A human inflammatory skin panel was analyzed
by real-time quantitative PCR (TaqMan). The skin panel included
normal, non-lesional and lesional psoriatic skin tissue, and
lesional and non-lesional atopic dermatitis skin samples.
Non-lesional and lesional psoriasis tissue was derived from patient
samples with PASI (psoriasis area and severity index) scores
between 9-20.75. Non-lesional and lesional atopic dermatitis tissue
was derived from patient samples with EASI (eczema area and
severity index) scores between 1.85-35.95.
[0038] The results of the PCR analysis were normalized to ubiquitin
and Kruskal-Wallis statistical analysis was performed on log
transformed data (median method). Normal skin tissue samples had an
average IL-17A mRNA expression value of 0.42, while the psoriatic
non-lesional tissue, psoriatic lesional tissue, non-lesional atopic
dermatitis tissue, and lesional atopic dermatitis tissue had
average IL-17A expression values of 5.19 (12.3 fold higher), 25.7
(61.2 fold higher), 0.72 (1.7 fold higher) and 2.1 (5 fold higher),
respectively, when compared to normal skin, as described in Table 1
(L=Lesional, NL=Nonlesional, AD=Atopic Dermatitis).
TABLE-US-00001 TABLE 1 IL-17A Normalized Values Normal Psoriasis
Psoriasis skin NL L AD NL AD L 0.13 0.08 0.06 0.12 0.11 4.95 16.41
55.06 0.19 0.12 0.95 19.00 46.43 0.08 0.12 0.09 18.13 27.84 0.07
1.53 0.08 0.89 13.35 0.16 0.08 0.10 0.08 4.69 0.11 0.07 0.06 0.66
5.53 0.09 1.31 0.06 2.37 10.43 0.10 0.08 1.39 1.79 22.67 0.18 1.46
0.07 3.84 24.76 1.55 6.00 0.09 6.26 51.92 1.58 0.54 0.76 9.39 49.53
0.16 0.09 0.06 0.09 16.50 0.53 9.01 1.53 0.87 22.67 1.29 2.07 0.08
0.05 23.21 0.95 1.46 0.11 1.02 20.51 0.09 0.53 0.20 0.08 11.26 0.39
3.16 0.11 5.25 6.44 4.29 14.59 0.09 30.77 39.85 0.07 1.29 0.18 1.05
9.78 0.08 0.05 0.06 18.34 1.07 3.62 0.07 0.10 41.04 0.10 0.87 0.15
0.84 49.24 0.08 0.09 0.10 0.75 52.22 0.16 0.11 1.54 4.92 19.45 1.33
2.10 0.12 0.09 1.60 0.09 0.06 0.92 0.11 2.58 5.80 0.95 0.93 2.68
0.05 3.13 1.62 0.07 0.06 0.05 0.08 0.10 Average 0.42 5.19 25.71
0.72 2.10 Fold increase over normal 12.37 61.22 1.72 5.01 Median
0.10 1.03 22.67 0.16 1.30 Fold increase over normal 10.84 238.01
1.66 13.68
[0039] IL-17F mRNA expression was similarly analyzed. The results
of the PCR analysis were normalized to ubiquitin and Kruskal-Wallis
statistical analysis was performed on log transformed data (median
method). Normal skin tissue samples had an average IL-17F mRNA
expression value of 0.90, while the psoriatic non-lesional tissue,
psoriatic lesional tissue, non-lesional atopic dermatitis tissue,
and lesional atopic dermatitis tissue had average IL-17F expression
values of 9.39 (10.43 fold higher), 55.85 (62.05 fold higher), 1.39
(1.54 fold higher) and 4.13 (4.59 fold higher), respectively, when
compared to normal skin, as described in Table 2 (L=Lesional,
NL=Nonlesional, AD=Atopic Dermatitis).
TABLE-US-00002 TABLE 2 IL-17F Normalized Values Normal Psoriasis
Psoriasis skin NL L AD NL AD L 0.15 0.15 1.71 0.19 1.41 3.22 23.90
67.24 4.72 3.28 1.49 12.30 61.57 0.09 0.18 0.27 33.80 64.53 1.89
3.93 0.11 2.59 79.74 0.16 0.09 0.11 0.13 21.50 3.13 1.19 1.12 0.25
20.51 0.11 0.13 0.08 20.03 36.49 0.10 2.30 4.22 0.09 85.06 0.24
4.80 0.08 0.17 44.56 0.21 11.13 3.30 3.54 82.60 2.17 4.77 2.64
37.14 137.74 0.17 0.09 0.84 0.14 27.52 2.10 7.38 2.53 1.85 65.68
2.25 7.20 2.58 1.35 21.62 1.79 18.24 0.10 0.15 22.01 0.16 1.12 0.93
0.08 64.91 0.22 10.19 0.31 13.43 27.20 7.33 38.92 0.80 50.12 68.44
0.10 0.12 0.30 7.08 71.73 0.09 0.12 0.13 86.58 1.40 1.17 0.10 0.17
49.82 0.09 0.09 0.22 0.12 47.54 1.29 0.12 0.12 5.40 106.98 0.16
1.48 1.16 11.39 33.02 0.11 0.97 0.13 0.14 0.15 0.10 1.62 0.08 0.14
1.37 2.20 0.77 4.37 0.11 0.16 3.89 0.90 2.83 0.13 0.09 0.09 0.13
Average 0.90 9.39 55.85 1.39 4.13 Fold increase over normal 10.43
62.05 1.54 4.59 Median 0.22 2.22 61.57 0.23 1.18 Fold increase over
normal 10.19 282.24 1.04 5.40
[0040] IL19 mRNA expression was also analyzed. The results of the
PCR analysis were normalized to ubiquitin and Kruskal-Wallis
statistical analysis was performed on log transformed data (median
method). Normal skin tissue samples had an average IL-19 mRNA
expression value of 0.75, while the psoriatic non-lesional tissue,
psoriatic lesional tissue, non-lesional atopic dermatitis tissue,
and lesional atopic dermatitis tissue had average IL-19 expression
values of 23.44 (31.11 fold higher), 199.40 (264.66 fold higher),
9.65 (12.80 fold higher) and 31.55 (41.88 fold higher),
respectively, when compared to normal skin, as described in Table 3
(L=Lesional, NL=Nonlesional, AD=Atopic Dermatitis).
TABLE-US-00003 TABLE 3 IL-19 Normalized Values Normal Psoriasis
Psoriasis skin NL L AD NL AD L 0.13 3.13 15.47 1.16 5.60 19.68
65.68 192.56 0.19 0.12 1.80 40.09 126.86 0.08 1.58 0.09 66.45
133.75 0.72 2.01 0.08 2.28 44.30 0.16 2.90 0.10 0.84 63.78 0.11
1.09 0.06 0.06 9.17 0.09 0.07 0.06 8.25 30.23 0.10 0.08 0.06 2.70
588.28 2.97 11.87 0.07 14.16 41.77 0.49 13.04 1.02 13.75 784.64
71.73 348.65 0.10 40.56 212.80 8.85 14.50 0.06 4.15 92.36 6.95
20.51 0.14 17.40 143.53 123.19 282.16 0.08 10.56 97.95 0.16 0.91
0.11 5.66 39.15 4.83 6.48 0.20 0.99 116.84 0.39 1.36 0.11 11.46
4.48 9.44 25.80 0.09 163.34 171.20 3.75 4.53 0.18 14.76 63.78 0.08
0.05 0.06 1.53 129.88 7.38 24.32 0.07 0.07 856.96 2.36 4.64 0.15
7.46 473.30 0.08 8.30 0.10 67.24 354.86 0.63 27.84 0.07 197.14 4.61
4.48 0.12 0.98 0.12 0.09 0.06 0.69 0.11 1.85 13.20 0.07 3.38 6.83
0.05 32.63 112.79 0.07 0.06 0.05 0.97 0.10 Average 0.75 23.44
199.40 6.65 31.55 Fold increase over normal 31.11 264.66 12.80
41.88 Median 0.09 9.40 126.86 1.07 5.12 Fold increase over normal
99.31 1339.95 11.27 54.03
[0041] IL-17A, first isolated from an activated rodent T-cell
hybridoma, was initially named CTLA-8 (see, e.g., Rouvier, et al.
(1993) J. Immunol. 150:5445-5456). The cytokine had substantial
homology (58%) to an open-reading frame in Herpesvirus samiri.
Initial biological characterization found that IL-17 could promote
the production of other inflammatory cytokines and chemokines such
as IL-6, IL-8, and G-CSF from epithelial, endothelial, and
fibroblast cells (see, e.g., Yao, et al. (1995) Immunity 3:811-821;
Kennedy, et al. (1996) J. Interferon Cytokine Res. 16:611-617; and
Fossiez, et al. (1996) J. Exp. Med. 183:2593-2603). IL-17 has been
associated in various inflammatory and proliferative disorders,
including rheumatoid arthritis, airway inflammation, transplant
rejection, systemic sclerosis, psoriasis, and tumor growth (see,
e.g., Aggarwal and Gurney (2002) J. Leukocyte Biology 71:1-8).
[0042] IL-17F has high sequence identity to IL-17A. However, the
level of expression of IL-17F (also known as ML-1) is low compared
to that of IL-17A and the expression patterns for IL-17F are quite
distinct from those of IL-17A. RT-PCR results indicate that IL-17F
is expressed by activated CD4+ T cells and activated monocytes
(see, e.g., Starnes, et al. (2001) J. Immunol. 167:4137-4140).
IL-17F expression and activity has been linked to pulmonary
epithelial cells as well angiogenesis (see, e.g., Starnes, et al.
supra; Kawaguchi, et al. (2001) J. Immunol. 167:4430-4435; and
Kawaguchi, et al. (2004) J. Allergy Clin. Immunol. 114:1265-1273).
The present invention reveals that expression of IL-17F in lesional
and non-lesional psoriasis and atopic dermatitis mirrors the
expression of IL-17A in the same tissues (see, e.g., Tables 1 and
2). Thus, using one or both of the IL-17 family member expression
levels should provide useful information in predicting the outbreak
of these two inflammatory skin disorders. Also antagonizing one or
both of these cytokines should provide preventative therapy to
avoid outbreaks of these disorders.
[0043] IL-19 is a member of a novel family of IL-10-related
cytokines that consists of IL-19, IL-20, and IL-24. Monocytes are
the major hematopoietic source of IL-19 (Nagalakshmi et al, (2004)
Int Immunopharmacol 4:577-592). Monocytes also respond to IL-19 by
producing IL-6 and TNF (Liao et al, (2002) J Immunol
169:4288-4297). IL-19 binds to the heterodimeric receptor
IL-20R1/IL-20R2 (Parrish-Novak (2002), J Biol Chem 277:
47517-47523). These receptor subunits are highly expressed in
epithelial cells, including keratinocytes (Wang et al (2002) J Biol
Chem 277:7341-7347; Blumberg et al. (2001) Cell 104:9-19), and are
elevated in human psoriatic skin (Romer et al (2003) J Invest
Dermatol 6:1306-1311), suggesting a possible role in psoriasis
pathogenesis. IL-19 mRNA is expressed by keratinocytes in human
psoriatic lesions and disappears after treatment with cyclosporin
or calcipotriol (Romer et al, supra). IL-19 mRNA is also reduced in
psoriatic patients after IL-4 therapy (Ghoreschi et al (2003) Nat
Med 9:40-46). Elevated IL-19 levels in serum has also been
associated with asthma (Liao et al (2004) J Immunol.
173:6712-6718).
[0044] IL-23 is a heterodimeric cytokine composed of one unique
subunit, p19 (also known as IL-B30, IL-30) in association with the
p40 subunit from IL-12 (see, e.g., Oppmann, et al. (2000) Immunity
13:715-725). Transgenic overexpression of IL-23p19 was shown to be
sufficient for the induction of systemic inflammation and premature
death, however, this effect appeared to be IFN.gamma.-independent.
Thus, suggesting that IL-23 has effects independent and
substantially different from IL-12 (see, e.g., Wiekowski, et al.
(2001) J. Immunol. 166:7563-7570). Recent studies have shown that
IL-23 may act to induce a distinct T cell activation state leading
to the production of IL-17 (see, Aggarwal, et al. (2003) J. Biol.
Chem. 278:1910-1914). Therefore, antagonizing IL-17 and/or IL-23
should be efficatious in the prevention of cutaneous inflammation,
in particular, psoriasis.
[0045] IL-23 gene expression is increased in human psoriasis (Lee
et al, (2004)J Exp Med 199:125-130). To investigate whether IL-23
may play a role in disease pathogenesis, we injected 1 .mu.g IL-23
intradermally daily into three different wild-type mouse strains
(C57Bl/6, 129SvEv, and B6.times.129) and examined its effect on
skin histologically and by gene expression. IL-23 induced clinical
and histological changes in mouse skin that bears some similarities
to human psoriatic lesions, Table 4.
TABLE-US-00004 TABLE 4 Comparison of clinical and histological
features of human psoriasis with IL-23-treated mouse skin.
IL-23-treated Human wild-type psoriasis skin Clinical Erythematous
yes yes Well-demarcated from yes no symptomless skin White silvery
scale yes no, although small areas of flaky skin Histological
Acanthosis yes yes Parakeratosis yes yes Elongation of rete ridges
yes no Intracorneal pustules yes yes (Munro microabscesses)
Recruitment to dermis of- CD4+ lymphocytes yes yes dendritic cells
yes yes macrophages yes yes neutrophils yes yes mast cells yes no
CD8+ cells in epidermis yes no Prominent dermal yes yes papillary
blood vessels
[0046] IL-23 induced the expression of IL-17, IL-17F, and IL-19 in
comparison to vehicle control suggesting that these cytokines may
form part of an important pathway whose dysregulation may
contribute to psoriasis pathogenesis, Table 5. Antagonism of either
of these cytokines may therefore be efficacious in the treatment of
cutaneous inflammatory diseases such as psoriasis.
TABLE-US-00005 TABLE 5 IL-23 induces IL-17A, IL-17F, and IL-19 gene
expression in mice. Values are relative to ubiquitin and represent
pooled mRNA (n = 4) from three different wild-type strains. Vehicle
Avg. IL-23 Avg Day 1 IL-17A 1.42, 9.43, 0.07 3.64 47.86, 48.71,
18.62 38.40 IL-17F 1.2, 1.02, 0.05 0.76 184.73, 91.21, 66.72 114.22
IL-19 0.89, 3.16, 0.96 1.67 12.9, 16.07, 10.04 13.00 Day 4 IL-17A
2.76, 5.81, 0.23 2.93 23.36, 44.19, 4.27 23.94 IL-17F 5.53, 1.93,
0.06 2.51 43.24, 38.10, 22.76 34.70 IL-19 0.97, 2.82, 4.89 2.89
56.51, 58.22, 109.36 74.70
III. BINDING COMPOSITIONS
[0047] Binding compositions provided by the methods of the present
invention include reagents such as IL-17, IL-19, and IL-23, soluble
receptors, and antibodies, as well as nucleic acids encoding these
reagents.
[0048] Monoclonal, polyclonal, and humanized antibodies can be
prepared (see, e.g., Sheperd and Dean (eds.) (2000) Monoclonal
Antibodies, Oxford Univ. Press, New York, N.Y.; Kontermann and
Dubel (eds.) (2001) Antibody Engineering, Springer-Verlag, New
York; Harlow and Lane (1988) Antibodies A Laboratory Manual, Cold
Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y., pp.
139-243; Carpenter, et al. (2000) J. Immunol. 165:6205; He, et al.
(1998) J. Immunol. 160:1029; Tang, et al. (1999) J. Biol. Chem.
274:27371-27378; Baca, et al. (1997) J. Biol. Chem.
272:10678-10684; Chothia, et al. (1989) Nature 342:877-883; Foote
and Winter (1992) J. Mol. Biol. 224:487-499; U.S. Pat. No.
6,329,511 issued to Vasquez, et al.).
[0049] An alternative to humanization is to use human antibody
libraries displayed on phage or human antibody libraries in
transgenic mice (Vaughan, et al. (1996) Nature Biotechnol.
14:309-314; Barbas (1995) Nature Medicine 1:837-839; Mendez, et al.
(1997) Nature Genetics 15:146-156; Hoogenboom and Chames (2000)
Immunol. Today 21:371-377; Barbas, et al. (2001) Phage Display: A
Laboratory Manual, Cold Spring Harbor Laboratory Press, Cold Spring
Harbor, N.Y.; Kay, et al. (1996) Phage Display of Peptides and
Proteins: A Laboratory Manual, Academic Press, San Diego, Calif.;
de Bruin, et al. (1999) Nature Biotechnol. 17:397-399).
[0050] Single chain antibodies and diabodies are described (see,
e.g., Malecki, et al. (2002) Proc. Natl. Acad. Sci. USA 99:213-218;
Conrath, et al. (2001) J. Biol. Chem. 276:7346-7350; Desmyter, et
al. (2001) J. Biol. Chem. 276:26285-26290; Hudson and Kortt (1999)
J. Immunol. Methods 231:177-189; and U.S. Pat. No. 4,946,778).
Bifunctional antibodies are provided (see, e.g., Mack, et al.
(1995) Proc. Natl. Acad. Sci. USA 92:7021-7025; Carter (2001) J.
Immunol. Methods 248:7-15; Volkel, et al. (2001) Protein
Engineering 14:815-823; Segal, et al. (2001) J. Immunol. Methods
248:1-6; Brennan, et al. (1985)Science 229:81-83; Raso, et al.
(1997) J. Biol. Chem. 272:27623; Morrison (1985) Science
229:1202-1207; Traunecker, et al. (1991) EMBO J. 10:3655-3659; and
U.S. Pat. Nos. 5,932,448, 5,532,210, and 6,129,914).
[0051] The present invention provides a bispecific antibody that
can bind specifically to at least two cytokines chosen from IL-17,
IL-19, or IL-23, or receptors, thereof (see, e.g., Azzoni, et al.
(1998) J. Immunol. 161:3493; Kita, et al. (1999) J. Immunol.
162:6901; Merchant, et al. (2000) J. Biol. Chem. 74:9115; Pandey,
et al. (2000) J. Biol. Chem. 275:38633; Zheng, et al. (2001) J.
Biol. Chem. 276:12999; Propst, et al. (2000) J. Immunol. 165:2214;
Long (1999) Ann. Rev. Immunol. 17:875).
[0052] Purification of antigen is not necessary for the generation
of antibodies. Animals can be immunized with cells bearing the
antigen of interest. Splenocytes can then be isolated from the
immunized animals, and the splenocytes can fused with a myeloma
cell line to produce a hybridoma (see, e.g., Meyaard, et al. (1997)
Immunity 7:283-290; Wright, et al. (2000) Immunity 13:233-242;
Preston, et al., supra; Kaithamana, et al. (1999) J. Immunol.
163:5157-5164).
[0053] Antibodies will usually bind with at least a K.sub.D of
about 10.sup.-3 M, more usually at least 10.sup.-6 M, typically at
least 10.sup.-7 M, more typically at least 10.sup.-8 M, preferably
at least about 10.sup.-9 M, and more preferably at least 10.sup.-10
M, and most preferably at least 10.sup.-11 M (see, e.g., Presta, et
al. (2001)Thromb. Haemost. 85:379-389; Yang, et al. (2001) Crit.
Rev. Oncol. Hematol. 38:17-23; Carnahan, et al. (2003)Clin. Cancer
Res. (Suppl.) 9:3982s-3990s).
[0054] Polypeptides, antibodies, and nucleic acids, can be
conjugated, e.g., to small drug molecules, enzymes, liposomes,
polyethylene glycol (PEG), or fusion protein antibodies. Antibodies
are useful for diagnostic or kit purposes, and include antibodies
coupled, e.g., to dyes, radioisotopes, enzymes, or metals, e.g.,
colloidal gold (see, e.g., Le Doussal, et al. (1991) J. Immunol.
146:169-175; Gibellini, et al. (1998) J. Immunol. 160:3891-3898;
Hsing and Bishop (1999) J. Immunol. 162:2804-2811; Everts, et al.
(2002) J. Immunol. 168:883-889).
[0055] The invention also provides binding compositions for use as
anti-sense nucleic acids or for small interference RNA (siRNA)
(see, e.g., Arenz and Schepers (2003) Naturwissenschaften
90:345-359; Sazani and Kole (2003) J. Clin. Invest. 112:481-486;
Pirollo, et al. (2003)Pharmacol. Therapeutics 99:55-77; Wang, et
al. (2003) Antisense Nucl. Acid Drug Devel. 13:169-189; Cheng, et
al. (2003) Mol. Genet. Metab. 80:121-128; Kittler and Buchholz
(2003) Semin. Cancer Biol. 13:259-265).
IV. PURIFICATION AND MODIFICATION OF POLYPEPTIDES AND NUCLEIC
ACIDS
[0056] Polypeptides, e.g., antigens, antibodies, and antibody
fragments, and nucleic acids for use in the contemplated method,
can be purified by methods that are established in the art.
Purification can involve homogenization of cells or tissues,
immunoprecipitation, and chromatography. Stability during
purification or storage can be enhanced, e.g., by anti-protease
agents, anti-oxidants, ionic and non-ionic detergents, and
solvents, such as glycerol or dimethylsulfoxide.
[0057] Modification of, e.g., peptides, polypeptides, and nucleic
acids, includes epitope tags, fluorescent or radioactive groups,
monosaccharides or oligosaccharides, sulfate or phosphate groups,
C-terminal amides, acetylated and esterified N-groups, acylation,
e.g., fatty acid, intrachain cleaved peptide bonds, and deamidation
products (see, e.g., Johnson, et al. (1989) J. Biol. Chem.
264:14262-14271; Young, et al. (2001) J. Biol. Chem.
276:37161-37165). Glycosylation depends upon the nature of the
recombinant host organism employed or physiological state (see,
e.g., Jefferis (2001) BioPharm 14:19-27; Mimura, et al. (2001) J.
Biol. Chem. 276:45539-45547; Axford (1999) Biochim. Biophys. Acta
1:219-229; Malhotra, et al. (1995) Nature Medicine 1:237-243).
V. THERAPEUTIC COMPOSITIONS AND METHODS
[0058] To prepare pharmaceutical or sterile compositions including
an antagonist of IL-17 or IL-23, the reagents is mixed with a
pharmaceutically acceptable carrier or excipient. Formulations of
therapeutic, prophylactic, and diagnostic agents can be prepared by
mixing with physiologically acceptable carriers, excipients, or
stabilizers in the form of, e.g., lyophilized powders, slurries,
aqueous solutions, lotions, or suspensions (see, e.g., Hardman, et
al. (2001) Goodman and Gilman's The Pharmacological Basis of
Therapeutics, McGraw-Hill, New York, N.Y.; Gennaro (2000)
Remington: The Science and Practice of Pharmacy, Lippincott,
Williams, and Wilkins, New York, N.Y.; Avis, et al. (eds.) (1993)
Pharmaceutical Dosage Forms Parenteral Medications, Marcel Dekker,
NY; Lieberman, et al. (eds.) (1990) Pharmaceutical Dosage Forms:
Tablets, Marcel Dekker, NY; Lieberman, et al. (eds.) (1990)
Pharmaceutical Dosage Forms: Disperse Systems, Marcel Dekker, NY;
Weiner and Kotkoskie (2000) Excipient Toxicity and Safety, Marcel
Dekker, Inc., New York, N.Y.).
[0059] Selecting an administration regimen for a prophylactic or
therapeutic depends on several factors, including the serum or
tissue turnover rate of the entity, the level of symptoms, the
immunogenicity of the entity, and the accessibility of the target
cells in the biological matrix. Preferably, an administration
regimen maximizes the amount of therapeutic delivered to the
patient consistent with an acceptable level of side effects.
Accordingly, the amount of biologic delivered depends in part on
the particular entity and the severity of the condition being
treated. Guidance in selecting appropriate doses of antibodies,
cytokines, and small molecules are available (see, e.g.,
Wawrzynczak (1996) Antibody Therapy, Bios Scientific Pub. Ltd,
Oxfordshire, UK; Kresina (ed.) (1991) Monoclonal Antibodies,
Cytokines and Arthritis, Marcel Dekker, New York, N.Y.; Bach (ed.)
(1993) Monoclonal Antibodies and Peptide Therapy in Autoimmune
Diseases, Marcel Dekker, New York, N.Y.; Baert, et al. (2003) New
Engl. J. Med. 348:601-608; Milgrom, et al. (1999) New Engl. J. Med.
341:1966-1973; Slamon, et al. (2001) New Engl. J. Med. 344:783-792;
Beniaminovitz, et al. (2000) New Engl. J. Med. 342:613-619; Ghosh,
et al. (2003)New Engl. J. Med. 348:24-32; Lipsky, et al. (2000)New
Engl. J. Med. 343:1594-1602).
[0060] Antibodies, antibody fragments, and cytokines can be
provided by continuous infusion, or by doses at intervals of, e.g.,
one day, one week, or 1-7 times per week. Doses may be provided
intravenously, subcutaneously, topically, orally, nasally,
rectally, intramuscular, intracerebrally, or by inhalation. A
preferred dose protocol is one involving the maximal dose or dose
frequency that avoids significant undesirable side effects. A total
weekly dose is generally at least 0.05 .mu.g/kg body weight, more
generally at least 0.2 .mu.g/kg, most generally at least 0.5
.mu.g/kg, typically at least 1 .mu.g/kg, more typically at least 10
.mu.g/kg, most typically at least 100 .mu.g/kg, preferably at least
0.2 mg/kg, more preferably at least 1.0 mg/kg, most preferably at
least 2.0 mg/kg, optimally at least 10 mg/kg, more optimally at
least 25 mg/kg, and most optimally at least 50 mg/kg (see, e.g.,
Yang, et al. (2003)New Engl. J. Med. 349:427-434; Herold, et al.
(2002) New Engl. J. Med. 346:1692-1698; Liu, et al. (1999) J.
Neurol. Neurosurg. Psych. 67:451-456; Portielji, et al. (20003)
Cancer Immunol. Immunother. 52:133-144). The desired dose of a
small molecule therapeutic, e.g., a peptide mimetic, natural
product, or organic chemical, is about the same as for an antibody
or polypeptide, on a moles/kg body weight basis. The desired plasma
concentration of a small molecule therapeutic is about the same as
for an antibody, on a moles/kg body weight basis.
[0061] An effective amount for a particular patient may vary
depending on factors such as the condition being treated, the
overall health of the patient, the method route and dose of
administration and the severity of side affects, see, e.g.,
Maynard, et al. (1996) A Handbook of SOPs for Good Clinical
Practice, Interpharm Press, Boca Raton, Fla.; Dent (2001) Good
Laboratory and Good Clinical Practice, Urch Publ., London, UK.
[0062] Typical veterinary, experimental, or research subjects
include monkeys, dogs, cats, rats, mice, rabbits, guinea pigs,
horses, and humans.
[0063] Determination of the appropriate dose is made by the
clinician, e.g., using parameters or factors known or suspected in
the art to affect treatment or predicted to affect treatment.
Generally, the dose begins with an amount somewhat less than the
optimum dose and it is increased by small increments thereafter
until the desired or optimum effect is achieved relative to any
negative side effects. Important diagnostic measures include those
of symptoms of, e.g., the inflammation or level of inflammatory
cytokines produced. Preferably, a biologic that will be used is
derived from the same species as the animal targeted for treatment,
thereby minimizing a humoral response to the reagent.
[0064] Methods for co-administration or treatment with a second
therapeutic agent, e.g., a cytokine, steroid, chemotherapeutic
agent, antibiotic, or radiation, are well known in the art (see,
e.g., Hardman, et al. (eds.) (2001) Goodman and Gilman's The
Pharmacological Basis of Therapeutics, 10.sup.th ed., McGraw-Hill,
New York, N.Y.; Poole and Peterson (eds.) (2001)
Pharmacotherapeutics for Advanced Practice: A Practical Approach,
Lippincott, Williams & Wilkins, Phila., PA; Chabner and Longo
(eds.) (2001) Cancer Chemotherapy and Biotherapy, Lippincott,
Williams & Wilkins, Phila., PA). An effective amount of
therapeutic will decrease the symptoms typically by at least 10%;
usually by at least 20%; preferably at least about 30%; more
preferably at least 40%, and most preferably by at least 50%.
[0065] The route of administration is by, e.g., topical or
cutaneous application, injection or infusion by intravenous,
intraperitoneal, intracerebral, intramuscular, intraocular,
intraarterial, intracerebrospinal, intralesional, or pulmonary
routes, or by sustained release systems or an implant (see, e.g.,
Sidman et al. (1983) Biopolymers 22:547-556; Langer, et al. (1981)
J. Biomed. Mater. Res. 15:167-277; Langer (1982) Chem. Tech.
12:98-105; Epstein, et al. (1985) Proc. Natl. Acad. Sci. USA
82:3688-3692; Hwang, et al. (1980) Proc. Natl. Acad. Sci. USA
77:4030-4034; U.S. Pat. Nos. 6,350,466 and 6,316,024).
VI. KITS
[0066] The present invention diagnostic kits/Provided are binding
compositions, including antibodies or antibody fragments, for the
detection of IL-17, IL-19, or IL-23, and metabolites and breakdown
products thereof, including products resulting from deamidation,
limited proteolytic or hydrolytic cleavage, or disulfide bond
oxidation or formation. Typically, the kit will have a compartment
containing either a IL-17, IL-19, or IL-23 polypeptide, or an
antigenic fragment thereof, a binding composition thereto, or a
nucleic acid, e.g., a nucleic acid probe or primer, able to
hybridize under stringent conditions to a nucleic acid encoding
IL-17, IL-19, or IL-23.
[0067] The kit can comprise, e.g., a reagent and a compartment, a
reagent and instructions for use, or a reagent with a compartment
and instructions for use. The reagent can comprise full length
IL-17, IL-19, or IL-23 polypeptide, or an antigenic fragment
thereof, a binding composition, or a nucleic acid. A kit for
determining the binding of a test compound, e.g., acquired from a
biological sample or from a chemical library, can comprise a
control compound, a labeled compound, and a method for separating
free labeled compound from bound labeled compound.
[0068] Conditions enabling stringent hybridization of nucleic acid
probes or primers are available (see, e.g., Freeman, et al. (2000)
Biotechniques 29:1042-1055; de Silva and Wittwer (2000) J.
Chromatogr. B. Biomed. Sci. Appl. 741:3-13; Long (1998) Eur. J.
Histochem. 42:101-109; Musiani, et al. (1998) Histol. Histopathol.
13:243-248; Gillespie (1990) Vet. Microbiol. 24:217-233; Giulietti,
et al. (2001) Methods 25:386-401; Schweitzer and Kingsmore (2001)
Curr. Opin. Biotechnol. 12:21-27; Speel, et al. (1999) J.
Histochem. Cytochem. 47:281-288; Tsuruoka and Karube (2003) Comb.
Chem. High Throughput Screen. 6:225-234; Rose, et al. (2002)
Biotechniques 33:54-56).
[0069] Diagnostic assays can be used with biological matrices such
as live cells, cell extracts, cell lysates, fixed cells, cell
cultures, bodily fluids, or forensic samples. Conjugated antibodies
useful for diagnostic or kit purposes, include antibodies coupled
to dyes, isotopes, enzymes, and metals (see, e.g., Le Doussal, et
al. (1991) New Engl. J. Med. 146:169-175; Gibellini, et al. (1998)
J. Immunol. 160:3891-3898; Hsing and Bishop (1999) New Engl. J.
Med. 162:2804-2811; Everts, et al. (2002) New Engl. J. Med.
168:883-889). Various assay formats exist, such as Real-time PCR,
radioimmunoassays (RIA), ELISA, and lab on a chip (U.S. Pat. Nos.
6,176,962 and 6,517,234).
[0070] The diagnostic method can comprise contacting a sample from
a test subject with a binding composition that specifically binds
to a polypeptide or nucleic acid of IL-17, IL-19, or IL-23.
Moreover, the diagnostic method can further comprise contacting the
binding composition to a sample derived from a control subject or
control sample, and comparing the binding found with the test
subject with the binding found with the control subject or control
sample. A "test sample" can be derived from a skin sample from a
subject experiencing psoriasis, both lesional and non-lesional,
while a "control sample" can be derived from a skin sample from a
normal subject, or derived from a non-affected skin sample from the
subject experiencing cutaneous inflammation. The subject can be,
e.g., human, veterinary, experimental, or agricultural. Derived
encompasses a biopsy, sample, extract, or a processed, purified, or
semi-purified sample or extract.
[0071] Alternatively, both test and normal skin samples, as defined
above, can be obtained and subjected to standard mRNA extraction
protocols. The mRNA is subsequently reversed transcribed into
ssDNA, which is then used for a second DNA strand synthesis. The
double strand DNA is then used in real-time PCR, e.g., TaqMan,
reactions. Data is analyzed as described below.
VII. USES
[0072] The invention provides methods for the diagnosis or
prevention of cutaneous inflammation, including but not limited to,
cicatricial pemphigoid, scleroderma, hidradenitis suppurativa,
toxic epidermal necrolysis, acne, osteitis, graft vs. host disease
(GvHD), pyroderma gangrenosum, and Behcet's Syndrome (see, e.g.,
Willams and Griffiths (2002), supra). The most common form of
cutaneous inflammation is psoriasis.
[0073] The broad scope of this invention is best understood with
reference to the following examples, which are not intended to
limit the inventions to the specific embodiments.
EXAMPLES
I. General Methods
[0074] Methods for the diagnosis, prevention, and treatment of
inflammatory conditions of the skin in animals and humans are
described (see, e.g., Ackerman (1997) Histological Diagnosis of
Inflammatory Skin Disease, 2.sup.nd ed., Lippincott, Williams, and
Wilkins, New York, N.Y.; Gallin, et al. (1999) Inflammation: Basic
Principles and Clinical Correlates, 3.sup.rd ed., Lippincott,
Williams, and Wilkins, New York, N.Y.; Parnham, et al. (1991) Drugs
in Inflammation (Agents and Actions Suppl., Vol. 32), Springer
Verlag, Inc., New York, N.Y.; Chan (ed.) (2003) Animal Models of
Human Inflammatory Skin Diseases, CRC Press, Boca Raton, Fla.;
Kownatzki and Norgauer (eds.) (1998) Chemokines and Skin,
Birkhauser Verlag, Basel, Switzerland; Kanitakis, et al, (eds.)
(1999) Diagnostic Immunohistochemistry of the Skin, Lippincott,
Williams, and Wilkins, New York, N.Y.).
[0075] Animal models of cutaneous inflammation, and related
methods, are available. These methods include use of skin grafts,
skin grafts injected with immune cells, subcutaneous injection of
immune cells, and use of animals such as various mouse models of
psoriasis, in particular xenotransplatation models (see, e.g.,
Kruger, et al. (1981) J. Clin. Invest., 68:1548-1577; Nickoloff, et
al. (1995) Am. J. Pathol. 146:580-588; and Schon (1999) J. Invest.
Dermatol. 112:405-410).
[0076] Standard methods in molecular biology are described
(Maniatis, et al. (1982) Molecular Cloning, A Laboratory Manual,
Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.;
Sambrook and Russell (2001) Molecular Cloning, 3.sup.rd ed., Cold
Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y.; Wu (1993)
Recombinant DNA, Vol. 217, Academic Press, San Diego, Calif.).
Standard methods also appear in Ausbel, et al. (2001) Current
Protocols in Molecular Biology, Vols. 1-4, John Wiley and Sons,
Inc. New York, N.Y., which describes cloning in bacterial cells and
DNA mutagenesis (Vol. 1), cloning in mammalian cells and yeast
(Vol. 2), glycoconjugates and protein expression (Vol. 3), and
bioinformatics (Vol. 4).
[0077] Methods for protein purification including
immunoprecipitation, chromatography, electrophoresis,
centrifugation, and crystallization are described (Coligan, et al.
(2000) Current Protocols in Protein Science, Vol. 1, John Wiley and
Sons, Inc., New York). Chemical analysis, chemical modification,
post-translational modification, production of fusion proteins,
glycosylation of proteins are described (see, e.g., Coligan, et al.
(2000) Current Protocols in Protein Science, Vol. 2, John Wiley and
Sons, Inc., New York; Ausubel, et al. (2001) Current Protocols in
Molecular Biology, Vol. 3, John Wiley and Sons, Inc., NY, N.Y., pp.
16.0.5-16.22.17; Sigma-Aldrich, Co. (2001) Products for Life
Science Research, St. Louis, Mo.; pp. 45-89; Amersham Pharmacia
Biotech (2001) BioDirectory, Piscataway, N.J., pp. 384-391).
Production, purification, and fragmentation of polyclonal and
monoclonal antibodies is described (Coligan, et al. (2001) Current
Protcols in Immunology, Vol. 1, John Wiley and Sons, Inc., New
York; Harlow and Lane (1999) Using Antibodies, Cold Spring Harbor
Laboratory Press, Cold Spring Harbor, N.Y.; Harlow and Lane,
supra). Standard techniques for characterizing ligand/receptor
interactions are available (see, e.g., Coligan, et al. (2001)
Current Protcols in Immunology, Vol. 4, John Wiley, Inc., New
York).
[0078] Standard techniques in cell and tissue culture are described
(see, e.g., Freshney (2000) Culture of Animal Cells: A Manual of
Basic Technique, 4.sup.th ed., Wiley-Liss, Hoboken, N.J.; Masters
(ed.) (2000) Animal Cell Culture: A Practical Approach, 3.sup.rd
ed., Oxford Univ. Press, Oxford, UK; Doyle, et al. (eds.) (1994)
Cell and Tissue Culture: Laboratory Procedures, John Wiley and
Sons, NY; Melamed, et al. (1990) Flow Cytometry and Sorting
Wiley-Liss, Inc., New York, N.Y.; Shapiro (1988) Practical Flow
Cytometry Liss, New York, N.Y.; Robinson, et al. (1993) Handbook of
Flow Cytometry Methods, Wiley-Liss, New York, N.Y.).
[0079] Software packages for determining, e.g., antigenic
fragments, signal and leader sequences, protein folding, and
functional domains, are available. See, e.g., Vector NTI.RTM. Suite
(Informax, Inc., Bethesda, Md.); GCG Wisconsin Package (Accelrys,
Inc., San Diego, Calif.), and DeCypher.RTM. (TimeLogic Corp.,
Crystal Bay, Nev.); Menne, et al. (2000) Bioinformatics 16:741-742.
Public sequence databases were also used, e.g., from GenBank and
others.
II. Real-Time PCR
[0080] Total RNA from homogenized tissue samples (see below) was
extracted and reverse transcribed as previously described (see,
e.g., Homey, et al. (2000) J. Immunol. 164:3465-3470).
Complementary DNA was quantitatively analyzed for expression of
IL-17 by the fluorgenic 5'-nuclease PCR assay (see, e.g., Holland,
et al. (1991) Proc. Natl. Acad. Sci. 88:7276-7280). Specific
primers used were as follows:
TABLE-US-00006 Human IL-17A Forward Primer SEQ ID NO: 1
5'-CAACCGATCCACCTCACCTT-3' Human IL-17A Reverse Primer SEQ ID NO: 2
5'-GGCACTTTGCCTCCCAGAT-3' Human IL-17F Forward Primer: SEQ ID NO: 3
5'-TGCCAGGAGGTAGTATGAAGCTT-3' Human IL-17F Reverse Primer: SEQ ID
NO: 4 5'-ATGCAGCCCAAGTTCCTACACT-3' Human IL-19 Forward Primer: SEQ
ID NO: 5 5'-TTGGCTCCTGGGTACAATACTG-3' Human IL-19 Reverse Primer:
SEQ ID NO: 6 5'-TCCTTAGCTTGGATGGCTCTTT-3'
[0081] IL-17 or IL-19 specific PCR products were continuously
measured by means of an ABI PRISM 7700 Sequence Detection System
(Applied Biosystems) during 40 cycles. Values were normalized to
ubiquitin. Log-transformed data was subjected to Kruskal-Wallis
statistical analysis (median method). The expression level (log
transformed) corresponds to the amount of IL-17 or IL-19 expressed
in the tissue sample, such that the higher the expression level
(log transformed), the greater the amount of IL-17 or IL-19
expressed in the tissue sample.
III. Human Inflammatory Skin Disease Panel
[0082] The human inflammatory skin disease panel included normal
skin, non-lesional and lesional skin from psoriatic and atopic
dermatitis patients. The panel included 35 normal skin samples (15
from autopsy donors and 20 from normal donors in clinical trial
setting, see below), 24 non-lesional psoriasis skin samples, 25
lesional psoriasis skin samples, 30 non-lesional atopic dermatitis
skin samples, and 30 lesional atopic dermatitis skin samples. Two 4
mm punch biopsies were taken from each patient. Non-lesional
psoriatic and atopic dermatitis skin samples were taken from sites
distal to a psoriatic or atopic dermatitis lesion. Samples were
obtained in a clinical trial setting at Stanford University
Dermatology Department. Autopsy donor materials were obtained from
Zoion. The study was approved by the local ethics committees of the
respective institutions.
[0083] All non-lesional and lesional patient samples were ranked by
severity using either the PASI (psoriasis area and severity index)
score or EASI (eczema area and severity index) score. For psoriasis
patients, the PASI scores were in the range of 9-20.75. For atopic
dermatitis patients, the EASI scores were in the range of
1.85-35.95. These scores reflected the extent and severity of
disease over the patient's body.
IV. Methods for Cell Culture, Histology, and Skin Grafting
[0084] Alternatively, cell lines may be used. Cell lines are
cultured in Dulbecco's modified Eagle medium (DMEM) (GIBCO BRL,
Grand Island, N.Y.) supplemented with 10% fetal bovine serum (FBS).
Human keratinocytes may be derived from newborn human foreskins and
are cultured in Keratinocyte SFM (GIBCO BRL; Rheinwald and Green
(1975) Cell 6:317-330). Skin is separated by gently tearing along
the cartilage plate and floated on 0.5% trypsin (GIBCO BRL) in
phosphate buffered saline (PBS) at 37.degree. C. for 45 min.
Epidermal sheets are peeled from the dermis, re-suspended in 0.05%
DNAase (Sigma, St. Louis, Mo.) in PBS containing 10% fetal bovine
serum (FBS). Single cell suspension is obtained by vigorous passage
through a syringe. For reverse transcription polymerase chain
reaction (RT-PCR) analysis, cells are cultured in Keratinocyte SFM,
and RNA is isolated by standard methodologies.
[0085] For flow cytometry, freshly isolated epidermal cells are
washed once in cold phosphate buffered saline (PBS) and
4.times.10.sup.5 cells are stained for 30 min at 4.degree. C. with
any of the appropriately labeled antibody reagents. Cells are
washed twice in cold PBS and analyzed by flow cytometry on a Becton
Dickenson FACScan.RTM. flow cytometer (San Jose, Calif.).
[0086] Many modifications and variations of this invention, as will
be apparent to one of ordinary skill in the art, can be made to
adapt to a particular situation, material, composition of matter,
process, process step or steps, to preserve the objective, spirit,
and scope of the invention. All such modifications are intended to
be within the scope of the claims appended hereto without departing
from the spirit and scope of the invention. The specific
embodiments described herein are offered by way of example only,
and the invention is to be limited by the terms of the appended
claims, along with the full scope of the equivalents to which such
claims are entitled; and the invention is not to be limited by the
specific embodiments that have been presented herein by way of
example.
Sequence CWU 1
1
6120DNAArtificialPCR forward primer for human IL-17A 1caaccgatcc
acctcacctt 20219DNAArtificialPCR Reverse primer for human IL-17A
2ggcactttgc ctcccagat 19323DNAArtificialPCR Forward primer for
human IL-17F 3tgccaggagg tagtatgaag ctt 23422DNAArtificialPCR
Reverse primer for human IL-17F 4atgcagccca agttcctaca ct
22522DNAArtificialPCR Forward Primer for human IL-19 5ttggctcctg
ggtacaatac tg 22622DNAArtificialPCR Reverse Primer for human IL-19
6tccttagctt ggatggctct tt 22
* * * * *